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PostPosted: Sun Oct 02, 2011 2:11 pm 
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OK, this is getting old. I'm not going to argue with you. Everyone on this site and Dr. Junig and I are all on the same page. Maybe he'll pop in and explain it. But what I'm thinking is perhaps you came here trolling, so it wouldn't matter what he were to say anyway. This site is for support and it seems that maybe you've just come here to stir up shit. Maybe just ease up on the argumentativeness?

Oh and BTW, opiate receptors cannot be "permanently damaged". Remove the opiates and in time they will return to normal. Again, refer to Dr. Junig.

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PostPosted: Sun Oct 02, 2011 2:54 pm 
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I certainly do NOT know who is right or who is "wrong" here;and I am certainly NOT trying to defend anyone here;
nor am I trying to argue here.I am just simply presenting what I have found.
(Disclaimer: I am just striving to be fair and unbiased in this issue,
as I seek to understand this seemingly controversial issue.)

With that said, this is what I have found:

1. From an article from Medhelp.org, titled Understanding the Ceiling Effect of Suboxone/Subutex:
An excerpt:

"The ceiling effect of suboxone ranges between 16-32 mgs depending on the individual.
This is why you will not see a doctor prescribe more than 32 mgs of suboxone daily as it would have no further effect."

Link:

http://www.medhelp.org/tags/health_page ... ?hp_id=574



2. From an article on eHow, titled Ceiling Effect of Suboxone:

An excerpt: "The ceiling effect of Suboxone occurs at large doses of the drug.
Doses beyond 16 to 32 mg of Suboxone are unlikely to produce
additional effects beyond this "ceiling," according to the Substance
Abuse and Mental Health Services Administration."

Link:

http://www.ehow.com/facts_6076340_ceili ... oxone.html


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PostPosted: Sun Oct 02, 2011 3:45 pm 
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I think I get it now, we are talking about 2 different things. When I say the ceiling is at 4mg I am referring to the fact that you will get no more of an euphoric effect taking anymore above that and as long as you keep your blood level above that dose you will also feel no lows or withdrawl symptoms. However higher doses can give you the benefit of reducing cravings but doses above 4mg will not give you anymore of an opiate effect. So you will get the benefit of reduced cravings between 4 and 32mg but that benefit stops at 32mg, The 32mg ceiling is why a person cannot OD on Bup, anything of above 32mg has no more of a depressant effect. So we are both correct but were talking about 2 different things.

However what started this conversation was you saying nobody needs more than 4mg. You ask me below if I know anyone that has gotten an euphoric effect on bupe the answer is yes. Read thru here you will find many people who were tapering say they could feel their doses when they got below 4mg. You say it yourself:

" Norbuprenorphine, which is what buprenorphine metabolizes into, is actually more "euphoric" than bupe itself. At more than 4 mg a day, your receptors are saturated and no norbuprenorphine can attach."

You yourself say above that doses below 4mg are more euphoric and that at doses above 4mg your receptors are saturated.

That is why low doses of bup are used to treat pain, at low doses it metabolizes into Norbuprenorphine and works like a full agonist. When one is taking suboxone for addiction maintenace it is suggested to stay at doses above 4mg so you are always above that ceiling level. Then your receptors are always saturated and you experience no highs or lows, you ust feel normal.

When you take doses of 4mg and below the ammount of receptors being stimulated goes up and down so one feels the ups and downs and can get an euphoric feeling from their dose. This is exactly what most are trying to avoid on maintence.

You also ask if I plan on staying on sub forever and the answer is no I do not, however I take it for my pain as well so I do not know when or if the time will come that I can get off it.

So people that want to stay above that 4mg mark so they have there receptors continually saturated so they always feel the same or normal can not take doses below 4mg and to always stay at that level you must take a little more than that. I have tried a 4m, 8mg, 12mg and 16mg dose and 16mg is where I feel the best and have no cravings so I will get back to my original question, I understand that you feel good on your low dose but why are you trying to convince everyone else that their dose is wrong and they would feel better if they took your dose.

