Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

Changing from Suboxone to Duragesic - Need Advice

BluesLoverBBluesLover Posts: 6
edited 06/19/2014 - 9:08 AM in Pain Medications
Lumbar fusion 2001, foramenotomy and laminectomy Dec 2013, spondylosis, stenosis

I'm a 60-year old male.

After many years of oxycontin therapy before and after my 2001 fusion surgery, the pain clinic rushed me through a weaning period (2 months from 4 80mg oxys daily) and I was still totally sick with withdrawal. My family doc was sympathetic, tried easing the symptoms with vicodon, etc...all the time I was missing work, basically a sick zombie. Finally gave up and checked myself into the methadone clinic. Two years there, up to 165 mg daily. I wanted out desperately, but I get so violently ill with withdrawals I was trapped.

Finally checked into an inpatient rehab and was inducted onto Suboxone - left there with a scrip for 4 8mg tabs per day. Great drug, no more withdrawal, functioning well, and my life was putting itself back together. The fusion surgery took care of most of the lumbar pain for 2-3 years, but it came back - epidurals, etc. to control it. Still on Suboxone. In the last 3 years, stenosis has started taking its toll, and I live in level 2-3 pain with flares up to 4-5.

MY problem with Suboxone is the way I'm treated by anybody in the medical field. Example: I fell and broke 4 toes on my right foot - went to the ER - not much they could do other than a special shoe, but when I asked the nurse for some pain meds, I heard her ask the doc and heard him say "he's on Suboxone - he's an addict - don't give him anything" - told me to take Tylenol and sent me packing.

Same story any time I have to list my meds - all of a sudden I'm a pariah and am profiled as a drug seeking wack job. Three years ago I'd had enough of this kind of treatment, I tapered myself to 4 mg per day, and at the same time discovered another doc in the same clinic as my family doctor 2 miles from my house had the Suboxone license, so I changed to him to help me with the last bit of weaning to nothing. Granted my pain levels were increasing, but I wanted off the Suboxone just to be treated like a regular patient once again.

His comment at my first appointment was "OK, but what are you going to do for pain control?" I said "I don't know" and then and there he talked me into going back up to 24 mg per day of Suboxone. I am almost positive my health insurance won't pay for Suboxone for pain control, but they've been paying for it for 3 years because the doc uses his DEA number. I'm actually on Suboxone for pain, but as far as the insurance (and anyone else in the medical field) knows, I'm on it for drug addiction. I hate that - I have NEVER abused any of my scrips. I really dislike this Suboxone doc - he knows so little about the drug, even tried to tell me it was easy to come off from - "You'll feel like you have the flu for a couple days, then you'll be fine". I know better.

Anyway, fast forward to today. I just want to be back on traditional pain meds - It's only a matter of time before my insurance catches on and I'll be out in the cold because there's no way I can afford $800 a month for Suboxone. So I asked my long time family doc (I trust him implicitly, we've got a great long-time relationship, and he's a personal friend) if he would put me on Duragesic to replace the Suboxone. I was on Duragesic for a couple years between surgeries and did well on it other than the patches falling off all the time.He was fine with that - did the equivalency calculations, and it looks like a 75 mcg patch will cover the pain. But...I'm having second throughts now - I'm currently weaning the Suboxone to be at 4 mg or less for my July 8 apt, and will stop completely 2 days before. Just spoke with my doc in the phone and he's concerned that the Fentanyl will take at least a week to overcome any Suboxone left in my system, leaving me both in withdrawal sickness and lots of pain.. Am I going down a dead end street here?

I read all kinds of posts on using Suboxone to stop taking Duragesic, but what I am planning is the opposite. I really need some advice - I am sick and fed up with the stigma of being on Suboxone, really tired of the way Suboxone docs know so little about what they're prescribing, sick of being labeled an addict when all I am is a chronic pain patient. My family doc knows me and treats me fine, he's great to work with. Can I make this transition and end up with adequate pain control without going through weeks of hell? I realize Fentanyl is a powerful drug, but I'm just not an abuser, and with all the spinal ailments I have I'm going to have to be on something for the rest of my life. There's more surgery in my future, and after 7 days of hell after my neck surgery with nothing but Toradol for post surgical pain meds, I just don't want to be on Suboxone any more.

