How to Get Off Suboxone with a Quick Taper

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Will a Sublocade taper with the Sublocade injection, or a Brixadi taper make Suboxone tapering any easier?

Buprenorphine is an opioid receptor blocker that also partially activates the opioid receptor. It is used to treat opioid dependence, including addiction to heroin, fentanyl, oxycodone, and many opioid pain pills.

Buprenorphine, also referred to as “bupe,” is found in various forms, including monthly and weekly injectables, such as Sublocade or Brixadi. Bupe is a highly effective treatment drug, which, when combined with counseling and psychotherapy, has a very high success rate in treating opioid addiction. Buprenorphine is one of three MAT treatment drugs used for opioid use disorder, the others being naltrexone and methadone.

Many people in the addiction treatment field are interested in the possibility of using a long-acting Suboxone injection as a natural Suboxone taper. Sublocade and Brixadi are both long-acting injectable buprenorphine products, containing the same buprenorphine that is available in sublingual Suboxone, Subutex, ZubSolv, and Buccal Bunavail.

A shot of Sublocade lasts for a month, and then gradually ramps down over time. It may take at least several months for the buprenorphine in the Sublocade shot to fully leave the patient’s system. The natural reduction of systemic buprenorphine over time could work as a buprenorphine taper, when the patient gets their final Sublocade injection.

The monthly bupe injection, Sublocade, is a product of Indivior, the same company that makes Suboxone Films. Sublocade contains a special patented delivery technology known as https://iovs.arvojournals.org/article.aspx?articleid=2394901. Atrigel is the stuff that forms a matrix under the skin that releases bupe gradually, over time. A taper using Sublocade might even be called an Atrigel taper instead.

The idea of using Atrigel to do a buprenorphine taper is very intriguing. Possibly, the company that holds the patent might allow further research to be performed in order to optimize Atrigel to be used specifically for drug tapers.

In addition to Suboxone, and other bupe meds, there are other meds that require gradual tapers. Could Atrigel be used for a benzo taper, rather than following the complicated Ashton Manual guidelines?

Regarding a bupe taper, there are many possibilities to consider with monthly buprenorphine injections and Atrigel. Maybe a final shot of Sublocade, or Brixadi, is the solution to a gradual, painless Suboxone taper with minimal buprenorphine withdrawal symptoms.

What about Sublocade in sober living homes, halfway houses & addiction recovery homes vs Suboxone?

In sober living houses, recovery homes, or half-way houses, Suboxone treatment has been frowned upon in the past. Residents who are not ready to recover, in what is called the pre-contemplation phase, may try to sell or trade their prescribed Suboxone.

Or, they may take it the wrong way, thinking they can get high from it. Sober living homes are sacred places of recovery, where most residents expect safety from the temptations of the streets.

Because of this, sober home administrators have, in the past, banned Suboxone treatment from their sober homes. In more recent times, Suboxone therapy, or medication-assisted treatment, has become more acceptable.

There are Suboxone-friendly sober homes, and even Suboxone-friendly IOP and PHP. Still, there remain the headaches of having to watch the Suboxone-prescribed sober home residents more closely, including monitoring with specialized urine drug tests.

Would Sublocade be a better option? Another advantage of Sublocade is that the patient is given the shot once a month. It is about equivalent to taking 16mg of sublingual buprenorphine daily, but the patient never has the bupe in their possession.

Sublocade does present administrative difficulties in that it is very expensive, hard to get covered by insurance, and difficult to get approved and shipped by the very few specialty pharmacies that carry it. If, however, the process is made easier in the future to access Sublocade for more patients, it would certainly be better for clients of rehabs and sober living homes.

Why is a gradual Suboxone taper so important, rather
than simply quitting Suboxone cold turkey?

The issue with quitting Suboxone is that patients become physically dependent on buprenorphine (also known as “bupe”). Quitting buprenorphine results in short-term acute withdrawal symptoms, and possibly long-term post-acute withdrawal symptoms (PAWS).

A typical weaning schedule with sublingual Suboxone films, Suboxone tablets, Subutex tablets, or ZubSolv tablets, involves a gradual reduction in dosage over time. Many Suboxone patients find that it is not too difficult to wean off Suboxone at the beginning.

