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Suboxone withdrawal

I am in the health adm field. I know little about Suboxone - except I have a family member on it for two years and he got sick of the Doctor charging $200/mth and quit abruptly. He is very sick. We are watching him closely. Should he see the Doctor again to taper off or how long will these withdrawals last. (Physician will not call in even a few)
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It wouldn't be appropriate for the doctor to 'call in a few'-- a person must be in treatment or out of treatment, and prescribing for people in the 'fuzzy middle' guarantees eventual problems with the DEA.  That type of prescribing is also what kills people, in the rare cases that people die from Suboxone;  if a person stops, his/her tolerance decreases, and then when the person gets a script for a few that person often uses them compulsively, sometimes with other respiratory depressants-- since they are no longer at risk for urine monitoring coming up positive.

I am an advocate of long-term Suboxone.  If a person is doing well, most doctors decrease the frequency of visits-- perhaps to every three months if the person is stable for more than a year.  There might be reasons that your relative is still being seen each month that you are not aware of-- and if that is the case, stopping Suboxone usually results in disaster sooner rather than later.

Even with the monthly visits, treatment with Suboxone is a bargain compared to using.  A typical opioid addict uses 80-200 mg of oxycodone, which costs a buck per mg-- EACH DAY.  When I hear someone talk about the expense of treatment, I'll ask them how much they used- and the math usually shows that they are saving huge amounts of money by taking Suboxone.  At $200 per month, the person is spending $6.50 per day-- I have never seen a heroin or OC habit that cost less than even ten times that much.

If I haven't made my point yet, realize that the death rate from untreated opioid dependence is very high.  In the county that contains Oshkosh Wisconsin, 17 young people died in the past 5 months-- and another 30 were resuscitated by paramedics and almost died.  Most diseases with a fatality rate anywhere near that high require tens of thousands of dollars in medical costs each month.  Opioid dependence is a fatal condition, and the treatment is the biggest bargain in all of medicine.  As a healthcare administrator, what does $200 buy a person in YOUR hospital?  Maybe a dozen tylenol tablets?

OK--- enough of my soapbox...  when a person goes on Suboxone, that person avoids withdrawal.  They are still tolerant to opioids-- although usually people on Suboxone have a tolerance significantly lower than when they were using.  But they still must do the work of getting their tolerance down, and that takes time and misery.  It is not 'Suboxone withdrawal';  it is withdrawal from the opioids that the person has been using BEFORE taking Suboxone.  

The withdrawal from opioids generally takes a couple months.  With Suboxone, the dose/response curve is not linear, but instead has a ceiling-like plateau. Because of that, the withdrawal is minor until the person tapers down to below 2 mg per day;  that is where the majority of the withdrawal begins.  Most people make the mistake of tapering to 2 mg per day and thinking they are done, and just stopping it; they must taper to very low doses if they want to avoid significant withdrawal.  Many people do not have the 'will power' to do a taper, instead just using right up to the last minute, and then worrying about it.  So tapering often sounds better than it actually works.  Your family member surely knew about the withdrawal that would occur;  he/she likely did what most people do, i.e. plan a taper but find themselves unable to carry it out.

There are meds that reduce opioid withdrawal;  clonidine is the classic one.  Most urgent care docs should know how to prescribe it;  it is used to treat high blood pressure also.

Studies of people who take Suboxone for less than a year show a relapse rate of virtually 100%.  Opioid dependence is, unfortunately, a chronic and permanent affliction.  I know-- I've had it for 17 years.  If the person was MY relative, I would do everything I could to keep the person safely treated.

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