These guys are all forces in the recovery community but together WOW, you can expect lots of inspiration, differences of opinions and thanks to Bobble every topic will be explained so that everyone will understand completely.
December 1st RECOVERYRADIO.FM went live out of Palm Beach, Florida. Three huge names in recovery are hosting the show, RJ Vied, James Sweasy and Bobble. These guys are all forces in the recovery community but together WOW, you can expect lots of inspiration, differences of opinions and thanks to Bobble every topic will be explained so that everyone will understand completely.
The show runs for three hours every Tuesday and Thursday from 9 pm to 11 pm on
96.1FM for Pompano to West Palm / 97.5FM for West Palm to Jupiter/ 1340AM for all of West Palm County. You can also watch the show live on RECOVERYRADIO.FM OR on Facebook at www.facebook.com/recoveryradio.fm
If you aren’t familiar with these guys, let me tell you a little about them from my perspective.
RJ Vied is a Recovery Advocate who is a talented writer, speaker and all around genuine guy. I guess you could say he is the eye candy of the show…at least that’s what all the ladies are saying but don’t take my word for it, check him out yourself. You can follow RJ Vied on Facebook at www.facebook.com/rjvied. Don’t think that means he is just pretty to look at, this guy has a genuine passion for reaching the addict still suffering and supporting those in recovery. RJ Vied is a triple threat, intelligent, talented and honorable. The eye candy part is just a bonus.
James Sweasy is one of those magnetic guys that when they talk you just know you need to listen. Sweasy is from my hometown Louisville, KY and his no-nonsense approach to recovery has made him one of the most followed Public Persona’s in Recovery, and he is just getting started. Sweasy’s fans are die hard and with Sweasy’s creative video angles and call it like it is approach this guy going to be HUGE…ok he already is huge so how about Enormous. Relatable is Sweasy’s middle name. If you aren’t a Sweasy Fan, you need to hope on over to www.facebook.com/jamessweasy and learn you a thing or two. That’s what us Kentuckiana’s like to say.
Last but not least is Bobble. Bobble is a musician that is rocking the recovery world with his relatable rhythms and hip hop recovery music. I don’t know a bunch about Bobbleother than thank goodness for him being on this show. Sure enough, when I am scratching my head about some odd term, idea or recovery approach Bobble is quick to say, HUH? Please explain that so we all can understand it. You can follow Bobble at www.facebook.com/bobblemuzikRAW
Three beautiful young men, all from the same family are just gone. It’s not the leading story on the news and the comments below this story will include horrible judgment and hate. All because these wonderful young men have a disease that people have decided make them less than.
Losing one child to an overdose is devastating, imagine losing your third. Jeanmarie McCauley is having to bury her third son, Jesse. In the go fund me summary they wrote:
I can’t believe that I am having to do this again. Jeanmarie McCauleyis having to bury her third child, Jesse. He was a big-hearted kid who was so lost after both of his brothers died. He went to Florida to try and get his life back. Sadly, he did not make it. I can’t imagine the pain she and the rest of the family are in. She has to come up with the burial expenses as well as the added cost of bringing him back from Florida. She wants to have the three brothers together in their final resting place. We would be so grateful for any help. No mother should have to go through this. She and her family appreciate all the love and support they have received.
If this story is not proof that our Country is in the midst of an epidemic, what more will it take? It was only a few months ago that a mother that runs the page I HATE HEROIN, on Facebook lost two of her sons in the same night. Both of these mothers are fighters that actively fight to spread the word about this epidemic in hopes that no other mother will have to endure the pain of having a child who suffers from Substance Use Disorder, much less losing a one.
When this happens to families that are knowledgeable about this illness and actively fighting it, it just goes to show how powerful it truly is. So what does that mean? It means that we as Mothers and Fathers cannot do this alone. We need the full support of our police forces, judges, politicians, and communities.
