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PostPosted: Fri Mar 24, 2017 3:38 pm 
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I'm in a spot. Perhaps this is appropriate, and perhaps not. I have been taking buprenorphine/naloxone through the brand, Zubsolv, for just over a year and a half now. Early on, I was set on a dose of two 1.4/.8 milligram tablets daily. Almost immediately, I began to have issues, personally, with taking my medication as prescribed, often taking three and as many as five in a single day as I began to feel--however erroneously--the effects wearing off. Three months into treatment I switched doctors but not doses, and I run out early very routinely. Up to now, I would switch to kratom for the few days that I would be without zubsolv, but this led to use of a credit card and got me into exactly the same trouble that got me into addiction recovery in the first place. It has made a dent in my finances and has all but destroyed my marriage. That being said, I am thinking of coming clean with my doctor about my misuse but am afraid that this may result in my being ejected as a patient. I believe that I could find another doctor, but this could come at a substantial expense of time and money. On the other hand, it could result in my being re-dosed at a higher amount. I just can't count on any specific outcome and am completely terrified of being cut off. I am not out yet, but will be soon, a full ten days before my next appointment and kratom, alas, will not be an option this time around. If there is any advice or related experiences that anyone has to offer, I would be greatly appreciative. I understand the gravity of my actions and at this time am trying to pick up the pieces of my relationship and salvage/take charge of my recovery. Thanks very much in advance.


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PostPosted: Fri Mar 24, 2017 3:46 pm 
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Hi Grove,

Nothing at all inappropriate! You're in the company of other addicts. This is the kind of stuff addicts
do while still sick and suffering.

First, I'd make an effort to find out the rules of your clinic. Is it a clinic? Telling the doctor
might be my last choice, especially if unsure of what the consequences would be. Others might well disagree.

You know, I might bite the financial bullet and find another doctor and start clean. A new doc likely
will have no problem with what you've done in the past, as long as you don't do it with him

It's likely not too late to save your marriage. Heck, she's stayed with you this long!

Others will chime in.

YOu've come to the right place!

Best wishes,
Godfrey


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PostPosted: Fri Mar 24, 2017 3:56 pm 
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Godfrey, thank you. Thank you, thank you. I've looked into other doctors before, mostly to get my prescription earlier, If and when possible. I am currently being prescribed through the same pain management place that supplied my painkillers during my days as a user--talk about them getting you coming and going!--which has worked to narrow down the hefty $150 per appointment to a very manageable $30 since I still continue with them for pain management. A new doctor might well be the ticket, though the last one I spoke to required documentation of current enrollment/participation in a treatment program, which I have long since "graduated" from. I am going to look into other possibilities as I know certain psychiatrists can also prescribe these kinds of things without going off label and could provide some much needed counseling and mental support. I'm a mess.

And yes, she's stuck with me this far, though I fear I might have reached her breaking point this time. Thank you again for your very encouraging response. I hope you are well!


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PostPosted: Fri Mar 24, 2017 7:05 pm 
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Grove,

I honestly feel for you. Your sincere desire to get clean and to get on the right side of your own conscience
come through loud and clear...and are such good signs. Each and every one of us has a story, and none of them are pretty. No one here will judge you, as long as you're making an effort to be honest.

Yes, addiction psychiatrists could fill the bill. I think your current arrangement is at a little confusing.
You need unambiguous treatment for addiction it seems to me. This disease is confounding enough
without adding to it.

Talk to your wife man. Get down on your knees and cry if you have to. She's undoubtedly a good woman
and she deserves an honest, sober husband who's gonna be there for her when she needs you.
I'm betting she'll give you this one last chance. And if not, well that' just another loss you'll have to deal with
and grow from.

Keep posting. And I can promise others will be around to support you and give you advice...


Best wishes,
G


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PostPosted: Fri Mar 24, 2017 8:21 pm 
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Can your wife or anyone else hold your medication for you?? If so, can you take maybe one a day instead of 2 so you can stretch them out until your next appointment??


