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PostPosted: Thu Dec 17, 2015 7:58 am 
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hey

So, on this forum I have quite often read and then been informed that above 16mg is not much good or isn't necessary or just not done these days. Stuff like that. Im on 32mg and some guy implied that was crazy and all in my head that I was not covered by 24mg. (maybe I was, maybe I wasn't - either way I tried 32mg and my doc was fully supporting this, saying due to my habit he thought in the beginning I would need to be at that dose; but from the beginning I have been against suboxone to start with.
Here is Aus, above 16mg is no big deal. Many people here are on over 24mg.
So I am under the impression and Im sure someone told me if I was given 16mg and told it was 32mg (which is what dose im on) I wouldn't even notice a difference.

I have not seen my doc for 3 weeks or so, and he is very hard to get into because of my work hours matching his. I am seeing him on Sunday but thought I might get some feedback from you experienced and knowledgeable people.
I have done what a guy on here said (cant remember which one) and on Tuesday took half my dose; 16mg instead of 32mg. I didn't feel any or much different and thought wow that guy was right.

Today being day 3 I woke up extremely sore, aching and it actually took me a big struggle to physically get out of bet and get ready for work.
Do you think it was the sudden drop or just in my mind like the guy suggested. (I must look up who he was as I hate saying 'that guy' when he has a name). So after a while I took another 8mg strip and felt much better.
Would taking half do that to me you think? Because, its said over 16mg does nothing, im thinking it couldn't have been the sudden cut of dose.
Any ideas, opinions, educated guess etc would be appreciated.

P.S I will do 16mg tomorrow and continue that and see if it happens again.

Thank you


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PostPosted: Thu Dec 17, 2015 9:11 am 
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Hey Mel,

"That "guy" I believe was donh, a loug time ,well informed member who knows his stuff.

Sometimes he says things with a zing in it, but he wants people to know the truth about this med as much or more than I do.

It is important to get the Right information, this is why I strongly recommend reading Dr Jungs Users Guide to Suboxone, It is a Must read, even for Drs!! Plus Talkzone blog.

Your system is slowly getting rid of the extra sub and you will be fine. 32mgs was way over the top and 16mgs is plenty at this point.
Understanding the ceiling point of Buprenorphine is where confusion on dosing begins. Go over to the Talkzone and read. Seach Ceiling Effect".

You say you aren't crazy being on sub, well if your thinking of Not staying on it for whatever reason you ll need to get that dose down anyway. Ceiling is ,for most people around 4mgs. I know because of my personal experience in tapering. Once you are stable on 16mgs, a drop to 12 or even 8mgs will feel the same.

Razor


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PostPosted: Thu Dec 17, 2015 4:20 pm 
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Hi razor

Thank you for your reply. I will stay on 16 until I see my doc and then go from there.
I wasn't keen on the idea to start with, actually starting suboxone, as its just another thing I will need to painfully get off (but worth it as it has changed my life). But then I realised it was a better option than what I was doing.
So would the jump be causing the discomfort do you think?

Im in no hurry now to get completely off of it as im not safe enough yet at all and with family members who deal its another reason to stay on but at as low a dose as I can slowly get to.
I will take your advice and educate myself at the talkzone blogs.

Thank you again so much for your help :)

Mel


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PostPosted: Thu Dec 17, 2015 4:44 pm 
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Hey Mel :)

I know very little about Australia except for the Melbourne Housewives ;) I'm a huge watcher of housewives regardless of the city or county they're in lol. Anyway I'm getting off topic, I remember u said once that in Australia the doctors tend to prescribe sub in higher doses sometimes compared to the US. Maybe that's why ur kinda apprehensive about dropping lower thinking it'll make u feel bad physically...and I totally understand that. But I promise u that u won't be able to tell at all physically. Now mentally we can make ourselves think just about anything and have just about any symptoms. I think maybe that could be some of the issues ur having with dropping down to 16. I know there's times that I won't have a headache and if I start thinking about...wow I didn't get a headache today, then after a few minutes I'll literally have a headache, it's crazy how we can do that.

When I dropped from 16 to 12, I couldn't even tell a difference. When I dropped from 12 to 8, mentally I had a little bit of paranoia thinking I had symptoms but it was just me freaking myself out. I think u will be fine regardless of if u drop to 16 or 12 or even lower. I think the majority of this forum would agree with that. Just try to not freak urself out, I did that too at first, but in the end this is a different type of drug than us addicts had been used to, less is really more and tolerance doesn't really matter in higher doses. Good luck Mel, I'm glad ur a part of the forum :)

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PostPosted: Thu Dec 17, 2015 5:48 pm 
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We may be making assumptions that are not correct. Do we know for certain that the formulation in Australia is the same as the USA? Drugs are often marketed with different names and formulations depending on the countries regulatory body. I don't know if that is the case for Sub. Maybe why their doctors prescribe higher doses.
Good day mate


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PostPosted: Thu Dec 17, 2015 7:47 pm 
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I'm in Australia and I'm pretty certain the film formulation is the same here as in the States.

