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Comment by aoeuaue | Hacker News Reader

I started taking suboxone 5 months ago and it (almost literally) saved my life. Before finding out about it, I thought I was going to be stuck in a hell-hole of heroin dependence forever. You wake up one day and realize that you are completely fucked, and that there's nothing in the world to help you. Suboxone changed that. I started taking it, with no/minimal side-effects, and immediately stopped doing heroin, stopped craving heroin, stopped everything. Finally, I can live in peace without there being a short-fused time bomb just waiting to blow up inside of me.

Thanks to suboxone, I can program and think and live again.

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So does this mean that the opiate addiction is still present, but satisfied by suboxone? In other words, if you stopped taking suboxone, would the heroin craving come back?

Heroin cravings never leave, it's the physical withdrawal you want to avoid.

That's extremely misleading and generally over exaggerated by anti-drug advocates. The cravings get weaker as the weeks progress and by a full year or so, they're completely gone. What remains is the nostalgia. You think back on the time you were doing them and remember how good you felt (while conveniently forgetting all the bad times) and you crave it like you crave something from a memory.

For me, (8 years clean) it's like remembering Christmas morning when you were a child. Now that I think about it, it's almost exactly like that. I don't crave it like a cigarette (You don't have an "urge"), instead it's like recalling a happy memory and feeling nostalgic. Why it's misleading is because the same could be said about virtually anything you can feel nostalgic about.

Mm, that's not completely true, however it depends on how you define "cravings". In my experience, anyway.

Yes, the addiction is still present. If I stop taking suboxone I will start feeling a little bad (depression, etc) by day 2 and will start withdrawing (feels like a really bad cold) on day 3. By day 4, I would be throwing up and unable to move/function.

The only downside of suboxone is that due to its long half-life, the withdrawals last a long, long time. With heroin you are out of the woods by day 4 or 5, but with suboxone, withdrawels last weeks/months.

Try getting your dose of Suboxone to less that 1/2 mg for at least a few weeks. Then try stopping again. You might need to take micro doses every other day for weeks before you can stop completely. Remember, we have been conditioned to believe it's harder to get off of through a lot of hysteria, and drama. It's almost like a negative placebo effect.

It is immediately clear that is too addictive for all but the worse cases. What would happen if instead of taking this stuff you were supervised by a physician during withdrawal? Would you be addiction free after 2 weeks?

Addiction is not just a physical process. I chose to go on Suboxone as dealing with the mental effects, the life changes I needed to make, and my already existing depression on top of heroin withdrawal was infeasible.

So, while yes, the "physical" part may be done, the rule of thumb that my clinic gave me was "Half the time you were addicted". I was an addict for 6 years, they work on 3 years clean before I'm truly "cured".

Soboxone targets opioid receptors differently than heroin and, while it is technically a "replacement therapy" it is almost impossible to overdose on and more difficult to use on a continual basis for recreational purposes (the "positive" effects of the drug decay rapidly with continual use. To answer the question, one does experience withdrawal effects if they use Buprenorphine for a long enough time, however some professionals in the Recovery Industry (tm) use it to do a "fast taper" which is a more aggressive treatment over a short period of time in which the patient only takes Buprenorphine for a week or so to reduce the pain of heroin withdrawal (but not completely eliminate it) and then taper the dose of suboxone quickly before the patient has time to grow dependent. Yesterday's discussion of Wikipedia's accuracy notwithstanding, the link below actually does give some useful jumping off points.

http://en.m.wikipedia.org/wiki/Buprenorphine

In short, users can get "strung out" on suboxone but if used in certain ways (I.e not for the long term "maintenance" that the pharma companies make their money on, but as a short therapy to quiet some of the discomfort experienced during opiate withdrawal, it can be effective and safe and not lead to long term use.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150159/

Suboxone still works through the same receptors as morphine or heroin (see the wiki link).

One important difference is that it's a partial agonist at the mu receptors rather than a full agonist. That makes the effects someone self limiting.

I didn't say that it targets different receptors. I said it targets them (i.e. the same receptors) differently. I failed to go into the details of how it targets them differently (wasn't sure if that LOD was called for, or in good taste, considering that this is not a site about pharmacology or neurochemistry). I did see the wiki link... (I wouldn't have posted it if I hadn't.) Thank you for clarifying though! (BTW, I think that you meant somewhat not someone in your final sentence.)

(wasn't sure if that LOD was called for, or in good taste, considering that this is not a site about pharmacology or neurochemistry).

In my experience, detailed knowledge is always welcome on Hacker News, especially if it comes from another highly technical field outside software.

Totally, my error for not adding value with some additional information in my last comment. Thank you. :)

1) some introductory material on receptor theory:

http://en.wikipedia.org/wiki/Receptor_theory

Yes, I know Wikipedia, a more comprehensive intro to basic neuro is "Principles of Neural Science, 5th Ed" (http://www.mhprofessional.com/product.php?isbn=0071390111)... It's large book but the de facto standard.

2) a reference to some basic pharmacology with respect to opioid receptors that includes a summary discussion on receptor interactions (i.e. full agonists/antagonists/partial agonists):

http://www.ncbi.nlm.nih.gov/books/NBK64236/

3) some explanation per the specifics of the mu receptor (click on this only if you are truly thirsting for knowledge on the mu receptor):

http://www.iuphar-db.org/DATABASE/ObjectDisplayForward?objec...

Have a nice night!

If you don't mind me asking, do you continue to take it? Or if not, how did you know when to stop?

Yes I still take it and have not lowered my dose since going on it. I've noticed that my mood on it is much higher than it was before I started doing the heroin (which I started in the first place because I was depressed and suicidal), leading me to believe that it has significant anti-depressant potential even in opiate-tolerant individuals. Also, there's some history in the literature of it being an effective anti-depressant[1]. I haven't lowered the dose or stopped it because I am afraid I will end up in the same situation as I was before and start using again.

[1]http://en.wikipedia.org/wiki/Suboxone#Antidepressant_potenti...

Why not just taper down to the minimum dose where you still get sufficient antidepressant effects? Especially since psychoactive drugs are typically prescribed at levels way beyond what is actually necessary.

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