Preventing The Pain of Precipitated Withdrawal from Suboxone

Buprenorphine (brand name Suboxone or Subutex) is a life saving treatment for opioid use disorder. However, it can be a double edged blade as it can cause intense discomfort if taken too soon after a patient's last dose of opioid drugs. These painful symptoms are known as "precipitated withdrawal" and include muscle and joint pain, sweating, chills, nausea, vomiting, diarrhea, stomach cramps, anxiety, restlessness, tremors, and insomnia. Once precipitated withdrawal begins, there is little that can be done to treat it, aside from waiting for it to pass. In this video, I describe why precipitated withdrawal occurs and how it can be prevented!
If you or someone you love is suffering from problematic drug or alcohol addiction use and is seeking treatment, contact us today.
northtampaexecutivehealth.com/
We are here to help.
North Tampa Executive Health Clinic is directed by Dr. Jack McGeachy. He provides confidential and comfortable addiction treatments and therapy for opioid and alcohol use disorder. Rather than a rehab or detox, meaning that each patient is cared for one-on-one by a medical doctor, in contrast to other treatment programs. Book your in office appointment in the Tampa office or via video conferencing today.

[@tantawan6]

Why is it that most people don't mention 'Restless leg syndrone' ? arguably the worst part of the 'Jone's' when your leg's twitch and impossible to comfort them and adds up to Insomnia,

[@djxboss1]

That’s something I’m going through right this minute as Iv just switched onto subuxone 🤯🤯

[@terryvlunsford1610]

I only got restless leg after during Fentanyl withdrawal. I haven't experienced under Suboxone treatment

[@rachellejones1361]

There are a few symptoms that weren't included that I'd like to add: involuntary body movents; uncontrollable, repeated jerking of head/neck, legs, and arms; electric shock sensations; sneezing over and over; gagging while coughing that feels like you're going to choke to death (personally most dreaded)... these are the ones that I can think of right now. On another note, I want to thank you very much for these videos. They are organized and informative as well as respectful and non judgemental. Too many people in the medical field are still treating addiction (and not even understanding the difference between it and dependence) as though the patient doesn't deserve treatment. I've known people that have died as a result of these biases. Praying your videos, and others like them, help to educate more and more so that people needing help are helped rather than shunned. ❤WITH MUCH LOVE❤

[@JackMcG_MD]

Thank you for sharing your experiences! I also appreciate your kind words.

[@kakarot666.]

Yes. The sudden kicking wakes u up from sleep .. it's the most common issue for every drug users.. sadly.. . But after remaining sober for few weeks it gradually goes down. It happens very rarely. In time.. but it will remain with us forever.. just won't be frequent

[@jeanclaude1916]

and personally, those are the worst of them. i was 40 hours sober and still in percipitated withdrawl so i went back and now im afriad to get sober. its terrible

[@darrenwilliams2921]

@@jeanclaude1916 it's that fear that can cause the block , i was like it i went cold turkey and it was horrendous but it did get better after 5 to 6 days . You can now get a buvidal injection on the NHS and it works wonders ,no withdrawl and it tapers off as you reduce .

[@Animal-Reaction-Clips]

You forgot appetite, sycosis

[@Xxplicit86]

Times everything he just said by 1,000x. Worst days of my life. He also forgot to note hallucinating

[@moeruss2726]

I just had a hallucination yesterday and it was terrifying . I didn’t realize that was part of withdrawal symptoms 😱

[@JackMcG_MD]

Thank you for your comment! I really appreciate people sharing their personal experiences. Hallucinations can occur with opioid withdrawal, but they aren't a typical feature and that's why they aren't mentioned. Hallucinations are more common with alcohol and benzodiazepine withdrawal.

[@Drusiah1]

I put myself into precipitated withdrawals just a few months ago and it was absolute hell. But I’m a fan of psychedelics and it seriously felt like I was tripping for a while. Craziest thing ever. That first day sucked so bad.

[@CallMeSteve88]

I can never take suboxone after opioids for at least 4-5 days anything before that no matter how sick I am it goes 10 fold

[@kristypucciarello4626]

Why is it that Dr's downplay withdrawal? I've been on suboxone for 10 years. I never had a problem with opiates. I have a collapsed L5/S1. They said it would help with pain. And, it did. I will tell you that withdrawal is real and horrific. This is coming from a person that has never abused meds, never did anything illegal. I don't judge anyone that has had an issue. I've experienced for over a month now- sweats, chills, insomnia, Extreme LACK OF APPETITE, restlessness, depression increased, anxiety increased, can't think, can't focus on anything, feeling of oppression, want to lay in bed all day & night, serious lack- NO energy/motivation is below zero. At all costs stay away from ANY addictive meds that your doctor wants to prescribe. Most all Dr's don't know or care that people have committed suicide from withdrawal symptoms.

[@stevenphillips3466]

You Doctors need to have a much better withdrawal protocol when ending Suboxone

[@rickp3753]

Aside from the insomnia and akathisia, it wasn't bad. I was never sick. I was on 8mg films for 16 years. I jumped from .25mgs in November '22. Now I'm free!

[@tonyg702]

I've been on them for 15 years now. I've tapered down from 16mg to 0.5mg daily. In a couple days I will stop completely and fight through this. Thanks for sharing your story. It gives me hope. 🙏

[@richellmcknight446]

Yay!!! Congratulations!!! That's a powerful feeling, isn't it! I'm almost there myself!❤❤❤

[@MrN75nokia]

Congrats keep up the sobriety

[@rickp3753]

@@tonyg702 How are you doing today?

[@jetjet642]

I’ve failed a few times on subs, trying too do w out. It’s a tricky process that I’m still learning

[@LincolnGTX]

And yeah, this channel really needs to grow cause it's really useful especially nowadays with opioid epidemics around the world, as an ex polytoxic addict I can really confirm that

[@MySpaceDxC_Suffo_AtTheGates]

Worst thing I ever felt in my 27 years. When they say extreme they mean it. I tried to drink myself into chilling out and it just made me drunk and equally as sick.

[@afrowitchdr]

Being put into precip was hands down and I imagine will be the worst experience of my life. Nothing only next to a long drawn out death describes the torture associated with experiencing precip withdrawal

[@alexmoritz-qe3tx]

Facts 5 years ago this happened to me didn’t time it out right and was the worst week of my life, currently going through suboxone withdrawals and it’s almost as bad just longer

[@lifelearner2020]

I just took on a nursing position at drug & alcohol rehab, and have been seeking out more info on medications and terminology used. This video was very informative and easy to follow. Thank you!

[@user-xj5mx5my4z]

Yes, I noticed that a long time ago, its the total opposite of the opiate high.

[@Ephesians-yn8ux]

It’s a travesty that you don’t have a lot more subscribers, this is good info and well produced.

[@JackMcG_MD]

Thank you for your kind words! Idk if it's an algorithm thing, but I'm going to keep publishing videos.

[@jetjet642]

It took 4-5 days of searching suboxone on KZbin before this video popped up Thank you so much so helpful

[@user-ns4tj5cs7t]

Agreed ❤ your vids and information is spot on from my personal experience of being on subs since 2001

[@hardknocknewshkn639]

Doc Ive been on Suboxone for around 16 yrs for opioid use for major surgeries , I’m having a knee replacement in a week , can I after going on opioids again then stop the Suboxone as I taper off the opioids ? Would it be easier

[@colinclement2752]

I went into precipitated wd once offer inducing bupe to soon I didn't need a doctor... I needed a priest for an exorcism

[@ThisGuyTho93]

You is not lying. I did the same shit trying to get off fentanyl. I took a 8mg strip way to soon. I went fucking nuts! Worst day of my life.