I have a few days to decide, but I really really need some advice and some idea what to expect if I make the switch. Please help.


  • LizLiz Posts: 7,832

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • sandisandi Posts: 6,343
    edited 06/20/2014 - 6:34 PM
    Oh boy, you are in quite a mess..........first of all you are on far too much suboxone for pain control. The doses of 16, 24, and 36 mg are for addiction management, not for pain management. Which may explain why doctors have reacted as they have when you tell them you are on suboxone.
    When used for pain, and not addiction, the doses are much lower, as in less than 4 mg..any more than that, has no additional pain relieving properties.
    Unfortunately, you bought into the hype of suboxone, where it is touted to being a great alternative for avoiding withdrawal from opiates.......as a matter of fact, you were on far too high a dose of methadone, so the dosage amounts were ridiculous for the purpose you were using them for. Going to a methadone clinic was a huge mistake on your part.
    The right thing to do would have been to have your pm doctor develop a tapering plan for you, over time, and you would have experienced very little in the way of withdrawal symptoms.
    You may find that you have some difficulty in getting a new pm doctor to treat you, and you may also run into problems with your insurance once you try to go back to opiate pain management. The inpatient treatment center, the methadone maintenence program, and now extended treatment with suboxone gives the appearance of addiction history. .
    First things first, you need to taper down on the suboxone, to the lowest possible dose........in an 8 mg film, you are going to need to work with a physician on a proper tapering plan....Because of it's long half life, you are going to need professional guidance, and you can not consider starting the fentanyl, at any dose until the suboxone is cleared from your system. Edited to remove misinformation.......To correct the erroneous information, I would work with the doctor to taper down to .25 mg slowly over time, and then stablize on that dose, then stop the suboxone period. Give yourself some time, at least 24 hours, and then apply the patch. That should give you enough time for the majority of the remaining suboxone to clear enough for the fentanyl to be applied and start building up to a steady blood plasma level. Just be watchful for the dosage of the fentanyl, you don't want to start out at too high a dosage.....you want to start at the lowest dose, then if you need to , increase it. You may find that you don't need nearly the amount of fentanyl that you think, since you aren't using and haven't been using pain medication for some time. It is better to start low and work your dosage up as needed then to start too high and risk breathing or other difficulties, especially since you are transitioning from suboxone to fentanyl.
    You need to find someone who can guide you in working a proper tapering plan with suboxone, and make sure that they know what they are doing when it comes to guiding you medically. DO NOT and I can not stress this enough, DO NOT attempt to do this on your own. You need professional guidance, with a doctor who knows what they are doing....

  • BluesLoverBBluesLover Posts: 6
    edited 06/20/2014 - 8:24 AM
    Yes, the last several years have been a series of me listening to and trusting doctors and other people that knew or cared a lot less than they should have. There's a whole lot of "should've, could've, would've" in my history, but I can't change any of it. A reasonable weaning plan by the pain clinic would have been a better start. Then post-acute withdrawal syndrome (I was extremely sick for 5 months) left me welcoming what would turn into the hell of the for-profit methadone clinic. Pain flares resulted in “we’ll just raise your dose to take care of that” and before I knew it I was at a ridiculous dosage. (165 mg is bad, but there were people there dosing over 250mg per day, so I honestly thought I was OK). I blame myself mostly, for putting trust in medical people just because they are medical people, and not recognizing soon enough that the methadone clinic was first and foremost a profit-making enterprise and the more I take the more they make.

    I will say, however, that with PAWS, if it had not been for Suboxone I probably wouldn’t be sitting here typing this – one can only take so many ER trips vomiting bright red blood from a torn stomach lining after months of horrific sickness. The drug did stop the withdrawal symptoms within 12 hours, and that was a huge relief.

    It’s new to me that buprenorphine is used for pain control in such small doses – the first Suboxone maintenance doc I saw after being discharged from rehab (at 32mg/day) asked if I would be willing to raise my dose to (5) 8mg tabs per day as part of his pain control “research”. In pain, I agreed. Of course I saw no improvement.

