Is tapering off subs in 5 weeks after being on 8mg a day for 3 years realistic?

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Is tapering off subs in 5 weeks after being on 8mg a day for 3 years realistic?

Post by jerziegirl » Mon Nov 04, 2019 4:55 pm

Hi everyone,

My Suboxone Dr is retiring, and after 3 years of being on one 8mg strip a day, I think this is a sign that it's time to taper off. I only wanted to be on subs for maybe a year, but decided to wait until everything I lost in addiction was built back up. I've rebuilt my life in just about every way, and I think it's time to give life a try without a crutch (not saying that in a bad way). I have 5 weeks left of my script of 8mg strips, and I'm wondering you if think it's possible to successfully taper off of 8mg a day in 5 weeks with minor discomfort. I'm also wondering if anyone can direct me to a really good tapering schedule to abide by (I tried clicking on the one here but the thread seems to be deleted). I'm definitely a little nervous, but I really don't want to be on subs forever, and seeing how everything in my life is great right now, I have to at least try to taper. I'm hoping there are people here that have had success tapering off in short periods of time.
If worse comes to worst, I will find a new doctor, but in the meantime, any help would be appreciated :D !

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Re: Is tapering off subs in 5 weeks after being on 8mg a day for 3 years realistic?

Post by suboxdoc » Mon Nov 04, 2019 9:39 pm

Thanks for stopping by. There have been many discussions about tapering here over the years... there are fewer contributors right now, but related posts should pop up next to yours, and if you search the forum you'll find many suggestions. The moderators here also know buprenorphine inside and out.

I will give you my suggestions based on general experience. Please check with your own doctor. though, to make sure this is right for you:

During a taper, think of two phases - the first phase gets you to 4-8 mg per day, and the second phase finishes things off.

The first part is easy. Dose twice per day - 8 mg in the AM, and 8 mg in the PM, reduce the AM dose by 2 mg for two weeks - i.e. 6 mg plus 8 mg. Then reduce the PM dose for 2 weeks. Then reduce the AM dose by another 2 mg, i.e. 4 mg AM and 6 mg PM. After two more weeks, reduce the PM dose by another 2 mg.

Now you're taking 8 mg per day- and you will have NO withdrawal on the way to this point. You can try to reduce by a bit more; some people have no withdrawal until they get down to below 4 mg/day.

That took about 2 months. I just realized that in your question, you asked about 5 WEEKS. My schedule is not going to get you there.. and my schedule, from what I've seen, is about as fast as you can go without some amount of discomfort. With opioids, it takes about two months to reset tolerance to zero - so 5 weeks just isn't enough time.

Would your doc stretch things out a bit? Or maybe you can stretch what you have? I would just remember that the first part can go very fast, and the second part more slowly. I'm sure you'll get a couple more suggestions too....

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Re: Is tapering off subs in 5 weeks after being on 8mg a day for 3 years realistic?

Post by jerziegirl » Mon Nov 04, 2019 10:48 pm

suboxdoc wrote:
Mon Nov 04, 2019 9:39 pm
Thanks for stopping by. There have been many discussions about tapering here over the years... there are fewer contributors right now, but related posts should pop up next to yours, and if you search the forum you'll find many suggestions. The moderators here also know buprenorphine inside and out.

I will give you my suggestions based on general experience. Please check with your own doctor. though, to make sure this is right for you:

During a taper, think of two phases - the first phase gets you to 4-8 mg per day, and the second phase finishes things off.

The first part is easy. Dose twice per day - 8 mg in the AM, and 8 mg in the PM, reduce the AM dose by 2 mg for two weeks - i.e. 6 mg plus 8 mg. Then reduce the PM dose for 2 weeks. Then reduce the AM dose by another 2 mg, i.e. 4 mg AM and 6 mg PM. After two more weeks, reduce the PM dose by another 2 mg.

Now you're taking 8 mg per day- and you will have NO withdrawal on the way to this point. You can try to reduce by a bit more; some people have no withdrawal until they get down to below 4 mg/day.

That took about 2 months. I just realized that in your question, you asked about 5 WEEKS. My schedule is not going to get you there.. and my schedule, from what I've seen, is about as fast as you can go without some amount of discomfort. With opioids, it takes about two months to reset tolerance to zero - so 5 weeks just isn't enough time.

