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Avatar universal

Suboxone Induction - will Tramadol cause precipitated withdrawals?

So my DOC is the opiate painkiller DHC (Dihydrocodiene), I was taking up to 1000-1200mg a day of the DHC Continus which is the time released version.  I had an appt. with a sub clinic to start suboxone this past Monday morning so my last dose of DHC was Friday evening.  I really didnt experience horrible physical withdrawals up to Monday morning, it was mainly all mental depression and cravings.  I took 8mg of Sub Monday morning and received a script to get more.  The clinic was an hour away from home so I got a hotel the night before because I had to be at the Clinic at 6am. Anyways, after the couple hours of paperwork, urine test, blood test, and getting my first sub dose I went back to the hotel because I wanted to lay down.  

After about an hour or two I was experiencing the hot/cold sweats, bad joint pain in my legs, RLS, depression, and I couldnt sleep even though I didnt sleep at all the night before.  It wasnt insane withdrawals like I have read about describing precipitated withdrawals but I had always read that Sub was supposed to make you feel instantly better and almost high the first time (I took 8mg) so I wasnt sure if this was precip withdrawals or I didnt take enough sub.  I didnt fill my script yet because I forgot my prescription card and was in another town and honestly didnt feel like getting in my car and driving around searching for a pharmacy.  My ignorant self ended up taking a small amount of DHC just to see if it would relieve the withdrawals some but I didnt feel it (to be expected). I also had some tramadol on me and took some of it and to my surprise I actually felt the tram and it got rid of the withdrawal symptoms I felt.  I didnt get my sub script filled until the next morning (Tues) but am currently afraid to take any because I took the DHC and Tramadol.

I plan on waiting a few days until the DHC is out of my system but I HAVE to work this week, can I take tramadol for a few days to help with work and then get back on the sub or will I get precipitated withdrawals from taking tramadol?  I have researched and researched and have seen both answers.  I want to think that I can start my sub right away even with tramadol in my system since I could feel the tramadol while taking sub, so I could use the tramadol for a few days until all the DHC is out of my body and then go right back on Sub.

Has anyone taken tramadol for awhile and then starting suboxone immediately without waiting 24-48 hours after the last tramadol dose and avoided precipitated withdrawals?  I really dont want to go cold turkey for 3 full days before starting the sub again, I have too much work to do. The tramadol at least allows me to work during those times when I run out of DHC.

Also, is Suboxone supposed to help the depression aspect?  I noticed I was still pretty depressed after taking the 8mg of sub that first day and was still craving the DHC pretty bad (although it was likely due to still not feeling well).
11 Responses
7163794 tn?1457366813
I really think u need to talk to the sub Dr about this. Once they gave u 8 mg they still should have kept u to make sure it was enough??? When I went the 48 hrs with nothing, then went to get the subs I did get instant relief so I'm not sure why that didn't happen w/ you? I'm not sure what tramadol does, brain wise, but if its opiate based then I think you'll be wasting it. Subs attach to neurotransmitters so opiates can't. If u have a good, reputable Dr then u need to go back to him and say something!
BTW....do NOT stay on the subs too long. My opinion, its real easy to switch from one drug to another, and subs are definately drugs. I took them for 6 yrs.
480448 tn?1426948538
I agree with the above, you need to clarify all of this with your sub doc.  Even though your usage is high, I'm leery of people being put on such high doses of subs.  Sub should make you feel normal, not "high".  If you feel high, the dose is too high.

The KEY (one of them anyway) to a proper induction of Sub is to ensure that the person is experiencing at LEAST moderate w/ds (assessed using the "COWS" scale).  If you were only having mild w/ds, then it was probably too soon to take the sub.  It doesn't sound like you necessarily had PWS, but more like your system was confused.  Then you added insult to injury by taking the dhc.  You need to cut your sources and get rid of whatever you have, including the tramadol.  Self medicating is just more addict behavior.

