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?

I haven't had opiods for several reasons. Several don't even come close to dulling the pain and the one that works is Percoset but no one will write a prescription any of these. One doctor did mention Suboxone. I am interested to see if anyone noticed a difference in pain? With or without having to cut off the opiods.

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I have never heard of suboxone ?

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Suboxone is an opiate that was traditionally used in addiction and treatment centers – similar to methadone. It is less addictive than most opiates, doesn’t cause respiratory issues like other narcotics, and doesn’t need to be as closely managed as other narcotic medications. Doctors were surprised when many of their patients who were switched to suboxone kept mentioning how it was also effective in treating long term chronic pain. So, it is now sometimes used off label to manage pain in patients who will need to be on narcotics long term. I’ve met a number of pain specialists here in Wa state who are recommending patients give suboxone a try to see if it will work for them.

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Hi Melanie, my name is Carol and I had to cold turkey off morphine. Can't say I was on high doses, just 15mg x 3 a day, but was on for over 12 years. I didn't have any bad withdraws, but the pain was hell. I went 3 weeks without any pain meds, still took my muscle relaxers, Cymbalta, Lyrica, etc. Found s Dr that wrote me script for Tramadol which I honestly think works better than the morphine. Years ago they tried methadone, it didn't do anything for pain, just gave me horrible headaches.
I've never heard of Suboxone, but never hurts to try. Everyone's body is so different on what meds do or don't do.
Is going on this med a permanent thing? Will they give you something else if doesn't work?
Wonder if they would do pain pump for you??
I wish you the best of luck.
Let me know how goes for you.

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@faithgirl30

Suboxone is an opiate that was traditionally used in addiction and treatment centers – similar to methadone. It is less addictive than most opiates, doesn’t cause respiratory issues like other narcotics, and doesn’t need to be as closely managed as other narcotic medications. Doctors were surprised when many of their patients who were switched to suboxone kept mentioning how it was also effective in treating long term chronic pain. So, it is now sometimes used off label to manage pain in patients who will need to be on narcotics long term. I’ve met a number of pain specialists here in Wa state who are recommending patients give suboxone a try to see if it will work for them.

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@faithgirl30
Melanie my name is Rob and I am taking suboxone now. Opioids don’t help my daily all day abdominal pain down the middle from xiphoid to pelvis. I was screened for depression and that psychiatrist prescribed subutex(no naloxone just the buph part). He monitored the first 48 hours going 4mg the hours later another 4 then next am 8mg and another 8 later. It took 50% of all pain away for 24 hours. Then I had so much in me that 24 hrs after that threw up. I have had many ct scans etc. hospital 3 times.

After that I worked with him taking 10-16 mg a day. Never got the one hit wonder again. Though at times I think if helped some. Can mess with bowl’s

New palliative doctor who treats pain put me on suboxone but started real low at 2mg in AM. not sure about your mornings but it’s awful pain starts right back at leve 8 after bathroom use at 6am. Just moved up to trying 8mg again. The pills are tricky as they need to melt under your tongue. It’s not a swallow pill. You have nothing to lose I would try it. Lots of folks who took opioids like this drug. Let me know please what you decided to do as this is 7 months old post. Rob

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@rt061069 Thank you for sharing your experience with suboxone, Rob. Although this post is seven months old, it is still relevant. The move to suboxone has been put on hold while I deal with acute chronic fatigue syndrome. All my doctors are in agreement that the jump,to suboxone, and the need to go into withdrawal would be too hard on my already exhausted body. So, for now I continue my usual, but steady regimen of dilaudid. My pain specialist tells me there is no hurry to switch, so he is content with leaving where I am until I decide I’m ready to make the move to suboxone.

I am sorry to hear about the serious pain you have to contend with each day, Rob. It sounds miserable. Thank you for reaching out and sharing your suboxone experience with me!

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If and when you do get off the opioid you can and should do it very slowly depending on the dose that you are needing now it may take months to stop them without cousins withdrawals it can be done I know that so talk to your doctors about it because stopping them and going cold can put you into shock and it’s not easy thing to do it can last for days I know from what my doctor did to me I was lucky That I made it through if you see my story on this sight you can understand I have been on dialaudid for 21 years it was only 6.5 milligrams per dad straight into my lower spine but I had a problem with it earlier this year so they operate to replace the catheter but did not have to it was something else but they did take out the medicine I was getting which was 15 milligrams per milliliter to one milligram and turn it off I was sent home without being told what they did the technician from the company that makes the pump set me an email with what had been done I new I was going to get sick and did for seven days my wife wanted to call an ambulance I would not let her but I was lucky to make it through it so have your doctors do it very slowly it can be done so you don’t have to go through that they know how to do it with you getting sick

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@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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@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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I understand what you are saying but if you have been on opioids for any time then it does not matter I was on 6.5 milligrams a day for over twenty one year it was in the lower part of my spine I didn’t get any of the affects other than pain relief and constipation it did not interfere with me driving or doing anything else this was the best of both worlds I had a lot test after I got it they found no other affect on me but after all that time of having it there was no difference between me and someone on oral meds my body went through withdraws and what you are saying about this drug withdrawal they are very serious it’s a lot more than the Shakes I know also naloxone blocks opioids it is used for over dose if you use enough of it it will cause the same effect of just stopping them your body won’t know the difference just talk to your doctors about this you are the one who will be going through this not them. I am seeing a new doctor on the sixth I hope that he get my pump back working right so I can have my life back.

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One more question how much is high dose to you

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Thank you @bear338 for your concern and wise counsel.

I take 4 mg of Dilaudid 5 times a day.

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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.

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