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PostPosted: Wed Aug 21, 2013 7:13 pm 
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Firstly let me apologize if this is posted in the wrong place. This is my first post.

Secondly let me apologize for the length, but I think most of the following details will help with any advice. You can however skip to the :evil: :evil: :evil: if you would like to get to my current predicament.

I've been an opiate addict for about 10 years. For all of this I have been what one might describe as a "functional addict". I had a dependency to be sure, but no one would ever knew I was on them or had a problem unless I told them. For the duration of my dependency I maintained a regular 3 10mg a day regimen. I never graduated to Oxycontin or Heroin.

In late 2007 I made the choice to go on Suboxone after several failed attempts at 12 step programs. I was engaged at the time and wanted to rid myself of this habit before I was to become a married man. I told my fiance this and she was most supportive... From Jan 2008-Feb 2012 I was on Suboxone. I had insurance during this time. I intended to remain on Suboxone for the rest of my life. While there were altering opinions my Dr. told me there no were long term side effects that I should concern myself with. My logic was (and still is) that as long as there was this safety net in place then it was really impossible for me to relapse... Even if I slipped up and took a pill (which I did early in my treatment), the Naloxen would simply block the high making this a pointless act.

I digress, because my story actually has nothing to do with whether or not one should spend their life on Suboxone.

In late 2011 I was living in Las Vegas and in the Real Estate industry and took a considerable financial blow. By February 2012 I was living with family and my insurance had lapsed. With no money or insurance to pay for Suboxone or Dr visits I weened myself off. Despite tapering off for over a month the withdrawals still lasted 3 weeks and were the most difficult period of my life.

I started to get myself together and was opiate free for the first time in nearly a decade. Even after the WD's had subsided I felt as though there was a permanent emptiness in my body that could only be filled with an opiate. Needless to say I relapsed in the summer of 2012. I was now working a more humble day job and as I noticed my desire for hydrocodone pills becoming more and more persistent I decided it was time to try to get back on Suboxone.

No insurance would give me the time of day. All of the underwriters declined me because I had "drug dependency treatment within the last 2 years". This was particularly aggravating because this was all around the time that Obama care was in the news and there was talk such as "You will be required by law to have health insurance." And here I was trying to get it from no less than 8-10 companies only to get the door slammed in my face each time.

In late 2012 I was once again making money and once again taking opiates at my regular rate of 3 10mg pills a day. This continued until last week...

:evil: :evil: :evil:
Now living in Portland, OR. I made the choice that even though I am not on insurance I need to get back on Suboxone.... I found a Dr. up here and met with him last week (it's quite a racket up here, but I will save that conversation for another time.) The Dr. was professional enough and charged me $300 for my first visit with future visits to cost $150. He spent a half hour speaking to me about my addiction and my drug history etc, and then he did sort of a physical on me before drug testing me. My test of course came back positive for opiates as expected. He wrote me a 2 week script for Suboxone (2 8mg film/day) and made a follow up appointment for two weeks later.

My first day back on Suboxone was very encouraging. I felt like the shackles were off of me and was just in better spirits in general. That night is when the problem began. I got up to use the restroom in the middle of the night, and I couldn't go... This happened about 3 times the first night and it wasn't until the next morning that it had occurred to me that during my Sub treatment in 08-12 I had this same issue which resulted in me going to a Urologist enduring an extreme amount of pain from being "scoped" only to find out that there was nothing wrong with me. The problem got worse on the second night, and worse again on the third. It was to the point where I was falling asleep on the toilet and very literally sitting there for as long as 45 minutes... I also woke up with a headache on a par with a very bad hangover. I thought perhaps I was dehydrated, but I didn't know. It was time to contact the doctor.

I spent the next 2 days trying to phone and email him until I finally heard back by email. He informed me that "urinary retention" was not listed as one of the major side effects of Suboxone and that if I was certain that the cause of my new urinary problem was the medication "then we need to discontinue Suboxone at once, file a REMS report with the drug manufacturer, and follow your symptoms to complete resolution and/or follow up with a Urologist."

I was taken aback. There was no way I was going to quit my treatment. I wrote him back and told him (respectfully) that I myself had issue during my last treatment that lasted for a few weeks and eventually went away when the Urologist noted I was fine down there and prescribed me something to relax my bladder. I also pointed out to him that there are multiple discussions on the internet of people having had this same exact issue.

His next email was a completely different tone and apologetic. "Having done more extensive review of the medical literature regarding buprenorphine side effects (buprenorphine is the main ingredient in Suboxone) there have been some rare/isolated cases of individuals developing urinary retention while taking buprenorphine." He told me that he could no longer treat me for Suboxone due to the dangers it could cause me!

My reply was angry, but still respectful. I told him I'd just spent $500 for treatment and medicine and was now being told I had to stop taking it even though I'd taken it without issue for 4 years... He offered me two alternatives while maintaining an apologetic tone. The first was to transfer me to another doctor that works with methadone maintenance(I was not interested). The second was to do a rapid weening (2mg less per day over the next week) and prescribe me clonidine and promethazine (Phenergan) as needed for withdrawal symptoms.

