Question: Hello Anna. I've just read your article on the dangers of combining methadone (or suboxone) with benzodiazepines. It is very clear & well-written in my opinion. I have been on methadone for 14 years & my most common 'reward to self' has been benzodiazepines. The combination turns me into a dribbling baby in a man's body (but I'm so 'stoned' that I'm unaware of this). I am on a methadone wean and have decreased from 135mg/day to 30mg/day. I decrease 5mg per month. I am so happy that you are Christian! God bless you!! Sorry I havn't got a question. Love from New Zealand. James Ingle

Anna Deeds Says...:

Hello James,

Thank you for writing. I'm glad you read my article. I'm sure you are aware of how dangerous benzodiazepines are when combined with methadone. I'm so happy you have been able to decrease from 135 mg to 30 mg. That is amazing progress! You should be so proud of how far you have come. You didn't mention if you have been able to stop taking benzodiazepines. I hope you are doing well with not taking them. Abstinence will make it so much easier to come off methadone. Any abuse of benzodiazepines can set you back. Because benzodiazepines increase the effects of methadone, the use/abuse of them will make it seem like your dose of methadone is going up and down, depending on how many benzodiazepines you have taken. I'm sure you can see how this arbitrary increase/decrease of methadone potency can affect your decrease schedule. If you feel like you are going up and down in dose, you're likely to have more withdrawal and negative effects while you reduce your methadone dose. 

In regards to your mention of benzodiazepines as a "reward," it shows the addictive thinking process. An addict will commonly think drug use is a reward for accomplishments, doing well at their job, etc. But drug use only hurts the person who is using. The risks include health problems, overdose, lost jobs, failure at school, poor relationships with family or friends to name a few. I hope you have found another reward as you are working so hard to come off methadone.

Here are some suggestions for alternative rewards:

• Fun night out with friends (movie, dinner, bowling, etc.)
• Physical affection (hug, cuddle, sex, etc.)
• Family time
• Spa (massage, Reiki, sauna, acupuncture, etc.)
• Material possessions (clothes, games, electronics, etc.)
• Singing
• Church services or activities
• Dancing
• Being silly

Question: I have been dealing with a basic opiate addiction for almost two years now. I was first using opiate pills. I tried to get off of them by going to a methadone clinic. Unfortunately the methadone clinic is too far away and does not accept any (including mine) health insurance. The gas money and the price of going was costing me almost $1000 a month which is basically what I was spending on the drugs to begin with. When I expressed to the clinic that I wanted to taper off of the methadone because I could not afford it anymore they did begin the taper from 60mg dropping me 10mg a week, and because I have the worst luck in the world when I finally got down to 10mg for the week, where the next week they would have put me on 5mg, then 2mg so I would not experience any withdraw symptoms, I was in a very bad car accident and the methadone clinic kicked me out for missing a couple of days. Methadone clinics work a certain way and are kinda strict. I was paying $15 a day for my "dose" as they call it and $20 a day in gas to get there and get back home. And you have to be there every single day except Sundays. They will let you take your Sunday "dose" home. If you miss a day they can and will kick you out. I actually missed a couple of days from the car accident being so severe. I was not getting high or taking any medication on the days I missed I just was extremely sore and had no transportation to get there and back. When I realized that they would not take me back my addiction started again. This might just be justification but I needed something from being so sore from the accident, which I was very lucky to still be alive from, and I was beginning to start having withdraw symptoms. I am sick and tired of being addicted to this drug and am more then ready to quit. Im at the point where the only thing holding me back from quitting cold turkey is the fear of withdraw for two weeks and the fact that I have children to care for and would not be able to if I were that sick for that long. I was wondering if a hospital might admit me for 4 days to a week so I could be quickly tapered off of the drugs and finally be done with this thing that is holding me back in life and making me miserable, but also be monitored by doctors while doing so. I have tried to just slow down on my own at home and I just get entirely too sick and can not do it alone. But I absolutely do want to be done with this nonsense and am at the point where I'm desperate. I am just terrified of the withdraw symptoms and would feel much more comfortable knowing that I'm in the hands of doctors and nurses while going through something so painful and scary. I have some education on CDC and I know the extenuating factors. I know afterward changing people places and things in necessary, groups are necessary. I just cant get past this step. I need to do this for my children, my husband, and more importantly myself. I want to go back to school and take steps forward in my life. I cant just quit and get sick because I need to be able to watch my children but if I can find a hospital that will take me for a quick (weekish) taper, my family will more then likely help me with the children that week so I can get past this point. Plus I just get so scared of actually how sick I really do get that being watched by a doctor and tapered down I really do think is the best way. The methadone clinic takes up so much money and time. And I did try my hardest there, and I can not take the time or money to start all over again. I was so close to being done when I was in the car accident. I'm more desperate then ever to find a hospital to help me. My life may actually depend on it. I live in Cincinnati. If anyone can please help me find a place to go to get over this hump in my life, my recovery, grateful would not come close to describing how I would feel. I know the steps I need to take afterward. I was sober for 6years. I want my life back. Can anyone please help me find a place to take me for my taper? I'm desperate. My kids and husband need me back and I want more then anything to be back to normal...... Please??