[@JackMcG_MD]

Sorry to hear that, I hope you're doing better now.

[@nancyleehampton8]

And it lasts days … was at least 3 of muscles seizing non stop. Can’t sleep or lay down, but can’t walk or talk either. People don’t understand that at that point using isn’t to get high - it’s to not feel like you are being tortured and dying.

[@Mark-wt3md]

Came off methadone waited 72 hrs took suboxone and had bad paw!!!!

[@jetjet642]

??????????????????Thanks for sharing your knowledge. Very helpful 1. ??? Can you talk about a safe way of tapering Suboxone, and what not too do while taking subs. Living in country sometimes makes supply difficult!!! 2. ???can you build a tolerance for subs??? 3. ??? Is the brand name better than generic ??? I felt I was just getting headaches w no energy on generic and we trying brand, but living in the country can be more difficult at times to get w out missing a beat (for example) They have to order brand name and I’m already in precipitation w drawals from lack of. 4. ??? Does your age play a factor??? I’m 67yrs old and been on suboxone for 8+yrs. Worked fine until I moved and taking a different brand. I’m trying to figure out why I went into precipitation w drawals on subs and why I was getting headaches and no energy. Wondering if brand name is worth the trouble

[@Jesussavedme]

I can help😊 suboxone has naloxone so that's why you feel tired hun.. also if your able to switch to subutex it has no naloxone an you will feel much better on it 😉 yes they are very addictive as far as your body becoming used to them an extremely hard to tapper off of so just a heads up on that, they will last in your system around 30 hours max before you get really sick from withdrawal and if your going to try an get off take it really slow like 1 mlg at a time! Hope this is helpful let me know if you have anymore questions 🙂

[@SuadaBoskovic-es7dp]

Yes I do have a question for you my friend was on fentanyl for a long time about 2 years and a half he is getting she has a he eye doctor he Suboxone and he'll be taking that and still has so pain what can he do please let me watch your one of your thank you so much for helping people❤❤

[@kariaxxx]

Do you get withdrawals while tapering? I started tapering 2 weeks ago by decreasing my dosage weekly. This week I started taking just one tiny square piece daily. However I’m feeling it hard. Diarrhea, body ache, insomnia, sneezing etc. am I doing it wrong? Or should I continue like this

[@drgauravuppal]

We are from India . What would be an excellent treatment for suboxone withdrawal , ultra rapid detox plus naltrexone implant and ketamine ? The expectations from the policy makers is to completely stop suboxone and person should be both substance and medicine free

[@Centrefresh11774]

At night I'm suffering breathing problem too sir (suffocating type) what is this ?

[@RobertHowley-cv6bc]

If you went through precipitated withdrawal when can you try to dose Suboxen again

[@garypedigogaeu5787]

Entered a treatment center that used buprenorphine after quitting 10 years of methadone with a very fast detox. (Kicked off program) at about 10 mg level of detox a bed became available at treatment center so I took it. I had to lie to them to get admitted and say I was on 10th day of no methadone and just hope for the best. I got the worst. About 20 min after 1st I.M. dose of buprenorphine it went from fine one minute to the next minute the most unusual and bizarre and SCARY sensation I’d ever experienced. Different that hard withdrawal symptoms like cold turkey gives you there was an otherworldly almost roller coaster like sensation of being shot toward the end of your life by heart attack. The unknown. Oddly this only lasted about 15 minutes. And about an hour later I was pretty comfortable. I wouldn’t do it again.

[@thedevilsadvocate5210]

An hour later you were ok What's wrong with that.

[@dangelomurdaugh5818]

I have to work how do i get through opioid withdrawal

[@brianguta6592]

Great channel buy the way, I’m sure you’ll hit your goal by the end of the year if you keep up the great videos thanks!

[@JackMcG_MD]

Fingers crossed!

[@francesmartel7948]

When I try to stop taking them, I sweat, get anxious, my nose runs, my stomach cramps so hard and then the diarrhea starts-it’s literal body torture . I keep putting it off.

[@Animal-Reaction-Clips]

Doc you forgot the main one , loss of appetite

[@johnnyatkison3066]

Oh yea bro I haven't ate in 4 days and have a disgusting mucus coating my mouth and my snot is running like water driving me insane

[@darrenwilliams2921]

I've been smoking heroin every day for about 2 years i stopped for 5 days and felt terrible sickness and restlessness anxiety etc i just had 4mg of suboxne and now iseem to feel fine and tomorrow i will have 8mg then up to 12mg daily it seems to work for me anyway .

[@Caanaabinool]

Hey, so I was prescribed suboxone from online doctor, he told me to wait 12 hours, so at night I did all I had left (a loooot) In the morning after sleeping about 7/8h I took half of the strip, this was worse than any withdrawal ever, anyway I ended up in hospital i passed out there, after I woke up ( an hour of sleep) there withdrawal stopped, so there has to be a way to cancel out suboxane somehow

[@JackMcG_MD]

Your doctor got half of the process right but forgot the part where you need to wait for withdrawal symptoms to appear. Sorry, that happened to you.

[@alaskayoung3413]

I’m sure it’s real but I’ve used opioids literally like 12 hours before using buprenorphine and never experienced withdrawal. And I’m a full blown addict. So I’ll be on subutex for a year and sometimes I’ll relapse and use oxy 400 plus mg in a day and then pass out and when I wake up in about 8-12 hours later I’ll start my subutex again and I’ve never had any withdrawal issues.

[@tinarickman5465]

I have been using kratom when I run out of opiates to keep from having withdrawals. Can you take buprinorphine if kratom but no opiods are in your system?

[@JackMcG_MD]

Good question. I can't give advice for personal medical questions, but I can make a general statement. Kratom acts like a mild opioid and binds the same receptors that other opioid drugs bind to. Thus, it is at least possible that a person using kratom might experience precipitated withdrawal if they don't take steps to avoid it. I encourage you to talk with an addiction professional or your personal doctor before making any decisions regarding medical treatment.

[@tinarickman5465]

@@JackMcG_MD thank you for responding.

[@Xxplicit86]

​@@tinarickman5465use the same rule of thumb for any opiate and subs...I wouldn't risk it.

[@user-mr1xj5sb9z]

Been on subutex(UK) for three months now, first four days I used, the precipitating withdrawal kicked in next day, I was cooking sausages and my concentration must have lapsed cos I never cooked em properly where I normally would, the result precipitating withdrawal combined with a week long bout of food poisoning, the withdrawal lasting the first 12 hours or so until my next dose, I was ill, it was vile, precipitating withdrawal is very real and for me it felt like being at the peak of a methadone withdrawal albeit shorter lived. I knew of people using on top of their subs on lower doses of sub like 8mg but I am on 14mg so maybe's that has something to do with it, and the strength of the gear being used. If that's ok any help to anyone, also when tapering off do a mg a month or at most a fortnight but if you do an mg a fortnight you may wanna hold that last 1mg for a month before coming off or even snap your last one in half and do .5mg for a month then another .5mg for the last month.

[@Animal-Reaction-Clips]

U wanna stop smack brother. No point taking this and then gear too. Try the kasar taper. You'll stop all drugs in 1 month

[@brittanybyland]

I find theres a ton of questjons specifically on microdosing schedules and how to properly follow it. How to take suboxone - spit after, swallow, rinse and spit etc. Thank you

[@MainelyW212]

With all due respect…. How does this doctor look both 12 and 52 at the same time?