I don't really agree that doctors prescribe more Suboxone in Australia than in America though. From what I can tell from visitors to this board, doses seem to be pretty much the same down here as up there. The only difference is, in Australia we don't have to pay more $ for higher doses. Suboxone down here costs on average $5 a dose, whether you're on 2mg or 32mg. This may make patients less resistant to being prescribed higher doses.

Mel, I actually think the jump from 32mg to 16mg might be what's causing you this discomfort. I haven't been on a large dose of Sub for many years, but I do remember feeling it when I dropped from 16mg to 12mg. Many believe that buprenorphine's ceiling effect kicks in at 4 to 8mg, and beyond that there's no increased effect. I'm more of the opinion that the ceiling effect kicks in gradually, and never fully plateaus. Also the fact your "symptoms" kicked in 3 days after your drop is very much indicative of withdrawal. Because of bupe's stacking effect, it usually take 2 or 3 days to feel the effect of a dose drop. If it was some kind of placebo effect brought on by your drop, you would assume you would have felt discomfort on day 1.

Whether or not you're experiencing some withdrawal, 32mg is in my opinion a pretty high dose, and unless you're a rapid metaboliser of buprenorphine, probably unnecessary. I personally try to stay on the lowest possible dose that holds my cravings. At the moment that's 5mg, and I'm soon to drop to 4mg. If you think you're ready, maybe you could experiment with lower doses. Do it under the guidance of your doctor though. And don't rush it. It's better to be on a higher dose than to have a lapse on your drug-of-choice.


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PostPosted: Fri Dec 18, 2015 6:45 am 
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Thanks for all of your help guys, its really important to me as I have no one else to discuss this stuff with.

I am on 16mg still and when I see my doc on sunday I will tell him I have dropped. He may suggest I stay on 16 for another week or something and then drop a bit again then.
The thing is that I know I cant do it all too fast because like many of us addicts I want everything to happen immediately. If not yesterday lol.

Summer is here and im really feeling it not being able to drink. I have the pity party happening in my head this week. Xmas and work parties, you know. On the 30th dec it will be 1 year since I have consumed alcohol so im pretty happy about that but I need to be really careful as my evil head is telling me its ok. It tells me 'i have been off it so long I could probably handle it better now' but I know I cant but still think about it. Argggg its annoying.
This is why I cant mess with my sub too fast. Im 100 days clean with suboxone tomorrow and that's really early days. Im a cronic lapser so im trying to be mindful. I have been trying since jn this yer to get clean and its taken this long to get anywhere, only thanks to suboxone. I feel like im doing a really good job at the moment but that's when I need to be extra careful. Its when im feeling good about myself I feel a reward is ok - u have all felt it I know.
I have xmas day with family where 3 members (combined) have anything u could possibly want plus they are all piss heads.
I do have a backup plan though. An NA member who is a mate now is having an open xmas day at theirs and its clean and dry only. And not far from my home which has turned into my safe zone.
Now im rambling. My head is all over the shop at the moment!
Ok so I think its been nearly a week on 16mg, apart from when I took another 8mg that 3rd day I felt really shitful. If or when I feel like shit I know (thanks to your posts) its ok as it wont kill me and just think to myself its nothing to do with sub, deal with it like its nothing. Power of the mind style.
I will have to check out the tapering section.
After all of your helpful, knowledgeable advice, I imagine being at 100 days, its not too soon to start trying to get down to 8mg or maybe I should do the 12, 10, 8 ? Big jump or little at this stage? What do you think? How do you know when your ready to drop a dose?
I think as long as im no higher than 16mg im doing well.

Teejay I totally agree its better to be dosed a bit more than enough than to relapse. But I don't want to use any excuses like the way I have just twisted what u wrote lol giving myself approval not to cut back much yet.
This whole getting clean journey is fucked and I am now crazier than when I was self medicating. Plus my bipolar
I sometimes wish I went cold turkey but then remember back 18 years ago doing that off heroin, obviously it doesn't work because I have not had one clean day since.
I really need sub to get used to living clean for a really decent amount of time. I was told 6 months at least but now im not putting any time limit on it.