When one of our loved ones gets picked up for possession or petty theft and it’s evident to the arresting officer that they are using opiates that person needs to be taken into custody. Not just for a few hours until they are let back out to wait for court. The presiding judge needs to look over his podium and imagine it’s their child standing in front of them. They need to recognize that this is their chance to possibly save a life.
Why can’t they be held until a bed somewhere can be found? We know if they are released that the first thing they will do is whatever it takes to get high. They can’t help it, it’s a disease. So that means if they have to steal something out of your garage or sell their bodies they will make the money it takes to feed the disease that is doing everything in its power to kill them. If the judge knew they were going to leave and commit suicide they wouldn’t let them go. What is the difference?
The politicians need to pass laws that make it possible for judges and police officers to take advantage of these opportunities to save our loved one’s lives. I know this is America and typically we allow adults to make mistakes and then learn on their own from them. This isn’t the same. Many of these people won’t get the chance to learn from their mistakes, they don’t live long enough to. Don’t you see, this isn’t like smoking pot, doing a line or having a drink? You don’t have two, three or five years to screw up and decide that you want to get clean. With the Fentanyl and now Carfentanil every single time they use might be their last.
Three beautiful young men, all from the same family are just gone. It’s not the leading story on the news and the comments below this story will include horrible judgment and hate. All because these beautiful young men have a disease that people have decided makes them less than. I can promise you this. Those boys were loved, their lives mattered and their families feelings matter. Please, take a stand. If you love someone who suffers from Substance Use Disorder don’t be scared to speak out. You hold the keys, all of you. If we all stand together and tell our stories we can stomp out this stigma and force the public to take notice. Those of us who fight every day need you. Together we can make a change.
Please give to the go fund me for this family and if you can’t afford to give you can surely share.
Update: Thank you for your generous donations, please keep them coming for this family. Because of all of you this mother might get to bring her son back home from Florida and allow him to rest beside the brothers he loved so much in life. Every little bit helps.
Hello, you don’t know me but I am an addict. I am one of the “junkies” you love to bash whenever someone mentions addiction on Social Media or hear it in conversation. I know it’s hard to forgive the things we sometimes do because of our addiction but I have a question for you.
WHAT IS THE WORST THING YOU HAVE EVER DONE?
Obviously, I won’t get an answer to this question but think about it. The thing that you hate that you did. You know, that one thing that not too many people even know about. Well, what if everyone knew about it. What if for the rest of your life you were labeled by that one act that you would erase in a second if you had the chance?
That is what being an addict is like, kind of. Now I don’t feel like being an addict is the worst thing a person can be or do. You, however, feel like it’s a terrible thing. Don’t get me wrong, if I could erase it from my life I would. In an instant, it would be gone, but I don’t have that option. I can’t even do what you do and pretend that this thing I did, didn’t happen. In order for me to ensure it never happens again I have to work hard on making sure it doesn’t. If I don’t my disease will tell me I can have a drink or do a line and not fall back into full-blown addiction, but I will.
DO YOU WORK HARD TO MAKE SURE YOUR WORST THING NEVER HAPPENS AGAIN?
Let me guess, you are thinking, addiction is not a disease…it’s a choice, right?
Yes, all addiction starts with a choice.
The same damn choice you made when you were young and hanging out with friends.
You drank the same beer I drank.
The same pot I smoked.
You even tried the same line of white stuff someone put in front of you at a party.
You were able to walk away and not take it to the extreme.
Since I have the disease, I will spend the rest of my life either struggling to stay high or fighting to stay clean.
As children, we don’t decide we would rather be an addict instead of a cop.
You don’t see children pretending that their dolls and stuffed animals are dope sick.
When is the last time you talked to a little girl that told you she couldn’t wait to grow up so she could turn tricks to feed the insatiable hunger of her drug addiction?
My best friend didn’t tell me about exciting plans to become homeless.
My Dad, not one time, told my Mother to think twice before marrying him because he had high hopes of becoming an angry drunk.
My sister in law didn’t blow out her candles as a child wishing for an S.U.D. ( Substance Use Disorder ) because she couldn’t wait for the day her children were taken into foster care.
