Wednesday, 27 June 2012

Precipitated Withdrawal's ... A Painful Reality Check

I learnt a valuable lesson last night.. 12 hours isn't long enough to wait before taking suboxone!

I've been really struggling recently, every week I run short of my MST, the 600mg daily im prescribed just isn't enough. The problem is, because I stabilized for a good couple of months at 600mg, my doctor now doesn't think I need more.
Obviously my heroin use on top has blown my tolerance through the roof. 

I've had to come up with stories about loosing my medication, over-using it because I have a cold and am mistaking the symptoms for WD's etc, but last night was the final straw.

I was 24 hours short again, I wasn't too worried because I had 4mg in total of suboxone stashed, I thought this would be enough to get me through, maybe not comfortably, but enough nether the less.

I had my last shot at 4pm Tuesday afternoon, so by midnight I was starting to feel it.. the sickness was in the post as sickboy would say.
After some quick research I concluded that 12 hours was pretty much the minimum time needed before taking the subs.. this was suboxone too by the way, not subutex.
3am came, and I was really starting to feel it, 11 hours post last hit. So i nibbled a quarter of a 2mg suboxone and waited 45 minutes,.. nothing.. so I had a half, 1mg.. and waited again.. 
An hour later I felt a slight lessening of symptoms so I just shoved the rest of the other 2mg down me neck.

Well... the rest is a bit of a blur.. within half an hour I had grey, cold clammy, sweating skin. My bowels had turned to water and the snot was pouring out my nose. 
I started to panic, im asthmatic, and with the sudden lack of opiates suppressing my cough reflex I felt like someone was sat on my chest.

I was tearing the flat apart, quietly, trying not to wake up my boyfriend, anything!, I must have something stashed somewhere!
By 5am I was freaking out and felt like  I was three days into a methadone withdrawal.

I decided my only option was to call an ambulance and go to the ER. Through the snot and tears I was apologizing for wasting theyre time with my self inflicted, non emergency call out.
They were all lovely though and took me up to the hospital. 

It didn't occur to me until this morning that it wasn't just normal withdrawal I was experiencing, but the dreaded 'precipitated withdrawal' that happens when buprenorphine and naltrexlone is taken when you still have opiates in your system!

When the paramedics handed me over to the triage nurse in ER, she actually looked me up and down and said 'so, sorry, what's the actual medical issue?' .. I looked at the paramedic and said  ' yeah, that's exactly why I shouldn't have come'  haha.. 
The nurse just couldn't understand why I was there, no injury or obvious complaint.

She told me to go sit down and wait... The doctor will see me but there's a three hour wait..!
THREE HOURS! .. That's the one thing I dont have!... TIME!

By this point I thought I was going to pass out, I was dizzy and couldn't sit still, honestly the last time I was that sick was at rehab doing a cold turkey from 90mls of methadone!

At some point the doctor saw me, I told him all I needed was some methadone but they don't have methadone in ER, he was worried about giving me anything as he didn't want to OD me, if only he knew what my tolerance is like! I can easily get through 3grams of heroin a day plus 600-1000mg MST IV.. I finally managed to get 60mg codeine phosphate and 10mg diazepam out of him and sort of slipped into an uncomfortable sweaty sleep....

9am the 'substance misuse' nurse came to see me, told me they weren't going to admit me and all she could do was take me over to the 'specialist addiction unit' at 10am when they open. Then she just disappeared

I took myself over to the SAU at 10am but all the doctors and key-workers were in the morning meeting, and my psych wasn't even on site.. Now im just so tired, sick and pissed off I didn't know what to do. 
Im stuck 5 miles from home and a possible H link up, they they tell me I won't be dealt with till after 1.30, and even then theres no guarantee of getting any medicine.

I get a cab home, borrow some cash and go score.. like a zombie.. sick, no sleep, crawling down the road to my link, i make it, then I have to get to the park toilets.. Finally, I make it, I cook up, im telling myself 3 minutes, 2 minutes... I get it in.. I stare at the mirror at my pupils like saucers waiting for the gear to hit and them to pin... im waiting.. I just shot near enough half a gram of decent heroin.. nothing!.. Nothing happens!

It dawns on me as I tear up that the subs are blocking my opiate receptors.. I only had 4mg! Im still sick...!
I manage to blag some MST and shoot 200mg three times in a row.. NOTHING..

Its taken my all day, and a ton of gear to feel normal again, I literally cannot believe what's just happened to me!

So guys and girls, what's the moral to the story!? DON'T take subutex/suboxone 11 hours after shooting gear when you have the tolerance and habit of an elephant!


Fallen Angel... said...

I did that except mine was subutex. At first it felt like it was helping so in my effed up head I figure more wud bd evdn better. Uh no. I went into thr precip wd nd just like yu thought I was gonna die. I was amazed at the amount of liquid that was able to cum outta my face. That was the LAST time I ever tried using those. Hope yu feel better.

karl said...