Anna Deeds Says...:

Thank you for your question. A hospital can detox you in about a week, depending on your tolerance and how severe your withdrawal is. Since you live in a smaller area, it is possible not every hospital in your area has a detox unit. You can call several hospitals and ask them if they have a detox unit but they often won't tell you over the phone how to get in. They will tell you that you have to go to the emergency room and be evaluated to get in. What this means is that you have to be in withdrawal. They will take your vitals like blood pressure and heart rate to be sure you are experiencing withdrawal before they will admit you. You can really go to any hospital if you are in withdrawal. If they don't have a detox unit, they will refer you or transfer you to one that does. However, this will mean more time before you receive treatment. You will receive treatment faster if you know which hospital has a detox unit.

You may be able to find a place to detox you outpatient with Suboxone as well. There are some Suboxone clinics that offer a Suboxone detox. They will put you on Suboxone and reduce your dose over several weeks. This is usually done in a clinic and not a doctor's office. They will probably offer you counseling and possibly groups while you are going through the detox. To find a clinic, look on the SAMHSA website for Suboxone doctors. Call each one in your area and ask if they offer detox or maintenance treatment. You may want to consider maintenance too. Suboxone is often offered with less restriction than methadone so it may be a better option since money and transportation is an issue for you. They may only require once or twice a week visits and you can work up to monthly visits.

Another option is a rehab. Many rehabs have detox units too. You can choose to only go to the detox unit if you want. When you enter rehab voluntarily, you can leave at any time. This means you have the right to only go to be detoxed and then leave. See this article with resources to find treatment in any state. The SAMHSA website is a great resource for finding treatment. 

I do suggest that if you only go to detox, you go to daily NA and AA meetings for the first few months. You will need the support and help to deal with the cravings. Whenever you stop taking opiates, your body needs time to adjust to not having opiates. During this time, your body will want to go back to opiate use so it can return to a "normal" state. Right now, your body's "normal" state is on opiates. Your body doesn't understand that opiates are wrecking your life. It's job is to function and it won't know how to function without the opiates. Because of this, you will have powerful cravings or urges to take opiates. This doesn't mean you can't stop using. In time, your body will adjust to a new normal state without opiates. But during the adjustment period, it will be difficult to stay clean without help. There is plenty of help out there though if you ask for it.

Good luck with your recovery and don't be afraid to ask for help!

Question: I tried suboxone for about2-3 days and I got so sick. I vomited at least 4 times that day. I was very nauseated and couldn't keep any food or liquids down. Also I had a horrible headache like someone was beating me in the head with a hammer. I don't know if I was going through withdrawal or exactly what was going on. Should I have continued using the suboxone or what? I was very disappointment because I was so ready to get off opiates. Any suggestion?