You also asked below if I ever heard of anyone on a "ridiculously high dose" that was not getting kickbacks from RB or on generic, again I will say me. I am on 16mg of buprenorphine (generic) which I do not think is a ridiculous dose. Also if you read thru the forum you will find others on generic above 4mg. Did you watch Dr. Junigs videos I posted. Do you think he is getting kickbacks from RB? He prescribes generic Bupe and is an advocate for the generic. I just don't buy into the whole conspiracy idea thing.




Ironic wrote:
Breezy_Ann wrote:
Thus was your last post in the "Stop telling us we take too much" thread, I thought it was apropriateto bring here with our current discussion. I am also going to copy the response I left. You have not commented there again so I am not sure you have seen my post.


Your Post

Lillyval wrote:
2mg is well below the ceiling and isn't even a therapeutic dose for most people. Even the prescribing info. states that 4mg is the miniumum dose (for maintenence). So anyone who is saying this to you doesn't understand how the medication works.


If this were true, why would buprenorphine be available for pain in .2, .4, and .8 pills? Temgesic? Hello??

Opiophile link (I can't add links due to forum rules but I will come back tmrw and add it)

All of these hardcore junkies doing bundles of heroin a day agree that bupe works better at low doses. When I'm on a computer instead of a phone I will post scientific studies backing low dose bupe.

Norbuprenorphine, which is what buprenorphine metabolizes into, is actually more "euphoric" than bupe itself. At more than 4 mg a day, your receptors are saturated and no norbuprenorphine can attach.

I have a question. Has anyone ever told all of you that "more works better" when they weren't making money from you/receiving kickbacks from RB?
Has anyone on generic subutex ever been told to stay at a ridiculously high dose?



My Post

What you posted above is the exact reason it is prescribed above the ceiling for addicts. You are correct in that below the ceiling it will give you more of an euphoric feeling and it works like a full agonist. This is what addicts are trying to avoid, which is why for maintenence for addiction it is prescribed above the ceiling. People in recovery no longer want the highs and lows and when above the ceiling and your receptors are saturated you just feel normal and can not get an euphoric effect. If taken the way you sugest below the ceiling where it is a pain med and you can get high from it then what is the point of an addict switching from oxy or hydro or whatever the case may be? Now they are just on another pain med that they can get the euphoria from. I am happy your low dose is working for you but I don't understand why you feel the need to tell those of us on higher doses that we are wrong and just being taken advantage of. I can assure you my Dr. gets no reward for prescribing his patients Suboxone, he has switched me to generic subutex. To be honest I am offended by your accusations, I can assure you I have done a lot of research and am not so weak minded to just throw my money away. I have experimented with my dose and at 16mg is where I feel the best and who are you to tell me otherwise? Temgesic is used on people who have no tolerance to opiates to treat pain. The doses you list below would be like giving an addict a hydrocodone and expecting them to stop withdrawing.


I don't really know what you mean when you say "below the ceiling where it is a pain med and you can get high from it..."

I don't know anyone that gets high from buprenorphine. I certainly don't, and if you have a tolerance to opiates, no dose should get you "high." I don't know if you have ever used heroin, but it just isn't even close. It doesn't cause euphoria for anyone I have ever met, unless they were taking it while in severe withdrawal.

"The doses you list below would be like giving an addict a hydrocodone and expecting them to stop withdrawing." I don't know why you mention this. I didn't know we were discussing someone who was detoxing from a full-agonist. I am only talking about someone who is on ORT. I needed 8-12 mg per day while detoxing..that is totally different. After a week or so, you are no longer going to be detoxing from the full-agonist unless it is methadone.

Have you ever even tried to take a dose lower than >1 8 mg pill per day? What if you ever need surgery, or have a real medical need for full-agonist painkillers? At 16 mg per day I don't know how you would ever get pain relief from a full-agonist. I don't know about this, but I think doses that high could cause permanent damage to the receptors. Do you ever plan on getting off of Suboxone?

I took 2-4 mg per day for about a year, because I felt I needed to be on a blocking dose. Now that I have been clean for awhile, and don't desire to get high, it doesn't matter that I am not on a blocking dose. I am interested in eventually getting off bupe (it has been 14 months) because I KNOW that it is healthier to not be on it.

