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PostPosted: Tue May 08, 2012 9:56 pm 
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There is not enough information yet, but it seems that one group of people starting Suboxone are over the age of 45.

In some important ways members of this group are different, and require identification at induction, in order to be treated well and benefit the most from Suboxone. Often members of this group have only taken Prescription narcotics, often for pain or after surgery. Often their experience with synthetic pain killers after surgery or a degenerative disease is their only experience with drugs of that type.

If this type of patient is not clearly offered A B C type induction they end up being told to go to an NA meeting (or required to) which can make no sense to them at all. Since older people are more vulnerable to drug actions and are less likely to have strong recovery systems - they might be given too much Suboxone initially.

They are often not as knowledgeable about drugs in general and trust doctors no matter what. In spite of this there seems little concern or provision for this group. Maybe there should be more concern -- I am not sure.


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PostPosted: Wed May 09, 2012 10:46 am 
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scruffy wrote:
There is not enough information yet, but it seems that one group of people starting Suboxone are over the age of 45.

In some important ways members of this group are different, and require identification at induction, in order to be treated well and benefit the most from Suboxone. Often members of this group have only taken Prescription narcotics, often for pain or after surgery. Often their experience with synthetic pain killers after surgery or a degenerative disease is their only experience with drugs of that type.

If this type of patient is not clearly offered A B C type induction they end up being told to go to an NA meeting (or required to) which can make no sense to them at all. Since older people are more vulnerable to drug actions and are less likely to have strong recovery systems - they might be given too much Suboxone initially.

They are often not as knowledgeable about drugs in general and trust doctors no matter what. In spite of this there seems little concern or provision for this group. Maybe there should be more concern -- I am not sure.


So you're saying that "...older people are 'less likely to have strong recovery systems...are often not as knowledgeable about drugs...and trust doctors no matter what...". I'm sorry, but I must ask from where you've obtained this information and to provide some kind of source to this. I can't see how any such generalization can be made about an AGE group. How do you even define "OLDER PEOPLE"? Have studies been done on older people and their knowledge about drugs and feelings about doctors and types or availabilities of support systems? I think you're selling "older" people short. The older a person grows the more knowledge they have! The more people they've built up around them to have more support. No, I can't say that applies to everyone. But at the very, VERY least, you can't make generalizations arguing the opposite.

I guess I'm assuming you don't have a source, but if I'm wrong and you do, I apologize and would love it if you'd share it with us. Or perhaps I'm misunderstanding your post?

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 Post subject: Older different?
PostPosted: Wed May 09, 2012 1:31 pm 
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The post is not an attack on older people (over 50). It is taking the observation that a 19 year old male who is drug wise and street wise and has primarily obtained drugs on the street is, unfortunately, not uncommon. But it is different than a 50 year old male who has only taken Rx drugs and has taken Oxy for a time due to post-operative pain or a degenerative condition. These are different people starting Suboxone.

One trend does not need proof - the population is getting older. The start of the baby boomers taking more medications for pain means a great increase in numbers. Most in this group will be different from the 19 year old mentioned.

The question is: are there distinct groups in the population that have these common characteristics --- in such a way that they are different, and should be treated differently? This is not known, but a post might attract some people in these categories with their story.

One study (I will have to try and find the ref.)-- Large well done study - found that over the past years the number of people taking Suboxone shifted from 1/3 planning to stay on, and 2/3 using for detox. Over some years this has reversed, and now 2/3 have opted for being maintained in some way. It would be interesting to know if this is related to age in any way --- perhaps not.

In terms of sensitivity to doses -- It is a given in the medical community that young children and older people need adjusted doses. Maybe 50 is not "old" in this setting, but it may be. It appears much of the testing and development of Suboxone therapy and Dr. training has been geared to younger people.

It is stated in the prior post that older people have larger support systems of family. That well may be true, but it is also true that that group is vastly different than the hypothetical 19 year old who has a group of friends using drugs who must also learn to deal with that. The "support group" in these two categories may be very different. That is a question, not something with an answer.