Anna Deeds Says...:

Thank you for your question. There could be a few reasons why you got sick when you started taking Suboxone. First, Suboxone has a blocking effect on other opiates. It fits in the same receptors as the opiates you were trying to stop taking and will push out all other opiates. What this means is that if you still had opiates in your system, Suboxone will block them and can cause you to have withdrawal symptoms when you first start taking it. You are supposed to start taking Suboxone after you begin having withdrawal symptoms from the opiates. This can take up to 3 days but usually will start within 24 hours, depending on what you were taking. 

Second, you could have had a bad reaction to the medication. Any medication can have side effects and make a person sick. It is possible that you had a reaction to the buprenorphine or the naloxone in the medication. Third, the Suboxone may have interacted with another medication you are taking or a health problem you have.

Fourth, you may have taken too much or too little Suboxone. It is possible to have symptoms if you take more Suboxone than is needed although it is unlikely to cause an overdose due to the ceiling effect of the medication. Suboxone is only effective to a certain amount and then it has no effect. This amount may vary per person. And if you did not take enough, you may still have withdrawal symptoms until you adjust to the dose.

Fifth, while it is unlikely, it is possible to have a tolerance too high for Suboxone to be effective. Because it has a ceiling effect, people with a large tolerance to opiates may need a medication like methadone that is able to be prescribed at a higher dose. However, you would have to be taking an unusually high dose of opiates for this to happen.

You didn't mention if you got the Suboxone from a doctor or not. If you got it from a doctor, I suggest you contact the doctor right away and tell him what happened. He can better advise you on what to do. If you didn't get it from a doctor, I suggest you try going to a doctor. You may have a better outcome if it is prescribed because a doctor can check for interactions and be sure you get the amount you need. Plus, you need counseling in addition to medication. The medication will only help with withdrawal. Counseling will help with the psychological issues related to addiction.

I hope this answers your question and you try again to get treatment. Don't give up on recovery because this attempt didn't work out well. You may have a better outcome if you try again. If Suboxone isn't for you, you can try methadone as an alternative. I hope you find the right treatment for you.

Question: I have heard some real horror stories about how hard the withdrawals are from Suboxone. Will the withdrawals be a lot harder if I take the drug for a longer time? If I take it for only 3 months and then start to get off slowly will that be a lot easier than if I take it for 9 months or a year or will it not make much difference?

Anna Deeds Says...:

Thank you for your question. Unfortunately, I don't have a clear answer for you. I think it depends on a lot of factors. Everyone's body is different so everyone experiences withdrawal different. Factors such as age, other health problems and tolerance can effect on how much withdrawal a person has.

Plus, the mind plays a big part in withdrawal. Someone can be physically dependent on a pain medication but not an addict. If a physically dependent person stops taking their pain medication, they may experience withdrawal symptoms. But if they don't know its withdrawal, they may think they have the flu and have no drug cravings. I knew someone this happened to and I think it shows how psychological withdrawal is. 

I think the psychological part of withdrawal can make it harder for someone who is on Suboxone longer to come off it. After a time, it becomes a part of your life. You stop being able to imagine not taking it. You develop more fears of getting off it. So I do think it would be easier to taper off Suboxone after a few months than after a year or more. But I don't think it is because it is physically harder. I just think it is psychologically harder. 

You can minimize the withdrawal symptoms by taking the taper slowly. When you are ready, talk to your doctor about slowly reducing it over time. Reduce the chances that you will take more by only getting the amount you need each week. If you have access to more, you are more likely to give in if you feel even slight withdrawal. If you stick with a strict taper, you may feel little more than the anxiety of decreasing. Ask your doctor what you can take that is non-addictive that will help ease any symptoms you do have.

I hope this helps answer your question and good luck with your recovery!