I am not telling anyone they are "wrong." Being "wrong" is a matter of opinion. I am just presenting a set of facts that really hit Reckitt Benckiser in the wallet.

How many people who feel they need so many mg per day have actually tried a lower dose? Not an immediate reduction. A slow taper down to a lower dose, trying it for a couple of weeks, and seeing how it works? Most people report that they feel just as much mental relief with less side effects..and I am not just talking about <2 mg. 2-4 mg are still blocking doses and they just won't fuck up your tolerance the same way 16 mg does.


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PostPosted: Sun Oct 02, 2011 4:17 pm 
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There are valid reasons why some Suboxone maintainence patients take doses of >4mgs per day. Some of those reasons are:

1. They are also taking Suboxone for pain management.

2. Maintaining a consistent blood level of buprenorphine. This is an important factor in breaking the addictive cycle of dosing in response to feeling withdrawal. If you're on such a low dose of bupe that you're feeling the drop of medication in your blood as withdrawal symptoms either in the late afternoon or upon waking in the morning, and then you feel relief after you dose, then you are reinforcing the stimulus-response-reward circuit in your brain. Studies show that this cycle can become as addictive as the actual drug itself, and breaking this cycle is an important step in healing from addiction. The ability to dose once per day and not really "feel" your dose is conducive to breaking this cycle and unlearning the addictive behavior.

3. Maintaining a blood level of buprenorphine high enough to discourage or prevent relapse. Enough buprenorphine in the blood will block the euphoric effects of short-acting opioids. Some patients find that they need this extra insurance against relapse. Even though a dose of 4mgs may block some or even all effects of other opiates, it would be easier to plan for a relapse on this relatively low dose. Where a person on 16mgs/day would have to abstain from Suboxone for several days and then still might not be able to get high, a person on 4mgs a day would have a much higher chance of a "successful" relapse.

4. Subjective experience. Some patients just feel better on a higher dose. My best friend and I started Suboxone at the same time. I quickly decreased my dose from 16mgs to 8mgs, while she always felt better at 16mgs. I consistently tapered my dose throughout my treatment and my longest maintainence dose was 4mgs. She had to be forced down to 8mgs by her doctor and she really struggled with that dose. Her depression was much worse and she experienced cravings. I was able to complete a long, slow taper down to micrograms and she wasn't and basically quit cold-turkey when her eligibility for the low-income Suboxone program ran out. She and I are similar in many ways - our history of drug abuse, history of mental illness, age, socio-economic status. So I don't know what explains the difference, but I think her experience is as vaild as mine. She really did try for a lower dose and it just didn't work for her.

5. Compliance with treatment. This may not be a factor in a patients conscious decision to stay at a higher dose of Suboxone, but it is something that was considered when dosing recommendations for Suboxone were formulated. A higher dose means it is more difficult to discontinue the medication, which makes it more likely that patients will continue treatment. Since length of treatment strongly correlates to success (as measured by frequency of relapse) this makes sense.

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PostPosted: Sun Oct 02, 2011 5:09 pm 
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I am about to start tapering down to 4 milligrams. Started at 8 and stayed on it for at least a half year. I have been taking off a milligram a month since I started tapering. I just am not sure how one milligram less is going to make all that much of a difference.

Eventual goal of mine is not know, I would like to get off of the stuff eventually but I am not in a rush. I think I did start on a little higher than needed does. I was an extremely off and on user of opiates. So glad to be off of them. Closing in on a year (I want to say 2 more weeks, not a counter/12 stepper)


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PostPosted: Sun Oct 02, 2011 8:19 pm 
hatmaker510 wrote:
OK, this is getting old. I'm not going to argue with you. Everyone on this site and Dr. Junig and I are all on the same page. Maybe he'll pop in and explain it. But what I'm thinking is perhaps you came here trolling, so it wouldn't matter what he were to say anyway. This site is for support and it seems that maybe you've just come here to stir up shit. Maybe just ease up on the argumentativeness?

Oh and BTW, opiate receptors cannot be "permanently damaged". Remove the opiates and in time they will return to normal. Again, refer to Dr. Junig.


Disagreeing with you doesn't make me a troll. That is your argument to me presenting actual facts and citations? To call me a troll? Real mature, excellent moderation skills.

