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Am I being Unrealistic?

Wed Jul 08, 2015 6:58 pm

I have built up a pretty high tolerance to codeine and have just started suboxone (for the 3rd time). My daily intake of codeine was 800-1200mg (800mg would "hold" me, 1200mg would give me the opiate "buzz"). I seem to have plateaued at this level after a steady rise in tolerance over the past 18 months.
Totally fed up with trying to source the codeine, so I've just gone back on to suboxone.
I had my first 8mg dose on Monday, then had to wait until Wednesday before my second 8mg dose. This is because my work commitments only enable me to visit the dosing pharmacy every second day. I will need to continue this routine (dosing every second day) for 2 weeks in total before my Dr will allow me to take the sub away and dose myself. That is the law in my part of Australia.
The first 8mg dose had barely any effect and I was very uncomfortable until my second dose on Wednesday (yesterday). I should mention that I had a COWS score of >10 before my first dose and I don't think I went through precipated WD. My second dose did ease my WD symptoms and I got a few hours sleep shortly after dosing (although I did have an unwelcome "speedy" feeling). It's now been 18 hours since that second dose and I'm feeling uncomfortable again (hot/cold sweats, goosebumps, aching muscles/bones, running nose, RLS, also a slight headache that I didn't get with opiate WD). I won't be able to get another dose for approx 30 hours.
I suppose the 8mgs of suboxone was an insufficient starting dose, however I'd rather put up with these symptoms at the start rather than become accustomed to a higher dose, just because I can't live with the constipation that suboxone gives me and I intend to taper as rapidly as possible as soon as I am in charge of my own dosing.
Am I being unrealistic?
How long should it take for my receptors to be "satisfied" with 8mg?
Will the 2 day spacing between doses shorten the length of time it takes my body to adjust?
Would it be a good idea to continue with the 2 day spacing even when I'm able to dose every day?
Thanks for any replies.

Re: Am I being Unrealistic?

Wed Jul 08, 2015 8:14 pm

Hi Evee and welcome to the forum! Your symptoms are similar to others in the same situation. Being that you already have been on it before my guess is you know more about it than other newbies.

8 mg's is still a fairly large dose. But then, the amount of codeine you were taking was also a lot. The highest recommended dose is 120 mg's, so yes, your tolerance is quite high. Only one Sub dose every other day? Now that is not right. No wonder you don't feel right. They should have started you on 8 mg's, waited for an hour and see how you felt, then dosed you a second time for a total of 16 mg's. After you stabilize then you can taper down. It sounds like you just didn't get enough the first time around.

All I can think of is that it will pass once your body gets used to it again. How long and how much were you on before? Have you told your doctor about the symptoms yet? Being from Australia it's hard to give you any advice because we don't know how it works down there. Sorry, that's all I got. IMO, you need a bit more. Maybe not 8 mg's, but another 4 wouldn't hurt.

Stick around and see what the others have to say. I'm just one opinion and can't really think of anything to help you out.

Hope you feel better soon,


Re: Am I being Unrealistic?

Wed Jul 08, 2015 11:22 pm

Hi Moderator,
Thanks for the reply.
There were a couple of factors that meant my induction to sub this time wasn't ideal.
1: The prescribing Dr.'s surgery and the pharmacist are 15 miles apart. This meant that the Dr. wasn't able to observe me after my initial 8mg dose. Basically, I took the 8mg and went straight back to work.
2: My work involves a lot of travel. When I left the pharmacist after dosing I knew I wouldn't be able to return until 2 days later because of work commitments. The laws on dosing in Australia say you must take the sub in the presence of the pharmacist for the first 2 weeks. That meant I couldn't take the next day's dose with me. I discussed this with the Dr. He initially wanted to start me on 6mg but we both agreed that 8mg would better help tide me over the 2 days (my previous suboxone period was started on 16mg, but I did want to try a lower initial dose this time).
In hindsight I probably should have taken time off work in order to stabilise on the correct dose, but finances prevented this. I was also interested to see what effect the 2 day spacing would have.
One problem now is that I am locked into this 2 day spacing for the next 2 weeks (10 days now).
I have to see the prescribing Dr. tomorrow and he will ask me how it's going. I actually want to say I'm fine and wish to continue on the 8mg every 2 days until this first fortnight is up (at which time I am then permitted to take doses away from the pharmacist). I'll mention the WD symptoms to the Dr, but to be quite honest I think I can cope with them while my body stabilises at the 8mg. They are unpleasant, but knowing that they'll likely be eased when I can get to the pharmacist makes them bearable.
My main reason for posting here was to ask how many doses people think it might take for the 8mg to get on top of the WD symptoms, based on my level of codeine dependency, and also whether I am being realistic in planning to keep the dose at 1 per 2 days.
I have 2 reasons for wanting to try and continue the 1 dose per 2 days. Firstly, I'm hoping it will ease the constipation I get from suboxone, and secondly I will find it easier to taper down if I can stockpile my takeaway dose (another law in Aust says we are only allowed a max of 5 takeaway doses per week - the other 2 doses must be taken in the presence of the pharmacist) as I plan to start a taper almost immediately.
I haven't heard of anyone trying the 1 dose every 2nd day when first starting a suboxone program, and was hoping to find someone here who had tried it themselves, or had heard of it being done. I agree, it doesn't seem ideal, but it may have benefits?
Hope that all makes sense. :)