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PostPosted: Fri Mar 24, 2017 9:21 pm 
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Hey Grove,

A agree w Godfrey and Htown's thoughts. I often have to write out mine to think thru so I had to figure out what your dose is compared to suboxone. So here is different dose availability for brand name buprenorphine/naloxone products. Those in [brackets] don't exist as a single dose. I wrote them in for comparative purpose only bc I/we are often more familiar w Suboxone dosing here. Hopefully my chart will show up:
Suboxone -Zubzolv- Bunavail
[1mg]..........0.7mg..................
2mg............1.4mg..................
4mg............2.9mg........2.1mg
8mg............5.7mg........4.2mg
12mg..........8.6mg........6.3mg
[16mg]......11.4mg.................

So looks like you are taking the equivalent of 4mgs of suboxone/day which is perhaps below your ceiling, which could be 4-8mgs of suboxone. Not sure if you're aware of buprenorphine's ceiling affect but we usually need at/above the ceiling to cease the cravings and obsession to use. read around here. go to the top menu here, click suboxone talk zone and there see at the top a menu choice named suboxsearch. click and you'll have 2 sites to search 'ceiling effect'. and a bunch of links come up. read away!! Also, a few folks are rapid metabolizers who may find themselves burning through their buprenorphine faster than others. You can check w a simple blood test of the cytochrome P450 family of oxidizing enzymes. The CYP enzymes related to Suboxone are CYP3A4 and CYP2D6. An easy and not an expensive test.

As to your spouse, my heart breaks. Who I am now is who my ex would now love to be w!! It just took me awhile to get here. I agree w Godfrey, do everything you can to keep it together. If by any chance there is a family addiction program in your city, I've seen it do wonders. My best to you, P

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PostPosted: Sat Mar 25, 2017 5:01 am 
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I think u just need to ask ur doctor for a larger dose. I don't know if u should mention the kratom or not. Normally we recommend u just be honest with ur doctor, but I've seen it go completely wrong after they did.... so in fear of u being dropped by ur dr, I don't know what u should do about discussing the kratom. Does kratom show on any drug screens? I have no idea, anyone know that answer?

Imo ur maybe taking extra because ur under the ceiling level, so getting prescribed a little bit more will help that issue. Also, going to the exact same place for ur buprenorphine that u went to during ur active addiction would be tough for me. I say this because after I stopped using, I changed everything. I didn't even want to take roads I used to because it reminded me to much of my using days. I even changed the candy I ate during that time. So u being in the same place could be a reminder for u. I know u love the price and I definitely don't blame u because that's an awesome price. Just something to maybe think about. And u do need counseling, does ur place officer counseling? If not u can find an addiction counselor or anything to add extra support.

Good luck and please keep us updated!!

Oh and ur wife.... if u show her ur willing to do anything to change, it'll mean more than you'll ever know. But don't wait, take action now before it's to late :)

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PostPosted: Sat Mar 25, 2017 7:32 am 
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Pelican and Jenn,

That's great advice WRT dosing! Another reason to see a qualifies addiction doc.


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PostPosted: Sat Mar 25, 2017 8:07 am 
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Wow! Thanks for all the great responses! I did happen to find a new practice yesterday that seems like a godsend. They mirror the same procedures as the same spine pain clinic I already visit and have a psychologist on staff who has a pronounced specialty for graduate students with bipolar disorder, which is really how I would describe myself to polite company. At my first induction, the 2.9 mg Zubsolv didn't exist yet and my pain doctor just kept me on what I was getting from the doctor who performed my original induction several months before. The first doc was all about short term use with a swift detox, and the second, my current doctor up to now, has only mentioned a taper maybe once or twice in the last year. While I'm still working things out with my wife, I have set up an appointment with the new doctor for this coming week. As it stands, I am set to run out about ten days early--it's been a hard month--and I intend to be honest with them at this point that I have been trying to operate beneath my dose ceiling. The nurses at my current doc often comment on what a low dose I am on, given that in my pill popping days, I would down 20-25 10/325 Norcos a day. I was blitzing through a 30 day supply in 5-7 days on average. I'll keep you all posted as to how it goes. Again, thank you all for your very kind and detailed responses!