Also, I don't want to put words in exorphins mouth, but it seems that he agrees with me, at least about the ceiling dose.

I am not only stating my opinion, I am backing it with fact. Maybe you should do the same.

I am not trying to be argumentative, I am just angered by some things that I see as lies. I am not calling anyone "wrong," telling anyone they are going to relapse based on what they say, nothing like that. I think you are attacking me because I don't agree with you, and that isn't fair.


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PostPosted: Sun Oct 02, 2011 8:52 pm 
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Ok, so what you were calling the ceiling and what I was calling the ceiling were just 2 different "ceilings" for different properties of the drug. Like you stated yourself as I posted above, so in my view that is over.

Actually with everything you posted you proved what I was saying in the beginning. You posted that doses under 4mg give more of an euphoric effect and doses above 4mg cannot do this because the receptors are saturated. You also posted that there are benefits to doses up to 32mg. So what I said in the beginning of all this is what you posted. People on maintence take doses comfortably above 4mg and as high as is required to control cravings, when taking doses below 4mg not all receptors are saturated and you can get highs and lows and can feel an euphoric effect after dosing. Notice I said CAN everyone reacts to this med different which is also what I have been saying.

As interesting as this ceiling thing has been I would like it to get back on track. You were supposed to post scientific proof that there is no reason (besides padding our Dr.'s and R&B's pockets) to take doses above 4mg and everyone would feel better at doses below 4mg. Could you please post the link now? Thank you.


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PostPosted: Sun Oct 02, 2011 9:04 pm 
Diary of a Quitter wrote:
There are valid reasons why some Suboxone maintainence patients take doses of >4mgs per day. Some of those reasons are:

1. They are also taking Suboxone for pain management.

2. Maintaining a consistent blood level of buprenorphine. This is an important factor in breaking the addictive cycle of dosing in response to feeling withdrawal. If you're on such a low dose of bupe that you're feeling the drop of medication in your blood as withdrawal symptoms either in the late afternoon or upon waking in the morning, and then you feel relief after you dose, then you are reinforcing the stimulus-response-reward circuit in your brain. Studies show that this cycle can become as addictive as the actual drug itself, and breaking this cycle is an important step in healing from addiction. The ability to dose once per day and not really "feel" your dose is conducive to breaking this cycle and unlearning the addictive behavior.

3. Maintaining a blood level of buprenorphine high enough to discourage or prevent relapse. Enough buprenorphine in the blood will block the euphoric effects of short-acting opioids. Some patients find that they need this extra insurance against relapse. Even though a dose of 4mgs may block some or even all effects of other opiates, it would be easier to plan for a relapse on this relatively low dose. Where a person on 16mgs/day would have to abstain from Suboxone for several days and then still might not be able to get high, a person on 4mgs a day would have a much higher chance of a "successful" relapse.

4. Subjective experience. Some patients just feel better on a higher dose. My best friend and I started Suboxone at the same time. I quickly decreased my dose from 16mgs to 8mgs, while she always felt better at 16mgs. I consistently tapered my dose throughout my treatment and my longest maintainence dose was 4mgs. She had to be forced down to 8mgs by her doctor and she really struggled with that dose. Her depression was much worse and she experienced cravings. I was able to complete a long, slow taper down to micrograms and she wasn't and basically quit cold-turkey when her eligibility for the low-income Suboxone program ran out. She and I are similar in many ways - our history of drug abuse, history of mental illness, age, socio-economic status. So I don't know what explains the difference, but I think her experience is as vaild as mine. She really did try for a lower dose and it just didn't work for her.

5. Compliance with treatment. This may not be a factor in a patients conscious decision to stay at a higher dose of Suboxone, but it is something that was considered when dosing recommendations for Suboxone were formulated. A higher dose means it is more difficult to discontinue the medication, which makes it more likely that patients will continue treatment. Since length of treatment strongly correlates to success (as measured by frequency of relapse) this makes sense.


Suboxone isn't often used for pain management in non-junkies. Temgesic is used in Europe in .2, .4, and .8 mg doses for the treatment of pain. At >4 mg, no norbuprenorphine would be able to attach to the receptors, so it would be less useful for pain.

