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 Post subject: 2.5mg per day
PostPosted: Tue Dec 28, 2010 2:38 am 
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Hi all -

New to forums, nice to meet all of you guys. I have been on suboxone for about 3 years now. My question is, how many of you are dosing at 3mg or less?

I currently take 2.5mg daily as my maint dose and have been doing so for about a year. I take .5 in the morning, .5 at lunch and the 1.5 at night when i get home from work.

Is this considered a low maint dose? Kind of high? A long time to be on sub period? My doctor does not give me adequate answers to these questions and I was hoping someone could address it for me. I would like to get off sub but I dont think I can go any lower than I am already now.

If I were to take my 2 weeks of vacation time and jump from 2.5mg to 0 mg do you think 2 weeks would be enough time to get feeling ok before going back to work? Keep in mind I've been on sub for about 3 years and at this dose for at least 1 year probably closer to 1.5 years.

It seems to me that 2.5mg per day is a low dose, but I really dont know anyone I can compare to. Any info about doses the size I am taking would be very helpful. Thanks.

-- Anthony


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PostPosted: Tue Dec 28, 2010 3:06 am 
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Hi Anthony,

I'm going to say 2.5mg is a low maintenance dose. You've been at 2.5mg for a while now and you have stabilized at that low dose and that's great. I too was on suboxone for 3 years before I quit. If you're serious about quitting I hope you have 'all your ducks in a row.' I mean as far as understanding your addiction, preferrably with the help of a drug counselor?

You can jump off sub from the 2.5mg dose you're at now, but I'm afraid that's a little on the high side to jump from unless you're ready for the wd. Most people would prefer you taper even lower before you jump. You said you take .5mg in the am, .5 at noon and 1.5 at night. You have some opportunity to cut the evening dose, I would aim for 1mg evening dose, then I would go to .5mg evening dose. Then I would cut the noon dose out completely. That would leave you at .5 in the am and .5 in the evening, a total of 1mg. That's a little better scenario for jumping, still ocnsidered a bit high to many though.

Between each drop I would wait at least a couple of weeks, probably closer to a month to make sure I stabilized.

It all boils down to how long you want to taper, how much wd you want to deal with during the taper process. You can slowly taper and experience some wd during the taper process or you can jump and go through all the wd all at once. Make sense?

I would suggest you taper down as far as humanly possible then when you can't taper anymore, jump.

I jumped off sub at around 4mg or 5mg and it was difficult, very difficult....you can do it, it was just more difficult than it needed to be. I should have tapered lower.

Try looking in the 'liquid taper' threads, there's some good information there.


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PostPosted: Wed Dec 29, 2010 1:10 pm 
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Thanks for the response man.

I was really unsure about my dosage as far as compared to other sub patients. My doctor would not really tell me if the dosage I am taking is high, low or what. This gives me a good idea, especially after reading other posts on the forums. Maybe some other people can chime in too.

I dont think that I am ready to stop taking sub yet, but it kind of seems my doc is pushing me to. It is hard to tell from visit to visit what he is going to say. Sometimes he does not mention wanting me to lower my dosage, other times he pushes quite hard for me to go lower. Any lower than 2.5mg or 2mg max, I start to feel very crappy with lots of cravings etc. That dosage seems to be the "floor" for me. He is trying to get me to go lower on most visits but I am resisting. I think he may be trying to push me out so he can get another patient.....


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PostPosted: Wed Dec 29, 2010 1:53 pm 
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Hi Jobe and welcome,

I've been on sub for just a bit more than 2 years. I know people who've been on it longer than you, and others, less. Personally, I think 2.5 is a low maintenance dose. The ceiling is generally accepted as at or around 4 mg, but it takes getting solidly above that to address cravings (to keep a constant blood level). Also, when under the ceiling, suboxone "acts" more like a full agonist than the partial agonist that it is. For this reason, you might "feel" your doses.