[@joshmartin7558]

🤔 so if I take around 70mg of oxycodone daily, prescribed, how long should I wait before moving to subutex or suboxone? Im tired of it but I feel like I need something. I know people who take suboxone for pain and never had addiction issues. I just find myself needing more and more pain medication because im developing a tolerance. I just want to take something that helps with pain and I dont need more and more

[@cardsfan1590]

I'm no dr,but I think oxycodone doesn't stay on your receptors as long as heroin or fentanyl,but 70mg is a pretty high dose.Probably at least 3 days,or as long as you possibly can,i know it sucks but if you can wait till your throwing up and are for sure your in withdrawal you should be fine. The precipitated withdrawals are terrible,I made the mistake of taking suboxone when I started feeling mildly uncomfortable, and it was the worst experience ever,but if taken properly, it works great

[@Subbetweenthesoulandeyeplease]

Start around a day and half in . Microdosing it . At the end of the day its 50 50 but def wait as long as you can like when you start to feel bad wait 12 hours after that to start microdosing . But my advice dont stay on the sub unless you absolutely need it . Take enough to get through the worst of it and stop . Wd from sub is less intense but 10xs as long and no sleep for week or two . So come off the roxys or whatever take a little sub if you need to sleep or whatever but dont over do it. id take 10 % of what rehabs would give on a 5 day taper. Its gonna take a few months to fully reboot off anything . Worst is over in a week . Just hang in there . Take less and less before comin off . Plan a day and just do it .

[@JohnNeedham-zk5ms]

So just as example say I was giving fentanyl once then 24 hours later giving subutex I have a chance of going to withdrawal from it I messed up a vertebra and was giving subutex and Roxy it helped a lot I way on ketamine at first and they were talking about putting me on fentanyl patches with the subutex it would have messed me up

[@Animal-Reaction-Clips]

U about to get fkd brother

[@chevchellios84]

Geez just done 18 days detox from 0.8 sublingual and it wasn’t pleasant,been on and off of subs since 18 and I’m 40 now,it was only roughly a week detox before now I’m older I swear it took longer to get well again,yes twitchy achy body and cold all the time hot cold sweats lethargic an have been on my back basically for first 2 weeks,got out abit been eating loads since day 1 I took 2x ibuprofen a day and stopped after 7 days that also prolong the cluck I think but helped for sure when it come to trying to sleep,got about 3-5 hours per night but that also gets better it’s weird when you see something sad on tv and find yourself tearing up haha I guess it’s just the side effect of the blocker coming off brain receptors.long story short I felt like crap on the smaller doses of subutex it’s like it don’t really work,now I’m off it I can feel again and feel healthy,you can all do it ❤

[@pattif192]

Thank you. ❤

[@JackMcG_MD]

Glad that you enjoyed the video!

[@psychedelicartistry]

This doctor is top-notch, and I'm saying that as a person who's been on and off subs for 10+ years. Been interested in these vids lately b/c I'm considering doing peer recovery coaching. The way I taper subs is like this (though everybody is different): Every Month (28 days) 16 to 12 12 to 10 10 to 8 8 to 6 6 to 4 4 to 3 3 to 2 2 to 1.5 1.5 to 1 1 to .75 .75 to .5 .5 to .25 .25 to .125 Jump at .125 This is the way I do it. I've also tapered off Methadone 120mg/day. To do that I went down by 5mg a week down to like 40mg. Held for an extra week if I had to. 40 to 30 is 2mg a week. 30 and below is 1mg a week down to as low as you can get like 1mg, although I jumped at 10mg with some withdrawals but not too bad. Methadone is more dangerous to w/d than subs, but subs is harder IMO.

[@Asabra]

I just had surgery nine days ago and want to go back to my Suboxone. My doctor told me to take my half usual dose(6mg) and my ordinary 12mg dose the next day. But listening to you guys makes me nervous to follow my doctors instruction. What to do?😢 ..❤ from Sweden

[@JackMcG_MD]

It can be tricky sometimes to transition back to buprenorphine after surgery, if you've been receiving other opioid drugs. I can't provide medical advice on KZbin, but you could ask your doctor about microdose induction. Talk with your doctor first before you commit to any treatment plan.

[@tomazapat8520]

When you feel little withdraw. You can take your normal dose. No need to worry

[@tomazapat8520]

One more thing... Maybe try 6mg first.. Maybe it will be enough... And you cut your addiction on half

[@bordstif84]

I didn't listen to the Dr about being in full withdrawl before going to treatment. Maybe i had milf WD but 6 days later i am rocking with ZERO cravings.

[@clareburke7466]

Dont do it that is my best advice its not worth the risk. If they put you in precip withdrawal you wont ever forget it.

[@seank9755]

I need help I am the street blues for about 3 weeks anywhere between 2-4 a day I was on 16mg suboxone I am work tomorrow and Tuesday and Wednesday, I need to know when it will be safe to try and take a 2-4 mg sub please help I’m nervous !

[@Dumperr414]

R u still on Blues ? If so that’s fentanyl and fentanyl analogs, 16-24 hours , then start the sub.

[@justintime753]

How did it go??

[@LexyTheEbikeQueen]

Iam withdrawing now my back is hurting so bad iam hot then cold i feel like i losing my mind i havent slept in 4 days i just wanna I can’t stop sneezing and gagging while sneezing my legs are shaky I can’t walk my dog why would a doctor put anyone on this stuff iam so mad at myself

[@alexpeters1080]

Hope u feeling better now and haven't messed up.

[@Zboarts1990]

I took sub too earlier. I was about 12 hours off b4 i took sub. Crazy sick, just now able to grab phone. How long until i can try sub again?

[@madelineanabella6400]

How are you, what did u end up doing?

[@Zboarts1990]

@madelineanabella6400 I ended up pushing through the night. Slept for no more than 10 minutes at a time. Just kept hitting watching movies until the sun came up. After about 18 hours, the worst of it passed. Then I just felt dope sick for a few days.

[@Zboarts1990]

@madelineanabella6400 Thanks for asking

[@user-ey5mj9cs4f]

Yes right now but I had a relapse it's more sweats and anxious and that's bad in itself which when I came off of a month use it took 48 hours hopefully il be ok next dose

[@madelineanabella6400]

I’m ready to give up, I had a lot of hope w micro dosing but it’s not working for me. I must be doing something wrong. I did weeks of intense research but there r still things unanswered😢. I can’t live like this anymore , my life is holding on by a very thin thread rt now.

[@tonyabritt2328]

Paul Britt here I've been a drug addict for the last 20yrs ,I've been in methadone treatment and thought I would switch to Suboxone,I went to the house and waited 4 days and was in full withdrawal,I was at the sub clinic they gave me 2 mg and I stopped freezing and took my jacket off after an hour they gave me 2 mg more I started yawning and my eyes were watering bad I didn't realize it after an hour more I got 2 mg more and started presipatated withdrawal and for like 6 days I felt bad on the 2nd day I did fentanyl and the withdrawal stopped for 3 hr or so and then the super bad withdrawal came right back so now I'm stuck I went cold turkey off 120 mgs methadone and got presipatated withdrawal from Suboxone so I spent the next 5 or maybe 6 Weeks in cold sweat climbing out of my skin, during all this the drug abuse ruined me and consequently,I had two Major surgerys and so after I finally got out of the hospital I was in pain but I was sober and I am thankful, haven't been able to work the last tree yrs and still I'm thankful to be off dope.😊

[@JackMcG_MD]

Thank you for sharing your story, Paul. Your experience is a good illustration of how difficult it is to transition from methadone to Suboxone. It can take up to a week or more of abstinence from methadone before it is safe to start the buprenorphine induction. It sounds like your clinic was trying to perform a microdose induction (with the 2 mg doses, rather than the traditional 8 mg dose). Microdose induction can help prevent PW but it has to be performed correctly and it seems like they dosed you too fast. The idea with microdose induction is to gradually increase the level of buprenorphine in the body as the level of methadone drops.

