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Avatar universal

First post, starting recovery from opiates

Hi there folks.

My name’s Jordan, and I’m heavily hooked on opiates. I’ve been using for about two years, initially after a semi-severe accident that left me in pretty hideous pain. During the recovery period, I was taking well outside the recommended dosages for my painkillers, resulting in my running out early. My docs told me to tough it out; it was too early for me to refill. As I lamented this to an associate, he offered that he had 120 Norcos he’d be happy to sell. I bought them, of course. My major screw-up came about 4 months after the injury. I didn’t need the pills for the pain any more; now I needed them to halt the withdrawals. Instead of going to my doc and 'fessing, I kept buying them black market. Pretty stock story, right?

Recently, my GF found out I was still using them. I dunno, I let personal security lapse; I think I deep-down wanted her to find them. Regardless, a colossal battle ensued, ultimately culminating in her offering God’s gift to support, on the condition that I get clean. I have no qualms about getting off, indeed, I’ve been seeing an addiction management doc for some months now. Thing is, I‘ve been seeing him as little more than a cover. I’ve been stockpiling the prescribed Suboxone, for the time I really do take the plunge. This time has come.

My problem is I have an almost irrational fear of withdrawal. I hate it, hate it with an almost atavistic aversion, and, as such, I’ve been attempting to figure out the best way to minimize the transition, that I can avoid as much of the unpleasantness as humanly possible. I've done the transition twice before, but each time my dosages of opiates were far lower.

This time, I worked the math as reasonably as possible:

Based on my current dosages (around 25-30 Norcos per day), I need to be clean for around 20 hours prior to switching to the Subs. This means that if:
1. I take my last dose at 2pm,
2. I take nothing until 10pm that night
3. I take a couple of sleeping pills and a stiff drink at around 10pm.
4. Crash out and sleep until around 8:00-9:00,
5. Suffer until about 10:30-11:00,
6. Take my first dose of Subs around 11:00

This leaves me with a whopping 1-2 hours of withdrawal to actually endure, while sleeping through the lion's share of it. Pretty smart, right? I haven't filled my GF in on this plan (she's never used ANYTHING; she simply can't grasp why I don't “just stop”), but hey, it's only two more days, and I explained to her how all thins opioid need to be out of my system before starting the Subs.

Well, here's where I blew it: I began going through my “stash,” either using up, throwing out, or giving away what I had left. I left myself just enough to set myself up for the last two days' plan outlined above. I found myself left with the odds and ends I'd accumulated: a few morphine, a couple of Oxy 5mgs (remember, I used Norcos almost exclusively, Oxy 5's are on the strong side for me), a dozen methadone, and a few other misc. The stuff you buy when it comes around “just in case”.

So the day before yesterday, I took what I had left of that hodgepodge: the methadones. I took all dozen, stopped at 2pm, and waited. Next day (yesterday), I feel like crap, but I'm not in full-blown withdrawal. What's this? Methadone has a 72-hour halflife? Oh dear. Now I find myself in the untenable position that I will need to wait until Thursday night to start the Subs, enduring two DAYS of withdrawal, rather than two HOURS.

I don't dare go to my doctor (who's my stepmom's brother) and explain. I can't go to another doctor (let's face it: that's the definition of “drug-seeking behavior”). At this point, I'm torn between simply suffering for two days, or buying a two-day supply of Norco (around 40) and just carrying out the plan I laid out above.

Any thoughts? Any advice? Not the best segue into an introduction to the boards, I know, but I'm afraid if I try to tough the two days out I'll break down and relapse before I even start! Even now, I'm in so much pain I don't know how I'm going to be able to work this week. I'm a computer programmer with deliverables due Wednesday. What should I do?