Would your doc stretch things out a bit? Or maybe you can stretch what you have? I would just remember that the first part can go very fast, and the second part more slowly. I'm sure you'll get a couple more suggestions too....
I appreciate your reply. I'm only taking one 8mg strip a day, so I will figure out how that breaks down according to your suggestion. Today was my last "official" visit with him and I do have a referral to another doctor, but I'm really trying to only go back to the doctor if absolutely needed. It turns out I found an old script of pills from when I switched to this doctor years ago, so I actually have a little less than 2 months left, closer to your plan. I know there will be some discomfort, but I've heard with a taper it should be manageable. I've also heard that withdrawals start really peaking their ugly head when you start getting near 2mg and less. I'm trying not to psyc myself out, lol. Anyway, thanks again for the warm welcome!

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Re: Is tapering off subs in 5 weeks after being on 8mg a day for 3 years realistic?

Post by PremierHealth » Tue Nov 05, 2019 12:06 pm

You may want to consider the fact that opioid dependence changes the functioning of the brain. While it may be easy to quickly taper off of opioids such a Suboxone, there may be long term functional consequences. These may manifest as anxiety, depression, and even memory loss months after your last opioid dose. Often called Post Acute Withdrawal Syndrome (PAWS), it seems to be a phenomenon that can derail an otherwise successful taper. Furthermore, there are variants in our opioid receptors (OPRM1) leading to different withdrawal characteristics among individuals. So, it is very hard to predict if your plans are realistic. I certainly want them to be successful.

In my practice, there are 2 examples of withdrawal variations that I want to draw your attention to. One patient was prescribed 90 mg of morphine extended release and 45 mg oxycodone per day for SI joint pain. He had surgery for it and then decided to quit cold turkey. After 3 days of withdrawal, he had no PAWS, no further withdrawals, and no issues beyond that. I've followed him for a year without anything new other than better pain relief off of opioids and opiates. My other patient started his taper from 8 mg Suboxone and we are 3 years into it. He is finally down to 0.125 mg daily dose. The taper was complicated by significant withdrawals manifested by psychological symptoms (depression, lethargy and anxiety) even with Suboxone reductions of less than 10% per month. It regularly took 3-4 months for him to psychologically recover from the insomnia, anxiety, depression and lethargy.

Let me make some suggestions: I would highly consider ketamine infusion or therapy. Ketamine is well known to decrease opioid needs. There is literature on ketamine helping in rapid tapers. Ketamine infusions are expensive, but therapy with ketamine tablets are affordable. Also consider concurrent clonidine and gabapentin to help with withdrawal. Another underused medication is memantine which can help with withdrawal.

Hope that helps. In my practice, I use a combination of all of the above depending on the patient's needs. I don't advise tapers of less than a year if possible.

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Re: Is tapering off subs in 5 weeks after being on 8mg a day for 3 years realistic?

Post by Elex » Thu Nov 07, 2019 4:24 am

I have been on Suboxone for 3 months 8mg BID. I’ve missed quite a few doses with no symptoms of any kind, so I decided last week to try to taper myself unbeknownst to my Dr.
I cut to 4 mg 2x a day for 4 days, then 2mg 2x a day for 4 days and finally, I’m off entirely for 5 DAYS with absolutely no bad symptoms.
Am I an anomaly or is it just a matter of time before I get hit? I don’t wanna be long term on this drug like so many.
PS. I cold turkey off Xanax 3 months ago and except for some neurological jolts, I feel I’m in the clear.
I’m 67 yo male living in Arizona and, love reading and learning from you guys. Larry.

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Re: Is tapering off subs in 5 weeks after being on 8mg a day for 3 years realistic?

Post by jeffg » Sat Nov 09, 2019 3:41 am

I agree it's fairly easy and pain free to get from anywhere between 32mg and 2mg in very short time frame but the closer you get to that 2mg barrier the more aware your body becomes.
From 2mg to .5mg is where I personally fight the banshee both mentally and physically but compared to a full withdrawl it's pretty much kids stuff and should not scare anyone with half a backbone and some fizz.
From .5mg and then off is not for the faint hearted and I'm doing it again next month and yep I'm going to cheat and go back on full agonists for 6 weeks before Cold turkey and having done this once before I can say it works, it works it absolutely works. This time I'm going to destroy my considerable stash of 8s, 2s and cards of subtex so I can't fall back casually and not be tempted to ease the
Pain of paws.
To the op watch out for post 5 days off subs that beast can stalk you for a little longer yet so be on your guard.
Good luck

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Re: Is tapering off subs in 5 weeks after being on 8mg a day for 3 years realistic?