    As for today, I appreciate your input. In fact, my primary doctor called me this morning with an opening in his schedule – I just left his office, and based on some of what you said and other online research I’ve been doing, I decided to stop and learn more before making any changes. My doc left it entirely up to me, I could have left his office with a Duragesic scrip, or not. I decided “not” and will see my Suboxone doc again next week for 3 more months’ supply. This decision still leaves me wanting to be done with Suboxone for good, and to be treated for pain with pain medication rather than an addiction drug.

    While I am definitely not “doing this on my own” I am limited by the resources I have available to me in the rural area I live in...I have a first-rate primary care physician who is totally non-judgmental, knows my entire history and welcomes me being part of any medical decisions. There simply are no “PM docs” practicing anywhere nearby. The area that I live in is monopolized by one huge pain clinic run by anesthesiologists in between surgeries. You don’t have “your doctor” there, you see whoever is available that day and time – there is no continuity or real case management, I recall having medications and dosages changed almost month to month according to which doctor I drew. This is the same clinic who 12 years ago gave me 2 months to taper from 320 mg of oxycontin per day. There are no other PM docs with the exception of one who will write anyone a prescription for anything they ask for at any time at $300 per visit. He's very popular with the illicit drug crowd. There are 3 Suboxone docs within a 50-mile radius - one is the $300 a visit guy, one is a psychiatrist who 3 years ago dismissed me with zero discussion when I couldn't instantly produce a urine sample (prostatitis), and the one I am seeing now who is sure I can quit Suboxone cold turkey and feel like I have the flu for a couple of days. So, as it stands, it is up to my family doctor and myself to get this transition right.

    All of your points are well-taken and I thank you for your obvious concern for my well-being. I am a bit confused about your statement regarding precipitated withdrawal - I am very aware of PW, however I have never heard of it occurring with a Suboxone patient who takes an opioid with Suboxone in his/her system. All the examples I have read about have been with people who have opioids in their system, then take Suboxone without first being in opioid withdrawal. In fact, with my neck surgery last December, I was given fentanyl in recovery - I had taken my morning dose of Subxone just a few hours before. The fentanyl didn't work very well, for obvious reasons, but there was certainly no precipitated withdrawal.

    If you would, please elaborate a little more on precipitated withdrawal in this reverse scenario, if there's something I'm missing I sure need to know about it. If the point you are trying to make is that once I take the first dose of fentanyl I then cannot go back to Suboxone without experiencing PW, I am fully aware of that and so is my doctor.

    The biggest question for me, is trying to get a definitive answer on where the point in time lies that the fentanyl can occupy the receptors with traces of Suboxone present. As with most subjects, the internet yields everything from people claiming to shoot heroin and getting high 8 hours after a Suboxone dose to 8 weeks before any opioid will bind to any receptor. I recognize I am going to have to deal with some discomfort, even withdrawal sickness, but there has to be a point where the fentanyl will begin taking over and while everyone is different, at least I can plan ahead and be “down” for a minimal amount of time.
  • SunnySideUpSSunnySideUp Posts: 1
    edited 06/20/2014 - 2:11 PM
    I am a regular reader of this site but this is my first comment. Your post caught my attention and I thought I would give you my personal experience.

    I have been on pain management for a back injury that I sustained in a car accident a few years back. I have also struggled with the fact that my doctor had told me that I will always have a need for pain meds. I convinced myself not only once, but twice that I would try to leave my prescriptions behind and replace them with exercise and over the counter pain medicines. My family are really the ones that put this idea into my head. They believe all of the hype that is associated with narcotic pain meds and they do not understand the difference between addiction and dependence. They think that everything can be handled with therapy, massage, acupuncture.....ect.

    So while I am not an expert when it comes to suboxone, I can tell you what I have experienced for myself.

    You are absolutely correct about the precipitated withdrawal syndrome. This only occurs when going from a opiate agonist (oxycodone, methadone, morphine) to a partial opiate agonist (suboxone) and never the other way around. As you know, a simple Google search will tell you this and explain why, so there is no need for me to explain further.

    My experience was with changing from methadone and Percocet to suboxone the first time. And from OxyContin and oxcodone to suboxone the second time. The first time I changed over, I waited for 18 hours and the second time, I waited for 17 hours. This was plenty of time and I had pain relief very quickly.

