Benny called the office a few days ago to discuss refills for sleep medication.
Three months earlier he detoxed at the Coleman Institute for Addiction Medicine after 8 years of taking Suboxone® for an opioid use disorder. Prior to being prescribed Suboxone®, Benny had a bad pill habit and was close to using heroin. (He was using pills when it was still much easier and safer to buy them on the street.)
Benny is a professional in the IT world, a father of two little ones, with a strong marriage of ten years. Suboxone®, which is a mixture of buprenorphine and naloxone, was the perfect medication to transition him from using street drugs and to stabilize him as he grew into his recovery. Over the years he had a strong presence and involvement in recovery meetings and he developed a solid meditation practice. He was in a good position to stop taking Suboxone®.
Is Suboxone® a Life Sentence?
I have heard time and again from patients over the years that when they started on buprenorphine, there was often no discussion about the “end game,” or how and when they might stop.Many people told me their prescribers felt they should stay on it for life, like a diabetic who needs insulin. Others have shared that their doctors were reluctant to have the discussion or didn’t seem invested in helping them to wean down.
Benny was able to take himself down to 3 and 4 mg of Suboxone® for periods of time, but felt like he was in a constant state of withdrawal, especially when he tried to go lower. Finding our outpatient accelerated opioid detox facility was exactly what he needed, and indeed, he was off Suboxone® and onto naltrexone (an opioid blocker) in 8 days.
Life Without Suboxone®
Benny’s sleep is almost back to normal. He rarely uses the non-addictive sleep medication we prescribed to help him through the first several weeks when getting a few hours of sleep in a row was almost impossible.“Not only was the lack of sleep tough, the lack of energy just about killed me.” As a full-time father, employee, husband, and homeowner, Benny’s plate was full. He was unaware of the extent that the Suboxone® was keeping his energy going, that his own body had stopped making dopamine after years of having it supplied externally by a pill.
UNDERSTANDING ACCELERATED OPIOID DETOX
Energy Without Opioids
“That’s finally getting better, too,” he told me gratefully, “There were a few moments when I wondered if I’d made the right decision to get off the Suboxone® — it is so easy to let life just continue, and not rock the comfortable boat…but I knew I didn’t want to be on this stuff forever, and I knew my recovery was strong.”When I asked Benny what advice he had for people who were experiencing the same difficult post-opioid-detox energy slump, these are the suggestions that helped him:
- Drink lots of water. Keep flushing your system and stay hydrated.
- Resume (or start) an exercise regimen, but keep it really humble at first. “Just making myself push a stroller around a few blocks became my greatest ambition when I first returned home. Eventually the walk became longer, and within three weeks I was slowly jogging again. I’m back to my daily four to five mile run now….The exercise is super important.”
- Keep a journal. For Benny, spending about 15 minutes a day before anyone else was awake, gave him a chance to focus on his intentions. He would often read some inspiring literature and use that as a starting point. It also included a place to check off his accomplishments; a way to document-visually — the progress he was making. Meditation is a huge part of Benny’s life, and he believes his ability to sit still with discomfort-be it physical, mental, emotional, or spiritual — largely comes from this practice.
- Benny swears by his daily vitamins and probiotics.
- Prioritize sleep. He made a rule for himself to have lights off by 10:00 pm and to arise no later than 6:00 am. Moving with the earth’s light cycles is known to help people function optimally.
- Importantly, he leaned hard on his recovery community. His early sobriety was formed on the bedrock of NA, AA, and immersing himself in step work and having a sponsor. He re-entered that world, which helped him to remember why he was making this difficult choice.
Joan R. Shepherd, NP