Thanks again members. You have clarified things and helped me out a lot. One day I hope to pay it forward.


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PostPosted: Fri Dec 18, 2015 4:59 pm 
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Hi Mel,

First, I have to suggest that you slow down. Why is it that you suddenly feel the need to be off suboxone right now? Is it because of feedback you're getting from your sponsor? Do you feel horrible side effects on sub? Why right now?

Check out this thread: post102764.html#p102764

The guy wrote about how he tapered off sub with no withdrawals, because he was patient. You're striking me as more impulsive than patient. If you are feeling like you must be off sub to fit in with your NA group you are doing yourself a real disservice. The slower, the better. Don't let yourself be rushed.

Amy

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PostPosted: Sat Dec 19, 2015 2:17 am 
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Hi Amy

To be honest, the only reason I am starting to want to get on a lower dose is due to feedback on this forum.
It was written quite clearly that my 32mg dose was too high and so I jumped to 16mg as many said over 16mg is not necessary. The jump amount was my decision, not being pressured. When I heard above 16 is useless or something I just decided to do it.
I don't mean to put the reason onto the feedback I have received here but it actually is the only reason. I was happily doing what my GP suggested until I started being advised in here, that my dose was way too high. I am choosing to go with advice from experienced members here.
You are correct, I am extremely impulsive and currently trying to get my medication right for bipolar. I was on one drug for it and it was working a charm but then it made me physically sick. I cant remember the name of it but its known to cause stomach problems in some people. So now im on a different one and its just a thing of waiting a while to see if its working and right for me. Obviously its not working enough yet and I plan on discussing that with my GP tomorrow.
My plan is simply to try and get down to 8mg within the next 3-6 months but that plan is not set in concrete. I will keep on it until I get there eventually and then try for 6mg and so on.

My sponsor has no issue with suboxone, but I sure don't advertise it at meetings. That would cause unnecessary negativity from people who have a large lack knowledge on Suboxone.
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PostPosted: Sat Dec 19, 2015 4:02 am 
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I understand the situation much better now. Thanks for explaining it. Perhaps a better intermediate dose to drop to is 24 mg As soon as you feel good on that dose for a week you can drop another 4 or 8mg. Whatever works for you. That's my suggestion anyway. :)

Amy

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PostPosted: Sun Dec 20, 2015 12:47 am 
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Thanks for your reply Amy

Now that its been about 8 days on 16 mg (apart from the 3rd day were I took the extra 8mg - so day 3 was 24mg) I think I'm fine to stay on it.
I saw my doctor today and he was a tad shocked at my sudden drop but was very supportive and as he said, 'its my body, my journey and my choice (to reduce). He said, like you have Amy, that I can always go back up to 24mg and then 16mg a bit later. At this stage though, like I wrote before, I think I have adjusted to 16mg so will stay put for now.

Something I would really like to know is - how do you know when its time for a drop? Anyone?
Like I wrote on a previous message, I made the jump for a certain reason but now that I'm not on a REALLY high dose, I don't know when I should do the next one.

Thanks
Mel


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PostPosted: Sun Dec 20, 2015 1:39 pm 
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When I dropped I first felt stable at the dose I was on. That was my criteria. Once I was stable I felt ready to drop. I hope some others comment on their experience too.

Amy

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PostPosted: Mon Dec 21, 2015 2:03 pm 
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I just wanted to say hi. Im new to this forum but am also from Australia and also on 32mg daily so I found this post interesting. From other forums I have been on in the past, I did get the impression that Australian drs do prescribe higher doses, but it could be that we don't have to pay for the extra either. I am wanting to lower my dose but I did keep increasing as I didn't feel like lower doses were holding me either....until I started splitting my doses. I feel if I had done that from the start, I may have avoided being on 32.

Anyway, I will be reading along with your progress with interest and wish you good luck.


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PostPosted: Tue Dec 22, 2015 7:06 am 
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French1978 wrote:
I just wanted to say hi. Im new to this forum but am also from Australia and also on 32mg daily so I found this post interesting. From other forums I have been on in the past, I did get the impression that Australian drs do prescribe higher doses, but it could be that we don't have to pay for the extra either. I am wanting to lower my dose but I did keep increasing as I didn't feel like lower doses were holding me either....until I started splitting my doses. I feel if I had done that from the start, I may have avoided being on 32.

Anyway, I will be reading along with your progress with interest and wish you good luck.


Hey French it's possible you might be an ultra rapid metaboliser of Suboxone. You can get tested for this condition. The other possibility is you might be prescribed another medication that's speeding up your Sub metabolism.