[@samlazar1053]

Precipitatind withdrawal is nasty.But you should only be in consern if the patient is a fentanyl user and a high dose methadone user.This 2 drugs almost always lead to precipitated withdrawal. But hydrocodone oxycodone and other moderate strength opioids typically used in medicine....all u need is 24h waiting time.

[@Dead_Again1313]

Should I taper off my suboxone or my benzo prescription first?

[@Glory2Abba]

Subs 1st I will try to get off as well using Brixadi

[@justintime753]

Suboxone first definitely

[@jazzminebrierley6486]

My precipitated withdrawal from started when I use buprenorphine one full day after stopping fentanyl. I used an 8mg sublingual film correctly, after 30 minutes I was in full precipitated withdrawal. An hour later I tried using another Suboxone table of 8 mg. It started all over over again. I ended up having to use fentanyl again later that night to make it stop.

[@JackMcG_MD]

Believe it or not, that's a really common reaction that we are seeing in folks who use fentanyl. I made a video about this topic in particular: kzbin.info/www/bejne/jKHQnGVuo86gjdE

[@kupiddakidd1048]

Same thing happens to me. Ended up getting more dope and getting off the.fetty

[@jeanwonnacott2718]

Why I will never stop Suboxone or Methadone. I have RSD, chronic pain, that just flared up again. So, I get to take Gabapentin, and aspirin and tylenol and Celebrex to try to handle pain, cuz I am an addict. We don't get pain control? I am 60. Only getting worse. If the street was safe, I would be there...

[@JackMcG_MD]

For many people, there's very little to gain by tapering them off methadone or buprenorphine. For those people, it makes sense to continue treatment indefinitely, so long as they are benefitting. That's the most important question to ask about any medical treatment--does it benefit the patient?

[@smelltheglove2038]

@@JackMcG_MDbenefiting? It’s liquid handcuffs and the people at the methadone clinic treat you like you are garbage. 10+ years of clean urines, and you still get treated like I just came off the streets. Can’t work a job that travels. Going on trips is a pain. Forgetting your medicine in the morning then realizing you didn’t take it at work, it’s a nightmare. Going to the clinic is so gross, walking through a crowd of people selling Xanax to get to the clinic in the toxic waste part of town. I’ve seen the vast majority end up worse because of the clinic and the IOP program they make people do.

[@karthikhari5956]

great video!

[@JackMcG_MD]

Thank you kindly!

[@jennpiach]

Can you discuss ways of withdrawing safely from the suboxone. I deal with patients that ask about this and i feel we dont know enough and how to handle their pain after a surgical procedure.

[@JackMcG_MD]

Good suggestions! Tapering off buprenorphine is going to depend on the patient and their circumstances. Pain control for patients taking buprenorphine can be difficult at times, but there are a few strategies for managing this. Both good ideas for videos.

[@matthewsmith1941]

I'm on week two after taking 2:07 7.5 MG 3 times a day for over two and a half years. I'm freakin miserable

[@bioshawna]

​@@matthewsmith1941are you tapering? Please taper slow... Although I don't mean to insinuate you don't know what's best for you 🙏🏻

[@eileensianez6766]

I got Ambien prescribed to me.Still had some symptoms but slept all night to be sure!! One week and the worst part was over.Then I was lethargic for 2 months and ate a lot. I finally began working out and was back to normal by then. Jesus Christ is your only hope.Yoyr spirit may be willing but your flesh is weak!! God can't lie!! And He doesn't!! Blessings

[@dougyfresh5377]

I took one 100mg sublocade shot and quit from there. No withdrawal. It has about a 40 to 60 day half life and exits so slowly I didn't even notice it.

[@christisrisen6774]

How long do you have to wait to take Suboxone after your last Hydrocodone Oxycodone? Anyone? Thanks

[@RyRitchDiesel2009]

Wait until you are in full WD…I’ve used 12-24 hours after and it was okay. Try microdosing though…start with a 1/4 strip and see how you feel. But wait as long as you possibly can until the pain is unbearable and start small. If it helps, wait an hr and take a little more. Slow & steady wins the race!

[@christisrisen6774]

​yeah, thanks. Really glad you Took the time to answer. HNY!!

[@JackMcG_MD]

Usually, 12 hours minimum for short acting opioids. But never before experiencing withdrawal symptoms. I always tell patients that it is best to wait, if they are not 100% sure.

[@christisrisen6774]

@@JackMcG_MD Thank you. Unfortunately I Relapsed For the last 2 weeks after 3 years clean. Just want to be safe when Resuming Suboxone Have a Happy New year

[@joshuastephens894]

Precipitated withdrawal put me in the hospital for a week. Had never heard of it. Some jackass gave me a suboxone...next thing I know there is frozen glass running through my veins. Huge heart palpitations, a constant loud sound in my head and I was truly struggling to breathe. I then attempted to drive myself to the hospital before crashing into the rear of another car at the light to turn into the hospital. So yeah...F around if you want to. Do what this Dr said. Hell might be a better place than precipitated withdrawl. ✌🏼 Love is all powerful.

[@JackMcG_MD]

That's a harrowing experience! Thank you for sharing your experiences. I hope you're doing better today.

[@jentaylor-zb7et]

Frozen ice? Yep that’s about it. Worse thing I ever felt

[@Pedroandkalithemaligator6602]

I don't get withdrawals.

[@asafeibba4420]

Restlessness gets me at night

[@REALDEALMMA91]

Day 16 after 12 years on suboxone 8 mg and alot of days 16 mg .. very tough withdrawal , feel like im coming back to reality slowly

[@kakarot666.]

Sir? Madam anyone?.. honest answer pls anyone ?? . If a heroin addict use methadone. Will he face precipitated withdrawal ? On the first day?? And after usimg the methadone for 2 days .. and decide to induct to suboxone .. will he face the severe precipitation withdrawal?? If he use it after 2 or 3 days usage of methadone.. ?

[@JackMcG_MD]

Switching from methadone to Suboxone is a hard transition. You want to do this under the direct supervision of a doctor, as it's really easy to mess up. Be careful though, as inexperienced physicians may not appreciate how difficult this is and might be too aggressive in their induction plan. It is best to seek out a doctor who has experience managing Suboxone patients.

[@kakarot666.]

@@JackMcG_MD thanks.. sir. But my question was . Will methadone cause prec withdrawal for heroin user?? . Just like the suboxone causes precipitate withdrawal on the first day of leaving heroin. Even after 12 hrs gap of last heroin use , if we take buprenorphine naloxone (OST) when mild withdrawal symptoms arises, We surely face severe withdrawal.. . After taking the pills.. Same way if we take methadone instead of buprenorphine while mild withdrawal symptoms ?? Will precip withdrawal occur?? Or methadone doesn't have that issue?? . *Sorry for my bad English.. 😢. I hope u got it sir..

