I have been seeing many posts from people that are scared of their Suboxone treatment. Whether you are just starting treatment or working on a taper, hopefully I can offer some advice that will ease your minds.
Just so you don't think I am some random person trying to tell you something I heard from someone else, I will tell you that I am a licensed CDCA (chemical dep. counselor asst.), I am in college earning a degree in psychology with a focus on substance abuse, and work in the field. I am also in recovery and have been on Suboxone. Part of the reason I became a counselor was the lack of valid information I received from those treating me and the prejudice I was subjected to because I was on Suboxone from pharmacists to peers in support meetings.
Things have slightly improved since I was in treatment, but I hope to aid in making it better.
Helpful Tips
1. Be your own advocate-When you make the decision to use Suboxone for opioid addiction, there are some things you should take into consideration when choosing a doctor. I do realize that there is a shortage of doctors offering treatment and you may have to settle for second best which is why you should learn as much as possible about Suboxone from a qualified resource. You have to realize Suboxone is a drug, not a miracle cure. Many people start treatment thinking the pill is going to fix everything for them. This is not true. There are risks as well as benefits and you need to know what you are getting involved with. Just taking the drug to stop withdrawal is not good enough if you want any chance of success. It takes patience and willingness to change.
2. Look for a doctor that does more than just hand you a prescription- When you first meet your doctor he should perform a physical and verbal assessment. You should have blood work drawn to check the status of your health before you get put on Subs. When someone is abusing painkillers for extended periods of time, it takes a toll on their health. Some doctors just want to make a quick buck and do nothing more than a urine drug screen and write your script. You are paying for medical care, probably out of pocket. You deserve to be treated the right way. Just because you got addicted to pain pills doesn't mean you are any less of a person. Ask questions, that is what you are paying for.
3. Three phases of treatment, Induction, Stabilization, Maintenance-
A.)Induction is your first week. This is when you are finding the lowest dose of Suboxone to alleviate your symptoms. You do not need more and more Suboxone to feel right. I was fine on 8mg a day. If I knew then what I know now I would have cut that dose to 4mg a day. The higher the daily dose, the harder to come off it. You should be free of all opiates for at least 12 hours before you start Suboxone. If you do it sooner you will probably go into withdrawal. I waited 48 hours to start my treatment.
B.)Stabilization is the next one to two months. During this time no withdrawal symptoms are felt and best part is NO cravings. Many people at this stage think Suboxone is a miracle, but it is just a drug. Recovery is more than taking Suboxone. Since you are stabilized, consider adding some other recovery help services such as support group meetings, one on one counseling with a drug abuse counselor, or online forums. Remember that your thinking got you into this mess, try a new way of dealing with your addiction. You are going to need to find new ways of dealing with stress and emotional triggers that are positive. I took up volunteering at a local animal shelter walking dogs. It got me out of my disease and it felt like I mattered to the outside world. This is also a good time to start treating any other problems you have whether physical or emotional. If possible, get a physical and have a psychological assessment done to determine your health.
C.)Maintenance is the longest period, sometimes indefinite. By this time you should be totally stable in your treatment. If you are doing things as needed without relapses your prescribing doctor should have eased up on your visits and overall you should feel less stressed. Many people tend to think they are cured at some point and opt to get off Suboxone before they are ready. I know how great it feels to not have active addiction behavior in your life. You feel like you could go back to the way life was before you ever picked up a pain pill, but don't be fooled. When in active addiction our brains go through great changes and it takes time to heal from that. If you feel ready to get off of the Suboxone, discuss it with someone you trust. Don't rush through recovery.
One major point I feel is necessary to bring up is twelve step support while on Suboxone. If you are going to AA or NA as part of your recovery you will meet people who are against the use of medication to treat addiction. You may even have a sponsor that persuades you to stop your treatment because you are not “clean”. It is very important to understand that you are not alone in your situation. I personally struggled with this problem and it could lead someone back to relapse if they let it. The most important part of any recovery support group is the message that keeps you from using. Understand that the times are changing and so are the ways we handle treating addiction. People will disagree with your choice, but do not let that stop your treatment. If this becomes an issue, talk to someone who understands. It is important to have advocates who understand treatment with Suboxone. If someone is pressuring you to quit taking your medication, they do not have your best interests in mind. Other people in support groups are just like you. They may have more recovery time, but they are not professionals. Go to meetings for support and the message, leave the treatment to your doctor!
4. Ending your Suboxone treatment: When the time comes to end your treatment, whether by your personal choice or your doctor please follow a steady tapering plan. Suboxone has a long half life, meaning a single dose stays in your system for 37.50 hours before it is half gone. If you have been on Suboxone for a long time it will take up to two weeks to feel a drop in the amount as you taper. Some people think they will go from 32mg a day to nothing in a month and feel just peachy. This is not the case. You can find taper schedules on Suboxone specific websites or through your doctor. This is a powerful drug and needs to be tapered slow. This is calculated from the many people I have spoken with and the problems they had from tapering too quickly. They get angry and will say Suboxone is bad or that they were lied to about withdrawal when they quit. You will feel some unpleasantness as you taper down, but it will be a small fraction of the displeasure you would feel from your drug of choice. I think if you go into it knowing what to expect then you will not be so nervous about it. Most of the discomfort I felt came from worrying about the taper. I have co-occurring depression and anxiety so I let it get the best of me at one point. Stay focused, keep taking any other medication prescribed by your doctor, and keep getting peer support as you transition.
My only objective in writing this was to help someone in need. I am merely another person in recovery sharing my experiences and educational information from a trusted reference. While I continue to recover I have also become a certified substance abuse counselor assistant and am in college so that I may move up the counseling ladder. The confusion and misinformation I received during my treatment is what led me to help others who are going through similar situations. I will continue to write articles on addiction recovery and anything attached to it. If you have an idea for an article or an issue you would like to see a story on, please feel free to contact me.
Wishing all of you a safe recovery!
Reference:
Center for Substance Abuse Treatment.
Clinical Guidelines for the use of Buprenorphine in the treatment of Opioid Addiction. Treatment Improvement Protocol(TIP) Series 40
DHHS Publication No. (SMA) 07-3939.
Rockville, Maryland:
Substance Abuse and Mental Health Services Administration, 2004.