    Your questions are about switching from suboxone back to an opiate agonist, Fentanyl. My experience did not even involve an opiate this strong. My switch both times was to OxyContin 80mgs and 30mgs of oxcodone. The good thing about switching back to opiates is that you can take them as soon as you want after your last dose of suboxone. There is no uncomfortable or negative symptoms to worry about and absolutely no reason to wait until you're in withdrawal. I waited less than 24 hours both times after my last suboxone dose of 4mgs and could feel my prescription meds within 30 mins.

    This tells me that even though I still had suboxone in my system, I still had receptors that were not being used by the suboxone. It did not last for as long as it usually does but it didn't matter because I still did not have any pain. There is absolutely no reason why you need to wait longer than 24 hours because as soon as the receptors are free from the suboxone, it will be occupied by the opiates.

    Your doctor is completely wrong about the Fentanyl taking a week to work. Suboxone will not keep the Fentanyl from working for a week. It's just not possible. If you are able to tolerate your pain when you wean down to 2-4mgs, then you will have pain relief from Fentanyl within 24-48hrs after your last dose of suboxone. If you don't believe me just do a little more research about other people that have switched from suboxone to opiates. That is what I did and it gave me all the answers I needed.

    Hope this helps and good luck with your suboxone taper.
  • sandisandi Posts: 6,343
    edited 06/20/2014 - 6:36 PM
    what I meant to say was PAWS- post acute withdrawal syndrome.....in the event that you drop the suboxone too fast, without a taper, you may find that PAWS sets in.... Since you are familiar with it, I don't need to explain it.
    It's pretty obvious from the dosages of the various medications that you have been on, that your doctors have done you a huge disservice when it comes to managing your medication dosages, and handling withdrawal /tapering plans.
    What I would suggest, is tapering to the lowest dose of suboxone that you can, working with your primary......dropping the dosage to .25 mg which is the lowest that you can cut those strips........then taking it at that dosage for a couple of days.....then stopping the suboxone. Give yourself 24 hours after your last dose before applying the fentanyl patch, and between the time that the fentanyl needs to start to build to a steady blood plasma level, and the stopping of the suboxone, you should be fine.
    I am truly sorry that you have been handled the way you have, by some of these doctors.....it's a shame that you are here, having to try to sort things out for yourself. That is not the way any doctor, worth his salt would want his patients handled. I am glad that you have a good primary at your side.
    I would also make sure that your primary doctor is working with you, guiding you as much as possible through this transition. One last thing, be careful when starting the patches, you want to start at the lowest dose, especially since you are going from suboxone to fentanyl, going too high on the dosage right from the start may prove to be too much fentanyl at one time, so start low and go up as necessary.
    I edited my previous response to reflect the correct information......I was trying to type rather quickly and didn't re-read what I wrote......sorry for the confusion.
  • BluesLoverBBluesLover Posts: 6
    edited 06/21/2014 - 10:14 AM
    Thanks for clearing the PW question up Sandi, I was pretty baffled by what you were saying, but we all goof once in a while.

    Just some thoughts and a bit of rambling, but it feels good to be among people who have been there, understand, and care

    A couple of notes, I am not on the Suboxone film, the pharmacies in our area carry only the tablets, and to my knowledge (correct me if I'm wrong) there is no generic film yet, only generic tablets. A $15 copay versus $80... I have become pretty adept at cutting the 8mg tabs, I can get neat quarters (2 mg) pretty easily and eighths (1 mg) are not as pretty but doable. I really don't dare ask my Suboxone doc for the 2 mg tabs, he will immediately pick up on the fact that I want to taper and institute his "two days of flu symptoms" mandate and I'll be in dire straits. My family doc is equally disturbed by his colleague's lack of understanding of the drug. They actually practice at the same office clinic, and I have discussed with my family doc that I intend to taper on my own without the Suboxone doc's knowledge. He obviously can't officially condone this approach, but he also knowingly nodded and said "I didn't hear that". I have begged my family doc to get the Suboxone certification so we can do this together, correctly, but he flatly declines (does not want to take on the flood of addiction patients that would come with being on the the license list in such a doctor-starved area.)

    It's sad, but my experience has been that there are very, very, very few doctors who have taken the time to learn what they need to know when it comes to dispensing narcotic meds. Worse than that though, is the prevailing notion amongst doctors that withdrawing from opiates is "just not that hard" and all one needs to do is "man up, just feel bad for a little while, and then it's over". I wouldn't wish PAWS on anyone, other than the ignorant docs who take this arrogant stance.