Even with a very gradual Suboxone weaning schedule, the weaning off Suboxone side effects become more pronounced at the lower dosages, often from 4mg down to 1mg and below. Symptoms include anxiety, depression, muscle cramps, restless leg syndrome, aches, chills, insomnia, and fatigue.

The injectable, long-acting bupe shots, such as Sublocade and Brixadi, may provide a very gradual tapering, without the patient having to worry about focusing on cutting their medication over time. The idea of using a single buprenorphine shot as the final drop-off dose is intriguing and should be studied further.

Is it possible to taper with no withdrawal symptoms?

If you follow various tapering off Suboxone success stories, you will read about people who claim to have had little to no withdrawal symptoms, even after the drop-off, when they took their final dose. Having no withdrawal symptoms is not typical.

Most people who follow a Suboxone taper plan will experience at least some withdrawal symptoms during the taper, and for some time after the drop-off. The fact is that the brain needs time to heal and adjust to reduced levels of bupe, on which it has become dependent.

Whether a person follows a Suboxone fast taper schedule, or a very gradual taper schedule, there will be periods of adjustment and discomfort. A Suboxone tapering plan is best planned around vacation time or scheduled downtime, where the patient has fewer responsibilities to worry about, during the time they are adjusting to less medication.

Some doctors insist that their patients plan their Suboxone weaning off schedule to be such that they only make reductions in dosages every 2-4 weeks. A two-week reduction schedule, for example, gives the patient a week to adjust, and a week to feel relatively normal before making a reduction again.

Of course, a four-week schedule allows for even more time to adjust and less time feeling uncomfortable. It is important, in tapering off Suboxone, for the doctor and patient to work together closely and agree on a workable plan for stopping Suboxone.

What is the lowest dose of Suboxone that should be taken before stopping altogether?

The end of the Suboxone timeline, when the patient takes their very last dose of medication, is known as the “drop-off.” The drop-off can be a frightening moment, when the patient realizes that they no longer have the comfort of taking buprenorphine as protection against relapse.

Some people, even some addiction treatment doctors, believe that buprenorphine 2mg is a reasonable dose for the drop-off. In fact, even 2mg is far too high of a dosage to quit Suboxone.

Ideally, the doctor should help the patient to aim for tapering all the way down to a quarter of a milligram daily, or even 1/16 of a milligram if possible. In order to get to very low daily doses, it may be necessary to work with a local compounding pharmacist.

What about a ZubSolv taper vs a Suboxone taper?

ZubSolv is a buprenorphine/naloxone tablet with the same ingredients as Suboxone. It is also used sublingually, placed under the tongue to dissolve.

One issue with reducing dosage with Suboxone Films is that the films are only available in limited dosage forms. The easiest to find at pharmacies are the 8mg film and the 2mg film.

While there is a 4mg film, it is less readily available. In order to do a Sub taper gradually, it became necessary to cut the Suboxone films.

If you are interested in how to do this, you may search and find a Suboxone cutting guide online that instructs you on how to cut Suboxone films successfully Why does the manufacturer of the films not provide their own cutting guide?

In fact, manufacturers of buprenorphine/naloxone films and tablets instruct patients to not cut their films or tablets. Why can’t you cut Suboxone film or tablets in half or smaller pieces?

There are several issues they are concerned about. One issue is that the medication may not be distributed evenly throughout the film or tablet.

Another issue is that some addiction treatment experts are concerned that cutting medication is an addictive behavior that reinforces addictive behavior in general. However, in practice, patients do not generally find that splitting their Suboxone films or Suboxone tablets leads to behavior problems.

One significant benefit of ZubSolv is that it comes in more dosage forms than Suboxone does. Having more tablets at different strengths available makes it possible to taper down on ZubSolv without having to worry as much about splitting a ZubSolv tablet.

While ZubSolv is superior to Suboxone in this respect, it would be helpful to have even more dosages available, and it would be helpful to have scored tablets, designed to be broken into two, or even four pieces. This would make a ZubSolv taper schedule even easier to follow.

