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PostPosted: Sat Apr 30, 2016 4:49 pm 
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Of those who have spent too much time in the grips of opiate addiction.
Hi there, I'm a 39 year female, wife, mother of 4, RN in a busy, high acuity ICU. I'm also ending a 4 year, very dysfunctional relationship with hydros, oxys, and kratom (to fill the gaps..... upwards 40grams a day most days.) I never tried H, but as supplies became scarce as they often do, it went from absolutely not kind of option to a wellllllll maybe just once when I can't obtain something else. I think we all know how that turns out, and it was fast approaching.
I came clean to my psychiatrist who initially insisted that I must go to inpatient rehab. I considered, did research, but found that the cost and disruption to my family's life is more than we can handle. I'm fully aware that this is in part, is probably a lot more denial than anything - however, I'm one who has to learn everything the hard way. Obviously.
So, my psychiatrist connected me with a good outpatient rehab program that my insurance will pay for, and insisted that it would be much easier, safer, and better for so many reasons to taper with Suboxone than try to do it myself, which in past attempts, always failed miserably, to the point of me using significantly more in an effort to "make up" to my poor, empty and screaming receptors!
So this morning, in full withdrawal, I had my first visit with a sub doctor. He was nice, but very much to-the-point and stern, which honestly, I appreciated. I have found that being an ICU nurse has (unfortunately) enabled me to manipulate many a physician over the years. I had classic drug seeking behavior but I believe it went ignored due to my status as a nurse and being an outwardly functional seeming human being. I realize, I will have to answer for this one day.
I was surprised this doc didn't induce in office, rather wrote me a 30 day script for 8mg Suboxone films, with instruction to take 1 half in am and 1 half in pm. His reasoning for doing so is mostly so that I could come in for my initial visit without being in full blown withdrawal, and concentrate on the information/instruction he provided me, and ultimately go through the grueling task of withdrawal in the comfort of my own home. Unfortunately, or rather, fortunately depending on how one sees it, I was in withdrawal already, only using a signicant amount of kratom yesterday and a small amount this morning so I could get to my appointment - and only because my stash ran out. It was indeed very hard to concentrate, as I was snotting and tears rolling all over the place, stretching, yawning and just pretty much acting a fool in general. I don't know if he was being polite or if he's desensitized to all behaviors he has encountered in this practice but he didn't appear to notice. He told me while on this med, no benzos, alcohol, and obviously opiates or kratom, be prepared to provide urine at each visit, and I need to be in a program of recovery. Check check check check. Long story short, once I got home today, meds in hand, I was easily scoring high on the COWS, even in spite of my earlier kratom use, so, I went ahead and cut the first strip up and dove in. Now, only because I'm a very anxious person and have read so many horror stories about PWD, or just dosing too high, I started with 1mg. I waited a full hour and felt no relief from my WD symptoms. Not worse mind you, just exactly the same. So one hour later I tried one more 1mg. I almost immediately felt better. I was able to get out of bed, my legs are still sore but I'm sure that's due to kicking them around for the previous 15 hours! However, the restlessness, anxiety, and runny nose and eyes were subsiding. I'm wondering if this is my dose - 2mg in the AM and 2mg in the PM. I'm also wondering if I just should have followed his instructions and taken 4mg to start but all of my research led me to believe this dose would be way too high for me, as my habit, while bad enough to give me SIGNIFICANT wd, was not big enough to start with so much suboxone. Am I wrong? I did text my psychiatrist about doing less than directed and she felt this was absolutely appropriate. I'm just going to be completely honest here, the addict in me is saying "hey, if 2mg is okay, just think how wonderful you will feel at 4mg or more." My understanding is that this med does not work that way, in fact, higher dosing can cause sickness, and I'm really trying to stop this line of thinking and behavior.
On Monday I have an initial evaluation appointment with the outpatient rehab facility, and I do plan to start going to 12 step meetings after I gather information from them.
So that is me in a very long nutshell! I hope that didn't bore anyone to sleep, and I thank you so much for getting this far.
Praying for peace for ALL OF US in 2016!


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PostPosted: Sat Apr 30, 2016 5:48 pm 
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HI prayingforpeace! I just wanted to say welcome to the forum. I enjoyed ready your story. Sounds like you are doing a great job with your induction. I too was sent home to start mine as opposed to in office. Seems like there are many that do it this way. I am glad it went well and you are able to be OK on a lower dose. You are correct that some times higher doses can cause sick feelings and definitely can cause some of the initial side effects to be worsened. I have been on subs just almost 2 months and it's definitely a life saver for me. Anyway I just wanted to welcome you here. There are a lot of great people on this forum with a lot of knowledge and great support. Dr junig who started this forum is so knowledgeable and also very supportive. He has some great articles and videos you can access through his other site called Talk zone. Hope things continue to go well for you. Let us know how you are doing.