Nobody WANTS to have Substance Use Disorder.
Some of us just do.
So always remember –
YOU MADE THOSE
SAME CHOICES TOO
YOU JUST GOT LUCKY
IT WAS ME
AND NOT YOU.
If you still have doubts you can take those up with the Center for Disease Control ( CDC ) or the United States Surgeon General. Since they have classified addiction as a disease, but then again I am sure you know more about it than they do, right
So to you, I pray that you don’t have to reevaluate these opinions because you find out your child or parent is an addict. If you do, just know that we will accept you into our community. We will help your loved one. Do you know why we would do that? Because we are good people that just want the chance to live like everyone else.
So please, before you post another post bashing people who are suffering think about it. Not only are you hurting the people who, have the disease, you could be hurting everyone that loves them. You have people on your friend’s lists or that overhear you at work who have children who are suffering right this moment from addiction. What did they do to deserve the awful things you put out into the universe, that does nothing but perpetuate hate and judgment?
You have a right to your opinion, but no matter what, hurting people is wrong.
This is the best information I can find about tapering off of Suboxone. Please if you have tapered from Suboxone and had success send us a message so we can share your story. When I came off of Suboxone I didn’t taper. I went to a three-day medical detox where they gave me a cocktail of nonnarcotic meds to help with the withdrawal from the Suboxone and 20 years of Xanax ( benzo ) use. The withdrawal was very tough and lasted for months. I was successful though and you can be too.
Summary: The purpose of a taper (instead of just stopping) is to gradually reduce tolerance, thus distributing withdrawal symptoms over a longer period of time minimizing the discomfort experienced on any single day.
Ending the taper at the manufacturer’s lowest available dose (2mgs for Suboxone Film® and generics or 1.4mgs for Zubsolv®) can still result in significant withdrawal.1,6 Here we lay out the rationale for tapering to much lower doses. As the data will show 2mgs/day is closer to the midpoint of a typical taper than it is to the end.
General rule: Pace the taper with the body’s ability to adapt to each decrease. Dose decreases of 25% separated by at least 10 days has been reported to be tolerable by many.1
The whole point of buprenorphine treatment is to suppress cravings and withdrawal so that you can make big changes in behavior, routine, living situation and thinking. It’s these changes which, in effect, rewire the brain and reverse some of the craving-causing brain adaptations. If this is not done first the taper will likely be shortly followed by relapse.
Have you made significant changes in behavior and had a period of time to gain experience with those behaviors? Have you been able to deal with stress, anxiety, and depression without craving drugs? This takes time and doesn’t happen on its own, it is a deliberate effort. If you have been in stable treatment less than six months, tapering is NOT advised.
Buprenorphine is NOT a detox medication, it is a treatment medication. If you are not clear on this distinction go to the treatment page and understand it before tapering. But assuming you are ready to taper there are some things to consider.
Tapering to very low doses minimizes withdrawal
Before we continue, it should be noted that the following is a detailed explanation for those interested in the nuances of tapering and not necessary to conduct a taper. It does however, help make sense of why certain protocols are likely to be more effective than others.
Cut pieces of film
Fig. 1. Suboxone Film can be cut into small pieces. Accuracy is not that important when cutting the dose. Blood levels will average out over a few days. Also, it is not a certainty that the medication is evenly distributed throughout the film or tablet, so super-precision in cutting isn’t warranted.
To understand the tapering process there are a few concepts you should understand:
The Ceiling Effect of Buprenorphine:
In short, at a certain dose of buprenorphine, nearly all available opioid receptors become occupied with buprenorphine.3 Each helps induce a small opioid effect.4 The cumulative effect created from all receptors is the maximum effect or the ceiling effect.4 The minimum dose to reach this point is the ceiling dose. Taking more than the ceiling dose involves so few additional opioid receptors that patients are unable to detect any additional opioid effect.4 Whether the patient’s dose is at, near or above the ceiling dose, they experience virtually the same opioid effect. For this reason, tapering can be more aggressive (per mg.) at higher doses than at lower doses when more receptors are affected by dose decreases.2
Fig. 2. PET scan showing available opiate receptors at various doses.