What is an example of a ZubSolv taper, or Subutex taper that is easy to follow?

ZubSolv and Subutex are forms of sublingual buprenorphine that are only available in tablet form, unlike the various brand and generic bupe strips, such as Suboxone films. While breaking bupe pills is not recommended, some doctors do have their patients break them in halves and quarters.

If a patient takes two tablets daily, for example, the doctor may have them remove a quarter of a tablet from their daily dosage at a rate of one reduction per two weeks or four weeks. At this rate, a patient taking two tablets would complete the ZubSolv taper or Subutex taper in 16 weeks to 32 weeks.

This taper method, cutting a quarter tablet from the daily dose every 2-4 weeks, is simple, but may be too fast for some people. Another Suboxone titration option is to reduce it by a percentage.

For example, one Suboxone taper guide recommends reducing the dosage by 5% at the reduction point on the Suboxone taper schedule. Of course, making reductions by percentage is complicated when the medication is only available in just a few dosage forms.

Following a Suboxone film cutting guide online, working with a razor and metric ruler, can be difficult. Tapering by cutting Suboxone films can lead to uneven dosing and inadequate treatment during the tapering process.

Compound pharmacies may have a solution to help with Suboxone weaning by percentage. Custom-made Sublingual buprenorphine troches can be manufactured in a compound pharmacy for each individual patient.

Some compound pharmacists are willing to manufacture medication along a specified taper curve. By handling the math, the pharmacist can take some of the burden of figuring out the Suboxone titration away from the doctor and patient.

Are there any tips for getting off Suboxone quickly?

ZubSolv and Subutex are forms of sublingual buprenorphine that are only available in tablet form, unlike the various brand and generic bupe strips, such as Suboxone films. While breaking bupe pills is not recommended, some doctors do have their patients break them in halves and quarters.

If a patient takes two tablets daily, for example, the doctor may have them remove a quarter of a tablet from their daily dosage at a rate of one reduction per two weeks or four weeks. At this rate, a patient taking two tablets would complete the ZubSolv taper or Subutex taper in 16 weeks to 32 weeks.

This taper method, cutting a quarter tablet from the daily dose every 2-4 weeks, is simple, but may be too fast for some people. Another Suboxone titration option is to reduce it by a percentage.

For example, one Suboxone taper guide recommends reducing the dosage by 5% at the reduction point on the Suboxone taper schedule. Of course, making reductions by percentage is complicated when the medication is only available in just a few dosage forms.

Following a Suboxone film cutting guide online, working with a razor and metric ruler, can be difficult. Tapering by cutting Suboxone films can lead to uneven dosing and inadequate treatment during the tapering process.

Compound pharmacies may have a solution to help with Suboxone weaning by percentage. Custom-made Sublingual buprenorphine troches can be manufactured in a compound pharmacy for each individual patient.

Some compound pharmacists are willing to manufacture medication along a specified taper curve. By handling the math, the pharmacist can take some of the burden of figuring out the Suboxone titration away from the doctor and patient.

When would a rapid Suboxone taper plan be successful?

Is it possible that a rapid Suboxone taper can ever work and lead to long-term opioid-free recovery? For a patient who already has extensive experience in an abstinence-based program, such as Alcoholics Anonymous or Narcotics Anonymous, a quick Suboxone taper plan may be appropriate.

There are patients who have had a slip and relapsed on opioids, yet they previously had very strong recovery programs in 12-step fellowships or similar peer support programs. People who are deeply involved in Narcotics Anonymous are often not willing to stay on Suboxone long-term.

The Narcotics Anonymous program is an excellent support program, but the leadership of the fellowship, the NA World Services organization, is against “replacement medication.” Members of NA are encouraged to not stay on meds, such as buprenorphine or methadone, for very long.

It is possible for someone to have Suboxone success with a fast taper, if they have the right support system in place, and if they are willing to return to working with their recovery program.

Suboxone quick taper success may be possible if the patient reconnects with their home group and their sponsor, committing to working the steps and attending daily meetings. Full involvement in the program is necessary after completing a quick Suboxone taper plan, because the patient will likely experience opioid cravings during at least the first year of recovery.