Willow


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PostPosted: Sat Apr 30, 2016 6:29 pm 
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Hi Willow! Thank you so much for your kind reply. I'm looking forward to pouring over all of the information this website provides, thank you for pointing me in the right direction. I'm encouraged to hear that 2 months in you are doing well. Do you feel free of the obsessive thinking about your DOC? Among other things, I'm really looking forward to every waking moment NOT revolving around obsessing about how I'm going to get my next fix. I really feel like I've just taken a huge step to freedom! :-)


Last edited by praying4peace2016 on Sat Apr 30, 2016 10:48 pm, edited 1 time in total.

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PostPosted: Sat Apr 30, 2016 9:25 pm 
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Hello Praying,
So glad you ve found us and that your on your way to a new life free of that obsession to use opiates. Buprenorphine is saving lives and now including yours.
So I thought I would answer your question. This medication will take your obsession away. It did for this addict over five years ago. For that im very thankful. There wasn't much an addict could really do before Suboxone. Today there are many good success stories. Here on this forum and the many I personally know in the clinic that im a patient.

Willow is a Great success story in her own right. We all here are very happy for her. She gave good advice. The best one imo is to go to Dr Junigs Talkzone and read read read. Or watch his educational videos. Also, you can read "His Story " here too. Not only is he a great dr and the sites founder, he also is in recovery himself.

Congratulations on your induction, and no you were not wroug in going slowly with smaller doses to start. One never knows completely about tolerance and just how Buprenorphine will effect you in the begining.

With Buprenorphine having a ceiling effect taking more just to "feel it" can be a waste of time . Many believe the ceiling to be around 4mgs, some higher. See how your doing the first few days, and if cravings start to intensify you may need a little more. Time will tell.

Welcome again, and we do have a great group here with much experience and knowledge.

HHopefully peace has found you Pray. Good luck..

Razor R..


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PostPosted: Sat Apr 30, 2016 10:10 pm 
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I am 100% free of the physical craving with the suboxone. I still have the mental obsession some but definitely WAY less than before. More like mental cravings from time to time. Even when I had my d.o.c. I still would obsess constantly about if I had enough or where to get my next ones. What if this and that...you know the deal I'm sure. It's for sure not like that anymore. Yes I still have mental cravings some but if I distract myself they go away! I am in the process of removing people that were tied to my using. Staying away from triggers and that kind of thing. I'm sure in time it will be less and less cravings . But I can honestly say the obsession isn't anywhere near what it was. Such a miracle for me really ! I have such hope today. I am so glad you are going to read all you can. I did and still do. It really helps me stay positive. Keep in touch and feel free to pm me if you would like. I will help ya all I can. :D

Willow


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PostPosted: Sat Apr 30, 2016 11:08 pm 
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Wow, thank you both Razor R and Willow! I love the support of this site and the people here. It really truly helps. I have been so nervous about this day, but now I'm seeing that this is a new beginning! Not long after I wrote my last reply, I started feeling pretty craptastic again, I tried to ride it out as I wanted to keep my total at 4mg for the day, but I broke down and have taken a total of 6mg for the day. I do feel better, still quite a bit of general aches and a little restless but all other symptoms have dissapated and I'm not thinking about desperately needing to use. I feel normal. The hardest part of this battle will be mental for me. The way I've allowed my thought life to spin out of control, and for so long, has been the crux of why I'm where I'm at. Luckily, I have family that is still behind me, no legal issues, and no nursing board issues. I was coming close though, so I'm ever so grateful that the pieces came together before everything fell apart!
Thank you again, I look forward to reading both of your testimonies for encouragement on this journey :-)


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PostPosted: Sat Apr 30, 2016 11:49 pm 
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You did fine taking another dose! It will take a bit to find what dose u are fully stable at ....no physical withdrawl symptoms and lesser mental craving's. Then you can work on all the mental stuff after you find your stable dose. I think you are doing great for you first day! I too have a lot of work to do and know it will take time. We didn't get here overnight so we can't expect to get better overnight right?! But I feel like you have a great attitude and are gonna do great. Of course there are hard days . Ups and downs but that's life! We have to learn to deal with it sober and that takes time and work but can be done. If it was easy we wouldn't be here at least I know I wouldn't! So just keep going and you will be fine. We are here for ya! Have a peaceful night and hopefully you will get some rest knowing you have started your journey in recovery. Take care .

Willow


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PostPosted: Sun May 01, 2016 8:38 pm 
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Good advice all around. Understand that the dose/response curve of buprenorphine is not a diagonal line, as it is with agonists. Rather it flattens out very quickly, so that increases in dose do not cause an increase in effect-- or in tolerance level. In other words, taking more will NOT make it harder to stop down the line. Yes, it is hard to lower one's opioid tolerance, whether the tolerance is from buprenorphine or from fentanyl or oxycodone. You can either postpone that misery indefinitely, or you can go off Suboxone at some point and experience the hard work and misery of lowering your tolerance. Understand that people are not 'stuck on Suboxone'; they are stuck on a high opioid tolerance that usually requires a detox, or at least several weeks off work, to get it back down.