Fig 2 is a PET scan showing the amount of available opioid receptors at various doses.3 From this evidence it is clear that, for this particular patient, at some dose above 2 mgs. and below 16 mgs. the ceiling dose is reached, as the amount of available receptors have diminished to insignificant levels.3 If we extrapolate this admittedly very limited dataset and apply a curve shape common in biology, we can estimate approximate receptor involvement at various doses. Fig 2a illustrates this concept. It should be noted that there is great variability in reality and liberties have been taken with this particular graph, but it is meant to illustrate the point that the amount of receptors involved is not a linear relationship with dose. Therefore cutting the dose in half from 32mgs to 16mgs doesn’t mean that half as many receptors are affected, in fact due to the ceiling effect there would be no discernible difference.
involved receptor graph
Fig 2a. Approximate amount of buprenorphine-occupied mu receptors/dose
If a taper should follow a steady and gradual decrease of involved opioid receptors, then 2mgs would be about the midpoint of the taper. In one of the few taper studies, both long and short tapers ending at 2mgs resulted in very low success rates.6 The researchers concluded: “For individuals terminating buprenorphine pharmacotherapy for opioid dependence, there appears to be no advantage in prolonging the duration of taper”. They apparently gave no consideration to the possibility that maybe 2mgs is too high of dose to stop at. We will show it is and suggest their conclusion is wrong in that extending the taper well below 2mgs for a much longer period of time is beneficial.
Buprenorphine doesn’t completely metabolize between doses. It typically takes between 24-42 hours to metabolize half of it, but could range as much as 20-70 hours.9,10,11 We use 37 hours as an average in our calculations, but be aware of the range if your results don’t meet expectations. Therefore, after the first 37 hours, only about ½ of the buprenorphine has been metabolized, while half remains to continue to elicit an effect. After another 37 hours half of that remains and so on. At typical maintenance doses, previous doses can contribute to the overall blood levels for 5-12 days (depending on actual metabolic elimination rate). At very low doses, by day three the amount of buprenorphine still un-metabolized is so small its effects are negligible.
Although this graph starts at 16mgs., the curve would be the same for any dose.
Buprenorphine Blood Level Buildup, Stabilization
As patients take subsequent doses of buprenorphine before the prior dose has completely metabolized, a buildup occurs in blood levels. (Fig 3) The buildup continues for approximately 5-12 days at which time the dose taken 5-12 days prior has nearly fully metabolized. This is the stabilization period. When dose is decreased the effects of this build up should be considered before the effects of the new lower dose can be evaluated.
11 day half-life graph
Fig. 3. Blood levels build up until stabilization
Putting It All Together
We now know that doses at or above the ceiling dose can be decreased more aggressively than lower doses. We know that 2mgs/day is not the end of the taper but closer to the midpoint. We know that due to the half-life, buprenorphine builds up in the blood and may still produce effects 5-12 days later, particularly at higher doses. Armed with these considerations we can construct a taper plan which will minimize discomfort.
Buprenorphine Taper Plan
By coupling what we learned above with anecdotal taper testament found online, we can estimate that dose decreases of 25% with 10 days between drops should be tolerable.1 Furthermore, if our initial dose is at, near, or above our estimated ceiling dose we can taper more aggressive initially, maybe as much as 50% drops. As we approach 2mgs and below, we should expect more noticeable differences between each dose decrease and may need to slow down the pace. Once at a very low dose (less than 0.5mgs) we can speed up the pace once again as the buprenorphine is metabolized down to insignificant levels in just a few days.