Question: Is there any advantage to suffering during detox? For example, to going cold turkey instead of Suboxone. I feel like if a man does not have to feel pain when stopping then there is not much stopping him from going back to use again, since he knows he can always quit any time he wants to so easily.

Anna Deeds Says...:

Thank you for your question. I think the answer to your question depends on the person and the situation. A lot of addicts are afraid of withdrawal. This fear can keep some people from relapsing. But people have a tendency to forget the intensity of pain over time. Most memories fade and the emotions that are attached to those memories fade as well. Over time, the addict's memory of how bad the withdrawal was can fade and so their fear of it fades. Plus, addicts are masters of denial. Addicts who relapse often tell themselves things like, "I'll only use (drug of choice) once" or "I won't let it get out of control." This kind of addictive thinking overrides the fear of withdrawal because they tell themselves they won't let it get to that point. They are in denial about their ability to control their use of drugs.

I do agree that complete abstinence is preferable to Suboxone (or methadone) treatment. I don't think Suboxone or methadone are the quick fix that many addicts take them for. They are actually more of a long term treatment since it takes so long to get off them. Complete abstinence has many advantages over medication assisted treatment. Abstinence feels better physically and psychologically. But there are many addicts who try and fail at abstinence over and over. I believe these are the people who benefit most from Suboxone or methadone. I think it should only be for people who have tried rehab and Narcotics Anonymous repeatedly and have not been able to sustain abstinence. 

I do recommend that people on Suboxone or methadone who want to achieve abstinence, detox slowly to avoid withdrawal symptoms. The reason is that withdrawal leads them to relapse. It's an instinct for addicts to try to avoid withdrawal. This is another reason why I don't think feeling withdrawal will prevent relapse. I have found that it actually causes relapse. Most addicts are not able to tolerate withdrawal without relapsing. They need almost constant support to get through the withdrawal without relapsing. It is so easy for the addict to start thinking things like, "I can't take this" and "If I just do a little, I'll feel better." This is where rehab or Narcotics Anonymous can carry the addict through and keep their thoughts on track.

While your theory that the fear of withdrawal can prevent relapse might be true for some addicts, I don't think it works for everyone. Plus, the addict has to get through the withdrawal without relapsing for it to work. If the addict has nearly constant support through their initial withdrawal and continuing support for protracted withdrawal, consciously remembering withdrawal (and other consequences) can be one tool to avoiding relapse though.

I hope this answers your question.

Question: When tapering subs how low should you go before jumping off? I am doing a water taper and I am below 1 mg (.9 mg for 2 days and I am hurting on it) a day from 16 but my withdrawal symptoms are still really bad after each drop if you can believe that. I am dropping by .1 every 3 days now but do you think it would be worse to just stop completely now? The restless legs and anxiety and irritability and generally feeling uncomfortable all the time are my biggest problems.

Anna Deeds Says...:

Thank you for your question! I think you are probably having so much withdrawal because you are tapering too quickly. Slow the taper down. If I understood correctly, you are currently at about 1 mg. Stay at that dose until the withdrawal has passed. Your body will adjust to any dose in time. The problem is you are not giving your body time to adjust to one dose before you decrease again. This makes you have withdrawal on top of withdrawal. You have the withdrawal symptoms from one decrease and before you have adjusted, you take another decrease which adds to it. There is no hurry to complete a detox. If you don't allow your body time to adjust, you are likely to relapse. Relapsing will only make things much worse for you.

Take your time and wait until you feel no withdrawal for several days before taking another decrease. I think if you slow down the detox, you can have minimal withdrawal symptoms. The most withdrawal you should to have is some anxiety and irritability which is normal for any change to your body. It will pass in 3 to 5 days. Wait at least a few days after it passes before taking another decrease. Just be sure to never take more than the dose you are currently at. Increasing your dose during a detox will only confuse your body and make it worse.