Post by PAINguin1 » Sun Nov 10, 2019 7:15 am

PremierHealth wrote:
Tue Nov 05, 2019 12:06 pm
You may want to consider the fact that opioid dependence changes the functioning of the brain. While it may be easy to quickly taper off of opioids such a Suboxone, there may be long term functional consequences. These may manifest as anxiety, depression, and even memory loss months after your last opioid dose. Often called Post Acute Withdrawal Syndrome (PAWS), it seems to be a phenomenon that can derail an otherwise successful taper. Furthermore, there are variants in our opioid receptors (OPRM1) leading to different withdrawal characteristics among individuals. So, it is very hard to predict if your plans are realistic. I certainly want them to be successful.

In my practice, there are 2 examples of withdrawal variations that I want to draw your attention to. One patient was prescribed 90 mg of morphine extended release and 45 mg oxycodone per day for SI joint pain. He had surgery for it and then decided to quit cold turkey. After 3 days of withdrawal, he had no PAWS, no further withdrawals, and no issues beyond that. I've followed him for a year without anything new other than better pain relief off of opioids and opiates. My other patient started his taper from 8 mg Suboxone and we are 3 years into it. He is finally down to 0.125 mg daily dose. The taper was complicated by significant withdrawals manifested by psychological symptoms (depression, lethargy and anxiety) even with Suboxone reductions of less than 10% per month. It regularly took 3-4 months for him to psychologically recover from the insomnia, anxiety, depression and lethargy.

Let me make some suggestions: I would highly consider ketamine infusion or therapy. Ketamine is well known to decrease opioid needs. There is literature on ketamine helping in rapid tapers. Ketamine infusions are expensive, but therapy with ketamine tablets are affordable. Also consider concurrent clonidine and gabapentin to help with withdrawal. Another underused medication is memantine which can help with withdrawal.

Hope that helps. In my practice, I use a combination of all of the above depending on the patient's needs. I don't advise tapers of less than a year if possible.
I must agree with PremierHealth's post quoted above for the most part.

I have been taking Suboxone and/or Subutex depending on insurance, time, mood, etc for over 14 years. That's right, I have been a member of this forum since 2009 and this morning I have regained access to my account and have decided to post again. Please ready what I am about to share as it may be your saving grace.

Every since I started Suboxone/Subutex my sleeping schedule has been screwed. More damage has been caused in my life professionally and academically while on Buprenorphine than when I was just taking OC's. I cannot maintain a normal sleep schedule no matter what I try. I went from a person who was always the first to make it to the office and the last to leave to someone who could barely make it to work on time (and that was on the good days) or would sleep through alarms altogether and have to come up with some BS excuse as to why I missed work without calling in.

As you could imagine this never lasted long and I would lose my job. I have lost around 8 high profile positions over the past decade and destroyed a successful smartphone/computer repair and IT support shop due to my sleeping issues. Now I take three meds... Adderall, Klonopin and Subutex. For YEARS I have taken about 2mg-4mg/day of Subutex but no matter how little I take or how I control it the sleep issues remain. And trust me, I have tried IT ALL in terms of sleeping meds, scheduling, I have the loudest alarm clock with a vibrating module that goes under the mattress and while that will wake me up I am so lethargic and apathetic that I will just snooze myself back to sleep regardless of how important the task(s) I may have that day are.

In 2016, I injured my hand severely and so I had to close the shop for a short while. I planned on closing it for a few weeks and returning but my hand needed months to heal. Life was going so well, the business was doing GREAT and I was at a very positive place in life. So, when I injured my hand I decided that I would take that downtime and discontinue all of my meds for the first time in a long time. I stopped taking my adderall, klonopin and suboxone. I figured that without those vices I could achieve a higher level of success and I would have but what came after was a very deep and dark tunnel I never could have imagined I would have traveled down.