[@slunktycoon]

I have unfortunately experienced precipitated withdrawal 3 times. The second time was after overdosing on fentanyl and getting Narcan’d 6x. I woke up and immediately started puking all over myself. That was followed by full body spasms for about 2 hours. The third time was in the ICU. I was barely conscious and they dosed me with 8mg subutex only hours after taking IV fentanyl, morphine, and dilaudid. Goodfellas was on TV it literally traumatized me. The part where they have to dig up the body… I kept replaying the part where Joe Pesci says “Here’s a wing!” Over and over. The most dope sick I’ve ever been by far. Don’t watch that movie when you’re in withdrawal. It takes on a whole new meaning. It’s so much darker than you realize. Then I shit all over myself multiple times and was hallucinating. That kicked off 4 days of absolute hell. Worst kick ever. And I’ve kicked in jail and on the street. So glad to be on methadone now.

[@JackMcG_MD]

Thank you for sharing your experience! That sounds like a harrowing time. Glad that you're doing better now.

[@jentaylor-zb7et]

I am so thankful you write that. The exact same thing happened to me with the movie Hereditary. Now I avoid seeing that title when I stream movies on Cinamax. Words can’t express what that movie did to my soul. I thought I was crazy. But precipitated withdrawal can do this to you, as we’ve both learned. I’m trying to figure out WHY this happened to us. What’s your opinion?

[@laurajohnson3077]

What happens if your in treatment and on espranor buprenorphine only not suboxone! 16mg dose... and took heroin 24 hours later? Will that cause precipitated withdrawal? And how soon after herion can you go back on 16mg espranor

[@ThisGuyTho93]

I remember when i first start my sobriety journey i took Suboxone before the fentanyl was out my system. Boy i went fucking nuts! Worst day of my life! Checked into a sobering center that night and went to a rehab the following weeks. I started on 8mg of Suboxone a day went down to 4mg a day and now im down to 2mg a day.

[@patrickhyatt172]

@ Miko nice job getting down to 2mg, I'm in the same boat , I'm down to 1.5 milligram a day , it's a challenge once you dip below 2 mg, I had zero problem getting down to 2 mg ,.now I'm struggling a bit with fatigue, have a few more days then supposed to drop down to 1.0 Good luck my friend

[@JackMcG_MD]

Fentanyl really makes Suboxone induction much harder than it used to be. It sticks around for a lot longer than old school heroin but withdrawal starts well before all that fentanyl is eliminated from the body.

[@charliestyle575]

You made a statement saying there really is no way out of precipitated WD once it starts, that is incorrect. You can actually stop a precipitated WD by taking a higher dose than usual of an opiod. I do not recommend ANYONE doing so, but ive gotten myself out of precips 3x doing so in the past. Once again, this is a personal experience. Also, after the dose of the opiod once i was out of the precipitation WD i no further needed to take anymore opiods and the suboxone took over hours later after the opiod wore off. Im no scientist but, Im guessing this is basically the same concept of micrososing but at a much faster rate.

[@JackMcG_MD]

It's not a good idea. As a doctor with a platform on KZbin, I am responsible for delivering safe and accurate content to my audience. I can't endorse taking a deliberately large dose of opioids because it is potentially life-threatening. Someone could hear that and then overdose rather than seeking medical attention. My experience and that of my colleagues is that giving additional full agonists does not seem to help patients much. It's also counter-productive to the goal of getting onto buprenorphine (you reset the clock when you take additional full-agonist opioids). It's possible that this worked for you, but it's not something we would deliberately do in the clinic or hospital. Many of my patients have also told me that they were unable to stop their prior PW symptoms by taking additional drugs, so it doesn't seem to work for everyone. The key should be prevention; that's always going to be better than attempting to treat it. A better strategy is either a micro-dose or macro-dose induction. I made a video about micro-dose induction ( kzbin.info/www/bejne/jKHQnGVuo86gjdE ), and I'm planning on making one about macro-dosing soon!

[@joshua17630]

Worked for me

[@charliestyle575]

@joshua17630 But as Doc stated, it's simply not safe so I'm not condoning anyone to do that or try that, I was just sharing my personal experiences.

[@joshholden8561]

My dentist prescribed me 18 perk 5s I been on subutex for 5 years the dentist said it was ok to take it with subutex

[@Dumperr414]

Stop the sub, then take the perk 5s n I recommend a few at at time it being only 5mg of oxycodone

[@justintime753]

You wont feel them

[@joshholden8561]

@@justintime753 yeah on Subutex u do those don't have the blocker but u do have to take a much larger amount to feel them like 30!mg of oxy atleast

[@USViper]

The worst thing for me was RLS... I used pregabalin or clonidine for RLS.

[@JackMcG_MD]

Good point, RLS can be intolerable.

[@animevideos956]

Yes bro mee to i was taking pregabalin to prevent the withdrawals but pregabalin have more withdrawals then suboxon that really true

[@davidwells6556]

This guy knows his stuff. I didn't go to my primary care Dr., I went to a shrink and it cost me a lot. Like he said though "how much would you be spending on drugs", and he was right. I have been drug free for over 20 years now, or close to it. I started when it had first came out or about a year after anyway. Methadone didn't work at all for me, but Buprenorphine was great. The user has to be the one who says when. I was done with drugs and wanted off. I did my research and found this Dr. and got off. If a user is being forced off, it won't work. The best thing was I didn't get high from the Buprenorphine. The withdrawal wasn't bad at all. Get down to 2mg slowly then stop. I stayed on 2mg for 2 weeks which weren't the greatest 2 weeks of my life but at least I could sleep. Then I had a bad night when I quit and I was done. It took a few weeks to get back to normal, but I found the more I went to the gym the better I felt. I did notice if my friends didn't have an education or a trade, their success rate wasn't good. You need something to look forward to, like the money and life you would have by not spending it on drugs. To all trying to get off opiates, good luck, and my way may not work for you but find your own way. You can do it if I can. Also it's best to lose the friends you have now, and move somewhere else. It's way to hard to quit seeing the same people and places everyday knowing drugs are just a phone call away. You know the "friends" you have now aren't real friends anyway. I found out 4 years ago I have hep-c. I had it the whole time and didn't know it. Now I need a liver transplant. Do you know how hard it is to get a liver when the Dr.'s think you're a junkie? Some Doctors are cool, and some treat me like trash. Funny thing is I got it from a tattoo. I no longer have hep-c. The treatment cost $87,000. A pill a day for 90 days, almost $1,000 a pill. That's what Epclusa cost me. I hope there is a generic soon, maybe there is I don't know. I have spent at least $250,000 on everything and now I'm most likely going to die.

[@JackMcG_MD]

Thanks for the kind words David. What you said is so true. Treatment might cost money, but it's money well spent! Certainly, better spent than on more drugs.

[@davidwells6556]

@@JackMcG_MD Also, can you put price on your life?

[@margaretfishs500]

I was on Suboxone for 2 months going from 8, 2xaday, 4, 2xaday, 2, 2xaday.....kept cutting the film till I got to 1/16......a teeny tiny square....I took my last piece 6 days ago.....the withdrawals have been horrendous!!!!!! I'm hoping this stops soon!!!!! ....from what I read everything says seven days....I truly hope so!!!! IT'S AWFUL.....😢😊

[@user-yw8ck9vj2r]

Rls is the worst part of withdrawal

[@suckit5092]

What’s your opinion on kratom?

[@JackMcG_MD]

Hmm, that's a good video idea. In a nutshell, it's a mild opioid with additional effects similar to SNRI drugs. We still don't completely understand kratom and its alkaloids, so I am hesitant to call it "safe" but can it be helpful for people experiencing opioid withdrawal? Some patients claim that it has helped them. Would I recommend it over standard treatment with buprenorphine, methadone, or other FDA approved drugs? No. That's about all I can say in a KZbin comment.

