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PostPosted: Wed Apr 02, 2014 6:46 pm 
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Hello, I'll get straight to the specifics.

2nd time on Suboxone. 1st time was a fast taper inpatient dextox 4 years ago. Was using 480mg crushed oxy orally daily. I went to inpatient detox and was detoxed via Suboxone fast taper. Spent a total of 9 days inpatient. 7 of those on suboxone. The fast taper was fantastic. Easy, quick and for the most part painless. A little bit of RLS and insomnia for 2 or 3 nights starting 72hrs after discharge.

Fast forward to 2013. Using 2 50mcg Fentynal (matrix) between cheek and gum daily. Used for 8 months building up to this tolerance. Decided to stop. Unfortunately, I could not get back into inpatient detox this time. So I went the methadone clinic and regimen route. (daily observed doses in addition to twice per week urine samples at the clinic) The doctor at the clinic "inducted" me. I still had Fentanyl on board as I had stopped using 15 hours prior to induction so I spent 3 days in precipitated WD :evil: . I was put on 10mg Suboxone daily. I found the methadone clinic and treatment plan barbaric and not doable with work and family, so I decided to have my family Dr RX me doses of Suboxone that I could take home and dose at home. This is working out great thus far. I have managed to ween my dose down 25% every 4 days. ie Started at 10 mg ---->4days assess if stable 8mg---->assess if stable---->6mg assess if stable...etc.

I'll be starting 4mg tomorrow. Although, I must admit that I have some trepidation in proceeding with the final phase of this regimen as I fear, but not certain that I'll have already developed physical dependence to Suboxone to some magnitude.

I suppose my question is, after being on Suboxone for almost a month, and tapering down as I have been, does anyone have a reasonable tapering schedule from going from 2mg to 1mg, day on, day off sort of thing and then jump?

Would the application of a 5mcg patch of Butrans assist with WD management in the final tapering phase/regimen?

Any comments are most welcome!


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PostPosted: Fri Apr 04, 2014 12:31 am 
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Realize that you don't get tolerant to specific opioids. The issue is your degree of opioid tolerance--- THAT is what determines the work you need to do to get to zero tolerance (which equal zero withdrawal symptoms).

A person on a ceiling dose of buprenorphine--- over 8 mg per day or so-- has a tolerance about the same as a person taking 40 mg of methadone per day. The tolerance of a person taking 100 mcg of fentanyl per hour is considerably higher. I don't know what your tolerance is--- you would need to look at the amount of fentanyl when you chew it... but I suspect it is much higher than your tolerance would be on Suboxone. When you have precipitated withdrawal, that is from buprenorphine 'yanking' your tolerance down to the 40 mg methadone level, from wherever it used to be. Your choice is whether to pause at that dose, and get used to Suboxone-- and stabilize at a lower tolerance than you used to have-- or to keep pushing tolerance lower each day. An argument for the latter is that once tolerance starts dropping, that tells you that your body is now manufacturing new opioid receptors... and the quickest thing would be to keep pushing all the way down. IF you stop pushing and use, the machinery of making new receptors will grind to a halt, and greatly lengthen the time to get back to normal.

Be sure to ask yourself... after that first detox, why was I back on opioid? THAT is the big issue-- the tough part of the equation.


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PostPosted: Mon Apr 21, 2014 12:11 pm 
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suboxdoc wrote:
Realize that you don't get tolerant to specific opioids. The issue is your degree of opioid tolerance--- THAT is what determines the work you need to do to get to zero tolerance (which equal zero withdrawal symptoms).

A person on a ceiling dose of buprenorphine--- over 8 mg per day or so-- has a tolerance about the same as a person taking 40 mg of methadone per day. The tolerance of a person taking 100 mcg of fentanyl per hour is considerably higher. I don't know what your tolerance is--- you would need to look at the amount of fentanyl when you chew it... but I suspect it is much higher than your tolerance would be on Suboxone. When you have precipitated withdrawal, that is from buprenorphine 'yanking' your tolerance down to the 40 mg methadone level, from wherever it used to be. Your choice is whether to pause at that dose, and get used to Suboxone-- and stabilize at a lower tolerance than you used to have-- or to keep pushing tolerance lower each day. An argument for the latter is that once tolerance starts dropping, that tells you that your body is now manufacturing new opioid receptors... and the quickest thing would be to keep pushing all the way down. IF you stop pushing and use, the machinery of making new receptors will grind to a halt, and greatly lengthen the time to get back to normal.

Be sure to ask yourself... after that first detox, why was I back on opioid? THAT is the big issue-- the tough part of the equation.


Hi suboxdoc,

First of all, I'm sorry for the late reply. I've been busy working on this matter. And, as I'm sure you well know, it's a time consuming all encompassing thing. Thank You for your valuable input. I sincerely appreciate your response. And, as you stated in the part of your reply, Why end up relapsing? And, of course, that IS THE difficult part of the equation. And it's something I've been busy working on. Along with getting off Suboxone. I'm feeling pretty confident that I wont relapse again as I have no access to opioids other than through my family doctor. This includes ALL opioids. I don't have any access through street level dealer nor do I have any friends or associates that use.

In my part of the world, we approve only the tablet form of Suboxone. So, of course, getting the dosage down to a level below 1mg requires some creativity. I have been reading through some of the threads on this matter(how I wish I could get films here!) and it sound like dissolving tablets in distilled water to obtain 1mg< is really the only safe way of ensuring you are getting close to the dose you are looking for. Thank you whoever discovered and posted this!

So, today, right after I post this I will be dissolving my last 1mg dose. Starting tomorrow, I'll be attempting the dissolve in water method. And, I'll report back my results.

Brain chemistry sure aint easy!

Hope everyone had a great long weekend.

ttfn


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