Touching on PAWS... Is it legit? Bet your ass it is... Will YOU have to deal with PAWS? Bet your ass you will.. Will it last a year or longer? Bet your...well you get the point. And yes, I understand our situations are quite different... You have been on Sub for 3 years and I have for 14-15 years. Not trying to scare you but prepare for the worst...this way you will not be so shocked with the initial w/d is not as bad as you thought it would be. Again, however, it is PAWS that really gets you... I only pray that you do not have to deal with what I dealt with.

I was pill free for 14 months and my anxiety was so bad that simple tasks such as handling business, making phone calls, scheduling appointments, taking the trash off, etc, etc became impossible tasks. You may wonder how these tasks could become impossible to do but I assure you that for me it was absolute hell and quite frankly I have never been the same since I stopped taking the meds. I went back on them on month 15 as I saw no end in sight to the anxiety and depression. My family is oblivious to my plight though they are aware of what I've been taking and dealing with for so many years. However, they are not academics and I hate to say that my mother thinks that turning to God will solve all of your problems. Well, believing that will get you killed imiho. That is an old way of thinking and while positive reinforcement through religious belief can be helpful it can also cause you much pain.

PAWS never ended for me.... After 14 months I could not believe that I still felt like crap all of the time and could not even talk to my friends. I let my cell phone bill go to collections and lost a number I've had since I was 21 years old. Not a big deal really but for someone who was used to paying bills on time rather they be cell phone, car payments, student loans, etc it was devastating for me. To be such a strong person previously but such a weak person during PAWS.

Now, do I know for certain that it was the Buprenorphine that was the issue? No, not with 100% certainty as I stopped taking all 3 of my meds at the same time. But I have stopped taking klonopin in the past and no change in my sleep patterns. Once off of all the meds my sleeping went back to normal but I was so depressed that I would end up in these "loops" where I would wake up at 7am for a week or two and day by day I would wake up an hour later until finally I was on a third shift schedule again. Before, I had the adderall to force myself through the long nights but now I did not and THAT was absolute hell... Absolute hell...

I did not enjoy anything that I once did, I could care less about phones and technology. My once high levels of confidence and self esteem were gone. I was a shell of a person and have never come closer to suicide in my life than during that period. I was broke because I could not work... I was in big trouble... I begged my parents to help me get back on my meds and just like that I was back to normal but all of the sudden the adderall did not do for me what it once did and still does not. The kpins and subutex worked as usual though...

If you want to come off of Buprenorphine you need a tablet form first off. You can dissolve the tablets in 10 ml of water so if you crush an 8mg tablet into powder and mix it with 10 ml of distilled water preferably then squirting 1ml of the mixture under the tongue will provide you with .8mg of Sub/Bup. It is the only way to take less than 1mg because you cannot realistically crush the tablets (oval, round or octal) into pieces that would not crumble to dust.

I take such small does of Sub and always have... Taking 32mg, 16mg, 8mg daily is absolute crap and noone should ever have to take more than 8mg per day...EVER. I have NEVER taken 32mg or even 16mg of Sub in a single day...not once. They tried to induce me with 32mg when I first started in 2015 but I knew how powerful Buprenorphine was and as I stated, I break 8mg tablets into 4-6 pieces and one can last me a week if I really stretch it. Now I was never a heroin user either so perhaps heroin addicts who used via IV may need to start with 32mg or 16mg but aside from that I personally think those doses are ridiculously abnormal and some doctors will tell you to take that much in order to force you to come back sooner rather than later for your refills and then you're a slave to the "game" so to say.

The doctor had the best recommendation for tapering...but again, that is not a 5 week solution.

Whatever you choose to do be prepared for PAWS and if you have ever had anxiety in the past or depression (and even if you have not) make preparations to deal with those issues. IMHO Xanax is too strong and Valium too weak but Klonopin is perfect for me. I take 1mg tablets PRN but usually 2 a day. Talk to your doc and ask for an SSRI, SSNRI or Tricyclic antidepressant in addition to the benzodiazepine. Clonodine is well known to aid in easing the w/d but still, you WILL go through w/d no matter how you taper or how little you take. But you do not have to be afraid of the w/d, it is NOT as bad as some may lead you to believe unless you cold turkey stopped after dosing 4mg or more daily for more than a year.

Moreover, If you have addiction issues with benzos then obviously you do not want to take any of those. But the antidepressant will help counteract the symptoms from PAWS so speak with a doctor about that if you can.

