Subutex Withdrawal

Subutex withdrawal is a normal and predictable consequence of a sudden drop in Subutex levels in a person who is physically dependent on this type of drug. Your doctor will diagnose you as being physically dependent on Subutex if you experience flu-like symptoms when you skip a dose or take an inadequate dose.

Subutex withdrawal appears as a set of uncomfortable physical symptoms that can last five or more days. Psychological symptoms of withdrawal may last much longer, especially if left undetected or undertreated.

Causes

Your body adapts to the presence of certain substances, including opioids. Your body can grow tolerant of these substances, which means you have to take ever-stronger doses to achieve the intended effect.

With long-term use, your system could become dependent on the chemical. This means you must continue taking Subutex in order for your body to feel normal. If you allow Subutex levels to drop, your body will struggle to maintain chemical balance; you will feel this battle for chemical stability through withdrawal symptoms.

Physicians call this process "detoxification." Detoxification can be brought on by skipping a dose of Subutex, taking an insufficient dose or using a drug such as naloxone to reduce opioid levels.

Sometimes going through detoxification is called "going cold turkey," a reference to the pale, cold and clammy, bumpy appearance the skin takes on during withdrawal, somewhat like plucked poultry.

Facts

Subutex contains buprenorphine. Doctors prescribe Subutex to help patients overcome addiction to opioids but it is possible for a person to become addicted to Subutex. The FDA approved Subutex for use in October 2002.

About 9 percent of people abuse opioids at some point in their lives. Opioid drugs include heroin, codeine, morphine, OxyContin, Dilaudid, methadone and other drugs.

Many Americans struggle with opioid dependence. Even though Americans represent only about 5 percent of the world's population, according to the Institute of Addiction Medicine they use about 80 percent of the world's supply of opioids.

More of these Americans seek help for their opioid dependence than ever before. The Substance Abuse and Mental Health Services Administration reports that admission rate for opioids (other than heroin) leaped 414 percent in just 10 years. In 1997, only about seven people in 100,000 people sought treatment for opioid dependence. In 2007, this number climbed to 36 patients per 100,000.

Sometimes, patients become dependent on the medications prescribe to treat substance abuse problems. Chronic use of any opioid, even therapeutic drugs such as Subutex can cause opioid dependence and addiction. Anyone can develop a Subutex addiction or dependence if she takes this drug more than a few weeks. Consuming large doses of Subutex, using it longer than prescribed or using Subutex in an unsafe way increases your risk for developing dependence or addiction. About 25 percent of Subutex consumers suffer withdrawal symptoms if they stop taking this medication suddenly, especially for those who use Subutex for long-term treatment.

The intensity and duration of withdrawal symptoms may depend on how long you took Subutex. Withdrawal symptoms associated with Subutex detoxification are painful and demoralizing, but usually not life threatening.

Abuse, Dependence and Subutex Withdrawal

Medical professionals associate opioids such as Subutex with a high risk for abuse, physical dependence and addiction. The U.S. Drug Enforcement Agency, or DEA, classifies substances according to their potential for abuse, and classifies as a Schedule III narcotic. This means Subutex users face a moderate risk for drug abuse and mental or physical dependence. To reduce the potential for abuse, the DEA prohibits refills on Subutex: a doctor must write a new prescription when she determines the patient continues to need Subutex.

Some opioid-dependent or addicted individuals try to get around this law by placing an emergency call after hours or showing up at the doctor's office just as it is closing up for the day to pressure a doctor into writing a prescription without determining the patient's need. Another tactic is to go "doctor shopping" in an attempt to get as many written prescriptions for Subutex from as many different doctors as possible.

Some Subutex abusers present phony prescriptions to pharmacies. A person might pretend to lose his prescription to get multiple copies or even tamper with written prescription to get more pills in each bottle.

Symptoms

Subutex withdrawal typically causes symptoms similar to the flu, but detoxification is also associated with psychological symptoms whose demoralizing affects can be as overpowering as physical symptoms.

The physical symptoms associated with Subutex withdrawal last for five or more days, with the worst symptoms appearing on or about the fourth day. You can relieve these withdrawal symptoms by taking a variety of medications to address each symptom, use a drug that mimics the effects of Subutex or by taking another dose of Subutex. Without medical attention and professional support, it is very tempting to take another dose of Subutex to reduce uncomfortable withdrawal.