There's no real normal dose for sub maintenance. Some people are at 6 mg, others at 16 or higher. It's just a matter of what dose treats their cravings best.

If and when you decide to taper off, I would also suggest going much lower than 2.5 mg. Some people (the ones with the least amount of discomfort) taper all the way down into the micrograms. (See the Liquid Taper thread.)

Hope this helps.

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PostPosted: Wed Dec 29, 2010 2:02 pm 
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Thank you for reply hatmaker.

Maybe you can answer me this? Is it because I am below the ceiling that I have to split my dose into 3 parts and take 3 times a day to address cravings? That is the reason I do not take once a day. If I take my full dose in the morning I am a hurting unit when I get home from work. I know it is highly recommended to take your full dose once a day but I cannot do this. I could discuss with my doctor but I know he will not raise me up to 4mg and I don't really want to ask him.

I have been doing it this way for over a year, my doctor knows I take it more than once a day and he just kind of says "try to take only once a day if you can", while at the same time pushing me to go lower. It seems kind of like setting me up to fail?

Thank you in advance for any responses.

P.S - I am somewhat new to the forum, I signed up 6 months ago but did not really post or anything and now I'm back :)


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PostPosted: Wed Dec 29, 2010 2:14 pm 
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I'm glad you decided to come back around and post. I know you'll find lots of support and info here - I know I have.

I would most definitely say your low dose is exactly why you need to take it more than once a day. The low doses simply don't give you a stable blood level nor does it keep your receptors saturated - as I understand it. But hey, if taking it that way DOES address your cravings (or any w/d symptoms you might have between doses) and you consider yourself stable, then it works for you. Try not to compare your dose to others' - it's just a number after all. I'm on a high dose (for pain, I take 8 mg 2 or 3 times a day) and I remember worrying about everyone constantly telling me my dose was too high. It bothered me at first, but I finally decided that I need to do what works for me and not compare myself to others. So if you feel good at the dose you're on, then so be it.

What sucks, if you don't mind my saying, is that your doctor sounds woefully uninformed about the medication he is prescribing. And even worse - it's simply not unusual. They need a lot more education about suboxone and addiction than they're currently getting, that's for sure.

If you're not ready to go off it yet, and YOU are the one that needs to decide that (YOU are the one who might be at risk of relapse if you quit.), then it might be time for a heart-to-heart with your doctor.

Good luck and welcome back to the forum!

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-I'm only responsible for what I say, not for what you understand.


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PostPosted: Fri Dec 31, 2010 11:06 am 
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Jobe wrote:
I dont think that I am ready to stop taking sub yet, but it kind of seems my doc is pushing me to. It is hard to tell from visit to visit what he is going to say. Sometimes he does not mention wanting me to lower my dosage, other times he pushes quite hard for me to go lower. Any lower than 2.5mg or 2mg max, I start to feel very crappy with lots of cravings etc.


Jobe, I think that we may have the same doctor. Mine does the very same thing.

When I speak about cravings, my doctor will say, "That's psychological and you need to learn to deal with them." He's actually said to me, "Stop doing that," as though I control the cravings. (Ironically, my craving often are in the middle of the night. I'll wake with them. Sometimes, I'll recall a dream that set them off. Other times, I have no idea where they came from). During the day, it's usually when I'm stressed or am around someone who's using (oxys were my DOC and, all the time, I come across people at work who are on opiates, a good number seem to abuse their scripts).

I hope that your doctor listens to you and doesn't keep pushing you if you're not ready. I've hoarded a bunch of Sub, just in case that's what happens to me.