Jordan
49 Responses
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Avatar universal
Glad you responded and sounds like a good plan you've got going. Hang in there and I'm wishing you a great induction and please keep posting, were here to give you all the support you need.
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199177 tn?1490498534
Jordan thats right AFTER 72 hours sometimes its better to wait closer to 96 hour..I am gald you are hangering in there .... keep posting
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Avatar universal
Oh, one more thing:

I said I'd report what the Subutex 800 number's help line said about following Methadone with Subs:

The COWS scale IS to be used... no less than 72 hours after the last Methadone dose. In short, Wait three days, THEN evaluate your current state of withdrawal. The lady on the help line actually suggested I switch to a different opiate until said 3 days had expired. I informed her I had no such alternative, and she simply commiserated and gave me the age-old, time-honored advice: "tough it out."
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Avatar universal
Thanks for checking in...we worry.  :)

Hang on until Friday and God Bless~

Vicki
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Avatar universal
Jessie,

I mentioned in an above post that I've tried to cold turkey a couple of times. I have what appears to be abnormally bad reactions to withdrawal: convulsions, vomiting blood, diarrhea so severe that it requires a saline/sucrose IV drip. The last two times I tried, the hospital (yeah, it gets that bad) actually wound up giving me a morphine injection while making a none-too-subtle suggestion that cold turkey isn't for me, that I should use an assisted quit program like Subutex.

My fear of WD's stems from a combination of those experiences coupled with the heart-stopping, bowel-quivering fear of accidentally inducing a precipitated withdrawal by botching the initial dosing of the buprenorphine. I'm thinking medically-induced coma's the way to go if that happens. Regardless, though I appreciate the advice, and be assured that if I could "mind over matter" this I would, I've just established empirically that isn't a viable solution for me.

I have combat experience, I skydive and bungee jump, I've broken literally dozens of bones, and even with all that said, I'm an absolute coward when it comes to this one thing. Thank God there's other folks out there that understand what it's like.
Helpful - 0
Avatar universal
Sorry for dropping off the posting wire...

I've been doing what I can to get my work done; I'm sicker than hell. I'm up to shakes and vomiting, and occasional mad dashes to the bathroom, but I've certainly not hit the upper ranges of WD, at least as far as my standard symptoms go.

I've not taken any of the subs... regardless of the myriad advice I've received, I've simply read too much about the possible outcome of jumping the gun when it comes to buprenorphine. Considering how severely I react to WD, I genuinely don't think I'd survive if a precipitated withdrawal was forthcoming. I'm pretty much planning on just toughing it out until tomorrow night (that's 84 hours after the methadone: 72 hours plus a half day for safety's sake), or even Friday morning if I can hold out that long.

Regarding my work situation, I'm not going to make my deliverable deadline no matter what I do at this point, so I'm going to approach it with the "better to ask forgiveness than permission" angle. I'm a contract software engineer (I work from home), so the absolute worst case scenario is I lose the contract and get to spend the next few weeks scrabbling for a job.

This has resulted in a less than favorable reaction from my GF (whom I live with), who thinks I'm stalling for the sake of stalling (again, she's never touched anything that even looks vaguely like a drug while squinting heavily), despite my best efforts to explain the possible outcome should I rush into this.  Her fear is that I'm continuing to take Norco, despite the contrary evidence evanesced by my current physical state, and my hesitation to begin the Subs stems from that.

The final deal that I worked out with her is that I will be relocating to my father's house until Friday so the first thing she can see is my taking the Suboxone. My father just underwent back surgery and is well aware of my situation, so we - my father and I -  feel we can provide her with a sense of "supervision" until I've "safely" begun the subs. Since I work from home, her fear is that I have too much opportunity to obtain or take opiates, as she cannot find herself at home to "protect me from myself." In a way this is touching - she genuinely cares for my welfare and feels helpless to intercede - but with my emotional state so out of whack from the withdrawals it's simply resulting in fights. This is probably best all 'round.

Thanks for keeping an eye on me, I'll stay in touch today and tomorrow. I'll kick off a new thread when I'm about to take the Subs, and I'd certainly appreciate the support at that time. You've all shown a heartwarming interest, and, despite my abject terror surrounding the start of the Subs, your support gives me something to latch on to. Thanks guys.