You didn't mention if you were taking any other medication or drugs. You don't want to use anything addictive to help with the detox. Substitution will only lead to more problems. However, you can ask your doctor to prescribe non-addictive medication to ease withdrawal. Doctors often prescribe Clonidine which is a medication to reduce your blood pressure and heart rate. Withdrawal causes your blood pressure and heart rate to increase which leads to a lot of the symptoms of withdrawal. They may also prescribe something for sleep and restless legs that is non-addictive. Melatonin can be taken for this as well. Melatonin is an over the counter supplement which your body normally makes to put you to sleep. Always check with a doctor before taking any medication, even over the counter, because it could interact with something you are already taking or cause problems with other health issues.

You would have to contact your local hospitals to see if they can do this.

I hope this information helps and good luck with your recovery!

Question: I am thinking about getting clean with Suboxone. Only problem is that I hear that I have to give urine samples and that a nurse will stare at my junk while I go. I am a pretty shy person and I can’t even go in a regular bathroom if there is another person in with me. This has always been a problem for me. There is no way I can give a urine sample with some person starting at me it would be too humiliating. Is there any way I can get around this because if I can’t I am just going to buy my Subs from my dealer and I know if I do that I’m going to be topping up heavy all the time.

Anna Deeds Says...:

Thank you for your question. Suboxone treatment is less regulated than methadone treatment. Because of this, every program is different so you would have to check with the doctor or clinic that you intend to go to find out how they handle drug testing. They generally test clients through urine or mouth swabs to determine if the client is using other drugs. They have to do drug testing because other drugs can interfere with Suboxone treatment and can even cause overdose. Taking drugs like benzodiazepines with Suboxone is dangerous so the doctor or clinic may want to verify that you aren't taking something that can harm you. Plus, addiction is considered a disease. As a disease, the addict is not considered to be addicted to just one drug but to all substances. Treatment facilities need to know if you are taking other drugs so they can treat you properly. 

If you cannot urinate in front of someone, ask the facility if they can test you through mouth swabs or blood work. Some facilities are using mouth swabs so urinating in front of someone wouldn't be an issue. Drug testing through blood work might be more expensive but there is a possibility that the facility may let you do this if you pay for the testing.

I don't suggest that you buy Suboxone on the street. The whole point of taking Suboxone is to get better. If you buy it and take it like any other drug, you are defeating the purpose. Not only will you probably abuse it, you won't be getting any counseling to help with the psychological part of addiction. You will find yourself in the same position as you are in by taking opiates. Nothing in your life will change. You will still be doing something illegal, keeping the same friends, the same habits, etc. If you don't make changes, nothing will change for you. I'm assuming you aren't happy with the way your life is going or you wouldn't be considering treatment. The treatment programs are designed the way they are for a reason. You have to commit to their program in order to change.

I hope you choose to get treatment and go about it the right way. Good luck with your recovery!

Question: I am steady on 120 mgs of oxys a day now and I want to stop. I can get subs. I want to be done with detox in a week or 10 days. How many subs should I take and when should I take them? If I wait 24 hours after my last oxy is that long enough before I take my first sub? By 24 hours I am feeling pretty sick.

Anna Deeds Says...:

Thank you for your question! You have to be in withdrawal before you start taking Suboxone. If you're not in withdrawal, the Suboxone will cause you to have withdrawal. Suboxone is a full opiate blocker. When you start taking it, it will block your opiate receptors so any opiates in your system cannot use the receptors. This can cause you to have withdrawal if you take it too early so you need to be careful. 24 hours is the minimum amount of time to wait if you are taking opiates but it might be a good idea to wait as long as you can to be sure. If you were taking methadone or other longer lasting opioids, you would have to wait longer.