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PostPosted: Fri Dec 31, 2010 7:21 pm 
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Hey there.. I usually don't post on here, mainly just a lurker but I also take a very low dose. I initially started at 1.5 mg and have since weaned down and stabalized at 1mg. I only dose once a day in the morning and have no issues. Contrary to the belief that it acts more as a full-agonist at lower doses I have yet to experience this. The first week I definitely did, but doesn't everybody "feel" it when they induct? I have been on it for 7 months and truly believe low dose maintinence is possible. I don't know whether there is any validity to the notion that being on a lower dose allows your brain to heal as all of your receptors aren't saturated but it sure makes sense to me. If you can get by on a low dose there is no reason to increase just to reach the "Ceiling Effect" in my opinion. But each to their own


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PostPosted: Fri Dec 31, 2010 9:28 pm 
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Thanks again for more responses guys.

I don't think my doctor will actually drop me with no warning. If he is going to drop me I'm sure he will give me some sub to tide me over until I find a new doc etc. Here's hoping anyways.

In response to Rmac, I have been on this low dose for about 1.5 years now and I consider myself stable too now. Until I posted on this forum I didn't even know if that was considered a low dose or not. I usually lurk too but I had to post to find out. Thank you for your response too :)

Have any of you ever been dropped by a sub doctor for a reason that wasn't because you started using again? I mean, if you were following the program and have been a perfect patient for 3 years (which I have, never failed a UA etc. never been late to pay my bill), but doctors I'm sorry I think its time you stop being my patient now. Has that ever happened to anyone?


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PostPosted: Fri Dec 31, 2010 10:41 pm 
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Hey jobe,

I was on sub for three years and my doctor never hinted at dropping me. She asked on most visits if I was ready to make a drop to a lower dose and I would usually tell her that I was still having cravings, was afraid of relapse and she would drop the subject.

I'm not going to say it's impossible for your doctor to drop you, but I would say it's unlikely. I absolutely remember the same thoughts going through my head before every doctor visit...is she going to be there today, did she up and move her practice, did she decide to just skip town, is she going to force me off sub. My wife was dumbfounded by my fears and couldn't believe I even had thoughts like that, so I eventually listened to her and my fears subsided greatly...but they didn't completely go away.

You should maybe mention to your doctor that you would like to stay on sub long term if possible and see what he says?

Good luck.


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PostPosted: Sun Jan 02, 2011 9:18 am 
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Regarding the doctor pushing you to get off......I actually pushed back. I was blunt, respectful and honest with my doctor, and I just told him that at my age (47) with my history (30+ years of opiate abuse) and my illness (HepC positive) that it doesn't make any sense at all for me to get off suboxone and put myself at risk of another relapse.

He actually agreed with me, moved me to seeing him every OTHER month instead of every month and now we're very gradually reducing my dose to the goal of 4mg, where I will likely remain for the duration.

Now, I'm not saying your doctor will respond the same way mine did, but I don't think there's anything wrong with having an open and honest discussion about this topic with your doctor.

And if you're not ready to get off and your doctor is pushing you to get off, well, look for a new doctor.


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PostPosted: Mon Jan 03, 2011 12:20 am 
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Thanks again for the replies.

The big problem is money. I would not be so worried about him pushing me off except I have it pretty good right now. Visits every 3 months, 100 bucks a pop no drug testing. I checked around at other places and the intake fee is high, they require outpatient treatment which is expensive etc. All in all not a good deal compared to what I have.

Another thing is my age. I am only 27. Been on since I was 24. That is young. Maybe doctor thinks; he is young he can do it. It does not matter so much if I lose my job because I'm too sick to sell appliances etc. I'd be harder to kick me off if i was a 60 year old retiree or something. Just some thoughts.


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PostPosted: Mon Jan 03, 2011 2:55 pm 
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Hi and welcome to the best Suboxone forum there is (IMO).

