So I’ve been going through the withdrawal process from Subutex. Regular readers know that, but some of you who may have just stumbled onto my blog might not. Subutex is what is called a partial opiod agonist, meaning that it partially stimulates the opiod receptors in the brain. Those are the same receptors that are stimulated by pain-killing drugs like morphine, heroin, and oxycodone (also opium, from which the receptors get their name). As most of you know I am in the process of recovering from my addiction to this type of drug.
Interesting right? But I bet you might have some questions, questions like:
So how does the Subutex work, what does it do, and why is it helpful for addicts? And if it helps, why would you want to stop taking it?
You might also be wondering what withdrawal is and what it is like.
So I thought tonight I would just give you as simple an explanation as possible to answer those questions.
- How does Subutex work, and what does it do?
Imagine that those opiod receptors in your brain are like big push-buttons. You know that giant red button in cartoons that always has a sign next to it saying “don’t push” or something like that? Or is it that someone always walks in and tells the guy, “whatever you do, don’t push the red button”? Well anyway, you can picture it right? So when you introduce a drug such as morphine into the brain, it is like someone hitting that red button with a giant sledgehammer. The drug hits those receptors on practically every possible surface available. But the button is made of plastic. The sledgehammer doesn’t stick to it, it just slides off after it hits the button.
In contrast, Subutex is like someone pouring a bottle of epoxy onto the button. It presses the button down just slightly, but it also adheres to the button, then hardens, making it nearly impossible for anything else to get to it.
So while taking a drug like morphine has a significant pain-killing effect but also has side effects like euphoria, intense drowsiness, loss of coordination, slowed breathing and heart-rate, decreased libido…etc etc etc…I could list side effects forever, but you get the idea…on the other hand, taking Subutex does have some pain reducing effects, but mostly it prevents that button from popping back up (after having been hit repeatedly by the morphine sledgehammer) and prevents the morphine sledgehammer from hitting it anymore.
Not making sense? Keep reading, it will.
- Why do they give Subutex to addicts if it is just another drug?
I covered this a bit in the last question, because they overlap. But this is pretty easy to answer. Because the Subutex stimulates the opiod receptors gently instead of smashing down on them like morphine does, it doesn’t create the kind of “high” that other opiods do. In fact, it really doesn’t create much of a high at all. What it does is stop addicts, whose brains and bodies have adjusted to having those buttons (the receptors) pressed constantly, from going into acute withdrawal when they cease to use the other drugs.
Subutex also blockades the receptors so that if an addict who was taking the subutex had a moment of weakness and went out to get some heroin or morphine or whatever and used it, it wouldn’t have any effect while the subutex is still in their system. And the subutex stays in a person’s system for an average of 24-48 hours which means as long as those who are using it take it at least once every 24 hours (it is usually dosed 2-3 times a day to be safe) then they are safe from both relapse and withdrawal, the two biggest issues for recovering addicts like myself.
- What is withdrawal and what is it like?
I think I talked about this one a bit on my Info page, but let me give you a more detailed account. When a person (even someone who is not an addict) uses any of a variety of substances including drugs like heroin, cocaine, alcohol or tobacco over a long period of time, their bodies adapt to those substances. It is one of the most remarkable things about the human body, it adapts to its current circumstances in order to achieve equilibrium with its surroundings. This happens with other more innocuous substances too, like caffeine, chocolate, gluten, casein (the protein in milk/dairy products), sugar, and even some herbs.
The problem is that when the body adapts to the frequent use of such substances, it develops what we call a dependence. In other words, when that substance is taken away, the body has a rebound reaction.
Whatever the effects of a drug are, the withdrawal process is usually the direct opposite. So if morphine or heroin make you sleepy, euphoric, itchy, warm, and unconcerned, then the withdrawal process causes insomnia, depression, goosebumps, cold sweats, and anxiety. And of course, since opiods are used to kill pain, the withdrawal process from opiods usually causes what is called hyperalgesia – basically the body’s pain threshold is significantly lowered so that it seems like every single inch of you hurts.
Doesn’t sound like fun does it? You’d be surprised how little difference there is between the withdrawal process for a cocaine addict vs. a caffeine addict. Just because a substance is legal or even legally and legitimately prescribed to you (as the pain medications were for me at first) doesn’t mean it won’t cause dependence and withdrawal. ALWAYS check with your doctor or pharmacist when you get a new prescription so that you know the risks.
Here’s where we get to the final and more difficult question: if subutex stops you from having to deal with withdrawal, helps with pain and cravings and prevents relapse, then why would you want to stop taking it at all?
This one is tougher for me to answer, because it isn’t science I need to answer this question, it is personal feelings. You see, all the literature says that the longer someone stays on the subutex, the better chance they have of successfully recovering from addiction. The problem is that most addicts like myself are not capable of using our medication properly, even the subutex. Now my ability to manage my own medication is increasing, and if I had access to my last few days of subutex all at once, this minute, I would probably still stick to the dosing schedule I have laid out for myself. But I have also been on the subutex for over three months, and during that time I have built up a whole lot of other coping mechanisms for dealing with pain, stress, anxiety, and cravings. If I had been given a whole bottle of subutex to myself right when I left the hospital it probably would have been gone in just a few days. I wouldn’t have gotten any high from it, but my brain would have convinced me that if I just took a few extra pills I might feel better than I already did, and I would have listened.
But now, because I need someone else to distribute it to me, the subutex has become a liability. It also ties me down. I have to make sure I have enough of it to last me because if I were to run out of it before my next doctor’s appointment, I would go into painful withdrawal which might make me want to go back to my old habits and use other drugs again. I have to take it, every day. I don’t have a choice.
And having no choice but to take a drug in order to feel normal is the same thing for me as my addiction. They are too similar. And I don’t like it. I don’t want my body to be dependent on something like this in order to function. That isn’t to say that I think medication is bad or that subutex is bad. I think that subutex is a fantastic medication and that it can work wonders for addicts who use it responsibly and who have supervision and counseling. But after a while, except in rare situations, the subutex ends up just being another addiction or dependence, and I believe that the responsible choice is for me to end my relationship with this type of mind/mood altering substance once and for all.
I will probably have days in the next few weeks when I will regret this decision. But I will have an entire life ahead of me that I can live without being tied to a bottle of pills.
I hope all those answers made sense. I really just set out to write this post to answer some questions I have had both from others and from myself as I go through this process of weaning myself off of Subutex.
If you have any questions feel free to email them to me or leave a comment.
Peace to you,
- I have been hom… (fiveyearstomediocrity.wordpress.com)
- Suboxone: Buprenorphine Treatment for Opioid Dependence (addictionts.com)
- More doctors needed to fight addiction (todayonline.com)
- Pain Medications and the Risk of Addiction (everydayhealth.com)