Transitioning from High Dose Opiates to Suboxone for Chronic Pain

Posted by faithgirl30 @faithgirl30, Nov 25, 2020

Hi! My name is Melanie and I’ve been on high dose opiates for the last 5 years due severe degenerative arthritis in my neck. I’ve undergone 5 spinal neck surgeries in the last 4 years, the last of which was October 2019. I am now fully fused between C2-T2 and have rods in the back of my neck for stability that run the full length of my fusion. I suffer chronic daily headaches and have just undergone the first round of Botox for headaches and cervical dystonia. My pain specialist and surgeon agree that I will more than likely suffer long term chronic pain for the rest of my life. They have recommended that I make the jump from high dose dilaudid to suboxone to manage chronic pain, which is an off-label use for suboxone, but which has been shown to successfully manage long term chronic pain.

I am writing to find out if others have made the jump successfully to suboxone, and if so what your transition from opiates to suboxone was like? I have been nervous about this transition, because it requires that you go cold turkey off of opiates and enter into full blown withdrawal before it’s safe to start the ramp up onto suboxone. So, if you have made the jump, what was the withdrawal process like for you, and has suboxone been effective in managing your long term chronic pain? Would you recommend others make this move? Why or why not?

Interested in more discussions like this? Go to the Chronic Pain Support Group.

faithgirl30 | @faithgirl30 | Jun 28, 2021

Thank you @bear338 for your concern and wise counsel.

I take 4 mg of Dilaudid 5 times a day.

gcranor | @gcranor | Jun 28, 2021

I am not sure why you were told you would have to be completely off opioids before you start taking Suboxone. I went in a 30 day treatment program to help make the change. I am completely off pills; however, I have a morph pump to deliver the drug directly into the spine. Yes getting off of opioids are going to be a tough job, but no doctors will treat pain it pills anymore. I am looking to change to a Metronic stimulator to get off of drugs completed as my breathing is swallowed with taking morph and I might have ALS, so they are trying to make muscle skeleton changes to determine why all my muscles are becoming weaker.

bear338 | @bear338 | Jun 28, 2021

How long have you been on that because if over one week then you will need very close monitoring your body has become use to it and it can take as much as 7-10 days to come off with severe withdrawal it would take much longer to do it slowly I know from my own experience and others that went through it from heroin it is not to be taken lightly I will keep you in my prayers and good luck

gcranor | @gcranor | Jun 28, 2021

In reply to @faithgirl30 "@bear338 Thank you for sharing your story about getting off Dilaudid and the challenges you faced...." + (show)

@faithgirl30

@bear338 Thank you for sharing your story about getting off Dilaudid and the challenges you faced. I’m sorry that you underwent such a painful experience. Patients should always be informed by their doctors what they can expect from their treatment and be part of the decision making team about their care. It sounds like you were not sufficiently informed that they were taking you off your medication and provided with the necessary medical intervention needed to help you transition off opioids safely. It can indeed become a life threatening experience to go cold turkey off your medications altogether and to ride out that process for the several weeks it takes to completely rid your system of opioids altogether.

However, you misunderstand the transition from Dilaudid to Suboxone. Suboxone is a compound drug made up of buprenorphine (which is an opioid I and Naloxone (which is what paramedics and hospitals give to patients who are overdosing on heroine or fentanyl to reverse the overdose.

In order for Suboxone to work and not have the naloxone portion of the drug send you into full and immediate withdrawal, they have patients transitioning from opioids to Suboxone stop all opioid use for 24-48 hours. This indeed sends your body into a painful withdrawal - which is supervised by a physician. It can include nausea, vomiting, the shakes, watery eyes, abdominal cramps, craving, etc. In fact, before you can safely start on Suboxone, you must demonstrate that you are undergoing a certain number of withdrawal symptoms for both safety and efficacy reasons.

Then 24-48 hours into the cold turkey withdrawal process, doctors give you your first dose of Suboxone. Since you are already in withdrawal, the naloxone in the Suboxone doesn’t kick in — instead the opioid portion of the drug starts to work by reversing your withdrawal symptoms and providing pain relief. Doctors can now safely titrate up the Suboxone until your body reaches a safe and effective dose of pain relief.

Thus, the withdrawal portion of the transition onto Suboxone is both time limited and purposeful. The reason for adding the naloxone to the Suboxone, is to make it more difficult for people to misuse Suboxone in a manner for which it wasn’t intended.

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Now I know why you get off of opioids, sorry to hear you are having more problems.

bear338 | @bear338 | Jun 28, 2021

In reply to @gcranor "Now I know why you get off of opioids, sorry to hear you are having more..." + (show)

Yes I was taken off without ever being told not for medical reason ,as of now I still don’t know why he did this I went into surgery with the thought that they were fixing it but instead they had replaced what was in it and then turn it off with out a word of what or why my problem is with that doctor but please tread lightly it’s a hard drug to stop but it can be done

girl4god | @girl4god | Jul 18, 2021

In reply to @faithgirl30 "@rt061069 Thank you for sharing your experience with suboxone, Rob. Although this post is seven months..." + (show)

The problem with Suboxone (don’t know if your doc told you this) is that because it’s used traditionally for people struggling with addiction… once you are on it you will never be able to go back to regular pain meds again and insurance won’t pay for them. Make your decision with much thought.

jenatsky | @jenatsky | Jul 19, 2021

In reply to @girl4god "The problem with Suboxone (don’t know if your doc told you this) is that because it’s..." + (show)

I'm not certain where you got your information from but it is incorrect. You should not post information such as this without checking facts. Many treatment centers offer tapering methods proven to be effective moving off Suboxone. If your own personal experience was bad it is no reason to bash an important treatment for addiction. Also, Suboxone is only used for addiction treatment and not chronic pain control, unless the patient has an addiction component plus chronic pain. Buprenorphine has proven to be an effective pain control treatment.

Amanda Roe | @amandajro | Jul 21, 2021

In reply to @girl4god "The problem with Suboxone (don’t know if your doc told you this) is that because it’s..." + (show)

@girl4god can you share where you learned of this limitation with Suboxone? It sounds like it may be a personal experience with you and the insurance provider you have. Are you able to share some additional details for a greater understanding?

Amanda Roe | @amandajro | Jul 21, 2021

In reply to @jenatsky "I'm not certain where you got your information from but it is incorrect. You should not..." + (show)

It sounds to me as though this may be a personal experience for @girl4god. With insurance coverage being the reason she shared her experience, it is possible that people can experience this same situation different, as well as the many variables between addiction and chronic pain control.

Are you willing to share your experience with Soboxone?

jenatsky | @jenatsky | Jul 22, 2021

In reply to @amandajro "It sounds to me as though this may be a personal experience for @girl4god. With insurance..." + (show)

I have no personal experience with Suboxone except to know as a healthcare professional it is not used for chronic pain management. And there are prescribed methods to taper off the drug as well. We have enough false medical information floating around currently, we don’t need more.