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How To Ease Suboxone Withdrawal Symptoms?

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Posted on Fri, 18 Sep 2015
Question: I was discharged from suboxone Dr with no warning. How can I wean down and what should I take to keep withdraw away. I have 12 suboxone left. I was discharged yesterday. I am so scared. What should I take. Please help me.
doctor
Answered by Dr. Dr. Matt Wachsman (1 hour later)
Brief Answer:
Several issues.

Detailed Answer:
First, a taper regimen associated with the least discomfort is listed here.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
assuming being on 8 mg film twice a day it would be
16 (8 twice a day)
12 (half an 8 three times a day)
10 (4 2 4)
8 (4 and 4)
4 (2 and 2)
2
and 2
I usually add additional dosing days with the 12 for 2 days instead of 1 day and keep some reserve when tapering patients.
Furthermore there are medications that can lower some of the discomfort (aspirin like drugs, anti-diarrhea drugs, prescription anti-nausea meds)
what you really do NOT want to do is take any other narcotic with suboxone. Besides the obvious, the combination can also trigger withdrawal that is worse than only taking suboxone and tapering it.

and that isn't very important.
More issues are the drug addiction itself.
First there is the brain effects of the narcotics besides the obvious withdrawal.
Narcotic use changes the parts of the brain involved in the immediate interaction with the environment. These parts of the brain get the information from the senses and pick out what is important and start emotional reactions to it and start a physical response to this. Narcotics rewire this. In the context of withdrawal, the brain gets a lot of triggers to find and use narcotics. It is something to learn to be aware of in this context and use it to learn to avoid triggers and to realize that all the thoughts/feelings/justifications to use narcotics are automatically triggered by the taper and are not really true.

Due to all these deep brain structures, you hear your internal voice gives justifications. Due to the deep brain structures, you have emotions that make using seem a good idea. Due to the deep brain structures, you notice many things around you that have to do with narcotics. You are run by your deep brain structures.

There are ways to deal with them but realization is rather an important first step. Realization itself is "fighting it" and saying "realize the delusions you are under and don't do them" is exactly the pattern of 3000 years of failed Western Civilization approach. An Eastern approach is to actually induce the patterns of thoughts and compulsions in a context where one can just observe them. Spinning around in a circle, doing painful and ridiculous things like yoga, meditation til bored out of the conventional mind are mystical exercises but really pretty simple when you put it into this context. One of the oldest is just fasting for a few hours. You might consider starting the suboxone taper by not taking any at all and noting the thoughts, emotions, sensations that this triggers.
Then either going with a taper or not.

ANd..... besides realization about the automatic nature of these reactions to tapering, there is also avoiding the triggers and avoiding the people/places that facilitate getting drugs illegally. Suboxone is a near-perfect substitution for narcotics; not sure if there are other alternatives like it. Meetings and sponsors can be helpful in this context.

If not able to keep anything including any fluid down, then by 24 hrs it is a necessity to seek medical attention just to prevent dehydration.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Matt Wachsman (24 minutes later)
I have the option to go see another dr on monday. The money is outrageous. Should I just stop now? I feel like this might be a blessing.
doctor
Answered by Dr. Dr. Matt Wachsman (24 minutes later)
Brief Answer:
Oh, while I cannot answer that.

Detailed Answer:
I can direct you to the answer.

The thing about suboxone is that it establishes a safe sandbox.
https://en.wikipedia.org/wiki/Sandbox_%28software_development%29
Indeed, it's way better than my fasting for weight loss, or any other dieting modality. While I can fast, substitute low calorie items like fruit, none of this precludes me from eating on top of that. Suboxone precludes the effects of taking other narcotics with it.

Second.
Because of this, one can see what happens when one tries.... well... practically any tapering system including cold turkey. One can try total abstinence and learn what feelings/emotions/thoughts come up and how one is able to deal with them. And, if it fails, the suboxone is there.
One can try tapering regimens used in drug clinics (see previous post) and see what happens with those in terms of feelings, thoughts, sensations, emotions, etc.

Third WITH PHYSICIAN assistance, one can add other very minor drugs (benadryl, anti-nausea medications, over the counter aspirin like drugs) to a tapering regimen and see how the problems/sensations/cravings can be diminished.

Fourth, and yet, very important, this can be shared with a group. This reinforces one's commitment to going off of drugs.

