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PostPosted: Sun Aug 23, 2009 5:42 pm 
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Hello. My name is Greg, and I just joined this site. But I haven't told my story yet. The bottom line is this: 24 years on heroin, 2.5 years devotedly taking Suboxone, without "relapse" but with at least a dozen alterations in dosage (from the initial 4mg/day to the current 36mg/day), each of them achieved through gradual titration increases whose precise schedule my physician has allowed me to determine. Clearly my dosage is an "outlier", statistically speaking, when measured in reference to those who belong to this site/group and perhaps even to all suboxone patients. Moreover, my approach/perspective and beliefs seem to run counter to the norms of this forum. So I'm not sure how welcome I will be here.

Dozens of posts on this forum either explicitly or implicitly advocate for the lowest possible dose. Although I understand the financial issues implicated by such a position, the science and the ideology behind the advocacy are wrong-headed. As an opiate addiction/dependence/use (and these are distinct modalities) and opiate-related morbidity/mortality behavioral scientist, I can tell you with certainty that EVERYONE is different. Do you remember your days of using? Did you have exactly the same reaction as your fellow users had to the same drug? Did the drug(s) affect you in the same exact way? Was your withdrawal exactly like that of everyone else who was using the same stuff at a roughly equivalent level? Most likely, you would answer "No" to all of these questions. So why would we assume that everyone should be at the same dosage of suboxone? Every body (as in everyone's body) is different, and suboxone should be administered according to this fundamental premise. The standard dosage information we read about is based on large-scale treatment/trial sample studies ... they may represent the norm ... but just because the average dose is Xmg, it does not follow that you therefore will feel good at Xmg. There is no more logic in this presumption than there is in the statement "The average lifespan for males in the U.S. is 73 years; therefore, you will live to be 73." That's ludicrous. So is the tendency to view suboxone or any other drug/medication in its statistically normative terms.

A dose of 2mg/day does not work for me. Nor does 8mg/day. Same goes for 16. Also, from an empirical/data perspective, the claim that beyond 8 or 16 mg. you feel no difference is ABSOLUTE BUNK. Look at research employing brain imaging technology to see the physiological phenomena that vary in response to variation in dosage. It's fundamentally untrue to say that in all cases there's no different between Xmg and Ymg ... or beyond Xmg you feel no difference. How this insidious myth got started is a mystery to me, but I'll work my tail off shooting it down. Similarly, the notion of "fake withdrawal" or "psuedo-withdrawal" (two phrases enjoying strong currency in this forum) is preposterous. While some aspect and manifestation of withdrawal may be psychosomatic, this doesn't mean it's NOT REAL. Many illnesses are "psychosomatic" (meaning that they derive from or are inflected by a mind-body relationship), from various forms of cancer to many instances of cardio-pulmonary disease, etc. Would anyone claim that stress-induced illness isn't real, or is fake, or is "pseudo-illness"? Probably not.

Another issue I want to talk about is addiction vs. dependence. They're two different things. Very different. One can be dependent but not addicted. Addiction is a clinical diagnosis of a disease. Dependence is a clinical diagnosis concerning the body's orientation to homeostasis at any given point in time. I am chemically dependent on opiates. But I am not experiencing addiction at this point in my life. Addiction pertains mostly to manageability. When I was shooting dope, I was dependent and addicted for the most part. My life was unmanageable in nearly ever respect. As a suboxone patient, I am exceptionally functional--interpersonally, professionally, emotionally, cognitively, etc. I am an amazing father, a respected scientist, and a documentarian (film and radio). And I happen to consume 36mg/day of suboxone. Yes, I could take less. But I don't want to because I don't feel as good, I don't relate as well to others, etc. And yes, I could try to taper down, to quit altogether. But I do not want to quit. I enjoy opiates. "OH, that's the addict in you talking" would be the first response of many, to which I might say, "How do you know that?" or maybe "Yeah, so what?". Every day we engage in innumerable attempts to alter consciousness, to make ourselves feel better, look better, BE better. If suboxone assists me in this regard and does no harm to others, then what's the problem? Why do I have to adhere to your views on drug use, sobriety, etc.? Believe me, you'd enjoy my company a great deal more when I'm on suboxone than when I'm either opiate free or shooting dope. Ask my 12-year-old son which father he prefers: the 36mg/day dad or the 16mg/day dad. His answer beats everyone else's, every time. (Note: This doesn't mean that his answers to all questions are the most sound ... e.g., "Hot fudge sundae!" in response to the question "What should we have for lunch and dinner today?").