These are just questions, looking for responses. I see no outlandish hypothesis that requires documentation . If there is I will do my best to find refs. in the literature-- or statements from doctors who deal with this every day. I was just hoping to hear some responses - indicating these groups exist, or do not.


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PostPosted: Wed May 09, 2012 2:03 pm 
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I apologize if I came on too strong. Your second post sounds much more like opinion than your first, which was presented more like fact. It's all in how it's presented really. And that second post, as I said, really made much more sense. Thanks for the clarification. It all makes much more sense now. I believe it merits discussion.

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 Post subject: Boomers and Pain
PostPosted: Wed May 09, 2012 9:02 pm 
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I agree that there is a large difference between the young partying w/drugs set and the Baby Boomers getting the pain meds legally.

Take my older brother as an example. He is 61 and several years ago he fell off a ladder and broke his hip. That is a really painful break so he was hospitalized for over a week and started on Oxycodone with some Norco for breakthrough pain.

After the long healing process he tried to stop the Oxy's and found that it was too uncomfortable to do. He had a problem weaning down, kind of like an addict, but believe me he is not one. He was seeing a pain specialist and they recommended Suboxone to get off the Oxy's. They started him at 2mgs and within two months he jumped at about .50. Man was he sick! Poor bro didn't sleep for two weeks and said he felt like death warmed over, but he got through it just fine. He had no idea what Sub was and still doesn't really know much about it.

So did he need AA/NA, or to see an addiction specialist for therapy? Hell no. The part that bothers me is that on his medical record it will show the Suboxone as prescribed for addiction and it wasn't. I didn't tell him that 'cause it would just piss him off and do no good. If it happened to him, it must be happening to many others. As we BB's get older, arthritis, bad knee's, shoulders, backs, etc. cause us to seek relief. The physicians know their patients and have no problem prescribing opiates for legitimate pain, as they should.

I am also a cancer survivor who met many others who took Hydro or stronger meds for over a year and had a tough time tapering down from them. Wouldn't Suboxone be a better way to wean them down? Not if they are labeled "Addicts". Or just let them (and me) stay on the Sub for life as radiation is known as "the gift that keeps giving". A lot of us BB's are already addicts from the 60's and 70's and getting put on opiates lets the beast out once again. Not always, but sometimes like me. But then I am a hard core messed up brain addict and will never be normal in that sense.


Is this kind of what you are talking about? Hope I didn't ramble on too much if it is not on topic.


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 Post subject: THAT IS THE PROBLEM
PostPosted: Wed May 09, 2012 9:24 pm 
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Yes, Rule, that is the sort of thing that needs to be fixed. Your brother in all probability suffered way more than he had to.
He needed help off the Oxy and that is very common. But what is not at all clear is if the use of Suboxone in his case was wise use, or just a guess.

It looks like a guess. I wonder if a smaller initial dose to stop the Oxy w/d in a more controlled setting might not have worked. It sounds like it dragged on too long so he 'suffered from the cure'. And should not have.

I do not have all the answers, but an educated guess would be smaller initial doses and quicker tapers to deal with the bad two weeks of Oxy W/D. Someone needs to be demanding that the medical establishment get this right, and that good research is done, so we no longer have to rely on the ill informed opinions of too many doctors. Too many have come to think their opinion is scripture and it sure is not.

I think a call for more research, and some work on best practice from committees of experts is in order. Like the work done at the National Academy of Sciences on best practice.


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PostPosted: Wed May 09, 2012 9:29 pm 
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Ok, maybe I was a little hard on the people who don't do their own research in your other thread scruffy. With yours and Rule's example, I can understand why someone would get on sub and not realize it is addictive and how long it would take to taper off of. Makes me think of my mom. Whenever she has a question, I always tell her to google it. "Mom, anything you need to know, you can usually find on the internet." "Oh yeah," she says, "I always forget about that internet!"

She is STILL so amazed that anytime something happens to her, she can get online, and you bet, it has happened to somebody else. So I guess these are the types of people who will not research sub for hours and days and months on end, like I did before I got on it. Thank you for both giving me a different perspective.