Emergency Buprenorphine Taper
If you find yourself in a situation where you must taper off immediately for some reason and don’t have the time or enough buprenorphine for a planned taper, you can try an emergency taper. With the emergency taper you stop all buprenorphine until the onset of withdrawal. At that time you take small doses (<= 1mg) every hour until withdrawal is tolerable. Then, take buprenorphine only when symptoms become intolerable and only enough to stop the withdrawal. Although this method minimizes withdrawal intensity for a given amount of available buprenorphine, there could still be considerable withdrawal depending on tolerance and the amount of buprenorphine available.
Which brand of buprenorphine to use
As of early 2016 there are 3 name brand and at least 5 generic buprenorphine products to choose from. For ongoing treatment something can be said for the newer brands; with their better bioavailability side effects may be fewer and some dose and copay card combinations make it the least expensive option (including generics). (see cost page) But when tapering, particularly at doses below 2mgs, Suboxone Film (as pictured above) offers the advantage of being larger thus easier to cut into the fractional doses necessary for the taper. Pieces of film left over between doses should be stored in a childproof pharmacy bottle with a silica gel pack to absorb humidity and prevent the opened film from becoming sticky. (see storage section)
When to take your taper dose
Taking your buprenorphine first thing in the morning is best. There is good reason for this. By taking your dose in the morning, buprenorphine blood levels are lowest while you are asleep. Therefore, when the buprenorphine is providing the lowest level of craving and withdrawal suppression you are asleep and aren’t dealing with it. Another reason is, you want to avoid anticipation of taking the dose, because this is the type of brain activity you want to eliminate. Anticipating the dose then receiving the reward of the dose, may be reinforcing the behavioral patterns you have worked so hard to eliminate. By taking it early in the morning, there is no need to think about it for the rest of the day. Exception: If insomnia becomes acute, you may benefit from taking your daily dose at night.
Take your full day’s dose all at once
Don’t split up the day’s taper dose. As mentioned above, taking it early prevents you from thinking about and anticipating your dose. Also, once you finally stop, it is an easier transition from taking something once a day to zero times a day, than it is from taking something 2-4 times a day, to zero times a day. Also, avoid complicated rituals like dissolving the medication in water and metering out portions for the taper. Simply cutting the film or tablet is all you need to do. Exception: Again, if insomnia becomes acute, splitting the dose up by taking some in the morning and some at night might help.
Remember, the taper schedule is not etched in stone. Individuals will respond differently to the same taper schedule. It is meant as a rough guide which must be tailored to match an individual’s body and circumstance. The main concept is to pace taper rate with the individual’s ability to adjust to each decrease. However, it can be helpful to have a guide to loosely follow and to estimate about how long it will take and how much buprenorphine will be required.
Buprenorphine and Pain
Buprenorphine is a painkiller. A return of minor aches and pains is to be expected when you stop taking a painkiller. This is not withdrawal, it’s the pain the painkiller was killing but isn’t killing anymore. Aleve® or some other OTC painkiller might help but only when and if you need it. Hyland’s® Restful legs tablets have also been reported to be effective especially, at night. For sleep, patients have suggested Valerian root and Melatonin. Maintaining good overall nutrition and keeping well hydrated is also important. But maybe the most important thing is to keep busy, preferably away from home. Sitting home waiting for symptoms to appear is a sure way to fail.
Pain is progress
The discomfort you feel while tapering can be thought of as an indication of your tolerance diminishing. The necessary discomfort stimulates the body to produce endorphins. If you can possibly motivate yourself to exercise, even brisk walking, the pain will be less noticeable and you benefit form the exercise. It might also help you sleep better.
Depression and Tapering
Along with being a painkiller, buprenorphine has been recognized as an anti-depressant.7,8 Just as when you stop taking a painkiller, pain comes back, when you stop an anti-depressant, depression may come back too. The severity of the depression could determine the success or failure of the taper. Be prepared to deal with the reemergence of depression, particularly if you suffered from it before starting buprenorphine treatment. This might entail working with a psychiatrist and having antidepressant medication on the ready, before concluding the taper.