Feeling that I had my back against the wall I accepted the second option because... well frankly because there was no other option.... He has phoned in the 2 above scripts and they are waiting at the pharmacy for pickup tonight.

I am so confused as to what I am supposed to do here... Part of me cannot ignore the severity or the urinary problems I was experiencing and the loss of sleep it was causing. I am also not averse to be off of opiates all together.... I've only been back on subs for a few days so perhaps the WD with the help of these meds will not be as bad as it was when I was on them for 4 years and had no meds at all....

And yes, there is the part of me that wants to call another Suboxone Dr. and get his opinion. The trouble with this is that in Portland all the Suboxone Dr.s have a waiting list, and added to that I can't afford to go shelling out +/- $300 to find out....

So literally after I hit submit I am going to the pharmacy to get these meds. If anyone has any insight on this issue or suggestions for me I would be most grateful to hear it.

One last important piece of info:
While I was prescribed 2 films a day (16mg), I have only been taking .5 - 1 (4-8mg). The reason for this is that I was concerned with constipation issues, and we had discussed taking between 12-16 MG a day (perhaps half a film 2-3 times a day) before opting on the safe side (16). I wanted to start off by taking the lowest dose possible to eliminate any WD sickness. So far, 4mg has done the job just fine. It's now been about 16 hours since I took any at all and I feel pretty reasonable. My only aggravation has been a result of dealing with this all day...

While this doesn't make my notions of the situation on the whole any better, it does somewhat suggest to me that maybe I can kick Subs and Opiates altogether? Maybe it is better to do it now while it appears that I can vs. a year from now when I cannot?

I honestly don't know... Thank you for taking the time to read this...

With Respect,

DT


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PostPosted: Wed Aug 21, 2013 8:33 pm 
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That's an unfortunate, and unfair, thing to go through.

All opioids have the potential to cause urinary retention- especially the potent opioids like buprenorphine, fentanyl, and oxycodone. The risk is a function of tolerance. I think you wrote that you were taking primarily hydrocodone, a relatively low-potency opioid; that you would have that side effect is not, at all, surprising. Your constipation supports the idea that you are getting excessive opioid effects from buprenorphine.

When I was an anesthesiologist, difficulty urinating (from pain medication) was a common reason for hospitalization of day-surgery patients.

The proper course of action would be to lower your dose of buprenorphine, or perhaps dose every other day. There is some argument whether people on hydrocodone should be started on buprenorphine, since doing so usually pushes tolerance higher. It is a tough call.... on one hand tolerance goes higher, making discontinuation of opioids more difficult. But on the other hand, people become very miserable (and poor) when addicted to any opioid, including hydrocodone.

your doc should have stuck with you, in my opinion. But at least for now, medical care is a service, not an obligation--- and doctors have the right to refuse treatment, except for in the case of life-threatening illness (ER's cannot refuse to see patients with life threatening injury or illness, regardless of ability to pay).

As for quitting opioids completely, the odds are against you--- but if you want it enough to truly work for it, it is possible. In my experience the people who do best are those who realize that they have a serious, life-threatening condition that requires life-changing treatment. Something needs to take the place of opioids in your life-- a hobby, a vocation, a belief.. something. AA is a start... people who insists on THEIR choice of treatment don't accomplish the degree of change necessary to give up opioids, from what I've seen.


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PostPosted: Wed Aug 21, 2013 8:42 pm 
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Thanks for the reply. Are you familiar with the medications he is putting me on to get through the WD?


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PostPosted: Wed Aug 21, 2013 11:00 pm 
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Suboxdoc: your doc should have stuck with you, in my opinion.
Is there something that could be used to ease the urinary retention enough to allow a person to remain on the Suboxone? Or is his doctor correct in stopping the Suboxone and managing the withdrawals? Maybe you have already answered this in a Talk Zone post he could print off and take to his doctor. I've had two of your blog posts brought in this past month by patients.
Deviltalk - the catapres is often used for wd. I lean more toward vistaril instead of the Phenergan.
PAX


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PostPosted: Thu Aug 22, 2013 1:48 am 
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docm2 wrote:
Suboxdoc: your doc should have stuck with you, in my opinion.
Is there something that could be used to ease the urinary retention enough to allow a person to remain on the Suboxone? Or is his doctor correct in stopping the Suboxone and managing the withdrawals? Maybe you have already answered this in a Talk Zone post he could print off and take to his doctor. I've had two of your blog posts brought in this past month by patients.
Deviltalk - the catapres is often used for wd. I lean more toward vistaril instead of the Phenergan.
PAX


Catapres? Sorry which one is that?

I was also wondering if the fixing of the retention problem was a large procedure or not. As the day went on I began to start having the initial WD anxiety that made me feel pretty pessimistic about the whole thing. I don't know if it is bad form for me to go in to my appointment next week and state my displeasure and ask that he at least put me on a minimal dose of subs. I honestly think I can maintain on a very low level. Even 2-4 mg a day. That doesn't erase my concerns for my health re my urinal issue.

In my initial panic, I ordered some over the counter organic stuff that helps with urine retention on Amazon. But how is this sort of problem usually treated?