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PostPosted: Sat Mar 25, 2017 8:20 am 
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And to Jennjenn, so far as I know, kratom doesn't appear in any drug screens however, with my first doctor, I once had a false positive on UA for cocaine use--which I've never in my life touched, let alone even seen up close--and I wondered if the kratom might have been responsible as I'd taken it the day before. In general, I refer to kratom as "unicorn blood," if you're into Harry Potter at all. I call it this because it keeps you more or less alive, or at least not in full blown withdrawals and comes at a terrible--financial--price. I definitely don't suggest it, though it is currently legal though completely unregulated in the US, and has similar brand/potency issues to what one would experience buying edible cannabis products. I've mentioned it to doctors in the past and most have never heard of it. They usually just jot the name down on a Post-It and move on with life. It was this substance, and the dent it made in our credit card that landed me in the trouble I'm in with my wife. At my appointment with the new doctor, I intend to explain my reasons for switching, some of which I have stated--they are the same doctors who fed my initial addiction in the first place--and that they have become a money hungry revolving door for pain patients and new practitioners. They are aggressively expanding their practice, but seem incapable of keeping even family members as long term staff. Additionally, they offer no other services beyond spinal injections and surgeries, so any counseling must occur at my expense somewhere else. Two refills past, there was a man in the next room having a shouting match with my PA about how he had caught her doctor brother smoking marijuana in the office. While this seems absurd to me, they've very steadily made me feel less like a patient and more like number. I'm hoping all goes well with the new doc, and that my running out of meds early will not create an insurmountable obstacle to my continued treatment at the new practice.


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PostPosted: Sat Mar 25, 2017 9:47 am 
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Quote:
Does kratom show on any drug screens?


It does not. It can be tested for, but the lab has to be notified that you are looking for it. It won't show up on a 'pain management' panel or an 'addiction screen'.


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PostPosted: Sat Mar 25, 2017 10:50 am 
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Good to know, as far as kratom on a drug test. I'm hoping I've done my last dance with mitragyna speciosa.

As for my wife holding my meds, it is something that we've discussed, and while she has been in some ways very supportive of my recovery, she has also been the person most directly impacted by the negative aspects of my addiction and related bipolar disorder. That being said, her support only stretches so far as her own self preservation will allow, which to the perspective of many recovery programs is probably not far enough. But for her, it's like sticking her hand in a fire; not something she's going to fall all over herself to do. I'm grateful to forums like this for the advice, support, and experiential knowledge. One thing about being an addict is that you become a very, very good liar in the end, but all liars get caught up with in the end, no matter how good. I've lied and I've been charming, and for a time, that worked for me. In the end though, being secretive isn't the same thing as being mysterious, and neither of them make a person particularly interesting, and so I hope now to dismantle my double life and become something of a singularity. I just hope I don't become single in the relational sense.


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PostPosted: Sat Mar 25, 2017 12:15 pm 
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Grovelist, your posts are enjoyable to read, even if the subject is not a happy one. The posts read like prose.

I am sorry that you can't count on your wife to help you by doling out your daily meds. It's not like it's hard to do, at least in my opinion.

Amy

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PostPosted: Sat Mar 25, 2017 12:37 pm 
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Hey Grove,

Appreciate all your efforts here and for continuing to fight for your recovery. Impressive. Imo, seems obvious you need a higher bup dose, even above the ceiling to start w, perhaps the 8.6mg or at least the 5.7mg zubzlov total/day. And learn about the ceiling effect - that taking more and more does nothing more. If you still have problems on a higher dose, then testing for CYP3A4 and CYP2D6 would be of interest.

Yes yes to jennjenn's point on changing up life so old remembrances and habits get broken. NO way could I have gone back to my pain mngt MD clinic and been treated w bup. NO way bc all my addiction desires would only be extra pronounced and markedly exacerbated while there for my appt as well as throughout the time between appts. It makes me upset that those Drs didn't refer you out. So many cycles need to be broken including going there. How could anyone get and stay in recovery w going back to the same place where addiction started and was maintained?