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PostPosted: Thu May 10, 2012 1:35 am 
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same here" if i did not have sergury i most likely wood not be here on the sub program.
one saying'. first you have pain see a doc thats where the pills start "then sergury then more pills ,
but stronger with poor judgment then more poor judgment sets in with the legal outhor- from the lack of jydment.
now suboxone with less lack of judgment but still risking criminal behavier from volnerble people in NA /AA
make's some poor people B/B BM'rs poss- vulnerable criminal's :shock:

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PostPosted: Thu May 10, 2012 10:58 am 
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like any one from young to older. life is life no matter what" we all are in some kind of pain and i do remember my second doctor advise these drugs can become addictive, and the hospital wanted me to wean of after word witch i to found very diff-
and not really sure weather i should have. sooo... witch all go's to show we are all in the same boat. and when i was young
i remember being treated the same way practically .

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PostPosted: Thu May 10, 2012 11:18 am 
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I wanted to add something that Dr. Junig says about sub use in young people (under 30): that the relapse rate after going off suboxone or doing sub tx short term is extremely high (almost 100% according to Dr. J; see his blog).

Take this for what it's worth, but he says the studies bear this out, although I don't have the time right now to cite those studies; I've done so in other places on this forum. Also note that these studies were SHORT TERM, as there are little to NO long-term studies on suboxone, as it's only been out since the early aughts. Take what you will from this information.

Just wanted to throw that out there, as some may consider this important to the discussion.

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 Post subject: One More Time
PostPosted: Thu May 10, 2012 1:01 pm 
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What I failed to mention, as my post was too long already, was that my brother did try to get off the Oxy's on his own and said the Suboxone was a much better way to do it.

And guess what? He was bicycle riding months ago, fell and broke his elbow. Yep, back onto the Oxy's which he is still on today. We have discussed the Sub and he keeps asking to be put on it but his Dr. wants him to continue the pain meds.

Next time he will ask for the 2mg film and will be able to taper down much better than last time.

And I do remember people posting here about being put on Suboxone for pain. (LT for one) Although her case was a bit different. Sub should be used to wean people off of heavy pain meds so they can go function in the world again. If they stay on it, so what?

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 Post subject: RESEARCH NEEDED
PostPosted: Thu May 10, 2012 1:23 pm 
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It would be most helpful to see a research report comparing people stopping Suboxone by using it in a 28 day program
(Dr. Scanlan, YouTube) vs. various longer term taper to quit programs. Given great latitude, doctors invent various programs of tapering after a patient is established on Subs for relatively long periods of time on relatively high doses.

I would not be surprised to see a correlation of success to lower doses and shorter times. That would be a good null hypothesis for a study. I see few, if any, good studies out there. This, in itself, is wrong. When Buprinorphine first came out in the late 80s the dose was .2 mg. Not 2----(.2). And this was a schedule drug for moderate to severe pain.

And yet many people are led to believe it is Oxy light, or H light. It is not, it is powerful, and deserves a strong research program at NIH and other agencies. I, for one, will be writing to my reps. in Congress asking for research and best
practice guidelines from Nat Acad. of Sciences.

This new and powerful tool, Suboxone needs to be used just right, and distributed at low cost to many who need it most.
And for those with good insurance and money-- they need to be treated right too, and not "milked" for the money to be made by the greedy minority prescribing badly.


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PostPosted: Thu May 10, 2012 1:38 pm 
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Keep in mind, scruffy, that bupe by itself, used for a pain med only, in those low doses is not meant to treat addiction and is for people with low to normal opiate tolerance (or opiate-naive). Suboxone, AKA "high-dose bupe", is at those high doses specifically to address opiate addiction. Therefore, in my opinion, comparing the two doses is like comparing apples and oranges. They aren't even used for the same purposes.

Just my two cents so take it for what it's worth.

Any more studies about Suboxone is great. If you notice on the clinicalstudies.gov (or every time I've checked it), there have been numerous studies going on w/ regard to suboxone and/or bupe. And as I previously said, it just hasn't been around long enough to have any decent long-term studies. I honestly don't know the objective definition of "long-term" when it comes to studies, but I've seen them last as long as 20 years, and we all know sub hasn't been around that long.