I joined this board as a recovering addict who has found that suboxone is transformative in the ways I never imagined possible. I joined as a behavioral scientist who works very hard to conceptualize and examine his own addiction in the context of scientific studies of drug use and abuse and in relation to the experiences of friends, family, colleagues, and acquaintances dealing with the same disease. And I joined in hopes of finding a community of people who would support my decision to take suboxone INDEFINITELY (perhaps for the remainder of my life) because it's the RIGHT CHOICE for me and my family and my colleagues and my community. I remain hopeful that this community will live up to these ideals. If not, I'll be happy to remove myself from the list.

So yeah, that's a bit about me and my orientation to the issues at hand. I'd really like to make some connections here, share stories, learn, teach, relate, and generally enjoy my time with others. Because in the end, all we have is borrowed time ... and I'd like to share some of mine with fellow suboxone-consuming recovering addicts.

Best,
Greg


Last edited by billyklez on Mon Aug 24, 2009 11:17 am, edited 1 time in total.

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PostPosted: Sun Aug 23, 2009 7:33 pm 
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Greg-

Hello and welcome to the forum. There is nothing wrong with the ideology of your dosing scenario, you are 100% correct, we are not all the same and what works for one does not necessarily work for another.
In regards to the majority, there are valid reasons I personally ( I cannot speak for anyone else here) mention finding the lowest dose possible to find comfort in.First, there is the pharmacology which states, "The agonist effects of buprenorphine increase linearly with increasing doses of the drug until at moderate doses they reach a plateau and no longer continue to increase with further increases in dose—the “ceiling effect.In fact, in high doses and under certain circumstances, buprenorphine can actually block the effects of full opioid agonists and can precipitate withdrawal symptoms if administered to an opioid-addicted individual while a full agonist is in the bloodstream." Many people addicted to opiates are psychologically scarred by the abuse, and have a tendency to take more of any drug than required. In the mind of many addicts, more is better. This is why I find it necessary to offer the advice as given.The object for many is to not only stop withdrawal but to stop the behaviors that come with the addiction.
In regards to the pseudo-withdrawal scenario, I do believe that anyone that says they experience withdrawal symptoms is in fact doing so.Again, the mind of an addict is programmed to behave in a certain manner, so there may be situations where this programmed mentality takes over in place of an actual situation. For instance, I remember when I would feel the onset of withdrawal and my mind took over to perform the task of finding pills to alleviate the symptoms. After being on Suboxone for a few months, I got a flu bug, but the feeling was mimicking how I felt during withdrawal. I immediately took more Suboxone thinking that would be the solution, but it was not.I had to re program myself to be comfortable with physical illness.
I have been on Suboxone for almost two years.I have been researching addiction much longer.I also have a anxiety disorder in which my current medications do very well in keeping it under control.For years, I have struggled with trying to find a way to deal with my mental condition without causing myself harm, and today, I am more productive and happy than I have ever been, thanks to Suboxone. I have no plans on discontinuing it. Yes, I initially started taking it for opiate dependency, but it has managed to do allot more for me than what it is advertised to do.I will not apologize for that and I do not care what the rest of society thinks.I am comfortable and stable.
Not everyone here has the same ideas about Suboxone. I help those in need and challenge those I don't understand or agree with to try to see things from a different point of view. Not everyone agrees with my ideas and that is OK.This is a community of all different types of people with one common feature-Suboxone.
You are more than welcomed here and do not ever feel differently. You may get in a couple debates, but we learn by challenging what we disagree with, as long as you do it decently!
Thanks, Shel

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 Post subject: Indeed ...
PostPosted: Mon Aug 24, 2009 11:15 am 
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Shel,

Thanks for the reply ... very reassuring ... your message, along with the first response, have allayed some of my fears and certainly go a long way toward making me feel very comfortable and welcome in this forum. The spirit and content of your message mean A LOT to me, as hardly anyone I know personally is taking suboxone currently. So I find myself often feeling lonely in this regard. I talk to my clinician frequently, and my wife and son are very receptive to the concerns, hopes, and/or feelings I articulate in reference to Suboxone, but I've longed for the sympathetic ear (and to offer a sympathetic ear) to a fellow Suboxone "patient". Some might say "that's the addict coming out in you," but I would say it's the human coming out in me ... simply desiring the company of others dealing with similar issues.

Also, I appreciate your elaborating on the ceiling effect ... I do/did understand the concept, and I was trying to explain how both the floor and the ceiling vary within a range expressed by the standard bell curve residing in the space defined by the good ol' X and Y axes ... it IS a linear relationship, but the value of the covariance is different for everyone ... we're all a bunch of dots scattered throughout the area in that graph ... the linear, straight line is the one that "best fits" the pattern of scattered dots ... and it's a kind of average. The vast majority of people fall within a fairly tight range of units of drug to effect ... but a good many people are outliers at the low and high ends ... but the line is "artificial" in that very few people actually fall on it ... blah blah blah ... yes, everyone's different, but we're all very much alike ....