You've chosen a sub program, so commit to it and do it right.  I'm sure you know that doing it right doesn't include taking your DOC or other drugs.

Best of luck to you.
Avatar universal
My main question was if anyone has taken tramadol all the way up to Suboxone induction and then had precipitated withdrawals from the tramdol?  I definitely felt the tramadol when I had already taken Suboxone so I know tramadol doesn't work the same as other opiates.  I don't want to take tramadol at the same time, I just want to use it because I can't go cold turkey the rest of the week at work in order to start the suboxone.

My goal is to get back on the Suboxone, but in the meantime I have work I cannot miss.  I can miss most Friday at work, but I can't miss tomorrow. I haven't taken anything today but I have 4 meetings tomorrow including a one with my manager, so I don't want to be in my 2nd day of withdrawal if I don't have to.  If I can take tramadol for 2 days and then get back on Suboxone Friday then I have the weekend to adjust.

I really don't want to bring all this up with my doctor during the first week because I don't want him thinking I am not taking it serious.  Its easy to be on the other side and tell people their health is more important than work, or that your using excuses, yada yada, but not everyone's situation is the same. I have worked extremely hard to get where I am at and the last thing I want to do is to lose it because of this problem.
7163794 tn?1457366813
Am I understanding this correctly???  You used Tramadol during the 48 hr period when you were supposed to use NOTHING so that the subs would take affect? If I'm not getting it right, then I'm really sorry, but if that's correct then that's probably why the subs didn't work.  You can't have ANYTHING in your system for 48 hrs to then start on the subs.  There are people on this site that know more about Tramadol, and I'm sure they'll see this post soon, but I really think that's going to be the problem.  You probably DID put yourself into some type of precipitated w/d.  Didn't the dr urine test you Monday morning before starting this process?  Again, I don't know a lot about Tramadol, but NO....you aren't supposed to be taking ANYTHING else but the subs.
4810126 tn?1503942735
Hi Don,

While I've read on forums that you can take Suboxone while the Trams are still in your system & vice versa (as they're not technically an opiate), I'd be cautious as precipitated w/d's are horrific. Why take the chance?

Besides, Trams are weird & have their own strange effects & might interfere w/ the action of the Buprenorphine. The thing is, they usually monitor you for a day while slowly building your Sub dose. Many people (like me) felt uncomfortable & even ill on subs. They have to build up to a steady state in your bloodstream. For some people (me again):) subs never felt okay.

Like the posters above, I can't fathom why your Dr. didn't follow protocol. I'd also like to point out that you were on a high dose of your DOC & it's not likely that subs will get you 'high' the way they might a casual opiate user or someone with a lesser habit. Though it binds more tightly to receptor sights than any other opiate, it has limited potential as a euphoric or pain-killing drug. (i.e. It's a partial-agonist whereas your DOC is a full agonist.)

Btw, please, be careful of the Trams as they are supposed to be a brutal kick w/ an anti-depressant/benzo-type component to them in addition to the opiate-like withdrawal. We have folks here who can certainly testify to this. There's also a risk of seizures when using Trams. Besides, if you're using Subs to detox & then to stay 'clean' off other opiates & you can feel the Trams through it, I'd stay away from them as it would be a temptation down the line. The whole idea of going from DHC to Trams combined w/ Subs is truly jumping 'from the frying pan into the fire'. I'm not knocking going onto a responsibly monitored program of Subs with counseling. It's been a lifesaver for many. I just don't want you to end up in a more difficult situation than where you already were. ;)
480448 tn?1426948538
The whole issue as I see it is you want to use tramadol to help ease the w/d you're going to have during the days where you aren't supposed to take anything prior to the sub induction, when it's the level of w/d symptoms that are really the biggest consideration when starting someone on sub.  See what I mean?  You treating the w/ds may make it difficult to accurately assess your level of w/d.