I'd also not mention kratom or the problems its caused, to your new Dr. Since you're going to be out of bup, where can you get a script for clonidine and gabapentin? Your current pain mngt Dr? Your internist? A Doc in the Box? These will really help till the new Dr appt and are legit meds that won't cause problems w your new Dr.

Thanks docm2! Have you ever tested for it? What would trigger a Dr testing for kratom? Is Millennium Health the only lab offering kratom testing? To date, I've not yet read here of a patient that's been tested for it.

Randox Technologies, a UK based healthcare diagnostics company, has a Randox Testing Services division, a large workplace and legal forensic testing lab headquartered in the UK, is big across Europe. While kratom is not listed in Randox's employer workplace tests, Randox reports it helped shape the UK's drug driving law to include testing for kratom.

PS Thx Godfrey and agree w Amy's post.

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Stopping went well -- its the staying stopped -- where the real work begins.
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PostPosted: Sat Mar 25, 2017 2:57 pm 
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Thank you again, Pelican. I don't think I mentioned you by name earlier, but your previous response was much appreciated. I don't know why I hadn't taken into serious account the impact that getting my bupe from the same source as my old drug of choice could and would have on my recovery, but recent office visits have produced an uncomfortable sense of dejavu. I'm still the same nervous, high blood pressure addict who goes in, plays the "I've got it all together" card and hopes to score his new drug of choice the same day. Unless anyone has a compelling reason why I shouldn't, I intend to be up front with my new doc, that I'm out of my current prescription, that I don't think it achieves the ceiling effect I need to maintain and not look like I'm pretending to be human. That I've been getting my cure from the same place that field the disease in the first place seems a valid and viable reason for the switch in providers.

As for the gabapentin, I'm way ahead of you. I've got a refill coming on Monday, so that will be a huge help. I was getting clonidine from my first bupe doctor, but they switched me up to benazapril as I was only taking the clonidine for high blood pressure. At my induction, I was at the high end of stage II hypertension, and am usually somewhere on that spectrum every time I go in for a bupe refill. I'm not much of an optimist, so until I have those two lovely boxes of Zubsolv in my hands, I assume that anything and everything could go wrong at any moment.

And Amy, thank you very much for the kind words about my writing. It is something I do a lot of--when I'm not jonesing, anyway--and take great pride in. Thank you!


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PostPosted: Sat Mar 25, 2017 3:36 pm 
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Quote:
Thanks docm2! Have you ever tested for it? What would trigger a Dr testing for kratom? Is Millennium Health the only lab offering kratom testing? To date, I've not yet read here of a patient that's been tested for it.


Quest Diagnostics will. I have not tested for it. I don't see a need to confirm what I have been told. I don't have any body on Buprenorphine that had an admitted Kratom addiction. I've only seen one and we mutually decided to go with comfort meds and abstinence based treatment. 4 months and he's still doing ok. So, when I test I'm looking for their earlier DOC's.
I review a lot of UA's from our program, not just my patients. Occasionally I will see it requested.


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PostPosted: Sat Mar 25, 2017 6:43 pm 
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Doc2m,

That's good info. I wouldn't argue so much that I have a kratom addiction so much as it gets me by when I run out of buprenorphine. As it sounds like you're a medical professional, am I off base for switching to a different doctor and requesting a higher dose to prevent misuse? Misuse in this case being my regularity in coming up short every month? Perhaps you have answered this already and I missed it. I shall have another look in a moment. My terror of running out is exceeded only by my terror of being cut off by my doctor. Apart from my misbehavior, I believe my reasons for switching are well grounded. As I've already explained, I'm receiving my Zubsolv from the same doctor who prescribed the Norco that led me into rehabilitation in the first place. Secondly, I'm losing confidence in their office; I waited three months for my doctor to call my MRI lab to clarify results to see if an epidural lumbar injection was feasible. Twice she said she'd need to make a quick call and never did at two monthly appointments. I've been waiting three weeks to hear back from their scheduling department about having another procedure. The list goes on and on, but suffice to say that their eyes are bigger than their waiting room, if you know what I mean. They have been a revolving door for new doctors and PAs for the past two years, whereas when I first went in for treatment they maintained a varied and robust staff of doctors and PAs. To my knowledge, they now have two doctors and one PA overseeing six different offices accross three counties. Their Yelp reviews are in the toilet, and while I know that that isn't the most reliable indicator of performance, I have experienced a lot of the posted negativity firsthand albeit not as severely as most.

