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Transitioning from High Dose Opiates to Suboxone for Chronic Pain
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?
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This article may be of interest with regard to the debate about Suboxone, addiction and chronic pain.
- Buprenorphine for Chronic Pain Management:
https://www.verywellhealth.com/buprenorphine-for-chronic-pain-management-4156472
Does anyone else have articles and/or links that may be helpful to members in this discussion as a way to learn more?
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1 ReactionExcellent article Amanda, thank you. I wasn't aware Suboxone was prescribed for chronic pain off-label by providers. I will add that primary care and Emergency Room physicians among others (MD, DO, NP, mid-wife(?) can now prescribe Buprenorphine if they take an 8 hour 'X-Wavier" class which then permits the provider to prescribe buprenorphine for chronic pain.
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1 ReactionI’ve been taking suboxone for a year and a half daily, 4mg a day in the morning. I’m trying to ween myself off of the medication since I don’t need it to control cravings or anything else anymore. The only reason I continue to take it is because of the fear in my mind that I will get sick if I stop. I hope someone can help me get off it for good. I am going to start taking 2mg a day starting tomorrow and then just stop taking by mid next month. I hope that works.
Hi @stlr21 and welcome to Mayo Clinic Connect. Glad to hear that you are looking to stop using suboxone on a daily basis. I feel compelled to let you know that it is not an easy process on your own if you have never tried before. Normally it is highly recommended that you consult the physician that prescribes the medication to help you do that.
You will see that I moved your post to a discussion about opioids and suboxone. I did this because I wanted you to be able to connect with people who are either on the medication or trying to get off of it. @faithgirl30 started this discussion and may be able to talk about her experience of taking it.
Have you told your doctor that you are looking to taper off?
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1 ReactionHi, yes I told my doctor but she hasn’t responded yet. I’ve been off of any substance for over a year now but the suboxone is the only thing holding me down. Like I said earlier, I’m on 4mg now and I’m going to step down to 2mg starting tomorrow and try from there. I’m expecting to feel nauseous or some other side effect but I have to get through it. If anyone can help, please do so. Thank you!
@steeldove shared this interesting article with me that I thought members in this discussion might like to see.
Availability of alternative pain treatment decreased opioid use: https://www.healio.com/news/neurology/20211021/availability-of-alternative-pain-treatment-decreased-opioid-use
I was on Tylenol #4 for 15 years before being switched to morphine time release caps in 2008 and to buprenorphine patch in 2016 and still on it. I was increased to 20mcg/ days from 15mcg after one month. There is a formula pain docs use to switch from high dose narcos. I have had no problem and increased pain control. I’ve used oxycodone for breakthrough pain but now down to one of those a day thanks to cannabis oils.
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1 ReactionAnd now for something totally different…https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675640/
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1 ReactionBuprenorphine – an attractive opioid with underutilized potential in treatment of chronic pain: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675640/
Unfortunately it's still an opioid and not without risks for certain people - https://www.drugs.com/sfx/buprenorphine-side-effects.html
I guess I’m fortunate in that I’ve not had any negative SE from any of the meds I’ve been prescribed since 1988. I’m not counting the long term negative effects of my lumbar fusion with stainless steel plates. I accept the fact that I’m dependent to some degree for pain relief. I was just able to cut my oxycodone by using THC and CBD oil.