Question: I am taking suboxone for the past 4 years. I want to stop taking suboxone but I am afraid of having panic or anxiety attacks. Is suboxone helping anxiety or contributing?

Yerachmiel Donowitz Says...:

Suboxone is not designed or even given to have an impact on anxiety. The question is if you have had any issues with anxiety and either the thought of not having the support of suboxone or experiencing discomfort in the withdrawal process, that could trigger an anxiety attack if you are already prone to anxiety attacks. If you are using suboxone legally, consult the prescribing doctor. Ifyou are getting it by some other means, consult you mental health professional about your anxiety and things that can provoke an anxiety attack.I hope this information will be helpful to you. There is always a preference not to take even prescribed medication if not absolutely necessary.

Question: hello dr i 32 years old and i have used buprenorphine about 3 years, i use quarter of one pill every day i want to put it away please tell me what to do

Yerachmiel Donowitz Says...:

On one hand it sounds like you are taking very little. On the other hand, the mere fact that you are asking the question, you realize a little bit is still significant. You are correct. The only way to "put it away" is to first determine is it doing anything for you now other than preventing you from going into withdrawal if you would stop. If it is doing something for you, what will take it's place. If it is just maintaining itself, you are ready for the next step. If you are getting it legally, see your doctor and discuss what you want to do. If it is illegal, see an addictionologist and let him check that it is safe for you to drop down further and he can give you something to ease the transition.

Question: I only got addicted for about 11 months. How long should I stay on Suboxone for?

Yerachmiel Donowitz Says...:

This is a very delayed answer, but worth answering in any event. Suboxone treatment has no fixed timeline. It varies greatly from one individual to the next. There are three basic guidelines that need to be kept in mind that even in your case. First, give full year to basically change your life. Change you "playmates and playgrounds. Change how you will deal with emotional or even physical pain. Change how you will deal with unpleasant turns of events. Once you have established a new, drug free healthy approach, you can move on to step two. Step two involves taking an honest look at your life and determine if is as "normal" and stress free as it gets. At this point you can move into step three. Work together with the prescribing psychiatrist to taper down. A unilateral approach is a set up for relapse.

Question: I have a friend who has been reported to a professional board for narcotic use. She has been prescribed a small dose 25 mcg of a Fentanyl patch for systemic lupus nephritis joint pain . She works 40 or more hours a week and is a single mother . Will transition to Suboxone all ow to keep her license ; job ; insurance ? Or should she enter diversion program . The medication has improved her ability to work and she says she is not altered by it . On the other hand she suffers from anxiety and depression which she is told by a psychiatrist will improve with getting off opiates . What about suboxone ?

Yerachmiel Donowitz Says...:

The first thing that needs to be established is how bad is the pain? Is it something that the person is ready to put her job on the line for? It could be. If yes, why is not ok for her to take a legally prescribed pain medication? Would decreasing the anxiety and depression have enough of an effect to reduce the pain so it is "acceptable". Generally speaking, in her case, Suboxone is not a recommended path. It has very limited pain relief properties. It is known to relieve some pain, but it is not worth taking that route if that is what you really need.

Question: Is it dangerous to have a 6 pack once in a while if I am taking maintenance Suboxone? Before you say anything about addiction problems I can tell you I have never been a big drinker but I hate being that person who can’t have a few with the guys while on a Sunday afternoon. I just want a normal life again and that includes sensible drinking for me.

Yerachmiel Donowitz Says...:

The fact that you asked such a question seems to indicate you have some notion of the answer. One of the properties of Suboxone is to be a central nervous system depressant. One of the properties of alcohol is to be a central nervous system depressant. If there are too many CNS depressants in a person's system a person will not be able to breathe properly and could die. Given this as a scientific fact, the question is how much alcohol can you consume in safety. Every person is different. If you honestly think it is so important to drink to be normal, it would seem that alot less than a six pack can accomplish that. If you can stick to your own self imposed limits, then addiction is not an issue, if you can not, make excuses or change the rules, then addiction is a problem.

Question: I am really determined to quit. I am not ever going to try to inject my Suboxone or anything extreme like that. Is there any advantage to taking subutex over Suboxone if I am sure I am not going to try to use this medication for abuse purposes?

Yerachmiel Donowitz Says...:

It is great that you are determined to make a positive change in your life. Generally Subutex is used for the detox phase and Suboxone is used for maintenance. There is an issue with Subutex that makes it subject to abuse. It does not block the high that you could get if you were to use opiates while using it. I recommend that you go to a Dr. that has the special license needed to write the script and let them handle it. Getting things from the "street" is just a continuation of old behaviors that you are trying to stop.