-J-
Helpful - 0
Avatar universal
coffeegirl, I sent you a PM. I apologize for my bluntness but if he had taken that sub so soon after popping a handful of methadone pills he could have been in a world of unbelievable pain. And please do give advice, like I said in my PM to you people could use your support and advice. You've obviously been through wds before and could really help people with a lot of issues. But I think we all (myself included) have to be careful when it comes to medical advice. That's best left to qualified doctors. Anyways Jordan I'm hoping your doing ok, let us know how your doing when you have a sec. And sorry again coffeegirl, please give all the support and advice you can to help people here with their struggle.
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Avatar universal
Jordan, you remind me of myself 40 days ago. I was more terrified with the potential WD's than I was of quitting [CT]. I had such an irrational fear that I put myself [and my family] in financial hell because I just didnt want to think about the whole detox thing. One day- I said fck this- Im done. I was prepared to tough it out in my bed for the next 3 days and tell my family I was 'sick'. Day 1: I stayed in bed most of the day because- isnt that what youre supposed to do? I got up every now & then to do mundane tasks, and each time I was like "why am I ok"? So I got out of bed. I started doing laundry- and before I knew it, my house was immaculate. Day 2, 3, 4: Same thing. What I realized is it really IS mind over matter. If you truly want this, you WILL get through it. If you start to feel sorry for yourself, youre gonna be miserable. Try not to let your mind go there... redirect your thoughts if you should start feeling weakness or self pity.
For the physical WD's- Thomas' recipe will help considerably. Under the help pages there is a 'Protocol for unassisted opiate withdrawal. It's worth reading. Good luck to you- I have no doubt youre a soldier & you can do this. It feels SO good to be rid of the shackles and chains. :)
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1310038 tn?1282805060
Cumberland Heights in Nashville TN was my source.for protocol and expansion of what I knew medically
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1310038 tn?1282805060
Well I just did a large post and it was lost. Jordon I have apologized to you via email and to all in a post. I did not mean to send you a "whacked out" post and CERTAINLY did not mean to displace eyeballs. I believe I was misunderstood and misquoted. I WAS NOT suggesting SUBOXONE-it contains narcan which reverses the action of opiates. We use it in surgery to bring a patient out of anesthesia and in the ER for overdose cases. SUBUTEX competes for opiate receptors and has a stonger affinity, therefore it "WINS". Therefore any additional opiates will not attach and make you "high" From MY EXPERIENCE, I was administered SUBUTEX an hour after admission to a well known rehab facility. I suffered NO w/d, only mild fatigue after the rapid subutex taper. Months later after dropping the ball I went to an addictologist-he too, started subutex immediatley. I was not on a long acting opiate, as you are, so I should have been more careful. Both facilaties never used SUBOXONE initially BECAUSE of the pwd with Suboxone. Please forgive me if I caused any harm to you. I only wanted to help and be a part of the group. I will refrain from giving advice-will just listen and learn. Best of luck to you. I DO support you and now feel publically shamed. I meant well.
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Avatar universal
Hey Jordan what's the latest? Update when you have a minute.
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199177 tn?1490498534
THIS IS STRIGHT FROM THE SUB SITE

No SUBOXONE or SUBUTEX sublingual tablets should be given after the last methadone or long-acting opioid dose until the patient experiences maximal withdrawal discomfort (at least 48-96 hours after last dose). Earlier dosing with SUBOXONE or SUBUTEX is highly likely to precipitate withdrawal
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199177 tn?1490498534
methdone is diffrent
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199177 tn?1490498534
COWS does not matter if he has been taking methadone ......he has to maske sure its ALL out of his system ..
how much methadone and how long ago did you take it
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Avatar universal
I'm on hold right now with one of the Subutex 1-800 number counsellors. She seems to think that you're right, the COWS is the way to get an idea of where I should be at for initial dosing, but the fact that the last med I took was methadone makes it a "special case." She thinks that means it should be "Moderately Severe" instead of "Moderate" before taking the first dose, but she's checking with her supervisors. I'll post the answer she gives once I find out.
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Avatar universal
Not sure why my last post got posted 3 times but maybe one of the CLs can delete please? Jordan google COWS scale and see where you rate on it. And no you don't have to be in full blown withdrawls, "moderate" is what's advised on both subs website and the people on that suboxforum told me the same thing so go by the cows scale and see if you can get some feedback over there from people who have lots of experience with it.
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Avatar universal
I'm looking into this COWS scale now; I've never seen anything on this before.

