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What Are The Withdrawal Effects Of Suboxone?
Question: I have been on Suboxone 16mg for 4 years now. I see my doctor monthly, go to NA meetings and see a therapist. Last night, I found a very old methadone pill 10mg and took it. Instant regret, I haven't replapsed in 3+ years. My question is, I'm so scared I've been crying all morning. I took that methadone 15 hours ago, can I take my normal suboxone dose. From what I'm reading online I'd rather die then go through precipitated withdrawls. What do I do?
Brief Answer:
have withdrawal first !
Detailed Answer:
I can only give general information, not specific to your particular case without actually being there. And... general principles in addiction include:
1) learning from the mistakes. Avoid temptation, consciously visualize and remember this and consciously remember and visualize good memories from being in maintenance. (contingency management, mindfullness)
2) There's the standard (slightly wrong) diagram about pure agonist and partial agonist
http://www.buppractice.com/node/2979
moving downward gives withdrawal... moving upward removes withdrawal.
3) So, the standard protocol for beginning suboxone from methadone applies here:
waiting long enough without narcotics and they leave your system and producing withdrawal. The withdrawal from one pill on top of suboxone is not as large of a withdrawal as most have from initially coming off of full doses of methadone/heroin/etc. The classic dosing of suboxone is that when the withdrawal gets to be bad, beginning/restarting suboxone will LOWER the withdrawal and would be VERY UNLIKELY to make it worse.
have withdrawal first !
Detailed Answer:
I can only give general information, not specific to your particular case without actually being there. And... general principles in addiction include:
1) learning from the mistakes. Avoid temptation, consciously visualize and remember this and consciously remember and visualize good memories from being in maintenance. (contingency management, mindfullness)
2) There's the standard (slightly wrong) diagram about pure agonist and partial agonist
http://www.buppractice.com/node/2979
moving downward gives withdrawal... moving upward removes withdrawal.
3) So, the standard protocol for beginning suboxone from methadone applies here:
waiting long enough without narcotics and they leave your system and producing withdrawal. The withdrawal from one pill on top of suboxone is not as large of a withdrawal as most have from initially coming off of full doses of methadone/heroin/etc. The classic dosing of suboxone is that when the withdrawal gets to be bad, beginning/restarting suboxone will LOWER the withdrawal and would be VERY UNLIKELY to make it worse.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Not sure if you'll be able to answer but any idea how long. 24 hours since I took last methadone. How bad of withdrawals are we talking? Believe me when I say, nobody can be more disappointed in myself then me.
Brief Answer:
couple points.
Detailed Answer:
Actually, other than... about 1-2 day, I don't have much direct experience with patients with methadone.....
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/pdf/ndt-10-587.pdf
but these people are expert on it ! (great paper, details everything!, very readable).
about 1 day lag, peak at 2-3 days. The drug is gone by 2-3 days, and the withdrawal is at it's peak so, interaction with suboxone when it isn't there, isn't really possible. Restarting at 2-3 days when getting the symptoms as mentioned is...probably OVERLY cautious. The standard is about 24 hrs of drug free.
Then.... this is really interesting point. All the input into the brain goes through the base sections which do immediate processing and note the most important inputs. This part of the brain immediately responds to threats also to finding-things-sought. This occurs prior to conscious thought. Winding someone up with fear/anger/pain/emotions increases the activity of this part and strangles input from getting to thinking/deciding parts of the brain. So disappointment, upset, recrimination is counterproductive to avoiding automatic action/addictive behavior/etc.
And going, "well, that did not work out for me" might be a more productive approach? ON the other hand, XXXXXXX BUrroughs got off of heroin by specifically inducting the very worst withdrawal reactions by taking apomorphine on top of heroin (a naloxone like drug that also independently triggers withdrawal type vomiting even if you never took any narcotics). Aversion therapy. Let us not do that. And waiting until withdrawal gets significant and beginning suboxone is the more commonly recommended approach.
couple points.
Detailed Answer:
Actually, other than... about 1-2 day, I don't have much direct experience with patients with methadone.....
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/pdf/ndt-10-587.pdf
but these people are expert on it ! (great paper, details everything!, very readable).
about 1 day lag, peak at 2-3 days. The drug is gone by 2-3 days, and the withdrawal is at it's peak so, interaction with suboxone when it isn't there, isn't really possible. Restarting at 2-3 days when getting the symptoms as mentioned is...probably OVERLY cautious. The standard is about 24 hrs of drug free.
Then.... this is really interesting point. All the input into the brain goes through the base sections which do immediate processing and note the most important inputs. This part of the brain immediately responds to threats also to finding-things-sought. This occurs prior to conscious thought. Winding someone up with fear/anger/pain/emotions increases the activity of this part and strangles input from getting to thinking/deciding parts of the brain. So disappointment, upset, recrimination is counterproductive to avoiding automatic action/addictive behavior/etc.
And going, "well, that did not work out for me" might be a more productive approach? ON the other hand, XXXXXXX BUrroughs got off of heroin by specifically inducting the very worst withdrawal reactions by taking apomorphine on top of heroin (a naloxone like drug that also independently triggers withdrawal type vomiting even if you never took any narcotics). Aversion therapy. Let us not do that. And waiting until withdrawal gets significant and beginning suboxone is the more commonly recommended approach.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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