Question: Do you support or recommend the herb kratom for people going through heroin withdrawals? Do you think that people will get addicted to it if they just use it for the first 2 weeks?

Yerachmiel Donowitz Says...:

"Do you support or recommend the herb kratom for people going through heroin withdrawals? Do you think that people will get addicted to it if they just use it for the first 2 weeks?"

This herb is unregulated and not that well known in this country. It seems clear that it is addictive. It could be that it may help with opiate withdrawal and as a step down withdraw from it. The issue is how much for how long and if what you get is pure. It seems a little like playing "Russian Roulette". Physical addiction is one powerful aspect of opiates, but the other aspects are important to address as well. Bottom line, I can not recommend it. Detox is best done under supervision and addressing the entire aspect of addiction. Good luck on your path to be healthy.

Question: I have been on norcos for 8 months. I am taking 12 10/325s per day. I know this is not a huge habit but trust me I am very addicted and I cannot stop just yet. The issue I have is that I have a knee replacement surgery scheduled for the early August. I am only 42 but chronic knee injuries from running and sports have led me to have no choice but to go full surgery. It’s also how I got introduced to pills but at this point I would be lying if I said I was taking these just for pain. So here is my worry. Obviously my doctor is not prescribing me all these pills but he does prescribe me some. I do not want to admit what I have been doing and have this on my medical records. However, if I do not reveal to him how much I am taking I am really scared that I will get insufficient pain relief during and after surgery – since they won’t account for my high tolerance. I plan to go on Suboxone after I recover from my surgery maybe by September. But I am not sure how to proceed until then. Should I be very worried about getting insufficient pain relief if I do not reveal my high tolerance?

Yerachmiel Donowitz Says...:

Having an operation will naturally cause pain. The severity which you will feel the pain is dependent on a number of factors including your tolerance to the pain medication you are addicted to. Your options are a little like buying insurance, the greater piece of mind you buy raises the cost. If you reveal your addiction you will have the greatest assurance that your pain will be treated to the fullest, but that involves your concern about your records. You could say nothing and rely on the fact that some tolerance would be expected based on your prescription. You could even voice this as a concern in advance and add that you are afraid to take a very high dosage of that medication because you could become addicted. You could then encourage them to use a different pain medication that would work differently. You can also increase the chances that you would recover more quickly by eating healthy, working out regularly and learn stress management techniques to minimize your body's pain response. Obviously the choice is yours.

Question: One reason why I got addicted to lortabs was because they really took away my anxiety. I have an anxiety problem and now I want to quit and I am really scared that my anxiety is going to be a big problem,. I am wondering if I should go ahead with Suboxone. Will Suboxone help me manage my anxiety in the same way that regular opiates do? If it won’t I don’t think it will really work for me.

Yerachmiel Donowitz Says...:

The fact that the opiates helped is no surprise. The problem is that it is an opiate and similar to using a hammer to kill an ant. Anxiety can be a lingering and constant battle and discomfort. The way to handle it is with therapy and possibly antianxiety medication as well. It is a more involved treatment, takes more time initially, but there will be no addiction and you will be a stronger, more resilient person as a result. Suboxone will probably help. If you have been taking the Loritabs for only a short time it would be better to detox from them at this point than to go the Suboxone route.

Question: Should I use tramadol to help me taper off norcos? How long can I take tramadol for before I get addicted to it? I have heard that it can help with withdrawal symptoms but if you get addicted it is a bad one to detox from. Also, one of the hardest things for me to deal with during withdrawals is the restless legs I get when I try to sleep. They make it impossible to sleep and they are so bad it is hard to not just take a pill? What is the best way to minimize them? Are you familiar with the Thomas Recipe for opiate withdrawal at home? I see it mentioned a lot on different support forums and I was just wondering what as expert would think of it? Are there any risks to trying it this way? I am a 3 year norco addict.

Yerachmiel Donowitz Says...:

Your question about Tramadol is a good one. An expert dealing with substance abuse is really no substitute for a medical Dr. or researcher.

It has been tried for detox and there was some success. The fact that it is not widely used and the research that was done, that I am aware of, was more than five years ago, would lead me to believe it is not a good choice. The "Thomas Recipe" has some merit, but I was unable to find any reputable research on it. Opiate addiction is very tough, as I am sure you are aware. There is no simple answer. Before you get caught up in the method of detox, focus on maintenance. How to deal with cravings. Life style changes. Different ways to cope. The conviction to be sober and straight a day at a time. The issue of how best to detox will be easier at that point.