Physical

The physical symptoms associated with Subutex withdrawal include:

  • Abdominal Cramping
  • Diarrhea
  • Fever, Runny Nose or Sneezing
  • Goose Bumps and Abnormal Skin Sensations
  • Hot Sweats and Cold Sweats
  • Insomnia
  • Low Energy Level
  • Muscle Aches or Pains
  • Nausea or Vomiting
  • Pain
  • Rapid Heartbeat
  • Rigid Muscles
  • Runny Nose
  • Shivering, Tremors
  • Teary Eyes
  • Yawning

Psychological

The physical symptoms associated with Subutex withdrawal present a significant obstacle for those trying to overcome opioid dependence. Psychological symptoms of Subutex withdrawal may make you feel you are unworthy or incapable of recovery. Left untreated or undertreated, the psychological symptoms associated with detoxification from Subutex increase your risk for relapse to opioid abuse.

Psychological symptoms of Subutex withdrawal include:

  • Agitation
  • Anxiety
  • Depression
  • Hallucinations
  • Irritability
  • Poor concentration
  • Restlessness
  • Social isolation

Possible Complications

After any amount of detoxification, you are at increased risk for overdose if you return to Subutex withdrawal. Detoxification reduces the body's tolerance to opioids. Even after feeling moderate withdrawal symptoms, a person can potentially overdose on a smaller dose of Subutex than he used to take. While the risk for Subutex overdose is lower than methadone overdose, it is still possible to take too much Subutex.

Another complication of detoxification from Subutex is vomiting and then breathing the stomach contents back into the lungs, a condition known as aspiration. This complication could cause fluid in the lungs or lung infections. Severe or prolonged vomiting and diarrhea may result in dehydration that, if left untreated, could cause other serious medical conditions.

Relapse is the primary complication associated with Subutex detoxification and withdrawal. You may experience several cycles of relapse and remission, especially if you attempt detoxification without the help of trained professionals.

Treatment Options

There are two phases of treatment for Subutex dependence: detoxification and rehabilitation. Detoxification is the medical process of decreasing opioid levels and treating the ensuing withdrawal symptoms.

Rehabilitation focuses on the cognitive and behavioral aspects of opioid dependence. Rehabilitation typically includes behavior modification, counseling and other forms of therapy designed to give you the tools you need to live without Subutex.

Detoxification

Many people receive Subutex as drug replacement therapy to help them overcome dependence on other opioids. Some people subsequently grow dependent on Subutex and experience withdrawal symptoms when they stop taking this medication.

Self-Detoxification

After successfully overcoming addiction to the first opioid and participating in some amount of behavioral modification, you will eventually have to wean yourself from Subutex. You may be tempted to try quitting alone, without the help of medicine to reduce withdrawal symptoms, in a process known as self-detoxification.

Self-detoxification is a challenging course of treatment. During self-detoxification, you are unprotected from the uncomfortable withdrawal symptoms commonly associated with other opioids, such as diarrhea, abdominal pain, cold sweats and muscle pain. The complications and overwhelming symptoms of withdrawal may cause you to start using Subutex or other opioids again.

The Thomas Recipe

Some use homemade treatment plans designed to reduce symptoms associated with self-detoxification. Once such concoction is The Thomas Recipe, where you take prescription medication to calm your nerves and help you sleep, products that ease diarrhea plus vitamins and supplements to soothe muscle aches and fatigue.

While the Thomas Recipe can ease Subutex withdrawal symptoms, you are still at risk for complications and relapse. Self-detoxification and the Thomas Recipe address only the physical aspects of Subutex withdrawal; these home remedies do not deal with the behavioral aspects of your addiction. This gap increases your risk for relapse or overdose of Subutex or other opioids.

Overdose

Rehabilitation professionals recognize relapse as the largest complication associated with quitting Subutex and other opioids. Detoxification reduces your body's tolerance to Subutex while relapse increases your risk for overdose; you can accidently overdose on a lower dose of Subutex than you used to take before you experience Subutex withdrawal symptoms.