    If there is one thing I can say about Suboxone, it's that in the hands of a properly trained doctor, it CAN be a godsend to those with deep opiate dependency. The travesty is, however, that I have NEVER seen a Suboxone doctor that knew what he was doing with the drug (with the exception of the rehab doc that inducted me, and he doesn't do maintenance).

    Through my eyes, a Suboxone license is something that most of these docs do just to increase revenue, they must just skim through the training, barely listening, and as soon as they have the certification, apply their own creative ideas as to what the drug is, how it is intended to be used, and what is involved in getting a patient off the drug.

    Examples : My first doc taking me to 40 mg per day for pain control. Next, the pshychiatrist that banished me for not peeing in a cup within 30 seconds...my first visit with him, he said "we'll start you on 24 mg daily and in 2 months I expect you to be down to 4 mg, then we'll go to nothing the third month". When I said "wait a minute that's not how this drug is used and what it's intended for, I got the line we all love to hear "if you don't like it you can go somewhere else". With no other docs in the area to go to, I brought pages of documentation (mostly off the Suboxone website) to my next visit and basically shamed him into reading the highlighted parts stating that the drug is intended as a medium to long term drug used to help opiate dependent patients SLOWLY taper off. He relented, although it was only 5 or 6 months later that he dumped me using the excuse that I "wouldn't submit to a urine test".

    Why, WHY??? Do these doctors get the Suboxone license then fail so miserably to use the drug as it is intended? And why is there obviously no testing or other check/balance method that a doctor must pass to prove he/she knows what he/she needs to know to dispense the drug properly and manage dependent patients cases?

    I am choosing to go back to Duragesic for a couple of reasons - oxycontin carries such a negative stigma due to the abusers, everyone who reads the news "just knows" that it's an evil drug that will certainly turn every patient into a drug seeking freak. I already deal with enough of that garbage from being on Suboxone, I can't handle any more of it. Duragesic/Fentanyl seems to be less known and stigmatized. Think of it, most people who see a patch on someone think they're either quitting smoking or have hormone issues. Wish I wasn't so sensitive about this, but I'm past being fed up with society's ignorance of chronic pain patients. I also think that sooner or later the unknowing and uncaring (I spell that DEA, along with the know-it-alls who feel the best way to stop the nation's drug problem is to penalize everyone who uses the drug, even if it's for their intended purpose) will eventually simply outlaw oxycontin and most of its counterparts.

    Second, while I never abused my scrips, I do remember a period of very pleasant euphoria "high" with the oxycontin. I trust in my willpower not to abuse 99.9% - but the effect is too pleasant for me to trust myself 100%. I never felt that with Duragesic, only pain relief, and in fact, the patches falling off and the associated hassles using it keep it just enough of a bother to keep me not liking to use it. I also like the different dosage sizes, and the ability to cut the patches smaller should I ever want to taper off them.

    I am (especially lately since the stenosis has become more bothersome) wrestling emotionally with processing that I will most likely have to be on pain medication for the rest of my life. Knowing that I will always be in pain is hitting home hard since turning 60 - not sure why, I've been in pain since I was in my 20's, but lately it's just been a difficult concept to swallow. I'm not one to feel sorry for myself, but I do wish for just a semblance of a normal rest of my life rather than continuing deterioration of my spine and new pain areas cropping up as more nerves become impinged. (I've had counseling for this, in case you wanted to suggest that).

    I think the biggest hurdle I am going to have to deal with is knowing that in order for my doctor to obtain the insurance pre-authorization to replace the Suboxone with opiates, he is going to have to come right out and tell them that I have been on the Suboxone for pain control, not drug addiction. This will obviously mean financially I will never be able to go back to Suboxone (not that I want to, but should I run into any unforeseen problems such as my system not accepting the opiates for whatever reason, the Suboxone still feels like a safety net). This is my biggest fear as I sit here typing this today, and has been for at least the last year since I have seen increasing pain levels and recognized the need for returning to traditional pain control methods.