Hi Sid

Does suboxone contain natraxone ?
I've done subutex on & off for years & switched quite happily from it to gear. I've gone into withdrawal twice on it but that's only ever been on the first dose & extra subutex brought me out of it once & gear brought me out of it the other time.
I know people react differently to these drugs, but what I'm really interested in is, What is the actual difference between subutex & suboxone ?
Take care Sid

karl said...

Hi Sid
I've gone into withdrawal twice with subutex in similar cicumstances to you. However the first time a small hit of gear sorted me out & the second time extra subutex did the trick.

I've never tried suboxone & am interested to know in what way it it is different to subutex, Does it really contain naltraxone ? I've tried naltraxone & know that on a full dose you have no chance of fighting through it, but I've taken small doses & when the shit hit the fan I've managed to overcome it but that was years ago when the gear was a so much better than it is today.

Hope you feel better soon

Sid said...

Oh mate! It was fuckin horrendous!

Yeah suboxone is a mix of buprenorphine and naloxone, the nal has no effect sublingually though, it's literally only there to stop people shooting them.

BUT, buprenorphine alone is a partial agonist and antagonist, it's also highly competitive and will fill the opiate receptors with itself, emptying any other opiates. This is why precipitated withdrawals occours. You'd think I'd know all this shit too! I still fell into that trap!

I think it acts mainly on the mu receptor, not so much on the others, so theres not such a high with it. It also quite succesfully caps the receptors and blocks other opiates in high enough doses, typically over 8mg, I only took 4 but that was more than enough to leave me sick all day yesterday, shooting gear and MST to try and get well with nno effect whatsoever, all I could do was wait for it to wear off!

Not fun... Won't be doing that again.. If I need to stop gap then methadone is the way to go.. if you have a habit anyway.. Opiate naieve peeps can get high off them

Sid said...

Haha Angel, yep, it is mad how your whole body goes into reverse.... Everything liquidises, there is a medical reason for it, something to do with the cells suddenly starting to overproduce .. Opiate wd sure had some strange symtoms..

Fallen Angel... said...

Yea it was crazy enough to scare me away from em lol. Which says alot that sumthin was so bad it scared me considering most things dont even as bad as wd alone scare me my dumb ass keeps getting a lil here nd like there. Tomor makes 2wks since I detoxed nd thought I was gonna die bcz I went cold Turkey nd I made it thru started feeling better nd on day 7 decided doin a 20 wudn hurt. Wrong. Was si k for 2 days after but not as bad. So my genius brain decided today another 20 wudn br that bad. I swear I wana move its just to easy to cop when yur pretty lil white girl nd my dude is all about tryin to make me his girl. But anyways. I have dr apt next week to get put on suboxin bcz there's no way I can handle paws nd the cravings nd sooner then later my 20 once a wk will turn into more often then ima b right bak to where I was. Desperate to stop nd weighing out weather just offing myself wud be best for everyone involved. So gonna pay this dr 400 to Ger a new addiction. But hey. 400 a month is way cheaper then 300 a day that I was spending. So we'll see how it goes. And just wanna say yur blog has helped me tons these last 2 wks. So thanks. Check mine out if yu Ger a chance nd are bored lol. Hope all is well! !

Anna Young said...

The same thing happened to me the first time I took suboxone. Rapid withdrawal, and I would never wish it one my worst enemy. I was on 140mgs of methadone plus a two gram h habit. I was suppose to reduce my methadone down to at least 30mgs, and down to at least a quarter gram of dope.

I thought this was just doctors trying to get me off dope and methadone. I was stupid and did no research before hand. Plus, I was suppose to be in full withdrawal at least two days before taking the suboxone.

Like the idiot addict I am, after around 18 hours of methadone and h withdrawals I took two 4mg suboxone. Within 15 mins. I was in accute withdrawal. My bowel movments liqued, sever stomach cramping, uncontrollable leg movements, my sight went blurry, and the worst of all every emotion that I was dulling with opiates came rushing back. It was as if every emotion I felt was intensified times a thousand.

I called my doctor in tears and asked him what would make me feel better. I begged for methadone, and he told it wouldn't help. No opiate would work to take away the withdrawals. He wrote me scripts for colonidine(blood pressure med known to help a little with opiate withdrawals) Valium 20mgs, and Depakote. Even with those meds I was in accute withdrawals for 24 to 35 hours no matter how much h I banged, and valiums I took.

People, never ever take suboxone until you have tapered you methadone, and wait at least 24 hours after your last shot of h or dose of methadone before you take suboxone to stop dope sickness.

Anna Young said...

Yes suboxone contains natraxone, subutex does not contain natraxone. This is why people who take subutex have no idea what it's like to be thrown into accute wd. You seriously think you'er dying the most painful death an opiate addict could die when you take suboxone before your habit is way down. Subutex is a million times better than suboxone.