We've had these kinds of questions before, and unfortunately, if you want to give yourself the best shot at a proper induction, and not interfere with that, then you sort of have to just endure the w/ds for a brief time.  

Understand too that you don't necessarily have to go TWO days without any opiates to start subs.  It isn't the TIME factor, but again, the severity of w/ds.  Any w/ds that are on the mild side indicate that there is still enough of an opiate on board to put you at risk for PWS.

If you typically would be in moderate to severe w/ds in 12-24 hrs, then that would be sufficient.  You can call and ask the sub doctor, but it was ALWAYS the severity of the w/ds and the COWS scale score that determined whether or not a person should go forward with the induction when I worked with sub.  The only exception might have been a person who said they had w/ds an hour or 2 after dosing.  Even though for some that's true, it's not reasonable to expect a doc to go for that.

Of course you don't want to be uncomfortable, but look at it as such a BRIEF time before you'll be feeling better, and it really will be optimal to do it the right way, and not try to take a chance.   The last thing you want to do is end up experiencing PWS, OR having difficulty with the induction.  You don't want to muddy the waters for that.
Avatar universal
I didn't take anything for 2.5 days before my first dose of Sub, no DHC or tramadol.

My initial clinic assessment and first dose of Suboxone (8mg) was this past Monday.  I didnt take anything for around 60 hours prior to Monday, my last dose of DHC was around noon on Friday.

The clinic is about 45 minutes drive from my home so I got a hotel the night before because I had to be at the clinic at 6am Monday morning and I knew I wouldn't want to drive all that way while in withdrawals.  Since I got out of the doctors office at around 9am, I went back to the hotel and laid in bed until I was supposed to checkout.  At that time is when I started feeling the achy joints, heightened anxiety and depression, and cold sweats, but it wasnt horrendous like you read about with precip withdrawals so I don't know if the sub dose was too low or what.

Anyways, I ended up staying at the hotel again that night because I didn't feel like leaving the room and driving home.  I should of gotten up and tried to find a pharmacy to fill my script of Sub and taken more, but I was in that anxiety stage where all I wanted to do was try to sleep.  I also forgot my insurance card and didn't know where any pharmacy's were in that town.  I eventually gave in and took some tramadol and surprisingly I felt it and it took away the physical withdrawals.

Based on that, and some other research on the net, I am pretty sure that you can take tramadol right up to your first dose of Suboxone and you won't go into precipitated withdrawals, at least nothing like that of true opiates.  I don't recommend it, but I think you can.  I know about all the risks of tramadol, that was actually the drug that started this whole addiction, however I don't take it anymore except for whenever I ran out of DHC.

Thanks for the replies, I just threw all the pills in the toilet so now I am totally committed to the Sub or just cold turkey. The physical withdrawals were never the reason I couldn't quit, its the depression and lack of motivation is what always got me to relapse.  I am really fortunate to have a career in which I get paid handsomely, however I have to work very hard to earn that pay which is why I tend to relapse. It never seems like I can take a week off mentally without missing project due dates. Plus I hold certain clearances that would be in jeopardy if people around me found out about my addiction.  Its why I am trying outpatient Suboxone treatment instead of inpatient rehab.  I would much rather go to an inpatient rehab to detox naturally and not be home alone or have to work while trying to deal with withdrawals, but unfortunately I can't tell my job I need to go to rehab, I would lose my clearances and I work as a consultant, so my image and reputation is very important.

It ***** but I have no one to blame but myself, at least I have committed myself to a program and threw out all the pills.  I am only doing a short term sub taper, the clinic is too far away to stay on it too long. I just want to stabilize myself and get back into a healthy routine.  I am tired of the constant mood swings and living in secrecy and guilt.