The only reason I can see to take >4 mg outside of a detox situation is..none. 2-4 mg is enough to fully block opiates. Why would a doctor want you taking more than enough to block full-agonists, unless he was in it for the $$, or misinformed?

I could see taking more than >4 mg only if you went down to 4 mg for two weeks, and honestly decided that 16 mg was better for you. The problem is that no one who knocks it will try it. My point in posting is so people know. The option is out there! If it doesn't work for you, it doesn't, and you can always go back up in dose, but why not try it?


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PostPosted: Sun Oct 02, 2011 9:31 pm 
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Ironic wrote:
Diary of a Quitter wrote:
There are valid reasons why some Suboxone maintainence patients take doses of >4mgs per day. Some of those reasons are:

1. They are also taking Suboxone for pain management.

2. Maintaining a consistent blood level of buprenorphine. This is an important factor in breaking the addictive cycle of dosing in response to feeling withdrawal. If you're on such a low dose of bupe that you're feeling the drop of medication in your blood as withdrawal symptoms either in the late afternoon or upon waking in the morning, and then you feel relief after you dose, then you are reinforcing the stimulus-response-reward circuit in your brain. Studies show that this cycle can become as addictive as the actual drug itself, and breaking this cycle is an important step in healing from addiction. The ability to dose once per day and not really "feel" your dose is conducive to breaking this cycle and unlearning the addictive behavior.

3. Maintaining a blood level of buprenorphine high enough to discourage or prevent relapse. Enough buprenorphine in the blood will block the euphoric effects of short-acting opioids. Some patients find that they need this extra insurance against relapse. Even though a dose of 4mgs may block some or even all effects of other opiates, it would be easier to plan for a relapse on this relatively low dose. Where a person on 16mgs/day would have to abstain from Suboxone for several days and then still might not be able to get high, a person on 4mgs a day would have a much higher chance of a "successful" relapse.

4. Subjective experience. Some patients just feel better on a higher dose. My best friend and I started Suboxone at the same time. I quickly decreased my dose from 16mgs to 8mgs, while she always felt better at 16mgs. I consistently tapered my dose throughout my treatment and my longest maintainence dose was 4mgs. She had to be forced down to 8mgs by her doctor and she really struggled with that dose. Her depression was much worse and she experienced cravings. I was able to complete a long, slow taper down to micrograms and she wasn't and basically quit cold-turkey when her eligibility for the low-income Suboxone program ran out. She and I are similar in many ways - our history of drug abuse, history of mental illness, age, socio-economic status. So I don't know what explains the difference, but I think her experience is as vaild as mine. She really did try for a lower dose and it just didn't work for her.

5. Compliance with treatment. This may not be a factor in a patients conscious decision to stay at a higher dose of Suboxone, but it is something that was considered when dosing recommendations for Suboxone were formulated. A higher dose means it is more difficult to discontinue the medication, which makes it more likely that patients will continue treatment. Since length of treatment strongly correlates to success (as measured by frequency of relapse) this makes sense.


Suboxone isn't often used for pain management in non-junkies. Temgesic is used in Europe in .2, .4, and .8 mg doses for the treatment of pain. At >4 mg, no norbuprenorphine would be able to attach to the receptors, so it would be less useful for pain.

The only reason I can see to take >4 mg outside of a detox situation is..none. 2-4 mg is enough to fully block opiates. Why would a doctor want you taking more than enough to block full-agonists, unless he was in it for the $$, or misinformed?

I could see taking more than >4 mg only if you went down to 4 mg for two weeks, and honestly decided that 16 mg was better for you. The problem is that no one who knocks it will try it. My point in posting is so people know. The option is out there! If it doesn't work for you, it doesn't, and you can always go back up in dose, but why not try it?




Ok, 1st not everyone on Suboxone was a "junkie" like you say. I for one was not a junkie and I do not believe most people in this forum are or were. Diary didn't say non-addicts are taking sub for pain management, she clearly said reasons why people on sub maintenece would take a higher dose

"Diary of a Quitter wrote:
There are valid reasons why some Suboxone maintainence patients take doses of >4mgs per day. Some of those reasons are:

1. They are also taking Suboxone for pain management."


For the last time I have tried doses from 4-24mg, at 16 is where I feel best. My cravings are controlled, my pain is controlled and I have no highs or lows.`

Also you were not simply posting it so the info is out there, you are saying there is no reason for it and if you are taking doses above 4 mg you are just being tricked by greedy Dr.s and R&B.