    If I could just manage to get past that fear, I would confer with my good doctor once more, set our plan in motion, and begin tapering the Suboxone immediately. Two days ago I was committed to doing just that, today I'm decompressing from the stress that accompanied that decision, knowing the finality of the process. I know I need to go through it, but after so many years of pain issues and doctor issues and drug stigma, it is very hard to set a course and get where I need to be for my long-term good.

    I welcome any and all feedback, ideas, comments, and appreciate them all.
  • I have stated the very same thing in regard to doctors using suboxone, without knowing the proper ways of using it, and especially when it comes to using it during a tapering process for those who are simply in need of a taper, not treatment for misuse or addiction issues.
    As I believe that I said in my first reponse, the dosages are drastically different when it comes to using suboxone as a taper for withdrawal......less is more........the LOWEST possible dose that alleviates the symptoms of withdrawal, usually 2-4 mg depending on the dosage of medication that the patient was at, and the length of time is usually more than sufficient for someone with no misuse/addiction history....then a quick taper off of suboxone, lasting no more than a total time of a week or two......It doesn't give the suboxone time to become a problem, and reducing the dosage day to day or every two or three days, gives time for the body to stabilize at the lower dose, then step down again.
    Even with addiction issues/misuse of opiates/street drugs, the dosage is still supposed to be the lowest possible dose that prevents withdrawal symptoms and cravings.....not an automatic let's start at 16 mg, work our way to 24, then 32 mg...
    As far as the reductions goes, a good pill splitter, used correctly can reduce a tablet into quarters, eighths and then 16ths....or as close as you can get to 16ths if you are careful...They may not be perfectly equal in size, but you can guesstimate .
    The education for these doctors who are treating addiction using suboxone is limited to just that topic.....they are told that it has pain relieving properties, but not how to use it correctly for the management of pain.....another idea that might be worthwhile is considering bupenorephrine patches. They come in varying strengths, 5 mcg, 10, 15 and 20 I believe, and contain the same medication as the suboxone without the naloxone. So that might be worth looking into. I forgot about that option yesterday... The bupe patches are used for pain management and if you want off the suboxone, you feasibly could transition to the bupe patches, then reduce the dose or use them for a week, then have your doctor convert you if you need to to fentanyl or another pain medication.
    That would be an option worth discussing with your primary.
  • BluesLoverBBluesLover Posts: 6
    edited 06/21/2014 - 4:42 PM
    use the bupe patches...another insurance roadblock - nothing but tablets or film, with quantity limits. Subutex or the like is flatly refused to be paid for, unless I submit to a 4-drug trial of NSAIDS first (3 months on each drug). There has yet to be made an NSAID that gives me any sort of reasonable pain relief, wish there was...

    I wish I could just forget about the insurance company, but unfortunately the cost of any of these medications is so high that working people like me simply cannot afford them. Just the Suboxone scrip is double our house mortgage monthly...and of course simply having a job precludes me from most of the financial aid available.

    I don't defend any of my Suboxone docs , but I was inducted several years ago (can't recall exactly how long) and at the time, everyone left the rehab clinic with scrips for 32 mg daily, that was the starting dose. It was still during the 10-patient limit days, however long ago that was.

    In my case, it was working against a 165mg daily methadone dosage, and actually the rehab doc was amazed that it controlled the withdrawal, he went in skeptical.

    I'm grateful for your input and a place like this to talk. Thank you.

  • sandisandi Posts: 6,343
    edited 06/21/2014 - 4:55 PM
    That's too bad, regarding the insurance issues and the choices of medications.....I was hoping, that it might be a good alternative for you instead of trying to learn and manage this tapering on your own.
    I will keep thinking and trying to come up with an alternative, but in the meantime, hopefully, with all of the research you are doing, a good tapering plan can be formulated.
    Hang in there, and I'll keep trying to come up with something. I hate that you were put into this position......it never should have occurred. I sent you some information that I found that may assist you.....check your private messages.
  • BluesLoverBBluesLover Posts: 6
    edited 06/23/2014 - 2:08 PM
    I have been experiencing some pretty extreme anxiety over this since my first post. I had no idea the amount of Suboxone I was on was so outrageous. The main stressors:

    1. Fearing a sudden notice by my insurance company that they will no longer cover the drug. Reality: probably nothing will happen, as long as the doc keeps prescribing it with his license number.