I'm definitely trying to justify my continued use of buprenorphine as I consider it rather miraculous. A friend described the experience as feeling extreme bladder pressure on a lengthy road trip. Buprenorphine is like finally getting to take that epic piss. It's the only thing that keeps me feeling remotely human and has even balanced out a lot of the symptoms of my bipolar disorder. I'm in no hurry to discontinue its use. Neither am I willing to jeopardize my access.


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PostPosted: Sun Mar 26, 2017 11:03 am 
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Quote:
am I off base for switching to a different doctor and requesting a higher dose to prevent misuse? Misuse in this case being my regularity in coming up short every month?


In my view, you should be increasing your dose so you are well above the ceiling effect. If continuing on Zubsolv that would be two of the 5.7 mg daily tabs.
Relapse can be so preventable, during the first weeks I ask if a person is on a high enough dose and work with them to find a level where they are comfortable. I know it runs counter to a lot of anecdotal stories on the internet but virtually all of the people I see end up on at least 8 mg, and most 12-16 mgs daily of Suboxone.
Somebody else recently posted that they had recently started Suboxone and they were also on too low of a dose. I am not sure how this is getting into practice. It is not advocated on the training website or any recent CME that I have taken.
I actually like getting someone like you, it is such an easy fix. I suspect you would be much more willing to address your addiction once the cravings and insanity of using is under control.

Regarding your blood pressure. You may have 'white coat' hypertension. Either routinely check your BP at home (home BP cuffs are under $30 at Walgreen's or be checking at various places when you are not worried or anxious about meeting with your provider. Lots of grocery stores and pharmacies have kiosks for checking BP and pulse. Mine is routinely 15 - 20 mm systolic higher when I go to my doctor, so he looks at the values I record during the month.

Seems like many areas have 'pain clinics' much like yours. We have two, I won't say more.


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PostPosted: Sun Mar 26, 2017 11:34 am 
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Doc2m,

Thank you for the very kind and thoughtful reply. When I was first inducted, I was prescribed one box (30) of the 1.4mg Zubsolv and instructed to just take "a few" to see the effect and how it worked. I took my very first dose very late in the afternoon after roughly six weeks without an opiate of any kind. I took two. And for that day and the day following, that seemed alright. I could tell from the outset that my first doctor was all about a fast taper, and once I had felt the effects, I knew that probably wasn't going to work for me. While his practice regarding regular UA and follow up with my treatment center seemed within expectation, I constantly felt like a criminal when visiting his office. Moreover, the first time I ran out early, he refused outright to up the dosage even a little bit. It was that experience that has shaped much of the fear I have around switching doctors and asking for more. And while I am not myself a doctor, I agree very strongly that 5.7 would have me well above my ceiling and safe in the attic, as it were. Again, thank you.


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PostPosted: Sun Mar 26, 2017 12:59 pm 
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Additionally, I would agree with you also about "white coat" hypertension. I've mentioned my high blood pressure readings at other doctors offices on occasions where I have no expectation of receiving favorable medications and my BP is almost always optimal. I do have a home BP kit just in case. Once, while visiting my current Zubsolv doc, my BP was so high I had to call out of work and go to the ER for an EKG. Everything was normal, so yeah, it would be hard to argue that it doesn't have to do with my anticipation going in for meds. It was always that way when I would go in for my Norco refill. Like I said before, until I actually have the medication in my hands, I'm psyching myself up and out for any kind of unforeseen obstacle that might separate me from my meds. It's a horrible way to live life.


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