– Good afternoon. This is Dr. B, and the question
I wanna answer today is: What are buprenorphine withdrawals like? Just for those of you that are unclear, buprenorphine, you can think of that as the same thing as Subutex. You can thing of it as the same thing as Suboxone or any of
the other formulations that are out there, put out
by different manufacturers. We’ll just call it buprenorphine. What are buprenorphine withdrawals like? I’d like to take this opportunity. The answer to that
question is really simple, and I just wanna take this opportunity to ask the right question. The answer to what are
buprenorphine withdrawals like is that it is a partial opiate and the withdrawals are like
withdrawals of any opiates. If you’re on a large
dose, or I take that back. If you are on a dose that is prescribed that is the normal dose
for opiate addiction, let’s say 16 milligrams, 24 milligrams, all of the withdrawal symptoms you have, somewhere on the spectrum,
if you just suddenly stop, depending on how long you’ve been on it, are going to be the same type
of withdrawals at opiates. Anxiety, sweating,
diarrhea, abdominal cramps, a feeling of severe restlessness, body aches, all of the same symptoms as withdrawing off of any opiates. The reason I’m bothered
by this question is that there’s so much
misinformation out there and there’s so much handling of all of these medications out there, and some of it is being
diverted and sold on the street, and there’s so much
self-management out there. The real question is how do
I come off of buprenorphine? What are the circumstances
I come off of buprenorphine? How long should it take to
come off of buprenorphine? Before getting into that,
lemme address one thing. The studies show this. Buprenorphine, getting off
of it takes a lot quicker, in terms of withdrawals, than methadone and the withdrawal symptoms are a lot shorter than they would
be coming off of heroin. So all of this information on the internet that says, “Oh, my god, “this stuff is a nightmare to get off of. “It’s worse than heroin,”
it’s worse than this and that, that’s all false. The studies show very clearly, I will repeat, coming
off of this medication, the withdrawals are
less severe than heroin and last less amount of time
than coming off of methadone. That being said, as you can see, it’s a very easy answer,
but what really concerns me, and I wanna use this
time, is just tell you that the question is wrong. Why are people asking this question? Lemme give you an analogy
to start that discussion. Insulin is a lifesaving medication, and if you take your insulin correctly and you’re on it for your lifetime you will pretty much have a very long, healthy life, for the most part. That being said, if insulin was
being traded on the streets, you would see a lot of
deaths from hypoglycemia, low sugar, because people are trading and using insulin on their own. If blood thinner was being
traded on the street, a medication that prevents so much death, if it was being traded on the street, you would see a lot of deaths because people can’t
manage the dosing correctly and they would bleed to death ’cause they would take too much. And if they take too little, they would have all of
the other complications that you’re taking this medication for in the first place to prevent. Suboxone, buprenorphine, Subutex, Zubsolv, none of these medications work any differently than insulin or the blood thinners out there. You should, number one, it’s illegal. You can’t be trading
this stuff on the street. You shouldn’t get this medication, pick your own dosing, and decide your own detox
with this medication. It just doesn’t work. And when you have a lot of people on the streets using this medication to stay well, get well,
attempt to get well, they can’t get heroin that particular day, they use it as a commodity to make money, pick days that they wanna be high, pick days that they wanna be clean. When you’re using it in this way, also a natural outcome of that is they get off it the wrong way and there is a whole bunch
of stuff being put out that is incorrect, and that is, this stuff is very difficult to get off of and horrible withdrawals. Well, you’re not on it, you
weren’t put on it the right way, you’re not on it the right way, and you’re getting off
of it the right way. So number one, you need
to be under the care of a physician who not just prescribes this stuff and sends you off
and says, “Okay, you’re on it,” but very closely monitors you, manages you, addresses
any psychosocial issues that you may have on this medication, and assures that you
stay on the right dose for the right amount of time. Once you are on this medication, when should you get off of it and when would you get off of it? Well, there’s no real data of when and there’s no real data of how. What there is is clinical experience and judgment of an experienced clinician. That’s important. And with that clinician,
the first question is, well, why are you coming off of it? If you’ve been on heroin,
now you’re on Subutex, and you’re not overdosing, you’re not getting hepatitis C, you’re not getting hepatitis
B, you’re not getting HIV, you’re not getting soft tissue infections, you’re not getting
infections in your heart, water in your lungs, overdosing, dying, being put in prison, prostitution, and all of the other host
of social maladaptive events that occur when you’re on heroin. The question is, if you’re on Subutex and you’re on the right
dose and life is going well, why should you get off of it? And when that time comes,
how should you get off of it? And that’s going to depend,
if it’s the right time, which you need to make that
decision with your physician, and he needs to start a very appropriate, individual-tailored taper
off of this medication that’s going to depend
on your state of mind, state of life, state of health, and how long you’ve been on it. It’s very difficult to give you specifics ’cause that would be
essentially tantamount to giving somebody medical advice, and there is no
protocol-ed way to do this. Your physician should first put you on it, bring you up to the right dose, maintain you on it, and
when that time comes, whether it’s six months or six years, or there’s a decision for
you to come off of it, he should tailor a taper
that is easiest and most, or rather least painless
for you to come off of it. And in those cases I will say that there really shouldn’t be any problems with withdrawal symptoms,
coming off of buprenorphine, that are significant enough
to even write home about. I do this all the time. Different patients meet
different criteria, different standards, different
times in their lives, and we can speed up and slow
down the taper according to their physical needs,
psychosocial needs, financial needs, court
needs, family needs. But I always advise them what I think, in terms of, is it time to
come off of this medication or is it not. Other than that, if this was the way it was being done in the first place, there would be no question
about buprenorphine withdrawals, and the reason there’s a question about buprenorphine withdrawals, I think, A, there’s so much diversion
and use on the street and personal management by addicts, and that’s gonna be a disaster because you need a professional to help you manage this medication. B, there could be practitioners out there, for whatever reason
they have gotten caught up on this social discourse of, you need to get off of this
medication as soon as possible, or they do a short detox
using this medication, which I feel that is really inappropriate and I don’t think there’s any
good data validating long-term or short-term outcomes if you do that. In fact, I think it increases
the chance of overdose ’cause you jump right back on heroin and you can have a possible overdose. But the first way is that there’s so much exchange of this
medication on the street. Two, there might be situations where the physician or
the healthcare provider is not really inline, in
tune, or has the know-how of how to put you on this medication, maintain you on this medication, and when the appropriate
time for the patient is to come off of this medication. If you have any other
questions, please click here. There’s a whole host of
videos on buprenorphine, that I talk a lot more about it in-depth and different issues with it. Two, you can always leave a comment below. I will answer any questions you may have. Number three, please
don’t forget to subscribe and ring the bell. That helps us out a lot. Have a wonderful day and
good luck to everybody.