Maggie and all others on sub or considering sub treatment:

I read something really interesting that i wanted to share about tapering the last two mg off of sub. I hope that it helps or at least touches on an explanation for why its so difficult to taper from 2mg to 0mg.
First let’s agree that withdrawal is subjective and “bad” withdrawal to one person might be “nothing” to someone else, and the opposite is true too. But too many people have reported difficulty tapering the final 2mgs, for that to be the only reason. No, some, if not most, people really do have difficulty on that last 2mgs. Why? Well first we have to understand that 2mgs is still a very significant amount of opioid. Therefore, it can maintain a fair level of physical dependence. In a PET scan , it shows available mu receptors at various doses. A significant amount of receptors are occupied even at only 2mgs. The scan also shows that in the brain there is virtually no difference between 16mgs and 32 mgs. Theoretically, a patient could dropp from 32mgs to 16mgs and not notice a difference. But as the doses get lower each drop become more significant. So it is expected that the lower you get the more you will notice drop decreases, because a higher percentage of receptors are affected with linear dose decreases. This makes it clear that it is expected to get more difficult to decrease a dose comfortably the lower you get, and 2mgs to 0mgs is the lowest you get.

Withdrawal is caused by changes to the brain resulting from tolerance/physical dependence and addiction. Buprenorphine suppresses these symptoms of withdrawal that would otherwise exist. Withdrawal is not caused by the drugs exiting the body but rather the brain changes that are left behind. While in treatment these brain changes, that existed before starting buprenorphine (suboxone or subutex), will remain, but they will not cause withdrawal symptoms because the bupe will suppress them. While in treatment and with time and by changing your behavior and thinking, your brain will begin to change back. If it were to change back 100% completely (which it doesn’t) and you discontinued bupe, you would not have any withdrawal because the brain changes that cause withdrawal would not be there. What happens is something in between. Many of the brain changes change back closer to pre-addiction status, while in treatment. If you taper off before enough changes occur, you will feel the affects of withdrawal that the remaining brain changes cause. If enough changes have occurred, the taper will be much less eventful.

People having an extremely difficult time tapering the last 2mgs are tapering before the brain has had time to change back. There are still too many brain changes ready to cause symptoms of withdrawal as soon as there is no bupe to suppress them. A longer or different treatment is needed. Even when someone does everything right there are still some brain changes that will not change back until someone has been off of all opioids for a while, these are the changes specific to physical dependence (not addiction) and they tend to get better in a few weeks.

Everyone is different and evaluating how altered your brain is from addiction is tough, also estimating how fast it will heal is equally tough. That is why the better treatment plans don’t have fixed treatment duration. Pacing your taper with your brain’s ability to heal is essential if you want a comfortable taper. Other things besides time help “heal” the brain. Changes in environment, behavior, routine, all help. Counselors/therapists can teach you how to think differently and stop compulsive thoughts. Things that don’t help are replacing the compulsion to do drugs with another compulsion (any compulsion) or constantly thinking about drugs or activities or people you associate with them. Basically what you want to do is help your brain forget as much about drugs and the ritual of it as you can.

So if it is extremely difficult to decease your dose from 2mgs, it might be a sign that a longer or different treatment is needed. It is also thought that some people will not be able to repair enough of their brain to ever feel normal without some kind of opioid supplement. These people would never be able to taper off of any opioid comfortably. 2mgs is a significant amount, don't think "oh, its only the last 2mgs I already dropped 14mgs, this should be nothing." According to the PET scan, 2mgs affects more receptors than the whole 16-2mg drop did.


Thought it was a good read.

How are you doing today?

hugs, michelle

Hi Michelle

I want to thank you for some valuable knowledge there. I didn't use the suboxone, but it is good to understand this anyway.


Although I did not taper from the sub, but from Oxycodone and Xanax, it still makes a lot of sense to me. The tapers at the end were soooo slow as far as cuts. That old 5% to 10% was something I used both with the opiod and the Xanax. I think that is why I became mentally stronger and more emotionally stable as I tapered. I didn't make a cut until I felt I had leveled off. And the cuts did take on more and more physical attributes rather than emotional ones.

You have a lot more knowledge of the various receptors than I do. I think, though, that the premise is the same for all who taper. Do not make it a race against time, but rather try to get into tune with our body and brain and make a cut... smaller and smaller cuts, as we progress towards the end.

I have also read that those who do a slow, slow taper are more likely to stay free and clear of drug abuse. Reading what you have shared helps me to understand the why of that more now. Hope many others are helped by what you have shared. I think it is also very important that we get help to change our thinking. The Social Worker really helped me to understand thinking in general and specifically to understand why I thought consciously the behaved the way I did by helping me to understand the subconscious thoughts behind it. It was truly a revalation to me and I was able to change the way I think about drugs and many, many other things in my life. I am much less controlling now because I have lerned to stop thinkiong that I must be the one to solve all family issues. I carried that control issue into all areas of my life including work as a union president and grievance handler. It is great to be free of that self-imposed burden. Chuckles.

Thanks. Your sharing is very meaningful to me and I am sure it will be to others here also.

And how are you doing there anyway, Sweetpea? Looking to read some about your own progress.

Hugs
reach

Hi Reach,

thanks for responding. I'm glad that you got something out of that, I sure did... It was helpful to me because I kept trying to taper down but kept having some pretty severe w/d symptoms. But I wasnt doing anything to change my thoughts... Right now I am talking to my sponsor pretty much daily. Im seeing a therapist who specializes in addiction. Im also going to meetings, and wishing I could find the time to go to more. Pretty much one a week right now. I'm a single mom with a full time job. On mon and wed i work late, till 8pm, and get home in just enough time to get the kids showered and in bed. The rest of the nights I am taking them to Agility and speed training, baseball training, karate, etc. Homework, you name it !!! LOL Life is busy. I work on saturdays for half a day too, so the kids are ready and waiting for me to get home to do something fun with them. Sunday is family day and we visit and/or just hang out and watch movies, etc.. Ok, ive given every excuse in the book now for just going to one meeting a week... lol. Thats not even funny, but its what my brain goes through when i try to get up off my butt and figure in another meeting for the week. But, life has definitely changed for the better, my attitude and my mood is so much better. And its because i finally did get up off my arse and begin to set in motion this process of healing.... and its working.
So right now im still taking 2mg in the morn and 2mg in the afternoon. I am just listening to my body and going from there.... I'm listening to my doctor as well. I will be making cuts as soon as my body/brain tells me im ready to. i dont have a plan, or a goal (like i told maggie) ive asked my doctor to come up with a taper schedule b/c i feel like i need to move on, im ready. (i think, lol)
But, Reach, thanks for asking...... i truly feel blessed to have found this board, because reading here has helped me so much to stay in recovery and out of the "mind gutter", especially while i was in limbo about asking other "real live" people for help with this...

I see that you are doing well, i read all your posts, and i am so happy for you... One day I will join you in the land of the living, REAL LIVING. drug free and happy.

take care, michelle