    2. Tapering is a double whammy for me - the more successful I am in tapering the Suboxone, the higher my pain levels will become. Reality: I own a small one-man manufacturing business...missing a day of work for either withdrawal or pain symptoms is very damaging financially. I can work in pain better than I can in withdrawal though. In my business I am currently 3 months behind on a major contract...whatever I do, I can't miss much work.

    3. I have experienced post-acute withdrawal syndrome more than once with coming off from oxycontin, if I could just be sick for a week or two and it would stop, I'd be good with that. I am deathly afraid of PAWS, it nearly killed me before and most doctors don't even know what it is or have told me it's "all in my head". It's one of the scariest stressors to me right now...

    I have found a taper plan on another forum, the 25% reduction every 4 days. Sounds good, but I have no idea what to expect. If anyone knows of a better taper plan, please point me to it.

    My "plan" looks something like breaking this problem into 2 steps - (1) trying to forget about the pain as much as I can (very hard to do) and just concentrate on jumping off Suboxone totally. I can get both lumbar steroid injections or epidurals with just a phone call, in case things get too bad. There isn't much I can do about the cervical stenosis pain though, although it's been fairly quiet since my C4 foramenotomy and hemi laminectomy last December. If I can first make it off the Suboxone completely, I know I'll be super inspired and then I'll go to step #2, going on a traditional pain med, probably Duragesic. I think once I'm no longer filling Suboxone scrips, I'll have an easier time with the insurance company, but who knows...

    I don't know what you all are going to say about this next part... My family doc has been prescribing tramadol 50mg for pain flares for 3-4 years now. I use them sparingly, never more than 2 50mg tabs per day and never for more than 2 days straight. They're not very effective pain-wise, but the insurance covers them no problem and they have helped some .

    I am also prescribed and use VERY sparingly klonopin 0.5mg PRN for anxiety. I have never taken more than 3-4 of these tabs over an entire week, but they do calm me and seem to help a little with the edginess of withdrawal in my previous Suboxone tapers. Both my last 2 Suboxone docs, including the psychiatrist and my current one, and my family doc tell me that the klonopin is OK used sparingly. Hope it doesn't freak anybody out here, but it's what I've been told and have been doing for about 4 years.

    Very truthfully, I have no fear I may abuse either of these drugs, I paid the price for tramadol 15 years ago when it was still being called a non-addictive drug - I had a different family doc then and in an attempt to help me with high pain levels, quickly had me up to 12 50mg tabs per day (2 every 4 hours 24/7). I realized something was going seriously wrong when I started craving the drug, and immediately quit it cold turkey - I "had the flu" for 11 months, but I kicked it. Now I know to use it very sparingly. Any more than 2 Klonopin in a single day puts me to sleep, so I just don't take it that much. I HOPE these other 2 drugs are not a serious problem, I'd like to be able to use them as a back-up while tapering for both pain and the anxiety of withdrawal. May not be a "perfect scenario" but they're a couple of my limited resources.

    So anyway, that's the plan - find the best Suboxone taper plan I can, fill my family doc in on it, but do it on my own. Hope I can deal with the pain until I'm clean from Suboxone. Then and only then, start fresh with traditional pain meds. If I turn into a train-wreck pain-wise using this plan, I'll need to re-group and come up with something else.

    You all have helped me realize and face the fact that I am in a non-sustainable situation, the truth is horrendously scary, and I have a lot of fears (I'm a chronic worrier anyway, always have been and it doesn't help the situation).

    Please feel free to comment with all the guidance any of you can lend. If you've been keeping up with this thread, you'll know my resources are pretty limited and I welcome any input.