[@jennpiach]

I know someone who, her and her husband kicked a bad pill habit with kraton. Now she is a kraton warrior and advocate. She says it saved their lives and gave her ability to be the mom was couldnt be before. She has energy and feels great! But it can be challenging I think once you get use to kraton because you can still have cravings. I think nutritional supplementation is very important also for brain chemical balance with gaba , certain amino acids and other supplements.

[@Xxplicit86]

​@@jennpiachtoo bad it's so expensive and can also withdrawal from it but to each his/her own. And depending where your friend is may be illegal very soon

[@prosegold]

I was in precip and the doctors had no idea what was wrong with me

[@Itried20takennames]

Doctors who work with it will know, but thanks to the growth of medical knowledge, now every nurse or doc can only be proficient in about 1% of all medical knowledge….no one doc will know all conditions or treatments. So try to pick a doctor who specializes in whatever you might have, and to be straightforward, not hope they figure it out.

[@sukmeeballz8327]

This is awesome. Thanks for the vid doc.

[@JackMcG_MD]

My pleasure!

[@user-mk3qz3et8i]

So I accidentally took narcan without knowing what it was and let me tell you... Absolutely Hellish. The worst days of my life. Couldn't even hold down water. Vomiting every 10 minutes diarrhea

[@JackMcG_MD]

Sorry to hear that. On a related note, this is why my preferred method of giving naloxone for opioid overdose is to dilute the dose into 10 cc of saline and give 1-2 cc every few minutes until the person is breathing again. Doing it this way allows you to give only the dose necessary to reverse the respiratory depression and avoid precipitating withdrawal. (As a word of caution, don't attempt to do this outside a medical facility; if you are responding to an opioid overdose and have a naloxone nasal spray or autoinjector, give the full dose according to package directions! If you are not a medical professional, follow the package directions to the letter. It is much better to be alive and in withdrawal than comfortably dead.)

[@Tloc111]

​@JackMcG_MD I'm on day 8 of microdosing took 16 mg today felt terrible. So I use fet and felt littler better after 2 hours. Do I continue 16 mg or 12mg?

[@sjfamily1581]

This guy's never been dope sick. 48 hours atleast 72 would be best. I'd send yourself into withdrawal take 8 mg at first or even 16 then use just enough to sleep do that for 3 days keep tsking subs and you'll be half sick for bout 2 weeks

[@sjfamily1581]

Tske and much as possible! More bupe on ur receptors the better!! It will be uncomfortable couple weeks

[@sjfamily1581]

Not like the old days 24 hours is not enough at allllll. You have friend that'll rock you for being a bitch get them around u.

[@JackMcG_MD]

Sorry, but I can't give advice for individual medical situations on KZbin.

[@Tloc111]

​@sjfamily1581 you don't know a thing about my story

[@jacobmeleciox8707]

Pause at 1:57.. long term use?? Uhhh no.. even if you've been clean for years and just use a couple days, it's like muscle memory, you're right back to square 1!!!

[@voxschair]

Im taking my first dose of Suboxone (through a doctor) on Friday. Ive been taking Methadone (non prescribed),for about 3 years. Ive been on about 20mg a day. My last Methadone dose is going to be about 5 days before my Suboxone doctor appointment. Ive switched to taking fentanyl this week. My last dose of Fentanyl is going to be roughly 48-72 hrs before my first Suboxone dose. In your non-medical opinion, strictly as a friendly piece of advice, do you think I will be ok to start Suboxone on Friday? (The day of my Sub dr appt)

[@JackMcG_MD]

Hey, sorry I missed this one. Generally speaking, tapering to 40 mg or less of methadone and waiting 5-7 days is the standard protocol for starting buprenorphine. It sounds like your doctor has the correct treatment in mind.

[@chadanderson2804]

My advice is try not to take it for long it causes severe tooth decay in the long run

[@kakarot666.]

​@@JackMcG_MDwhat if the duration of methadone use is Only 2 or 3 days after leaving heroin?? Can we jump to suboxone on 4th day?

[@kakarot666.]

​@@chadanderson2804ts a common issue for me too .. The root canal infection causing puss and pain . Which last atleast for week.. 😢 I hate that about OST meds.. Is that same issue in methadone too?

[@captainsledge7554]

So i was informed that if u spit everything out, after taking suboxone sublingually, then u can prevent PW. Because what u spit out, is the naloxone.

[@RealGenuineTalk]

The Naloxone isn't what causes the precipitated withdrawal... It's the actual Buprenorphine that causes the precipitated withdrawal, because it's a partial agonist abruptly displacing a full agonist such as heroin, oxycodone, morphine, or fentanyl. The receptors that are occupied by a Full Agonist opioid are violently displaced by the Partial Agonist and the receptors go into a shock, since they need the full agonist to be fully stimulated and the user most definitely has a tolerance to the opioids that are now being kicked off the receptors On top of the Buprenorphine having a higher binding affinity to the opioid receptors than most other opioids, it sticks heavy to the receptors and are difficult to displace with other full agonist opioids.

[@JackMcG_MD]

Excellent answer!

[@JackMcG_MD]

The answer below from @RealGenuineTalk is the correct one.

[@onbothsidesofthefence6661]

Dude it happen to me accidentally. I was goin to methadone clinic and I accidentally snorted a subutex thinking it was a perc. Holy shit me and my cousin both did. We split the subutex right before we was going to clinic that morning. Thinking we was doin a Percocet. 30 min later Wow. Luckily I been through it once before but my cousin was about kill hiself.

[@JackMcG_MD]

Thank you for sharing your experience. I imagine that snorting brought on symptoms pretty quickly. Hope that you and your cousin are doing better now!

[@onbothsidesofthefence6661]

That was over a year or two. Lesson learned. Don’t keep no subutex around house. For no one We still go to clinic. And doing well it was one those times did something we had no business doing anyways

[@dannyj7618]

I think lesson is dont do drugs lol@@onbothsidesofthefence6661

[@mjstow]

At last I understand. Best video on the subject, for me anyway.

[@JackMcG_MD]

Glad it help you!

[@user-nx9pz4kx6q]

Been on and off Suboxone up to 24 mg for 10 years. Weaned and cold turkey countless times.

[@JackMcG_MD]

What helped you the most?

[@ChrisChaney-zc9iq]

​@JackMcG_MD I can't speak for him but I quit cold turkey 1 time and I'm not a pot smoker but strangely pot took the edge off just enough to where I couldn't do it. I was still. Having terrible withdrawals but the pot helped just enough to make it doable

[@Xxplicit86]

Seriously don't risk it 💀 wait 3 days and take no more than 2 mg

[@JackMcG_MD]

You can always take more, but once the medication is in your system, you're never getting it back!

[@smelltheglove2038]

If you wait three days, don’t even bother taking subs, you’re almost done cold turkey, why catch a worse habit?

[@markwildt5728]

@@smelltheglove2038 it's all different now with fentanyl. I waited 5 days, withdrawals didn't even kick in until the 3rd day, and I still went into PW... It's different for everybody.

[@Xxplicit86]

​@@smelltheglove2038to prevent relapsing again and again. It's easier said than done

[@Xxplicit86]

​@@markwildt5728you're absolutely right

[@jennpiach]

As a nurse we are still trying to understand this medication effects on patients, pregnant women and effects and withdrawal on newborns. We are seeing alot of these patients.