If you tried that now, you would almost surely end up on agonists again in short order. At least that's what almost always happens. So instead, I recommend that you stay on buprenorphine or Suboxone for at least a year, until you are far from the using life. Most of my patients stay on it for several years, and some stay on it indefinitely.

Your tolerance was likely pulled lower, just by starting Suboxone. Most 'habits' drive tolerance up to equivalent to 100-200 mg oxycodone per day-- and on buprenorphine your tolerance is around 60 mg of oxycodone per day. That tolerance will be about the same, whether you take 4, 8, or even 24 mg of buprenorphine per day-- so take what you need, to feel comfortable. And if you distract yourself whenever you have cravings, the cravings will eventually disappear.

Good luck-- hope you stick around and help the next people who stop by!!


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PostPosted: Mon May 02, 2016 10:47 pm 
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Hi Praying!
I'm so glad you have found this site, what a wealth of evidence based medical info here! I hope you are continuing to do well. I have had two separate periods of treatment with Buprenorphine. My first was a detox style course of Subutex which was titrated/tapered from 8mg to 0mg over eight weeks at an inpatient program. I was there for opiates and benzos, and was down to 10mg Methadone/day when I started. Because it was 2003 there weren't any options for office based treatment to continue the Subutex/suboxone once out of the program. I left inpatient treatment AMA, well against counselor's advice, instead of continuing for the third month (an additional $5000) because I was getting bullied and harrassed for being on the Subutex by fellow patients and even my group counselor, a fundamentalist 12-stepper who didn't understand squat about Buprenorphine. I made it about a month before relapsing first on benzos, then later with Fentanyl. Wound up lucky to be alive in the hospital after an O/D. I remember feeling well past the opiate w/d's and was out of active benzo w/d's(was using benzos again) when I relapsed on the opiates. I guess it was that compulsion to use, despite getting rid of the old friends and haunts, and going to meetings. Now, I always considered regular opiate abuse to be varying degrees of overdosing. This relapse and O/D with my shiny new low opiate tolerance almost killed me. I didn't die because my wife was home when it happened (a true tale of horror nonetheless). I eventually went back to a maintenance dose of methadone and stayed there until Dec '14, when I switched over to Suboxone. Thanks to this forum I found the right information about the ins and outs of induction, optimal absorption in oral mucossa, dose req'd to occupy receptors, etc. This saved me from all the side effects associated with those higher doses. Most importantly, I got the real skinny on rates of relapse in abstinence based treatment, which told me that I wasn't the only guy to have multiple relapses. To hear that this was not unusual at all with opiate dependency, I began to feel less shame and embarrassment. That heavy load of toxic shame has left my body over the last sixteen months of taking Suboxone and I almost have my life back from the protracted benzo w/d's. Maybe in a few years I'll revisit the idea of slow tapering off Buprenorphine, but for now I have too much healing to do.
Good luck with findng a comfortable dose, I hope you find that it helps you the way it helped me. Mike


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PostPosted: Mon May 02, 2016 11:15 pm 
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Mike, glad to have you posting here! Welcome!

I'm so sorry that you had to go through 16 years of stigma and embarrassment because of your opiate addiction. I really like that this forum presented a realistic picture of opiate addiction for you and helped reduce the shame that you felt.

I don't know if it is because my addiction occurred in my mid to late 30s or what. But I would not, do not, let anyone try to make me out to be a bad person because of my addiction. I'm also very defensive of my fellow addicts. I try to be a vocal advocate wherever I go because you guys are my tribe. And nobody better try to put my people down!

I am mostly just honored to be a part of creating a safe space for other opiate addicts. You guys keep me motivated to continue my school work finished so I can really start making a difference.

Amy

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PostPosted: Tue May 03, 2016 1:19 pm 
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Thanks Amy. While working as an emt-paramedic I encountered some very serious bitterness from many medical professionals towards the addicted population. Before my addiction came to a head, I hated the way some patients who were in Methadone maintenance were treated by various levels of medical staff from fellow emt's to nurses and even doctors. I'm so glad to hear you are 'representing' your peeps in your program, including the wisdom set fourth on this site by Dr J. I've been baffled by the Addiction Medicine "specialists" I've met who just don't get it, but think they do. I talked with a local psychiatrist who advertises himself as an opiate specialist, but is not and does not plan to be lisenced to prescribe Buprenorphine. Not because he's abstinence oriented either. That blows my mind! This country could use thousands more like you and the docm2 to stem the tide of trajedy still in our midst.


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