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.

corycpainchronic | @corycpainchronic | Apr 30 9:58am

So happy if Suboxone will help you. I tried it for two months and couldn’t tell that it was helping me at all. If anything, my pain was worse as my oxycodone was reduced.

corycpainchronic | @corycpainchronic | Apr 30 10:19am

What is considered high dose of pain medication?

catheem | @catheem | Apr 30 11:25am

In reply to @sheilacollins29 "My Dr wants me to transition to Suboxone. I been on Norco 10.325,5 times a day...." + (show)

@sheilacollins29 My 2 level spinal surgery (L4/L5-L5/S1) was in 2009...I was on Norco 10mg 6 times a day for so long, I can't even remember...I finally had enough of the merry-go-round last year after getting a total knee replacement in November and started back walking every day and stretching, stretching, stretching..(I am 72 next month) taking Advil and Tylenol extra strength and stopping all opioids (I titrated down very slowly off of the opioids)..with help from my wonderful pain management doctor, and was also given a Buprenorphine patch and after 1 week, I was off of all medication..amazingly...Good luck to you!

cappy51 | @cappy51 | May 1 11:32am

I have had a cervical fusion and three lower back surgeries. I’ve also had an aneurysm clipped in the middle Cerebral of my brain.
I am due for a total right rotator cuff replacement and I am 73 years old. Not looking forward to more pain in recovery. I have been on 15 mg of morphine for probably over 15 years. I cut myself back to three and two, but I’d totally off of it, my general physician had me contact a pharmacy to take me off of the morphine with suboxone
I will let you know after the trial what I went through

lesliediane | @lesliediane | May 2 6:59am

In reply to @catheem "@sheilacollins29 My 2 level spinal surgery (L4/L5-L5/S1) was in 2009...I was on Norco 10mg 6 times..." + (show)

@catheem
There are many natural plant herbs that help with pain and anxiety so you can take that are soothing

lococo14 | @lococo14 | Jun 4 6:54pm

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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@faithgirl30

it is the buprenophine that causes the percipatated withdrawal the naloxone is gone as soon as it hits your stomach acids

currycat | @currycat | Jun 4 7:23pm

My son was on Colonapin in the Penatuary Now using Subxon he likes it but he gained weight. It almost knockes him out with his first shot which is monthly. He appears to care much less about his appearance. He is lucid and very interactive. But I see him possibly 1 x a month otherwise we get to text

barbarav1 | @barbarav1 | Jun 5 3:57pm

I’m sorry you have had so many problems at your age. Although I bitch about my pain, I didn’t have any problems until my late 60s. I was taking 20 mg of Oxycodone four times a day for many years. Then they stopped working. So in January of last year I stopped taking them. Withdrawal wasn’t great but doable. I felt rung out! The worst thing was a rush to the bathroom when I didn’t make it…poop on carpeted bathroom floor. I just stayed home and was miserable for a couple of weeks. I’m sure everyone’s experience will be different.

carolynhughes75 | @carolynhughes75 | Jun 6 12:32pm

I would not do that. Suboxone is notorious for rotting your teeth. Getting off your dilaudid may be hard unless they taper you really slowly. And opioid withdrawals is hard to endure. I am curious why your pain management doctor wants to do this if your current regiment is working.

jdkitkat129 | @jdkitkat129 | 5 days ago

In reply to @wheelerma "I haven't had opiods for several reasons. Several don't even come close to dulling the pain..." + (show)

@wheelerma I was addicted to Percocet years ago, but unfortunately mine was mental pain. Apparently all the grief I suffered throughout the years caught up with me. Losing my 19 year old son unexpectedly was the last straw that broke the camels back. I was addicted within one week. My daughter called me out so I went to rehab. I've been on Subs since 2012. I started having back pain in 2017 and was later diagnosed with degenerative scoliosis in 2023. The pain gets unbearable at times. The only relief I can get at times is ice packs. Long story short Suboxone will not help with pain. I take Gabapentin and 800 my Ibuprofen along with Sub but nothing touches the pain. My advice find a pain practitioner to continue your opiates. They may be hard to find, but they are out there. Good luck.

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