[@JackMcG_MD]

For sure! Buprenorphine (Suboxone) use has become more mainstream in recent years and that means that medical providers working outside of addiction medicine are encountering these patients more often. That's a big reason I made this video. Buprenorphine is generally considered safe to use in pregnancy (to the extent that any drug can be considered "safe" in pregnancy). Essentially this means that the anticipated benefits outweigh any risks. We know that treating mom's opioid use disorder is the best for baby, as it prevents overdose, HIV infection, and medical complications of injection drug use. Babies born to mothers on buprenorphine may develop neonatal abstinence syndrome, but this can be easily treated with symptomatic care and it leads to no long term harm. One strategy for treatment is to allow the baby to breastfeed while mom remains on buprenorphine and the small amount of buprenorphine in the milk can help alleviate the NAS symptoms in the infant. The other strategy is to bottle-feed and treat the infant with morphine as needed until their symptoms pass. In both cases, non-pharmacologic care (skin-to-skin contact, rocking, pacifiers, low light, etc) should be provided.

[@beingthesalt]

I was on subutex my entire pregnancy with both of my children, one a much lower dose than the other & I'm almost tapered completely off. But I've been able to nurse my daughter for a year as normal & she's so smart, perfectly healthy. So it's definitely possible!

[@vatorman]

I was on suboxone for 6 years at 24 mg a day. Worst mistake of my life was listening to the doctors that praise suboxone. I know they were praising all the money coming in.

[@mgonzo3881]

​@@vatormanWorst than active addiction? You think cold turkey is better?

[@vatorman]

@@mgonzo3881 Absolutely not. You have to be serious about getting away from suboxone and take tapering seriously. I was basically forced out of my program due to insurance purposes, this place was eating my insurance alive, so I was given a 1 month supply of suboxone films and sent away. After a serious meltdown I realized it was my way out so I meticulously cut my films into many different sizes knowing I’d need larger pieces up front and taper down to a tiny sliver. I was able to stretch that one month supply out to nearly 5 months. I was literally taking slivers and still went through like I had quit cold turkey, it’s awful without a doubt but you have to do this for yourself and put the work in.

[@beverlyallison4768]

Vit c , tyrosine , dlpa, and 5 htp help withdrawal …. Lots of c thru the day

[@ariesevokes3897]

Ok. It's all those symptoms at the same time that lasts at least a minimum of 12-36 hours Minimum. He left out RESTLESS LEG SYNDROME, HALLUCINATION, AND SEIZURES. Don't expect any sleep for 2-4 weeks. And your going to feign for 2 months

[@JackMcG_MD]

Good point, restless leg is sometimes lumped into the anxiety column, but it's severe enough to deserve its own mention. Hallucinations and seizures are more common with alcohol and benzodiazepine withdrawal and not a classic feature of opioid withdrawal. Still, severe opioid withdrawal might provoke a seizure in people with a history of epilepsy or other seizure disorders.

[@ariesevokes3897]

@JackMcG_MD Well, grandmal seizures are possible with heroin,fent withdrawal. I know that first hand experiance yes it's not as likely as the other symptoms to occur. And yeah, restless leg is a very harsh symptom. I hate it so much that I can't describe how bad it really is. Last time I went to detox with Fent in me, I went through PERCIPITATED WITHDRAWALS because I got dosed the subs too early. After begging the head, Dr. to knock me out or take my legs off, then my arms. I woke the entire detox unit of Md General Hospital. It took 4 nurses to hold me down while several nurses scrambled to get the typical protocol meds for Precip. It was decided to raise the sub doses, and I suffered more pain that night/day than anything I have ever known before. I detoxed off a 1 year heavy habit of fent, zylaxine, gabap, and THC in just 6 days. With Gods help, I'm sober today:

[@donkeyballs3307]

Fentynal in the hospital, b4 surgery ,is the best pain killer your ever gonna get & the best sleep your ever gonna have ,i did it & it was friggin awesome

[@JackMcG_MD]

Thanks for sharing your experience. Everyone responds differently to different opioid drugs and for some, fentanyl can be very efficacious for pain. In other patients, fentanyl provides little relief and is short acting. In my experience, the opioids which are most rewarding to patients include oxycodone, hydromorphone (Dilaudid), and meperidine (Demerol). At least, those are the drugs which are most likely to be asked for by name.

[@donkeyballs3307]

@@JackMcG_MD iv been on 360 mlg a day of morphine for many many years ,over 25 years ,fentynal still worked

[@jetjet642]

Yes, everyone is different. So many different things too learn w Opiod’s.

[@Xxplicit86]

All these scientific advances and they couldn't work around this problem? 🤔

[@JackMcG_MD]

Not really, but there are simple steps to prevent precipitated withdrawal. Micro-dose induction is quickly gaining popularity over the classic induction process.

[@Xxplicit86]

​@@JackMcG_MDNot really? With all the scientific advances in medication they can't tweak a chemical for this. I don't buy it. I bet if you guys depended on this and had this happen to you ya'll would look for an alternative. I know Walter White and Jessie Pinkman could have in a meth lab. Blue Subs 😂

[@kevo8137]

Touch felt like lava nails on my skins electrifying me.

[@JackMcG_MD]

That's gnarly. The medical term for that symptom is allodynia. Allodynia is the painful or uncomfortable sensations resulting from benign stimuli.

[@kevo8137]

@JackMcG_MD was started way to soon for my long half life of choice poisons. Clonidine saved me from blacking out or worse.

[@kevo8137]

​@JackMcG_MD 3 days AT LEAST or use cow scale with a doctor.

[@mgonzo3881]

I went into PW a couple times. I went after 8mg, and I read about macrodosing. I ended up taking 64mg that night! It did pass, but wouldn't recommend it. Bernese method is best.

[@JackMcG_MD]

Wow, that is a lot of buprenorphine. That's interesting, because the general consensus is that after 32 mg, there is no additional action at the mu-opioid receptors. That said, you can't reliably predict the clinical effects of drugs in a particular patient using basic science principles alone; the human body is more complicated than a petri dish.

[@mgonzo3881]

@JackMcG_MD I watched a video by Dr. Kenneth Starr, where he mentioned macrodosing. I may had taken his advice the wrong way, but I just kept taking subs until I was out of PW.

[@user-lq7sp3vu4x]

@@mgonzo3881does that work?

[@clareburke7466]

An addiction doctor used micradosing to try to get me onto suboxone and it failed i went into full precipitated withdrawel . It was the horrific and worst night of my life. Make sure you are in full withdrawel before you touch this stuff. Never again. Never ever ever ever again.

[@markdavids2511]

I did a long sweaty methadone withdrawl & this was just coming off 5ml, I got opiate clean & started living a life, one day another smack addict turned up at my home with H in his pocket, He knew I’d got clean & some other addicts hate seeing fellow addicts get clean, it’s the crabs in a bucket mentality. Anyway I was still weak when this c*nt rocked up & I smoked it off the foil. It was the beginning of my current methadone maintenance, quiting opiates pain free is impossible there’s always suffering involved.

[@kakarot666.]

Can cocaine ease the heroin withdrawal? Or precipitate withdrawal caused ny sub?

[@JackMcG_MD]

I wouldn't expect cocaine to help withdrawal all that much. Opioid withdrawal causes increased adrenergic stimulation ("flight or fight reflex") and cocaine would make that worse. Cocaine in the body would not precipitate withdrawal when Suboxone is taken.