Pausing the Taper
If you hit a dose level which produces unacceptable levels of withdrawal discomfort, it is acceptable to go back up in dose, one step, for a few more days. Alternatively, you can hold at that dose for a longer period of time than indicated on the taper schedule. Since everyone’s body and brain is unique, the generic taper schedule may need to be tweaked slightly. Once your body adjusts to the dose level the taper can be resumed.
It’s okay to take a break from the taper if you need to, as long as it is minimal and infrequent. An example would be if you have been at 0.5mgs/ day for a week and still feel withdrawal discomfort, taking up to 1-2mgs one day will remove all withdrawal symptoms for that day and possibly the next, giving you time to refocus, get things done, and prepare for the final leg of the taper. One day at a higher dose will not increase your tolerance, thus reversing your progress, as long as you limit such higher doses to once or twice during the taper. If you can, try and not take any the following day. This may not be that difficult since about half will still be present the next day. Then resume the taper schedule.
Optional Ending Kicker Dose
Once you fill out the form above and create the taper schedule, you’ll notice that on the last day of the taper is a higher dose than recent previous doses. The idea is to take advantage of the half-life property and extend the taper a few days more. The higher dose raises blood levels, without raising tolerance, and as this final dose metabolizes blood levels slowly decrease until reaching zero, thus extending the taper. That’s the theory, but we know of no studies that have looked at this, only doctors who employ this in their taper plans.1 It’s up to you whether or not to include it. Good luck.
Anecdotal evidence compiled from several social media sites over a period of several years
National Alliance of Advocates for Buprenorphine Treatment- http://www.NAABT.org
PET scans- mu receptors- Effects of Buprenorphine Maintenance Dose on mu-Opioid Receptor Availability, Plasma Concentrations, and Antagonist Blockade in Heroin-Dependent Volunteers – 2003 – http://www.nature.com
TIP-40, buprenorphine treatment clinical guidance – government document 2004
Results produced by the NAABT.org taper engine (beta)
Buprenorphine tapering schedule and illicit opioid use- Clinicaltrials.gov, Identifier: NCT00078117 -Ling – study
Buprenorphine treatment of refractory depression, Bodkin [study]
The Buprenorphine Effect on Depression, Richard Gracer, MD [article PDF]
Zubsolv full prescribing information submitted to the FDA – Zubsolv PI
Bunavail full prescribing information submitted to the FDA – Bunavail PI
Suboxone Film full prescribing information submitted to the FDA – Suboxone Film PI
Brand names for buprenorphine/naloxone (bup/nx) combination products in the US: Suboxone Film, Zubsolv, Bunavail, and generic equivalents of the discontinued Suboxone Sublingual Tablets.
Buprenorphine products in the US WITHOUT the added naloxone safeguard:
Subutex Tablets (discontinued in 2009) but the generic equivalents remain available.
Buprenex® is an injectable, FDA approved for pain NOT addiction – illegal to prescribe for opioid addiction.
Butrans® Patch, also FDA approved for pain and NOT addiction – illegal to prescribe for opioid addiction.
Pharmacy-compounded bup or bup/nx preparations – NOT FDA approved for addiction – illegal to prescribe for opioid addiction.
Probuphine® is an insertable buprenorphine rod which goes under the skin and releases bup over the course of 6 months. It was FDA approved in May of 2016, and is for the treatment of addiction.
Belbuca™ is a buprenorphine film which goes on the inside of the cheak. It was FDA approved in October of 2015, and is for the treatment of pain – NOT FDA approved for addiction – illegal to prescribe for opioid addiction.
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Nothing on this site should be confused for medical advice. The information provided here should only serve to inspire you to find out more from credible sources. We hope to help you understand the disease better so that you know what questions to ask your doctor. Never take any online medical advice over that of a healthcare professional, assume it’s all made up. Despite the links to peer reviewed studies all interpretations of said studies may be opinion, unreliable or erroneous. If some patients found something beneficial to them it’s not an indication that it will be beneficial to you, on the contrary, it may be dangerous. You, not us, are responsible for what you do with the information you get from this site or any site.