Lastly, why do you never respond to what I say. You claim no one has tried it and not felt better, I have. You claim doses above 4mg will not help with pain, for me they do. You say Dr.s will no prescribe generic in high doses because they dont get kick backs, mine does. I am on 16mg of generic Bup. Will you now post your proof their is no benefit to taking a sub maintenence dose above 4mg?


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PostPosted: Sun Oct 02, 2011 9:31 pm 
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The opiate receptors should BE saturated at 4 mg, but are not STAYING saturated, so it's best for those on maintenance to be comfortably above that dose so that their receptors are constantly saturated and their are no ups and downs. This prevents people from "feeling" their dose at low doses below 4 mg (that "euphoria" some were mentioning).

But at say, 8 mg, a person still has cravings, so they try 12 mg and that satisfies their cravings. So they then feel better at that dose.

So for the reasons stated above, some people do do better at higher doses.

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PostPosted: Sun Oct 02, 2011 9:36 pm 
Breezy_Ann wrote:
Ok, so what you were calling the ceiling and what I was calling the ceiling were just 2 different "ceilings" for different properties of the drug. Like you stated yourself as I posted above, so in my view that is over.

Actually with everything you posted you proved what I was saying in the beginning. You posted that doses under 4mg give more of an euphoric effect and doses above 4mg cannot do this because the receptors are saturated. You also posted that there are benefits to doses up to 32mg. So what I said in the beginning of all this is what you posted. People on maintence take doses comfortably above 4mg and as high as is required to control cravings, when taking doses below 4mg not all receptors are saturated and you can get highs and lows and can feel an euphoric effect after dosing. Notice I said CAN everyone reacts to this med different which is also what I have been saying.

As interesting as this ceiling thing has been I would like it to get back on track. You were supposed to post scientific proof that there is no reason (besides padding our Dr.'s and R&B's pockets) to take doses above 4mg and everyone would feel better at doses below 4mg. Could you please post the link now? Thank you.


Once again, buprenorphine does NOT provide euphoria in opiate tolerant individuals. I know you said "some" not all. Well, some people are prescribed Suboxone for Vicodin habits. Did you know that Suboxone is 25-50 times more potent than morphine? http://jpet.aspetjournals.org/content/282/3/1187.full So 16 X 25 (conservative estimate). That is a higher dose than a lot of people on Suboxone were abusing of the full-agonist in the first place! Suboxone shouldn't INCREASE your opiate tolerance, it just seems counter-productive when you say it, I think.

I never said that that there is "no reason" besides padding the wallet. There is one more reason. Misinformation. Doctors read next to nothing about the drug before prescribing it other than the info RB provides them with.

This study cites the ceiling dose at 12-16 mg for most patients.
http://www.naabt.org/education/technica ... rphine.cfm

This study is recruiting people to study bupe for depression. They are using UP TO 1.6 mg/day
http://clinicaltrials.gov/ct2/show/NCT01071538

Another study
"Many patients can taper their buprenorphine dose down to as low as 0.5 to 1 mg daily and feel
fine."
He is NOT talking about the detox phase. I am not, and never was, referring to the detox phase either.
http://www.naabt.org/documents/The_Bupr ... ession.pdf

An article discussing a study about bupe for depression (up to 2 mg/day). They also mention the current study that is under way that I cited above
http://www.psychiatrictimes.com/mdd/con ... 68/1733207

I guess part of it depends on how you feel about cravings. When I am less depressed, I get less cravings. People get less side effects (including depression) at the lower doses.

Answer me this: what will you do if you ever need to take pain meds for surgery or any other problems (God forbid), and did you consider this when deciding to take 16 mg/day?