  • Did you get my private message? I assume you did .
    The plan sounds reasonable, but again, talk it over with your doctor first. The pain may rise, but then again, it may surprise you and not be nearly as bad as you may think. Since you will still have suboxone in your system for some time, while you taper, you may be surprised at how quickly your body adjusts to the reduced dosage. The most important part of any taper is to not go back up in dosage. You will adjust, it is just a matter sometimes of mentally preparing yourself and being ready to stick with the reduced dosage. If you need to stick at a particular dosage for an extra day, so be it.......just don't stay there too long.
    As far as using the tramadol for pain, that may not be a bad idea, but since you are aware it is not harmless and misuse is a concern, make sure that you don't trade one problem for another. Try using anti inflammatory medications if you can......and stock up on muscle creams, ointments and rubs to ease some of the muscle related problems.
    I have seen before where anti anxiety medications have been used in a taper, but again, use them sparingly, and maybe reduce them in half for when you feel you need them....using them occassionally might help to ease some of the restless feelings that may come.
    Some melatonin might help you to fall asleep at night as well......and don't forget to make sure to keep gatorade or powerade around to keep you well hydrated.
    Let us know what your doctor says, and I wish you the best......I am truly disappointed that your sub doctor is so uneducated in the medication he is prescribing....and unwilling to work with you to develop a proper taper...but then again, this is one medication that you shouldn't have been put on.
  • peacelovehopeppeacelovehope Posts: 10
    edited 06/26/2014 - 7:08 PM
    Firstly, suboxone is the most misunderstood drug on the market, drs generally have no idea what they are doing! It IS a goodpain reliever, provided you are not in America! ! I have also used it for pain....& run into trouble later, although I asked for it & have never had a problem with addiction! There are too many problems associated with it to be used for PM, as you & I have found out. It's 20 to 40 times stronger than morphine opiate-wise, but does have a ceiling effect, where it won't work any better if you take more. However, it is used throughout Europe & Australia in pain management, & even post-op in opiate niave individuals due to the lower risk of CNS depression. I do think you need to cut back on the bupe, however, I don't see the need for you to get off of it completely before starting straight opiate therapy. The main reason it doesn't work for pain in the US is there isn't anything to take for BT pain due to the blocker. In Australia, they give you different forms of bupe for BT pain, which still only will work to a certain point due to the ceiling effect, however, given that it's actually stronger than fentanyl bas a pain reliever, it still works. I know fentanyl is 100 times stronger than morphine, but it's measured in mcg as opposed to mg,so once EVERYTHING is taken into account, that's actually untrue. It's actually impossible to get a good conversion, but I recently switched from 30mg morphine 3x a day, to 50mcg of fentanyl 2-3 days. I can assure you once everything is taken into account, it's definitely not 100x stronger. The main thing with the Fentanyl is of course it is a major cns depressant. I think you should take a intermediate med in between the sub & the Fentanyl switch. That way you will avoid all withdrawals & should have relatively less pain, as I understand you have obligations. I see no reason for you to be sick at all, you obviously won't get the full affect of the pain meds until the bupe is out of your system, normally 3 days, but if you've been on it for 3 years ? It may take a little longer, once you get down to 4mg or so. I feel with a good Dr there shouldn't be much of a problem. I apologize this is not as concise as it should be, I normally read every single post but didn't have time. As I understood it, your concern was the switch? I really don't think it should be a major problem. A strong opioid will break through the blocker in the sub faster, but whether fentanyl should be that your Dr should know. Suboxone is such an incredibly complicated drug, I want you to know I am a chronic pain patient who asked for suboxone because it controlled my pain like nothing else, people who say it does NOTHING for their pain, are just used to feeling some kind of "buzz" for lack of a better term, it's 25-40 times stronger than morphine (I said 20 before, it's 25-40) there's no way it would provide zero pain relief. I know what it's like for health professionals to wrongly assume you are a addict, for family members not to know the difference between naturally occurring dependence & addiction, and I believe you should get back in PM, try to minimize any records of taking suboxone for pain, they won't understand and you cannot argue with them! When I tried to explain suboxone was great for chronic pain & used all over the world for it (it's a deal with the pharmaceutical companies in the US not to cut into pain products profits) dr said "Are we in another country? " & I said "Why, does it work differently on European soil?" Of course no answer. It will become faded in your medical history & med professionals will no longer treat you like ..... you know. Best of luck to you! BTW, mine stopped helping with the pain after a year, 4mg 2x a day I think, I know you were on a higher dose, did you get pain relief for 3 yrs? It's still the best pain reliever I've ever taken, for about 10 mo anyway. Too bad there are so many drawbacks! Accidents or surgeries & you are in BIG trouble! (I knew immediately you were telling the truth because I could tell how you felt being treated that way, an addict would only be concerned whether they got their drugs)God bless! J
Sign In or Register to comment.