As if on cue, my dealer called me tonight and asked if I wanted my usual... I told him I quit...

I must confess I am absolutely terrified of the next week and unsure of myself. My head is spinning in circles.... I don't know if I should start making inquiries with other Suboxone docs in my area? I just feel like I paid $300 for the pleasure of having to go through Sub WD and I don't know the appropriate way to verbalize myself....

Thank you guys for your help and taking the time...


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PostPosted: Thu Aug 22, 2013 9:36 pm 
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I made an appeal with him (respectfully) by email but he is firm about not treating me. I told him I have little faith of being sobriety without the help of suboxone. He offered to put me in touch with a methadone maintenance Dr.

I've never taken methadone, but I've always associated it with hardcore heroin addicts who must retrieve their meds daily. Methadone seem like over kill to me for someone with a 30 mg a day opiate issue. Is this accurate?

I think my plan at this juncture is to swallow my losses of $300 from this dr and try to find another on Monday in the Portland area online, with whom I can speak to on the phone at length and honestly explain my situation to be sure there will be no hiccups....

I wish I could say that I think I can just stop taking it all and be fine... But I don't believe that....

:cry:


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PostPosted: Fri Aug 23, 2013 1:17 pm 
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Catapres is Clonodine.

I'm with you; methadone does seem like it would be more trouble than it's worth for you at this point. Federal laws govern the dispensing of Methadone in a clinic setting, you can not get it prescribed for addiction treatment from a Dr's office, you would be going to a clinic setting daily for a minimum of 3 months and depending where you are that could double. It's two years absolute minimum before you could ever possibly get 28 days worth of Methadone 'take homes,' and I know where I am (Minneapolis) many of our clinics are favoring two-week maximum take-homes regardless of time in programming. Some people are being 'grandfathered in,' but I know that at one clinic specifically two-weeks maximum for all incoming pts.

As your current Dr. seems firm in his line of thinking. If you are at all in any position to do so, unfair and really screwed up as it is, you would be best suited cutting your losses and finding a new Suboxone prescriber. Like Dr. J pointed out, there is already some controversy related to the prescribing of buprenorphine (Suboxone/Subutex) to treat hydrocodone or other low-dose addiction/dependence and that at least doubles with Methadone to the point that depending on where you are and what Methadone Clinic you are near, you may not be admitted due to the relatively low dosages you cite using.

My thoughts are that all short acting opioid addictions regardless of dosage can be out of control and Methadone and buprenorphine can be stabilizing forces. Buprenorphine should really be the go-to when needed or desired in situations such as the one you present. Dr. J made great points RE urinary retention and opioids and it makes perfect sense to me that going from one opioid (hydrocodone) to a more potent opioid (buprenorphine) you would be prone to experiencing side-effects until tolerance is established to the new stable opioid dose i.e. buprenorphine (a few days to a couple weeks, most likely.)

Travis

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PostPosted: Fri Aug 23, 2013 1:28 pm 
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Thanks Twist.

Today is actually my 3rd day without taking any opiates of Suboxone at all. I have to confess I don't feel too bad at all. I did get a bit aggitated yesterday but nothing compared to any WD I have had in the past.

Maybe this mess is a blessing in disguise?

Definitely not going to go on Methadone. I'm supposed to follow up with this Dr on Tuesday AM. But is there really any point in me keeping that appointment? I mean, why am I gonna shell out $150 for him to pat me on the head and say good luck?

I think pending on the next few days I will either stay off everything or if it gets uncomfortable I will seek out a new doctor.

One question I do have is- Is it possible for someone to have taken low dose Suboxone for only 5 days and that be enough to sort out their issues?


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PostPosted: Fri Aug 23, 2013 7:16 pm 
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Hiya,
I am on siboxone in the UK n we have to have our script on a daily basis - so please do not be alarmed by that. I would suggest that you do your reaearch first. As subdoc said, maybe you simply need a lower dose so perhaps finding another doctor.

You take care of you, ok. Evey xxxx

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PostPosted: Mon Aug 26, 2013 5:04 pm 
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Quick update-

Today is my 6th day off Suboxone. The WD's have not been very bad compared to what I went through last year but I have moments of extraordinary anxiety, depression, and most of all an overwhelming feeling that there's really no way I will stay clean if I remain off Suboxone.

Hence my current predicament. As always, I value your input.

I made multiple inquiries on getting a new Dr. for treatment. I finally got a couple call backs this morning from a couple doctors who have room for new patients and don't charge $800/mo for treatment. Both have requested records and/or info from the doctor mentioned above who refused to continue treating me due to my bladder issues. I had no issue with this. One of the nurses called me back after a few minutes and said the Dr. said "it wouldn't be a good fit". So strangely I can't help but feel if being as honest and transparent as I've been is the best thing for me? :?

That said, there is a part of me that feels as though perhaps I should continue through this journey free of Suboxone since I have already come 6 days and the damage has been considerably minimal. But in that same breathe I realize that I have not felt a sense of normalcy or comfort in the last decade without the crutch of opiates or Suboxone... I have tried anti depressants but they don't seem to fill this void...

Will keep you updated... Much thanks for the support and input.


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