Overdose is a serious, possibly fatal medical emergency. Seek help immediately if you suspect that you or someone you know has taken an overdose of Subutex.

Overdose symptoms include:

  • Extreme Drowsiness
  • Pinpoint Pupils
  • Nausea
  • Vomiting
  • Diarrhea
  • Confusion
  • Ringing in the Ears
  • Cold, Clammy Skin
  • Muscle Weakness
  • Fainting
  • Weak Pulse
  • Slow Heart Rate
  • Coma
  • Blue Lips
  • Shallow Breathing or No Breathing

Overdose requires immediate professional care. In the emergency department, doctors administer naloxone and other medications to reduce opioids to non-toxic levels quickly. Nurses monitor your vital signs, watch for complications and perform CPR and other life-saving measures as necessary. Once your Subutex levels are within safe levels, you can continue your behavioral therapy program as an outpatient.

Drug Replacement Therapy

Specially trained doctors may now prescribe Subutex as part of outpatient drug replacement therapy, or DRT, out of their regular offices. Other DRT medications such as methadone can only be administered in special clinics.

DRT drugs like Subutex bind to the same opioid receptors in the central nervous system as opioids do. This fools the body and, as a result, you do not feel withdrawal symptoms. Subutex lasts longer than other opioids, such as oxycodone or codeine, and do not produce the same intense euphoric effects, but it is still possible to become dependent on Subutex. Subutex and other DRT medications allow you to participate in treatment without a hospital stay.

DRT supporters point to the flexibility of this type of outpatient treatment while opponents say it is merely trading one addiction for another. Some patients struggle with DRT for years, unable to free themselves from drug addiction. Harvard Medical School says that about 25 percent of DRT methadone patients eventually quit opioid altogether, while another 25 percent continues to take the drug and 50 percent go on and off methadone.

Inpatient Detoxification Programs

Inpatient detoxification programs use medicine that eases your withdrawal symptoms. During this type of detoxification, physicians give you medicine to lower your Subutex levels alongside other drugs that to relieve the withdrawal symptoms. The nurses and doctors will watch over you for signs of dangerous complications, such as dehydration or aspiration, and take lifesaving measures whenever necessary. While this type of detoxification eases your physical withdrawal symptoms, you must still withstand the demoralizing psychological aspects of Subutex withdrawal.

Rehabilitation professionals and patients alike consider rapid detox to be the most humane method of dealing with Subutex withdrawal. During rapid detox, board-certified anesthesiologists will give you the standard detoxification and anti-withdrawal medications plus anesthesia and sedatives. You will nap in a comfortable "twilight sleep" rather than battle uncomfortable withdrawal symptoms. When you wake up a few hours later, you will not recall the grueling and demoralizing detoxification and withdrawal process. You can now complete the rehabilitation process without worrying about facing Subutex withdrawal again.

Rehabilitation

Medically-assisted detoxification is only the first step to recovery and, by itself, does little to change behaviors associated with substance abuse.

No two cases of opioid dependence are exactly alike, so no single treatment is right for everyone. Individual, family and group counseling and other behavioral therapies are the most commonly used forms of treatment. Treatment options range from weekly or monthly visits to outpatient clinics to long-term residential facilities.

Many drug-addicted individuals also have other mental disorders. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

No matter what form of treatment you choose, your treatment needs to be readily available to encourage participation. Quitting treatment and relapse are common; convenient therapy improves participation and completion rates.

Addiction and opioid dependence are complex but treatable diseases that affect your brain function and behavior. It is critical that you remain in treatment long enough to restore neurological dysfunction caused by dependence on opioids.

Your treatment for opioid dependence and Subutex withdrawal needs to attend to your multiple needs, not just your substance abuse. Many people experience mental disorders or social problems in addition to opioid dependence.
Your counselor will continually assess and modify your treatment plan to ensure it meets your changing needs. Your counselor may also monitor you for drug use during therapy, as lapses are common. Treatment may include assessment for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases. Your counselor may give you information to help you modify your behaviors in a way that reduces your risk for contracting or spreading infectious diseases commonly associated with substance abuse.

Treatment does not need to be voluntary to be effective. According to NIDA, individuals under legal coercion tend to remain in treatment longer than and do better than those not under pressure.