Once again, thanks for listening
Avatar universal
Its been three straight weekends of trying to go c/t long enough into withdrawal in order to take the sub's without getting precipitated withdrawals.  Finally I am on the sub only with nothing else (first day though).  I took a small amount after 48 hours but immediately started tearing up, getting RLS, and diarrhea so I knew I did it too soon. Luckily there wasn't a lot of the opiates left in my body and I took a small amount of sub so the precip withdrawals were not extreme.  I was actually able to take a few tramadol and it totally relieved the precipitated withdrawals.

  I don't know what it is about tramadol, but suboxone doesn't block all of it like it does other opiates. I wonder if tramadol would work with other patients who go into those nightmarish precipitated withdrawals? Its crazy how us drug users almost become more knowledgeable on how each drug works then the Dr's that prescribe us them.

Anyways, I think it was actually good to just start the sub early because I was close to just relapsing, 72 hours is a long time to go without any drug, after 24 hours the depression is already there and I am bed ridden with the lack of motivation. I will stay in bed for 3 straight days, I haven't left my house since Thursday and its Sunday evening.

Anyway, I don't have that much of the sub so I am going to try to get it to last me at least a full week and then just get off everything.  I don't know if I will have any withdrawals at that point, the worst for me is just the mental depression and anxiety, however its also hard to go to work when you are sweating and have to use the restroom every 30 minutes.

One other thing I noticed with Suboxone, it seems to block some of the effects of adder all. I have a script for 25mgs to take once a day and I took it right before the sub and the sub made me tired and I actually feel asleep when normally I would be awake.  I can still feel the adder all but its different.  Maybe the sub will help me get off that as well.  I hate taking it without opiates, It drys out my system and I feel like crap when I take it without an opiate. That combination of drugs is what makes this so hard, its like a double whammy on my brain if I quit both at the same time.
6726276 tn?1421126668
Hi Don Ret. I don't have experience with all of this chemistry.
  What I would like to suggest is getting a good psychologist and learning Cognitive Behavioral Therapy.  I read what you wrote. Depression,fatigue,and lack of motivation do not magically disappear.
  A lot of times we self medicate because of these issues.
   Plus a support group will help. Free thru NAMI.
  I want to see you succeed.  Pamela
Avatar universal
I took off work today because I wasn't sure how I would feel when I woke up.  Surprisingly, the suboxone does work well to transition off opiates, however I know that in my case it could be digging a bigger hole with Sub since I was taking DHC and not Herion or Oxy's.  The problem with me is that I take the combo of adderall and DHC, and its so hard to stop both at the same time.  However, I didn't take anything today and feel ok, I didn't take suboxone or even adderall.  I know its just the suboxone that is still in my body from yesterday, but if I can hold off between sub doses then maybe the final withdrawal (once my sub is gone) won't be too bad and I will at least have a bit of time staying away from the opiates that got me here.

I have mixed feelings about subs, I could see how this would allow people to get their lives back together because you don't feel high but it seems to produce enough good chemicals to keep your mood up and let you move on with your life. With a high enough dose it dose seem to stop cravings but eventually you have to get off it and of course the withdrawal from sub takes 4x's longer than anything else (just proves there is no avoiding the inevitable).  I guess a person might be in a better place and have more support and tools when they are ready to come off sub, but most of the reason why I am depressed is because I know I am addicted to pills and know that eventually I will be spending months going through the physical and mental pain of getting off them.  

I have 6 8mg Sub strips and I wonder if there is a way to taper over a week or two with that low of an amount to lesson the withdrawal so at least I could go through my daily duties.  I have a six figure job and I have been barely doing enough to keep up, so it makes it even harder when you go through all the stages of withdrawal. I know there is no miracle cure, it all comes down to one's will power.  The withdrawals are as bad as your mind makes it, thats why its always easy to detox that very first time and then gets harder every time after that until you have finally had enough of it.
Avatar universal
Hello there. I currently take suboxone and tramadol together. And it dosent matter which order. There's something about tramadol thats actually different than any other opioid. It will not cause PWD's. Be careful though, tramadol is in known to cause seizures..so keep the mg at a moderate level.
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