Now that I am back on the forums here I am going to seek assistance for coming off of Subutex (again). I have to take control of my life or I will have no life to take control of. I MUST return to that responsible, early to bed early to rise individual I once was or my life will always be shit. So the trade off is massive... Take subs forever and have no anxiety but always be constipated and always have to pay exorbitant amounts of money to doctors just to get the stuff of stop taking it and deal with the w/d all over again and hope that this time PAWS will not be such a major issue.

I have had jobs with the Department of Defense, provided IT support for numerous cities/municipalities in my home state, have worked for 3 Fortune 500 companies and started my own business that was actually a success and was making me a person that did not have to worry about money and did not have to work for some jerk using my skills to make him/them money. But I lost all of the jobs due to the sleeping issues brought on by the Subs...it has to be the subs. I work out everyday and am in great shape but nothing matters, nothing helps, nothing changes. The ONLY way I can wake up early is if I go to sleep at 9:30pm-10:30pm. If I wait an hour later then I will not wake up until my body has rested for a solid 12-14 hours. Thinking about all I have lost because of these sleeping issues really makes me want to just end it all right now. But I'm no bitch made motherfu**** and will never take my own life over a vice such as pills.

I think I am just going to have to learn to deal with the anxiety and depression that comes along with PAWS and hope I can make it through. I just cannot keep doing what I have been... The best years of my life have been a struggle and I should be financially stable now with money in the bank but have around $300 if I am lucky to my name right now. Not even enough to pay for my sub doctor fees and refills. I am disgusted by this completely... But this isn't about me man.. This post is kind of old now so I hope you've detoxed by now and all is well. But if not...well, just heed the warnings in this post. You CAN do it, it will not be comfortable but you CAN do it my friend.

I know this is a long read but I hope what I shared here will be helpful to others. I am one of the few people I know whom have taken some form of Buprenorphine for as long as I have (14-15 years). There may not be a way out for me, my brain's chemistry may be permanently altered now after such long use of the drug. But nevertheless I am going to try but this time I will stay on the adderall and klonopin and perhaps take Prozac or something to aid with the depression and anxiety.

Good luck bro and god bless!

Regards,

PAinguIN
"The only thing necessary for the triumph of evil is for good men to do nothing."

-Edmund Burke
1729-1797

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Re: Is tapering off subs in 5 weeks after being on 8mg a day for 3 years realistic?

Post by BlueLight » Tue Nov 12, 2019 8:03 pm

jerziegirl wrote:
Mon Nov 04, 2019 4:55 pm
Hi everyone,

My Suboxone Dr is retiring, and after 3 years of being on one 8mg strip a day, I think this is a sign that it's time to taper off. I only wanted to be on subs for maybe a year, but decided to wait until everything I lost in addiction was built back up. I've rebuilt my life in just about every way, and I think it's time to give life a try without a crutch (not saying that in a bad way). I have 5 weeks left of my script of 8mg strips, and I'm wondering you if think it's possible to successfully taper off of 8mg a day in 5 weeks with minor discomfort. I'm also wondering if anyone can direct me to a really good tapering schedule to abide by (I tried clicking on the one here but the thread seems to be deleted). I'm definitely a little nervous, but I really don't want to be on subs forever, and seeing how everything in my life is great right now, I have to at least try to taper. I'm hoping there are people here that have had success tapering off in short periods of time.
If worse comes to worst, I will find a new doctor, but in the meantime, any help would be appreciated :D !
I would say that you are looking at a minimum of a 3 month taper, and more likely a 6 month taper. It’s not just how long you’ve been on Suboxone, but also how long were you an opiate addict before getting on Suboxone. Can it be done in less than 6 months...sure. But the goal is to not relapse while tapering.

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Re: Is tapering off subs in 5 weeks after being on 8mg a day for 3 years realistic?

Post by Jess1208 » Fri Nov 22, 2019 11:18 am

PremierHealth wrote:
Tue Nov 05, 2019 12:06 pm
Also consider concurrent clonidine and gabapentin to help with withdrawal. Another underused medication is memantine which can help with withdrawal.
Can you please explain the use of Memantine for withdrawals??? How does that work?? What WD symptoms could it possibly help with??

I am on Memantine currently for chronic migraines. I have never heard of it being used to help WD symptoms! Pretty cool!

Jess
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