I encourage you to go to a detox program instead of buying Suboxone and trying to do it on your own. There are programs that will detox you in outpatient treatment if you don't want to be inpatient. If you go to a program, they will be able to tell you how long to wait according to how much pain medication you were taking and they can give you the proper amount of Suboxone. They can also monitor your detox and provide you with counseling. Contact your local drug and alcohol programs to find treatment in your area or try the SAMHSA website where they have a treatment locator. In my state (Pennsylvania), every county has a drug and alcohol commission where people can get free treatment or referrals to treatment. I think most states have something similar.

If you try to do the detox yourself, try taking the least amount of Suboxone that you can to take away withdrawal symptoms and then reduce your dose at regular intervals. Whenever you detox or taper, it's important to be consistent with decrease. You don't want to take less one day and then go back up the next day. This will only make it harder to detox. And don't make the mistake of taking other drugs to ease withdrawal. This can lead to other addictions and makes withdrawal more difficult. However, over the counter vitamins and supplements are fine to take. For example, melatonin is a natural supplement that can help with sleep. Always check with your doctor before taking anything though in case it could conflict with other medications you are taking or interfere with health problems you have. 

Good luck with your recovery!

Question: What do you think of using vivitrol to play it safe after finishing tapering down from methadone?

Anna Deeds Says...:

Thank you for your question. Vivitrol is definitely a good option after you taper completely off methadone or other opioids. Vivitrol is naltrexone in extended release form. It is given in the form of an injection every month. Vivitrol can help opiate addicts stay clean because you cannot use opiates or opioids while on Vivitrol. An addict cannot get high while on this medication. Using even small amounts of opiates or opioids could lead to overdose. I think it can definitely help addicts stay clean. Addiction is a physical, mental and spiritual condition. Vivitrol has an effect on the physical and mental aspects of addiction. Physically, it blocks the effects of opiates. Mentally, you know you cannot get high and you risk overdose so there is no reason to use opiates. It also claims to reduce cravings. Overall, it seems like a good option. However, there are a few reasons to use caution. It can have some serious side effects. Be sure to read the link to side effects on the Vivitrol website. You cannot have any amount of opiates or opioids in your body when you take it. If you do, you will have sudden withdrawal symptoms. There is a high risk of overdose if you would relapse. It can cause liver damage or hepatitis so it's probably not a good option if you have hepatitis or liver problems. Be sure to discuss these side effects with a doctor before making a decision.

Good luck with your methadone taper. Take it slowly while learning coping skills and other psychological and behavioral techniques. And be sure to have plenty of support.

Question: My wife started getting prescribed 16mg of sobetex the doctors told her that she woukd probably need to increase her dose, now he won't write her another perscriptuo, because someone told him she was selling her medication. While, she is 35 months pregnant how harmful is quitting cold turkey for my unborn child.

Anna Deeds Says...:

Thank you for your question. Withdrawal symptoms are extremely dangerous to an unborn fetus. Your wife needs to continue taking Subutex at least until she gives birth. She would be at higher risk of having a miscarriage if she suddenly stops taking Subutex while pregnant. I suggest you talk to her doctor who was prescribing the Subutex and remind him that it is dangerous for her to suddenly stop taking the medication while pregnant. If he will not prescribe it, then you must take her to another doctor. Be sure she lets her OB/GYN know that she is on this medication. Her OB/GYN may be able to help you find another doctor or consult with her doctor to be sure she continues the medication. If you need to find a doctor, there a treatment locator on the SAMHSA website. Some additional information about pregnancy and Subutex: She cannot breast feed while on Subutex because it will pass into the milk. The baby may go through withdrawal but it is still safer for the baby than if she goes through withdrawal while pregnant. Even if the baby does have some withdrawal symptoms, it does not mean your baby won't be healthy. While it isn't ideal to get pregnant on Subutex, you can still have a healthy baby that meets normal developmental milestones. Here are some other links to information on pregnancy and Subutex:

Suboxone Talk Zone

Food and Drug Administration

NIDA

SAMHSA TIP 43

I hope your wife gets the treatment she needs. Congrats and good luck with the baby!