Are there any good websites that teach how to wean yourself off Suboxone?

Not surprisingly, there are many online resources with taper plans. You can find a Suboxone taper chart or Suboxone taper calculator on many websites that are available to help patients figure out a Subutex taper plan or Suboxone taper plan without help from a doctor.

In fact, patients sometimes present to their doctor to get a Suboxone prescription with a secret plan of using the medication to follow a one-week Suboxone taper or a two-week taper that they found on some website. Of course, I do not recommend taking medical advice from websites.

While there is nothing wrong with asking a doctor about a Subutex taper plan, Subutex taper schedule, or other information found online, the purpose of bringing up the topic is to have a discussion with the doctor. Patients may be surprised at how their doctor is willing to work with them and help them to achieve their goals.

A doctor may first present the risks of tapering quickly from Subutex or Suboxone, but then may express support for the patient’s goals, regarding Suboxone quitting. Share the plan with your doctor, whether it is a 3-day Suboxone taper, or a 2-week Suboxone taper, or any other plan you may find online.

If a patient has found a Suboxone chart with instructions on how to wean off Suboxone, they must first discuss their thoughts with their doctor. If anyone tells you that quitting Suboxone is easy, sharing various quitting Suboxone success stories, remember that this is your life, and that you may not want to risk an unsupervised Suboxone quick taper.

What is the best way to wean off Suboxone after a year or more of treatment?

Imagine that you have been taking Suboxone for one year, two years, or even three years, without any problems. The Suboxone protocol works for you, allowing you to live a successful life in recovery.

Now, you find yourself under pressure from your family, friends, coworkers, or even from your doctor, that you should be quitting Suboxone. Is it time to plan for a Suboxone detox when your family decides you have been on it for long enough?

This scenario is one of the most common causes of Suboxone failure. Outside pressure to quit treatment too soon is the number one cause of opioid relapse for Suboxone patients.

Imagine that your parents, spouse, or your doctor present you with a Suboxone taper protocol and insist that you use this Suboxone taper method to complete your treatment. What if you do not feel that you are ready to stop?

Buprenorphine treatment should always be patient directed. Doctors are not supposed to Suboxone-shame or bully their patients.

It is important that the patient is allowed to make the final determination, if they are ready or not to finally quit taking bupe. Sometimes there is a specific issue that leads the patient to conclude that they should quit Suboxone.

One issue that comes up regularly is a new job or career that will not allow for buprenorphine use. For example, jobs that involve flying airplanes, driving large trucks, or working in law enforcement, may have medication limitations for employees.

If a patient has a dream of working with the FBI, or flying a commercial airliner, or becoming a police officer, it may be necessary to make plans to stop Suboxone. Of course, these careers can take a long time to prepare for, so there is also significant time to plan out a proper taper with the prescribing doctor.

Are there medications to help people to better tolerate a Suboxone taper?

Using medications to treat the symptoms of medication withdrawal is a sensitive subject. All prescription drugs have side effects, so by adding a new drug, there is the potential for new side effects, and possibly new dependence issues.

For example, benzos should not be used for opioid withdrawal symptoms, or buprenorphine withdrawal. The exception would be in a controlled setting under medical supervision, benzos can sometimes be used for a very short period.

Antidepressants, antipsychotics, and other psych meds present a similar problem. While these meds may help to treat some symptoms of Suboxone physical withdrawal, they may create a new drug dependence and cause new side effects.

However, there are some meds that can be used safely for short periods that will provide some relief from specific withdrawal symptoms. Lucemyra is a unique drug that has been approved for treating the symptoms of opioid withdrawal.

Lucemyra can be used for withdrawal from traditional opioids, or for buprenorphine withdrawal symptoms. It is the only prescription drug formally approved by the FDA for treating opioid withdrawal.

Other drugs have been prescribed by doctors to help with the withdrawal symptoms, including clonidine and gabapentin. Clonidine is a blood pressure medication that is closely related to Lucemyra. Gabapentin is an anti-seizure med that helps to alleviate Suboxone withdrawal symptoms.

What about non-medication techniques to alleviate buprenorphine withdrawal symptoms?