And I get what you're saying about pseudo-withdrawal. I sort of figured that's what you meant, so I'm glad you expanded on that too. For me, it certainly has been an struggle getting used to physical discomfort (I used to be able to vanquish it with a bag), but even more challenging for me has been just getting used to my own body ... living in it, understanding it, accepting it for what it is rather than constantly working toward changing it, altering consciousness, etc. That's been hard. The dose I'm at now for the most part eliminates any sort of withdrawal feeling an nearly all instances of craving. At lower doses I got a burst of energy for two hours and then a "buzz" for an hour or two ... and then leveled off ... one of the many reasons I increased my dose was to eliminate the buzz and level out. That's been a struggle ... addicts enjoy the buzz ... I don't see much discussion of that in this forum, and I could probably guess many of the reasons behind the silence. So I'll just say that an important part of my own recovery involved raising my suboxone dose to a level that would discontinue the energy bursts, the intoxicated buzz feeling, and would just level me out.

Okay, I've rambled enough. I'm really thankful that you replied. I do feel quite welcome in this forum ... and I'm eager to get to know others, to learn, to debate, and to support ....

Best,
greg


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PostPosted: Mon Aug 24, 2009 5:59 pm 
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Welcome to the forum Greg :) I was very happy to find a place where I felt others could understand what I was going through and talk about how Suboxone has helped alot of people including myself to find a semi-normal life post addiction. Wanted to point out that you sharing your experiences did not offend me in the slightest. I'd encourage you to continue doing so but ultimately I'm just so happy to hear about another opiate addict who is no longer using. Hope to hear again from you soon :)

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 Post subject: Interesting first post
PostPosted: Sat Sep 19, 2009 1:47 pm 
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Greg,

I find your level of intelligence to be very high, and I am sure that your level of education matches my first statement. Thanks for posting here and allowing me to see a "different" view, if you will. I have only been on Suboxone for approx. 18hrs at the time I am writing this, but have years of addiction issues under my belt, hence my joining of the forum. On some of your statements, I fully agree and with others, I am not sure what to say?, as I do not have the years of experience you have in researching human behavior etc.

Therefore, the only issue I can speak of is my own. I personally have never experienced any "pseudo" withdrawal effects, as they have always been real, especially when there is an extended period of time between my last pill and my next score. It is amazing how easy it was for me to develop and maintain a "supply" network. There were times though, that no matter how well I had established connections, I would go through periods of time without the drug (Oxys, Percs etc) and I would go through the various stages of withdrawal. The longest I have ever gone is 3 days (The scary thing is that this is over a 7 year period!), as we were on vacation and my pills somehow got misplaced when packing. I had a certain amount on me and it held me through by rationing it so that I didn't ruin my family's vacation. Anyhow, when I ran out 3 days before our departure date, I started to lose my mind initially and even thought about trying to find it on the street in the town we were visiting. I was on the elevator and was heading to the ground floor when I realized what I was about to do would be the dumbest, craziest thing I had ever attempted in my life. I went back to my room and actually thought about quitting at that point, but I never did, as the first thing that happened when I got home was to drop an Oxy and take a deep breath.

I guess my point to this story is that everything I have ever felt is real from the lack of pills and I wonder how anyone could have any other type of withdrawal feelings?. You either have something in you system or you don't?, and when you don't?, the evil Demon comes knocking at the door. I will suppose that anxiety would cause you to "anticipate" what will happen within the next few hours and you can use your memory to <I>FEEL</I> something that isn't there yet by simply going back in your mind and <I>thinking</I> it?. Is this what you are speaking of?, is this where these "pseudo" withdrawal feelings you speak of come from?.


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PostPosted: Sat Sep 19, 2009 2:12 pm 
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We're only talking about "pseudo-withdrawals" in the context of Suboxone. The half-life of buprenorphine is around 36 hours, so if you take 16mgs at 8am and you start feeling "withdrawal" at 5pm...it's not physical, it's mental. If you just ride out the craving for a little while, it goes away - as opposed to real withdrawal which would progressively get worse the longer you waited to dose.

I'm not saying it doesn't FEEL real, because it surely does. I'm just saying it's probably not necessary to keep taking more and more Suboxone every time you start to feel slightly dopesick. It passes and your body quickly gets used to dosing once a day.

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PostPosted: Sat Sep 19, 2009 2:26 pm 
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Diary of a Quitter wrote:
We're only talking about "pseudo-withdrawals" in the context of Suboxone. The half-life of buprenorphine is around 36 hours, so if you take 16mgs at 8am and you start feeling "withdrawal" at 5pm...it's not physical, it's mental.
I'm not saying it doesn't FEEL real, because it surely does. I'm just saying it's probably not necessary to keep taking more and more Suboxone every time you start to feel slightly dopesick.


OK, I understand now to some extent. I didn't realize we were only discussing or you were referring to Suboxone directly. My Bad!. :D


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