HOW DO I GET OFF SUBOXONE?

How do I get off of Suboxone?
There are multiple ways, as with most things, everybody thinks their way is the best. The way we are going to discuss here is weaning, in which you gradually decrease your dose over time until you get to where you’re taking a small enough dose that the withdrawal is not very bad.
What I’m going to present here is just one way, you can take it or leave it. It’s totally up to you.
If you were to stop your Suboxone today, you would most likely not have any withdrawal symptoms until day 3.  But after 12 hours, most people would begin to freak out and think you needed a dose.  This is the obsession of the mind they talk about AA and is called a craving.
To avoid craving we are going to WEAN.
Take whatever dose you are on. A strip or a pill is 8 mg for most people.  If you are using another milligram, taking a different dose or type of Buprenorphine, you do it the same way in general.
What I tell my patients to do: “is just to try it.” Try to cut your dose down a little bit, even if you are not going to get off. You will feel better on a lower dose than a higher dose. You will have more energy and less side effects.
This is one way to cut up your suboxone dose.

(MISSING PICTURE CAN BE FOUND AT ROBERT WESTCOTT MD FACEBOOK OR ASK ME)
 

The sane process can be done for pills.
 
So the goal is, we are going to remove such a small piece that there is no way your body will notice it. The first time, I want you to remove 0.13mg. That’s all. If you remove that much from your daily dose:
 Do you think you will feel it?   I don’t think so.
Then the next day you do the same thing. And the next. We usually do this for a 2-4 weeks just to get the hang of it. I want my patient to notice that they can do this without ever feeling it.
          Almost all of my patients come back in and say “I can’t believe how easy that was, what was I so afraid of?”
The really tricky thing is however, you mind will obsess over that tiny little piece all day long. So it is better to throw it away. As soon as it is gone we somehow quit thinking about it. So throw awat the piece you cut off, don’t try to save it.
(If you’re taking a tablet, then break it in half first.  Then take one tiny piece off of one of the halves and throw it away. It’s the same principle just a different form of medicine.)
So then I tell them they’re ready to wean. Most people will start by taking 1/16 or 1/8 off their doses (0.5 mg or 1 mg) every week.  If that does not work or that they feel that is too much, I tell them they can do 0.25 mg.  Thus they would go week by week, decreasing their dose.
Most people have the weekends off work. I tell them the best day to decrease their dose is in Saturday. So we go from 8 mg to 7.5 mg on Saturday. Then comes Sunday. They see how they feel. If they feel good wonderful-keep on weaning. If they don’t, then we do this:
I always want to give my patients “a way out” if they don’t feel good. Let’s say for example, they have been weaning for 3 weeks and this Sunday they decrease their dose and they feel anxious or bad (it probably won’t happen, but if it did).  What I want them to do is go back to last dose they felt good at, wait another week, and then try it again.  This way you are not locked in to decreasing your dose.  I don’t care how often you have to do this.  As long as you are making progress and trying, you are doing great.  I don’t want people to feel shame because they’re not making enough progress.  Everybody is different.
Of course if you feel fine on Sunday you are ready to go. But what I really want you do is this - and it’s very important:
Pre-cut your doses for the whole week. By that I mean you will prepare your doses for the week (Sunday thru Fridays dose) on Sunday. If you don’t do this you will likely not be successful. This is because one day you will be in a hurry. Another day you will be too tired. You will not do it every day.
 
I tell people not to wean, or sometimes to stop weaning for a while if they’re having a stressful time in their life.  I tell most people not to wean during the holidays, especially Christmas, as this can be very stressful time with family obligations.  Don’t forget, addiction is a family disease.
We continue doing this though until we get down to 2-4 mg. Then we have to go slower. We will then wait 2 weeks between dose changes. Eventually we get down to where we are only taking a small dose, say 0.25mg or 0.13 mg. Sometimes, I then tell people to go to every other day for a few weeks and then every 3rd day.
At some point we quit weaning and pick a stop day
Preferably they have some vacation time at work they can use. At least a long weekend. We stop the medicine 3 days before their day off. I give them a prescription for something to sleep because that is the biggest problem they will have is sleeping. I also give them a prescription for a few clonidine and Librium 10mg tabs to help them with their withdrawal. I tell them they will have the worst case of the “Blahs” they can imagine. They won’t want to get off the couch. But they won’t feel like they are dying like they used to do when they were in withdrawal.
By getting down to such a low dose they limit the time they have withdrawal. Hopefully it will only be 3-7 days of not to bad  withdrawal. People who quit at 4 mg or above often describe feeling bad for 3-4 weeks.
There is also a rapid detox method you can do here, where you will feel bad for 24-48 hours only. We will talk about that later.
In Summary
1. Try to cut off a tiny piece of your dose, for a couple weeks.
2. See that you don’t feel it physically, just emotionally.
3. Then take 0.5 or 1 mg off of your dose each week.
4. Throw away the piece you take off.
5. Prepare your week’s dose on Sunday, so you don’t have to do it every day.
6. Take a break from weaning if going thru a stressful time
7. Don’t feel ashamed b/c you are not going fast enough, everybody goes at their own pace.
8. When you get to a low dose, you need to slow down-2 wks before dose change.
9. When ready to stop:
          A. Try to have a vacation planned so you do not have any responsibilities.
          B. Quit your suboxone 3 days before your time off.
          C. Get a Rx for sleep from your Dr.
          D. Get a Rx for Clonidine 0.1 mg and Librium 10 mg (15 each).
          E. On day 3 to 7 you hopefully will wake up and feel normal.
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