Question From Anonymous

I am going to move this question to a new post so that everyone can read it:

hi,

i am in recoverery and was injured, was on percocets for about three months. i kinds detoxed with a lower dose of opiates but then took a few days worth again after a hard weekend. a few days later the wd symptoms came right back! oh, i couldn’t take it so i asked my doctor for suboxone. he knew nothing about it and wanted to give me yet more opiates. after a lot of convincing he gave me 2 mg tabs/30 days worth. I want to be done with all this stuff asap- so what’s your suggestion as to how to take this just to make it through the wd’s from the opiates? thanks!

My Answer:

This question illustrates a number of points. The first point is that opiate addiction is a life-long illness. Anonymous does not say how long he or she has been ‘in recovery’, but for the most part it does not matter; people who have been clean for years or even decades will find themselves brought instantly back to the mess they thought they left behind, after just a percocet or two. As addiction is a conditioned, or learned, process, it makes sense; If I take you back to your childhood neighborhood after twenty years away, you will likely be able to find your way around without difficulty. Unfortunately we cannot erase conditioned behavior any more than we can intentionally forget bad memories.

A second point concerns the nature of withdrawal. I am convinced that the intensity of withdrawal is more related to the intensity of prior withdrawals than to the amount of drug used. I have heard people describe very severe withdrawal after minimal relapse. There is a term in medicine– ‘kindling’– which describes how CNS symptoms such as seizures become worse each time they occur. I have found that withdrawal is similar.

A third issue is the legality of prescribing opiates. It is illegal for anyone to prescribe a narcotic for the purpose of avoiding withdrawal, with the exception of certified methadone clinics or suboxone prescribers. It is illegal for a pain physician to taper a person off opiates to avoid withdrawal; it is illegal for a family practice doc to prescribe vicodin to avoid withdrawal. A family practice doc can prescribe suboxone for pain, but cannot prescribe suboxone for addiction UNLESS the doc is suboxone certified.

As for answers, My first question would be, what is/was the nature of your recovery? If you are involved in AA or NA, I recommend stopping the opiates and getting to a meeting, and then hitting as many meetings as you can for the next few months. If you hope to be opiate-free again, your best bet is to just stop using, and take the withdrawal.

If, on the other hand, your recovery was a bit ‘shaky’, or if you always had intense cravings, or if you just cannot stop using (God forbid that you have found a source of opiates), you may want to consider suboxone. Many people find that after years of being clean they still felt like an opiate addict just hanging on…. those people will often feel ‘normal’ for the first time when they take suboxone. In such a case, though, you would likely end up taking suboxone for a long time– perhaps for the rest of your life.

Suboxone can be used to taper off of opiates, but it is most useful in this regard for coming off of high doses of methadone, which is extremely difficult to do. Suboxone (buprenorphine) is a very potent opiate– much more potent than oxycodone– and so it is probably as easy or even easier to come off oxycodone than to come off suboxone. The problem is that just coming off the opiate, as tough as it seems right now, is really the easy part. The hard part is staying off of opiates, as you found after your ‘tough weekend’. If you do not have a good program going on in AA or NA, then you really may want to consider suboxone. It will prevent relapse and put your addiction into remission with a minimum of pain or discomfort. But again, this is a long term proposition– just as opiate dependence is a long term illness.