I'm all for more studies. Not because I have doubts about suboxone, but because a lot of people DO have problems with it. Plus some feel like even though bupe has been around much much longer and they still don't quite trust bupe with the naloxone added to it.

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PostPosted: Thu May 10, 2012 10:06 pm 
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Yes, the earlier formulation was just for pain - and it is no longer available as a sub lingual .2mg. as far as I know.

I believe it was Dr. J at one point stating it would be nice to have some lower formulations for people tapering - there is just so much breaking one can do with a pill. I know there is much about water solutions to be found. But it would be handy if a drug company made .5 mg. and maybe even .1 mg for serious tapering. I recently asked a compounding pharmacy if they could do that and they said they could.

You mention naloxone and I think it is a bigger issue than it seems. Officially it causes a bad reaction in 15% of people.
It is just unknown how many people would be better off with pure Burpinorphine. Naloxone is nasty stuff only there to prevent abuse and for non-abusers it is worse than worthless. It caused headaches for me and the Dr. was good enough to Rx just Bup alone.

It may not be easy- but I am convinced there could be standards so that all initiations end up determining the very best plan for each person. If this means a doctors practice is limited to a particular method, and the patient is determined to be needing something else, that patient deserves to be maintained as a referral is made. One way or another a patient must always be with the right doctor and not suffering because their needs do not mesh with what is "always done".

I don't have easy answers for much of this. Just some relevant questions and a call for input regarding this.


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PostPosted: Thu May 10, 2012 10:52 pm 
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Sometimes I feel like Im in a total different class on this subject. My doctor, was completely different, than most of the stories Ive heard here.

The first time I saw him, he asked me three questions

what do you think suboxone can do for you?
what is your goal with suboxone?
How are you going to pay for it?

I realy hadnt done any research, I had gotten into the clinic with a refferal from my very good friend. a friend that I had used with previously, until one day she told me she got on suboxone, and about two years later I actually talked to her about it, becuase it seemed like she had the life that I wanted, but was completely outta reach.

Anyway, living in a small area, I always (jokingly) said we had "backwards" doctors that couldnt "make it" in the big city.

Well, my doctor said at my very first appt, he only had about one quarter of his patients go OFF suboxone, once they started. He made it pretty clear that many people didnt/wouldnt/couldnt go off it completely.
He's also made it clear that when/if Im ready to taper, he can "help" me with that.

Im not sure if I ever will be ready. Im on suboxone for pain issues too. And as long as I can get the Rx, I guess Im not going to worry about it. I do know I never , ever want to go back on full opiates agian. NEVER.

with that said, I dont think my arthritus/back/shoulder issues are going to get better with age. I work construction as it is. I carry things, all day long. Pretty soon when this condo job is over, I'll be back to doing deliveries agian, which is even harder on me. I dream of the day when I will have an easier job, but until then I have a son to support, so it is , what it is.

I just had to add that,
that in my case at least, I would say my doctor wasnt misleading in any way. and he pretty much leaves it up to the patient on what they want to do, for their "program"
Im fairly certain, if I would have said that first appt, I only wanted to be on sub X amt of time, he would try to help me with that. Or even if I said that now.

Good luck to everyone and thier "program"


one thing I forgot to add.........
after some horror stories I read, I asked him once about tapering. He said when a patient tells him they are ready to taper he makes them give THREE POSITIVE reasont for tapering.
I was like so ..
"so Im not spending money on suboxone"

he said NO. thats a negative reason. He said, positive reasons are ones with no negative effect. I asked for an example, he sheepishly smiled and said, then Id only have to come up with TWO.
Im gratefull that I seem to have a good doctor.

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Last edited by amber4.14.11 on Thu May 10, 2012 11:17 pm, edited 1 time in total.

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PostPosted: Thu May 10, 2012 11:15 pm 
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I got curious, so I just searched for "suboxone" on clinicaltrials.gov and found 48 current or just closed studies and 272 for "buprenorphine".

I'd say this is an indication that they are doing more studies all the time on sub and bupe. Just FYI.

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