[addict_throwawa]

throwaway account obviously. this got long but here's my (five) cents.

I'm an addict in recovery. In the past alcohol and then switched to opiates (sadly all to common story of getting pills from MD unnecessarily). I haven't faced many consequences and have been still successful in tech. still not 'out' about opiates to work or friends, just my peers in recovery.

I have found the underlying hypothesis of this - group support - has been a really big help for me. I found a group for those in recovery that participate in sports (the Phoenix) which has a double punch of great community and also physical activity which is super beneficial.

For me, I think this has been the second biggest contributor to success.

But my #1 - with opiates in particular - is medicine replacement therapy. I tried so many times to get off myself. I finally got on buprenorphine which has been a lifesaver and successful to date on first try [one year!]. There are also some drugs now for alcoholism but unfortunately stimulants seem to not have great options.

It seems a shockingly low amount of rehabs use replacement therapy [1] [2] or even know about it (or even as a short term withdrawal taper tool). There are also a scary amount of overdoses from relapse post rehab.

I think the science is pretty convincing - there are studies showing even if relapse after maintenance therapy the period of abstinence before relapse is longer [3] - and also just seems like MUCH higher success rate [4].

BUT this is still an opiate! My doctor has patients who have been on for years. A lot struggle to get off. I personally don't have a problem with very long term use - personally I see parallels with SSRIs/SNRIs where many users report problems getting off and withdrawal, but obviously who would say you should get off something like prozac - a mind altering drug that has clear benefit?

The most FU part of this for me - it still takes a special license to dispense buprenorphine replacement therapy, patient numbers are capped per MD, and there is a ton of stigma all around even at pharmacies who dont blink twice doling out opiates. Pisses me off when looking at how most MDs can dole out opiates with far less training/license requirements. also pharma definitely profits - though there are now generics. i've found at least for the strips it's basically the same price. The pills without naloxone are cheaper - but for addicts struggling that gets rid of the back stop and overdose preventer.

Plus having only a few Drs in many states (or none) that charge cash or medicare only makes it in-accesible for many of the downest and out addicts. It should be free (or covered by the worst pharma co s) and FAR more MDs should be able to write script.

[1] https://www.samhsa.gov/data/sites/default/files/N-SSATS%20Rp...

[2] https://www.rehabs.com/pro-talk/opioid-addiction-treatment-w...

[3] https://www.ncbi.nlm.nih.gov/pubmed/30094695

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874458/

[Pigo]

I've heard that part of the motivation for the escalation of opiate strength (fentanyl and carfentanil) is because so many people have begun seeing success with these new therapies. The illegal marketplace has probably been losing profits.

Maybe replacement therapy isn't perfect, but I've seen it help a lot of people who are in a bad place. I wish there was more motivation for finding exit strategies, but there doesn't seem to be any profit in that.

[addict_throwawa]

my dr mentioned that he's had success with the sub cutaneous thing. it lasts a month and it seems like it's a good way to slowly taper down. and he said the bupe stays in your body for a LONG time when doing that - longer than a month after the 30 day period

it's really hard to taper down! it takes a lot of willpower not to just take more since you have it sitting around. i wonder if would be more successful with like a 1 month taper for in patient program.

[formeruser]

I tapered off of my Suboxone prescription gradually over a long period of time. By the end of it, I was taking very tiny pieces of the film. They were small enough that at some point, it was probably more mental than anything.

I wish you all the best! After getting off of it, the hardest part for me was still maintaining a clean lifestyle while avoiding the types of people and behaviors that lead to scoring or abusing other drugs (alcohol included) as well.

[addict_throwawa]

How long of a taper did you do? im not on a very high dose but was still thinking about like 3 months. but I also am 50/50 like I'm worried about the after effects you have - this is working so well now I see very little downside to long term use and the upside is really big imho - except probably harder to eventually taper off the longer I'm on.

[formeruser]

By not high, do you mean around 2-4 mgs? If so, 3 months is probably a good timeline for taking a 25%-50% reduction every 1-2 weeks or so. I might have even taken longer for the last few doses. I think the big thing is not to rush it and take a pace you're comfortable with. Like you say, taking buprenorphine is much preferable to turning to alternatives.

My first experience with a taper was at rehab as they were pushing me out the door. They rushed it, and I was dopesick as I left. You can imagine that didn't turn out well.

Another thing I credit my recovery to is having strong support along the process. Also, building new lifestyle habits like going to the gym helped me improve my self-image. I don't know how much making that sort of change would apply to you but thought I'd mention it.

[addict_throwawa]

great advice - thank you. it's helpful hearing success, and triple from those who have successful business lives especially tech/engineering/etc

yup on on 4mg.

i go to the phoenix snd got into my preferred sport again! something i gave up while using that was a huge part of my life. and it's been so good to get it back both community, new friends, and just getting back into shape.