Anna Young said...

I always thought it was the naltroxone that put me in accute wd, but it's the buprinorphren huh. The worst part is knowing you did it to urself nd there is NOTHING you can do but wait it out.

Fallen Angel... said...

Yea I can say the exact same happened to me Anna. It was awful. Worst part for me besides the fact that it felt like my entire body was turning into liquid nd trying to force itself out was I didnt have a dr and considering my habit was totally secret from everyone I knew I had no clue wat was going on or wat to do. The person I got mine from said I shud try nd take more maybe that wud help bcz they had no clue about precip wd so of course I did nd eventually had a coherent enough thought sumthing was deff wrong nd looked up stuff online nd figured out wat I did nd wat was wrong. I ended up drinking so much nyquil to knock myself out bcz I cudn score til at least 2 days later. I seriously wanted to die.

I seriously encourage ppl to NOT do the same. Not unless yu actually enjoy dying without death. I did a 20 bag today and of course im pissed at myself but im gonna try really hard to not do anymore after today so when I go see this dr next wk I kno for sure there's nothing in my system.

Its just so hard doing life shit sober. Its like nothing is happy anymore nd just walking to my car drains every ounce of energy I have. Then like today I do a lil 20 nd had thr most amazing day with my husband. Other then the fact now I feel guilty bcz once again I lied to him nd am pretending things are going great.

Gledwood said...


When I was on Subutex and went through a messing around stage ~ using on top of it, having to go back on it... and so on... I found that if I took the Subutex and waited about 2 hours, then took a tiny bit of street gear on top, the gear seemed to rush to the receptors not covered by the Subutex and make me feel instantly better. And I'd feel better all night and into the next day.

Subutex also slaughtered my opiate tolerance so bad I could OD on a third of a £20 bag.

I recently got changed back to my old methadone clinic, because the council moved me back to the borough I'm actually from. Anyway, the first person I saw, who was the Duty Worker, suggested I might go on Subutex to come off my habit. I'm currently on methadone 25mg. Up from 20mg. But down from 120 (and more). I'm so wary of Subutex what with having to go sick and all that. And the fact my sleep just shrivelled to practically nothing. And stayed that way for weeks. And the weird way you feel so wide awake. Etc...

Years ago I remember saying to the titration nurse, who used to be my worker (not because I needed titration, I think she thought I was mental or something) well anyway I said to her yeah I'd like to go on Subutex but I'd really need some Valium to go with it as Subutex on its own is just too jittery. A point that everybody I know who's on Subutex would agree with. She shrugs and says Never heard that one before..!

Drug clinics drug clinics drug clinics... it's all secrets and lies!

Mitchell said...

I dont get iT....I have taken heroin while on subutex and it works on me just fine. Even if I take 2mg of subbies I still can feel the affects of H...I think it depends how strong your immunse system is and your receptors..I had a test not too long ago and every part of my body outinside and inside is perfect, nothing abnormal about my liver enzynes, testorine fine, heart perfect etc,..Then again I look after myself well, I excercise, eat right, have a stress free life, got a nice home, get on with my family, got a nice job, got 100s of subbies, methadone, morphine and other opiates at home and got enough cash to last me years on end. Only issue is I am on subbies and wanna get off thatm amn tapering at the moment, but I do know for a fact H always gets through.

Sid said...

Haha, well it seems we've all done it at some point! I can't believe even I fell for it! My psych wasn't too happy, she said the same.

I think it's different for everyone Mitchell, I've heard people say they've experienced blockading at 2mg too. Officially the blockade dose is around 8mg but I can vouch, 100% that 12 hours after taking it I shot half a gram of heroin which did precisely NOTHING!
I mean, I just burst into tears, nothing happened!

Just gotta wait for that bitch to wear off :/

Hey Anna, yep people get confused with the difference between the two, subutex is just plain old buprenorphine.
Suboxone has added Naltrexone. The nal only has any effect when taken IV though, orally it isn't absorbed so it's literally only there to stop people shooting it.

Precipitated withdrawals will occur with either drug as bup is a highly competitive on the mu receptor mainly.
As we know it's a partial opiate agonist AND antagonist, it basically kicks out any opiates in the receptors and fills them with bup.

I massively underestimated the amount of time between my last dose of H and the bup, I think I was 14 hours in but as I've discovered MST has a longer half life than H!

Anonymous said...

Hello mate remember me ?Gavin ...anyhoo as you found out 12h is far.
too short a time to take sub after gear or mst as a rule of thumb 24h is the minimum 36h being better basically just before you start shittin yer pants and puking - a little bit of yawning and a few sniffles dont cut it. Tried calling u the other day to see how you were getting on tx me some time
Take care mate

Anonymous said...

Hey, thx for sharing. Ive been on h for 2-3 years and have to quit, but sub doesnt seem to b the answer.jus another addiction. God bless, man. It sux!!