This is a framework of pretty much everything one can do on getting off of suboxone/narcotics.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Matt Wachsman (3 minutes later)
so basically, a 7 day taper, is the best way to go? I am scared of the lack of energy. How long til I feel like me again??
I am only on 8mgs a day, what is your suggestion?
doctor
Answered by Dr. Dr. Matt Wachsman (2 hours later)
Brief Answer:
fifty fifty ... you won't!

Detailed Answer:
ok.... about 5% of the population has an atypical reaction to narcotics; about FIFTY percent of those I'm treating with suboxone have it (genetic predisposition to narcotic abuse). This atypical reaction is having a LOT of energy after receiving narcotics. It is a drug effect that only a few people get; but it sets them up for a much higher risk of addiction to narcotics. If someone always gets energy from narcotics... if they don't get the narcotics they don't get the effect.

Then... there is the narcotic withdrawal effects. The stronger ones (which you might not have at 8 mg a day) would be peaking day 3 to 5 and dwindling by 7 to 10. However, there are mild symptoms like the blues, sleep effects, that last longer and are hard to pin down. There are effects like cravings which can last indefinitely (generally mild). The cravings/triggers/compulsions are what therapy, programs, psychotherapy are about controlling.

A taper of 8 mg from the same source as previously would be:
8, 6, 6, 4, 4, 2, 2.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/table/T1/
That is a total of 32 mg, or about 4 8 mg strips. Rather a lot of room for error if someone has 20 strips and an appointment the next week......

CONTINGENCY MANAGeMENT would not give "one right way" to taper but would have people learn about their addiction process as they go through it. This is one method. Cold turkey is another way. A very long term tapering with doctor supervision over years is another method.
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 4214 Questions

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How To Ease Suboxone Withdrawal Symptoms?

Brief Answer: Several issues. Detailed Answer: First, a taper regimen associated with the least discomfort is listed here. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/ assuming being on 8 mg film twice a day it would be 16 (8 twice a day) 12 (half an 8 three times a day) 10 (4 2 4) 8 (4 and 4) 4 (2 and 2) 2 and 2 I usually add additional dosing days with the 12 for 2 days instead of 1 day and keep some reserve when tapering patients. Furthermore there are medications that can lower some of the discomfort (aspirin like drugs, anti-diarrhea drugs, prescription anti-nausea meds) what you really do NOT want to do is take any other narcotic with suboxone. Besides the obvious, the combination can also trigger withdrawal that is worse than only taking suboxone and tapering it. and that isn't very important. More issues are the drug addiction itself. First there is the brain effects of the narcotics besides the obvious withdrawal. Narcotic use changes the parts of the brain involved in the immediate interaction with the environment. These parts of the brain get the information from the senses and pick out what is important and start emotional reactions to it and start a physical response to this. Narcotics rewire this. In the context of withdrawal, the brain gets a lot of triggers to find and use narcotics. It is something to learn to be aware of in this context and use it to learn to avoid triggers and to realize that all the thoughts/feelings/justifications to use narcotics are automatically triggered by the taper and are not really true. Due to all these deep brain structures, you hear your internal voice gives justifications. Due to the deep brain structures, you have emotions that make using seem a good idea. Due to the deep brain structures, you notice many things around you that have to do with narcotics. You are run by your deep brain structures. There are ways to deal with them but realization is rather an important first step. Realization itself is "fighting it" and saying "realize the delusions you are under and don't do them" is exactly the pattern of 3000 years of failed Western Civilization approach. An Eastern approach is to actually induce the patterns of thoughts and compulsions in a context where one can just observe them. Spinning around in a circle, doing painful and ridiculous things like yoga, meditation til bored out of the conventional mind are mystical exercises but really pretty simple when you put it into this context. One of the oldest is just fasting for a few hours. You might consider starting the suboxone taper by not taking any at all and noting the thoughts, emotions, sensations that this triggers. Then either going with a taper or not. ANd..... besides realization about the automatic nature of these reactions to tapering, there is also avoiding the triggers and avoiding the people/places that facilitate getting drugs illegally. Suboxone is a near-perfect substitution for narcotics; not sure if there are other alternatives like it. Meetings and sponsors can be helpful in this context. If not able to keep anything including any fluid down, then by 24 hrs it is a necessity to seek medical attention just to prevent dehydration.