[@Z1SUPREME99]

Doc can the withdrawals cause heart palpitations and back pain it's not like pain its a unique sensation in my back when I sleep restlessness can you tell me if its normal please...i got palpitations couple of days ago i got to hospital they told me its stomach issues and gas now it's the third day of not taking any med nothing i haven't got any palpitations but i have soo much anxiety restlessness neck pain in left side back pain or sensation sneezing cold chills sweating ...is it normal?

[@JackMcG_MD]

Sorry, I can't accurately diagnose you over the internet. I would recommend that you get evaluated by a doctor in person, because illicit opioid use can cause serious medical complications and it can be dangerous to write off your symptoms as opioid withdrawal without careful evaluation by a trained medical professional.

[@ericgibson2079]

Ode to the misery. So I found using meth lightly to get the dopamine switched off the herion or fentanyl works. Well all the prayer is what does it but anyway. Its not easy but im confident enogh to say it works . Forgivness from abouve can not be underestimated.

[@justintime753]

Meth does alleviate some of the symptoms and brings them down a notch.

[@heyitzantz]

If you do fent and take a sub , omg prepare for the most horrific withdrawal in a few minutes of taking that sub... Let me tell u. You are not gunna be prepared for which your about to embark... Yiur gonna flop all over the floor, punch yourself, pull your hair, you still dont feel any of the inflicted pain , that p wd is a damn monsters!!!

[@JackMcG_MD]

Unfortunately, fentanyl is the cause of many cases of precipitated withdrawal and that PW is a miserable experience. I hope that you're doing better now.

[@justintime753]

Worse than death

[@brannonmcclure6970]

I love opiates. And, I think they are the best drugs on the market. I take them for OUD. But sometimes I get little ahead of my schedule. I am familiar with the half lives of a lot of the opiate narcotic drugs. I have had a couple ruff transitions. Using medicinally is the key to avoid bad side effects with these drugs.

[@mattnoah8309]

I’m 72 hours off fent but still scared to take my suboxone. My metabolism is so slow. I keep failing trying to get back on it

[@JackMcG_MD]

I know this is a late reply, but I encourage you and anyone reading, to talk with their doctor about a micro-dose induction. It sneaks the buprenorphine in so you don't experience withdrawal.

[@clareburke7466]

Be careful about microdosing. I tried microdosing it sent me into precip withdrawal. My advice is make sure you are in full withdrawal not slight withdrawal. Remember everybody is different especially if you have been using a long time. It can take a long time for drugs to leave your system. They need to be full out your system. Microdosing didnt work for me.

[@ariesevokes3897]

THERE IS A WAY OUT OF PERCIPITATED WITHDRAWAL. you will need whatever drug you were on before, possibly more to flood the receptors that bupe hasn't attached, and reclaim the receptors the bupe stole

[@JackMcG_MD]

This is dangerous as it risks overdose. In my experience, it doesn't even work that well. This also doesn't help the person who is trying to get onto Suboxone long term; taking more just resets the clock. Aa safer way to avoid bupreprenorphine precipitated withdrawal: kzbin.info/www/bejne/jKHQnGVuo86gjdE

[@Aryan-xb5id]

No it works for me. I've been through precipitated withdrawal many times. Each time I used for relief.

[@ariesevokes3897]

@@JackMcG_MD besides doing it my self many times. The Head DR in MD General knows me well. There team flood dosed me out of precip. Saved my life. But every time I relapse I'm getting worse and worse.

[@JackMcG_MD]

Some have success with "macrodosing" buprenorphine (I've tried it for emergency department patients with mixed results). The commenter above was suggesting to use a large amount of another opioid to relieve precipitated withdrawal, which is potentially dangerous.@@ariesevokes3897

[@user-wb7yq6fu8p]

I can't believe that something that causes all this suffering would be given to people it's ungodly what a sad evil thing .

[@rickp3753]

If you take this stuff as directed you won't have a problem. But we always end up abusing it.

[@mitchellduran3388]

Methadone has me fucked I was on 60mg for OxyContin abuse and little by little I been buying the bottles from the people in the pg and now I’m up to 300 mg . I’m looking to doze down little by little but damn . I have not done opioids like heroin or oxy in about 10 years but the meth is killing my pocket and health

[@JackMcG_MD]

Sorry to hear that Mitchell, I hope that you can find some help.

[@mitchellduran3388]

@@JackMcG_MD I’ve always thought that if I decide to quit it will be cold Turkey . I know I can do it I’m just afraid that I can die since I have blood pressure issues . But I know one day I can do it just quit and go thru the pains .

[@thefoxfamily341]

I liv in austria 🇦🇹 and i become 32mg ..this was crazy times. I sell it and buy Coke..Now i am happy with my h .. expensive hmm no .Make my own mix or Dose everyday. Smoking is bad .but my 👃 offen destroy...Butter to Quit. But its not easy..best wishes from Vienna ❤

[@antoneckhart4010]

I wished i lived where you do!! Been usin H since 98!!

[@JackMcG_MD]

Thanks for the well wishes!

[@ryanpalma8005]

​@@antoneckhart4010 zero H left here in america.. literally none ..all fentanyl and tranq

[@antoneckhart4010]

@@ryanpalma8005 yeah..its almost like it was planned..the oxys then fent..the amounted needed to cover the US..the govt must be involved. Same in every country i think..well what do i know. Am so sick of trying all these different programes and now am on subblcade. Still usin H everyday...all the different programes av been on. Nothing works..used everyday none stop. Am about to email the govt and ask for a diamophine script. I wonder what they will say. I feel I am a good candidate. Av tired everything.

[@sjfamily1581]

​@@ryanpalma8005 yup

[@faramarzrad4037]

How can I get rid of buprenorphine?

[@JackMcG_MD]

In your body? Nothing to do but wait. It will be metabolized over the course of several days. Once it is inside, there's no taking it back. That's why we need to be careful before giving the first dose.

[@thebushbunker]

Restless legs syndrome

[@JackMcG_MD]

Thanks for sharing! I missed that withdrawal symptom and it can be one of the worst!

[@earlegavin5931]

Repeated neck and arm jerking

[@AmyBerry-vt1fv]

Dr never ever send anyine to the methadone clinic. I wish i could will u a methdonw habit n cronicile ur methone detox for 6weeks n post it to ur channel i promise u this u would never tell another pt to do methadone ever again.

[@JackMcG_MD]

Methadone withdrawal is painful, that's for sure.

[@Joefest99]

Isn’t this his first video?! Why is he speaking as if he has others?!

[@JackMcG_MD]

First video posted, but I had recorded others.

[@Joefest99]

@@JackMcG_MD 🤨 I seeeeeee…

[@Nobodspecl]

I’d rather go through herion pains

[@JackMcG_MD]

For sure, precipitated withdrawal is far worse than garden variety opioid withdrawal. Thankfully, it can be avoided with some simple precautions.

[@smelltheglove2038]

Where in the world are you finding real heroin? It’s all fetty out here in Philly to Boston.

[@Xxplicit86]

​@@smelltheglove2038things were never the same after we invaded the Middle East. It's all part of the big plan.

[@onbothsidesofthefence6661]

They don’t give u shit for it once it starts 😢😢😢😢 u just be prepared for the worst ride of your life for about 12 hours or longer. Max withdrawal times 1000

[@JackMcG_MD]

The unfortunate thing about PW is that there is little to help the symptoms once they start. You can give non-opioid medications, like clonidine and gabapentin, but those don't fix the problem. That's why it's important to prevent it in the first place.

[@chadhampton7537]

There is away to not go through severe withdrawals but he said there's no medical way not to there are just passed this clown and keep searching