2.5 is definitely on the low end for a maintenance dose. However, if you jump off at that amount, you will experience significant withdrawals. I think two full weeks off of work would get you past the really horrible stuff but I think you would still most likely have significant symptoms. I did jump one time from 3 mg and went pretty much exactly two weeks before restarting Sub. I restarted because I was still really, really sick and not sleeping. The first week I took nothing. Then, I had surgery and was given pain meds, which didn't keep me out of withdrawal whatsoever, except when given every 15 minutes via a drip. When I was discharged from the hospital, I was just too miserable and not functioning and decided to restart Sub. Back then, I was incredibly disappointed in myself because I thought (and my family thought) that 3 mg was a 'small' amount. That's not true. 3 mg is 3,000 micrograms, so 2.5 mg is 2,500 micrograms. To go off of Sub and not get really sick, it's best to wean to beneath 200 micrograms before jumping. If you did that and then took some vacation time, you'd be okay.

If you want to get off of Suboxone and feel confident that it's the right decision for you (which is a big choice and not to be taken lightly) try to get to .5 mg/day and once you're there, to minimize acute withdrawals, I'd recommend switching to the liquid taper method because it's too high to jump but the tabs get impossible to split. There's a girl on here named Diary of A Quitter who chronicled her Sub reduction regiment. Basically, she combined Sub with a small amount of water, and using a barrel and plunger (a.k.a needle thingy w/o the needle) she got down to tiny doses before jumping. Actually, she switched to liquid at 1 mg, if I remember correctly. The point is that you CAN go lower than 2.5 in you want to because there is a way of reducing very, very gradually. The doctor on here, Dr. Junig, gives a general guideline of a 10% reduction at a time and to not reduce again until you've had at least 4 consecutive comfortable days. I've gone all over the Internet, and I'm convinced Dr. Junig is pretty exceptional. I recommend you watch his videos and maybe think about getting his e-book. He is in recovery himself and he really gets this stuff. I try my best to follow his advice, simply because it actually works!

I've been on Sub since 2005 and the main reason I was put on it was for pain, since I am a recovering alcoholic and not a good candidate for addictive drugs, but I'd suffered a terrible injury. I had no experience with opiate w/d and I didn't have a clue what it felt like. I've tried getting off a few times, but not knowing what to expect or what is normal caused me to absolutely freak out when the symptoms hit. I've had three different Sub doctors and none of them have been as educated as I (now) am about the drug that THEY are prescribing. The biggest thing I've learned from this experience is to not wait around for a doctor to guide you in the right direction and be able to adequately keep you informed. It will not happen in almost all cases. You have to educate yourself and be your own advocate. Period! I'm now in the process of tapering. I have a good doctor and I bring him information every month, which he both receptive to and thankful for, which has made me respect him tons.

My first doctor did boot me out after I 'failed' a drug test. He later agreed to see me, since he was controlling my seizure meds and putting me at extreme risk by refusing to fill them. He showed me the test results, and apparently I'd been doing about 15 drugs and didn't remember taking them or even how to take some of them. I wouldn't admit to taking the drugs, so he wouldn't continue to treat me. We had a stand off. Eventually, he discovered that the drugs that showed a 'positive' were the ones he actually requested them to test for. Dumb Doctor!! Then he agreed to resume treatment, but he had destroyed my faith in him and I had to switch. From then on, I made sure I always had some Sub saved up in case of emergencies. IMO, it's not a bad idea. I also think it's a good idea to put your foot down with your doctor if your doctor is pushing you to do what is not the best thing for you. Like junkie said, stand up to your doc. This is your well-being that's on the line.

I hope you stick around here because this place is fantastic. There are people who are on Sub indefinitely, people who are weaning off, people who have already weaned off, people who are unsure, and people who have not even started Sub yet. It doesn't matter. There's no one way of doing things here. The main idea here, IMO, is to get as much information and support to people as possible. If you decide to stay on Sub 'forever', you will be supported. If you decide to get off, you will be supported as well. It's all about making the best choice for YOU. Without these people, I wouldn't have the confidence to wean off Sub. I'm forever indebted and will pass it on by supporting you in whatever you choose to do.

Best of luck,
laddertipper

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PostPosted: Tue Jan 04, 2011 9:14 pm 
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Awesome post, laddertipper. Just terrific, thanks.


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