Year ago I used to require 6mg morning and 6mg evening, otherwise I'd find myself in withdrawals by nightfall. Now with some medication changes I only need 4mg a day.


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PostPosted: Tue Dec 22, 2015 7:33 am 
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Yes, I think you are right, that's my theory also. I've always had a high metabolism in general and have always built very high tolerances to eveything quickly despite my small frame. I do feel if my dr had suggested splitting my dose from the start, I would have been ok on a lower dose but even climbing close to 32, I was still waking up aching everywhere. It was someone else who suggested splitting and it worked.

This time a couple of years ago I was on around 15 different meds so it's hard to say if they played a part. The only other medication I take now is a small dose of valium (20-40mg daily) on an ultra slow taper down from 100's of mg a day. Don't even get me started on rapid benzo detox...

Anyway, didn't mean to take over your post OP! Just noticed the similarities :)


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PostPosted: Tue Dec 22, 2015 8:24 am 
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yeah French, im small framed and metabolise quite fast. Eat heaps and don't get really fat. Although once I turned 30 I noticed a slight increase in weight.
I did get high tolerance fairly easily too so maybe its that.
Anyway I have stuck with the 16mg and told my head to fuck off. I do think about using, a lot but I think its just the mechanical default thought process so I dismiss it. Lets hope that works over xmas lol. If not I have many spares so I will be fine.

Thanks for your input. I knew it wasn't just my doc who prescribes 32mg.
Have a great nigh everyone. Americans, have a good day!


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PostPosted: Tue Dec 22, 2015 8:37 am 
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Hey French
I just read your last part about vals. I was on over 120 mg along with heaps of oxy, xan, endone etc daily. Your lucky, my doc only put me on 6mg for detox. After 3.5 months im now on 4mg. I miss it but that's just the junkie in me.

Ciao


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PostPosted: Tue Dec 22, 2015 9:48 am 
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That's good you've been able to stick with the 16mg. Hopefully I'll get there soon also. I find my metabolism is still high at 37 which is lucky after 5 kids; but I've had all kinds of eating disorders so it's really hard to tell I guess.

With the valium, I was on around 400mg a day (or equivalent of xanax) and did a 10 day rapid detox in hospital, it was hell, I was bedridden for 4 weeks AFTER I was discharged so I went straight back on it or the equivalent of xanax and lorazepam. Plus the oxy and whatever else. I started tapering the day I started on suboxone, so 2 years ago now. My dr is well versed in benzo withdrawal luckily and have been able to go very slowly as the first time was the worst thing I've ever done and I've done quite a few different detoxes, benzos are hell. My dose is so low now im starting to feel each drop and getting scared getting towards the end, but I've had so much going on lately that he hasn't reduced it any further at any of my last appts (3 monthly.) I've slipped up 3 times in that 2 years with xanax benders which hasn't helped but I've been good for probably close to a year now.


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PostPosted: Tue Dec 22, 2015 7:48 pm 
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Have your doctors do a genetic test to look for CYP enzyme deficits. Here's a blurb about it, but if you want to read more go to the link.

Amy


"In the past, genotyping for CYP450 polymorphisms was not cost effective or convenient. However, testing technology, commercial availability, third-party reimbursement, and most of all, clinical understanding, have recently coalesced to make CYP450 genetic testing an essential component of high-dose opioid therapy. It is my recommendation, therefore, that patients who require more than 150 mg per day of morphine equivalents be tested for three specific CYP defects—2D6, 2C9, and 2C19."

Found at: http://www.practicalpainmanagement.com/ ... d-patients

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PostPosted: Wed Dec 23, 2015 6:39 am 
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haha
French, when I said im on 4mg of val a day, I meant 4 tablets so its 20mg a day. I didn'trelly miss it with the sub in the beginning but now I would love 4 Xanax right now. I miss Xanax majorly but that's just habit I think. I didn't notice any difference dropping from 35mg to 20mg of val.

I love reading about all of our stories. I find it fascinating how different we all are.

BTW I have gone back up a bit to 20mg Sub as this time of year and the heat is making me slightly unstable. Its ok I tell myself as I was a bit disappointed. Doesn't mean I cant drop a little bit sooner or later. My Xanax thoughts are a playing a big role in my sub increase.
I don't suggest you do a drop of half amount your on, especially at 32mg. I have learnt my lesson as I was trying too fast. I will just listen to my body from now on and it will tell me where im at; not my head as that takes me places I shouldn't imagine.
Hope you all have a great Xmas and a happy and safe Ney Years!!
Mel xx


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