There are non-medication treatments that can help to make withdrawal from bupe more tolerable. A non-pharmaceutical approach is always preferable to prescribing more drugs.

Hyperbaric oxygen treatment (HBOT) has been studied as a treatment for opioid withdrawal syndrome, which includes withdrawal from buprenorphine-based medications. HBOT has been used successfully to make more tolerable the symptoms of post-acute withdrawal syndrome due to quitting Suboxone.

Mindful meditation can also help to ease the symptoms of withdrawal. Engaging in a formal mindful meditation technique, such as transcendental meditation, can be quite helpful.

Yoga, exercise, and massage are also good practices to improve symptoms and to promote a general feeling of wellbeing. Yoga is an excellent practice to free up physical stress, and even psychic stress stored up in the psoas muscle.

For people interested in spiritually-based practices, there is sound therapy and other related energy therapies that can free up energy blockages of the chakras. Additionally, acupuncture, hypnosis, and guided meditations are also excellent.

Another spiritual philosophy that I have found to be very interesting is what is known as The Three Principles. Founded by Sydney Banks, The Three Principles is a philosophy of mind, thought, and consciousness.

The principles help people to find their connection with the universe, and also to identify negative thoughts as being manifestations of the physical brain, and separate from a person’s true existence. The Three Principles has a practical application, helping people to identify negative thoughts and not take them seriously.

For example, if a person is going through Suboxone tapering and Suboxone withdrawal, it is very helpful to observe negative thoughts, but not act on them. The brain, when it is in pain during the withdrawal healing process, will generate thoughts and plans that the patient must allow to come and go without taking action on them.

Over time, as the healing process progresses, and the brain recovers and returns to normal functioning, these thoughts will be less and less frequent and less intense. It takes time, but the brain will recover.

Informed consent is an important conversation between doctor and patient.

When a patient makes the decision to start Suboxone, the doctor should explain carefully to the patient that they will become physically dependent on the medication. Physical dependence is different from addiction.

A person can be dependent on a drug without being addicted to it. Most Suboxone patients do not exhibit addictive behavior. Yet, they do have Suboxone withdrawal symptoms when they try to quit or taper off of Suboxone.

Another time for an informed consent conversation is when a patient wants to stop taking Suboxone. The doctor should explain that weaning off Suboxone film or tablets may increase the risk of opioid relapse.

The doctor should support their patient’s decisions, even if the decision is to quit Suboxone. Yet, the doctor should also clearly present the risks of tapering from Suboxone and finally quitting treatment.

Making the decision to discontinue Suboxone can be difficult, because the safe route is usually to continue treatment indefinitely. When a patient has decided to taper and quit Suboxone, or a similar buprenorphine medication, the pros and cons should be listed and weighed very carefully.

If you are making this decision, allow yourself time to consider the situation from all angles. How far removed are you from access to opioids? Have you had thoughts about opioids or cravings in recent months? Have you been involved with psychotherapy before making the decision to stop Suboxone?

Most importantly, do not let other people pressure you in making your decision. No one has the right to bully or shame you into stopping effective medical treatment. Would you ask someone to stop taking their heart medication because they depend on it?

We are entering a time when people are beginning to awaken to the idea that mental health conditions are no different from physical health conditions. A person cannot snap out of opioid dependence overnight any easier than someone can snap out of having a broken leg.

The brain, like a broken bone, needs time to heal. Suboxone treatment, and likewise, Subutex, ZubSolv, Bunavail, Sublocade, and Brixadi treatment, works effectively and quickly to help a person overcome an opioid addiction.

When Suboxone is taken properly, the patient is able to return to normal life activities, feeling as if they never had an opioid addiction in the first place. Over time, the brain is able to heal and recover from the effects of addiction.

Later, when the patient is ready to do a Suboxone taper, it should be a slow and gradual taper. And, the patient should be prepared for how they are going to feel, and how long it will take to recover, after taking the final dose of Suboxone.

Mark Leeds, D.O., is an osteopathic physician in South Florida specializing in treating alcohol and opioid-opiate dependence, among other drug addictions. For more information on Dr. Mark Leeds.