Don't take my being snippy earlier personally; I apologize if I'm coming across harsh/like a jerk. I acknowledge the fact that I screwed up here, and I'm very frightened that I have. I have VERY negative reactions to WD (see my post above), so I'm quite frankly a coward when it comes to it.

Going through the process is bad enough, but getting repeatedly hospitalized for it makes anyone a tad gunshy. Couple that with the possibility of precipitated WD's, and I'd rather face down an oncoming army than risk it. I've never thought of myself as suicidal, but I flat out don't think I'd choose to survive the idea of two or three solid weeks of what I went through on my CT attempts.

Thanks for all your input and support.
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199177 tn?1490498534
NO if you took methadone its NOT safe to take sub RIGHT NOW
Helpful - 0
Avatar universal
Thanks for the advice.

The problem with the medical literature for buprenorphine is that its "safe-to-start" time is so vaguely worded. The official line is "when the patient is experiencing full-blown withdrawals."

The pain here is that everyone's WD symptoms differ, so they, in fairness, have no way of truly quantifying what "full-blown" means.

My addiction-management doc tells me I have some of the worst reactions to WD he's ever seen. I've tried to CT three times now, and tried with Subs once. My most severe reactions are convulsions, persistant and near-continuous vomiting/dry-heaving, and diarrhea so severe that I've been hospitalized in both the latter two out of the three CT attempts within the first four days (vomiting blood, dangerously low blood sugar, and so dehydrated an IV was required). In both of those cases, I was given morphine by the hospital, and was told to use an assisted-quit plan, like buprenorphine, because it simply wasn't safe for me to CT.

Bottom line though, while I'm definitely withdrawing right now; I feel like crap, sweats, cramping, nausea, etc., I'm NOT vomiting blood and experiencing full-body spasms. So which is "full-blown" for me? How I feel now? Or how I get if I CT for a couple of days?

My NORMAL WD symptoms are so extreme that I have a sneaking suspicion that a multi-week precipitated withdrawal would likely be fatal, or at least certainly require continuous hospitalization. I'm scared sh*tless to risk getting myself into a position where that's a possibility, so I'm kinda finding myself in the position of waiting until the "bitter end" before switching to the subs.
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Avatar universal
Never mind I saw your response to the question after I posted. Anyways check out the COWS scale and that site I told you about. It's a very good forum for anyone on or considering suboxone. It's run by a guy named Dr. Junig and he really knows his stuff when it comes to sub so check it out and keep us posted. You got my prayers and I think your headed in the right direction. And sorry I made those comments about you not being serious, I misunderstood you.
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Avatar universal
120 mgs on Sunday is a lot of methadone. Considering it's only Tuesday if it were me I don't think I'd take the gamble and risk precipated wd's. Also, having researched sub for myself when I was going to start it I was told that it's really how you rate on the COWS scale, not a set amount of time that one should go by in determining in you are ready to start sub. Check out this website: suboxforum.com The people there have a lot of experience with sub and who might be able to help you determine if your indeed sick enough to start sub. Are you planning on using sub as a quick detox tool or for maintenance? Either way that site is excellent for all things sub.  
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495284 tn?1333894042
COMMUNITY LEADER
Thank you for explaining.
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Avatar universal
Sara,

I'm not sure you got the full context here... I'm not looking to take the Sub for a couple of days just to get by... I'm trying to figure out how to get by for a couple of days so I can start taking a doctor-prescribed and -monitored program utilizing Suboxine to quit my opiate dependency. Backwards, you see?

The reason I'm trying to "get by" for a couple of days was the last opiate I'd taken was methadone, which apparently lingers in your system for 72 hours or so. Since you're not supposed to begin Subs while ANY opiate remains in your system, and since I've not taken anything since Sunday (and am therefore already withdrawing), I'm trying to figure out what to do to minimize the WD symptoms until it's SAFE for me to start the subs.
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495284 tn?1333894042
COMMUNITY LEADER
I have to disagree with the sub.  It shouldnt be used for a couple days to just get by.  That is only prolonging the inevitable with a very strong opiate......sara
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