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PostPosted: Sun Oct 02, 2011 9:46 pm 
Breezy_Ann wrote:
Ironic wrote:
Diary of a Quitter wrote:
There are valid reasons why some Suboxone maintainence patients take doses of >4mgs per day. Some of those reasons are:

1. They are also taking Suboxone for pain management.

2. Maintaining a consistent blood level of buprenorphine. This is an important factor in breaking the addictive cycle of dosing in response to feeling withdrawal. If you're on such a low dose of bupe that you're feeling the drop of medication in your blood as withdrawal symptoms either in the late afternoon or upon waking in the morning, and then you feel relief after you dose, then you are reinforcing the stimulus-response-reward circuit in your brain. Studies show that this cycle can become as addictive as the actual drug itself, and breaking this cycle is an important step in healing from addiction. The ability to dose once per day and not really "feel" your dose is conducive to breaking this cycle and unlearning the addictive behavior.

3. Maintaining a blood level of buprenorphine high enough to discourage or prevent relapse. Enough buprenorphine in the blood will block the euphoric effects of short-acting opioids. Some patients find that they need this extra insurance against relapse. Even though a dose of 4mgs may block some or even all effects of other opiates, it would be easier to plan for a relapse on this relatively low dose. Where a person on 16mgs/day would have to abstain from Suboxone for several days and then still might not be able to get high, a person on 4mgs a day would have a much higher chance of a "successful" relapse.

4. Subjective experience. Some patients just feel better on a higher dose. My best friend and I started Suboxone at the same time. I quickly decreased my dose from 16mgs to 8mgs, while she always felt better at 16mgs. I consistently tapered my dose throughout my treatment and my longest maintainence dose was 4mgs. She had to be forced down to 8mgs by her doctor and she really struggled with that dose. Her depression was much worse and she experienced cravings. I was able to complete a long, slow taper down to micrograms and she wasn't and basically quit cold-turkey when her eligibility for the low-income Suboxone program ran out. She and I are similar in many ways - our history of drug abuse, history of mental illness, age, socio-economic status. So I don't know what explains the difference, but I think her experience is as vaild as mine. She really did try for a lower dose and it just didn't work for her.

5. Compliance with treatment. This may not be a factor in a patients conscious decision to stay at a higher dose of Suboxone, but it is something that was considered when dosing recommendations for Suboxone were formulated. A higher dose means it is more difficult to discontinue the medication, which makes it more likely that patients will continue treatment. Since length of treatment strongly correlates to success (as measured by frequency of relapse) this makes sense.


Suboxone isn't often used for pain management in non-junkies. Temgesic is used in Europe in .2, .4, and .8 mg doses for the treatment of pain. At >4 mg, no norbuprenorphine would be able to attach to the receptors, so it would be less useful for pain.

The only reason I can see to take >4 mg outside of a detox situation is..none. 2-4 mg is enough to fully block opiates. Why would a doctor want you taking more than enough to block full-agonists, unless he was in it for the $$, or misinformed?

I could see taking more than >4 mg only if you went down to 4 mg for two weeks, and honestly decided that 16 mg was better for you. The problem is that no one who knocks it will try it. My point in posting is so people know. The option is out there! If it doesn't work for you, it doesn't, and you can always go back up in dose, but why not try it?




Ok, 1st not everyone on Suboxone was a "junkie" like you say. I for one was not a junkie and I do not believe most people in this forum are or were. Diary didn't say non-addicts are taking sub for pain management, she clearly said reasons why people on sub maintenece would take a higher dose

"Diary of a Quitter wrote:
There are valid reasons why some Suboxone maintainence patients take doses of >4mgs per day. Some of those reasons are:

1. They are also taking Suboxone for pain management."


For the last time I have tried doses from 4-24mg, at 16 is where I feel best. My cravings are controlled, my pain is controlled and I have no highs or lows.`

Also you were not simply posting it so the info is out there, you are saying there is no reason for it and if you are taking doses above 4 mg you are just being tricked by greedy Dr.s and R&B.

Lastly, why do you never respond to what I say. You claim no one has tried it and not felt better, I have. You claim doses above 4mg will not help with pain, for me they do. You say Dr.s will no prescribe generic in high doses because they dont get kick backs, mine does. I am on 16mg of generic Bup. Will you now post your proof their is no benefit to taking a sub maintenence dose above 4mg?


"Junkie" is a name used for people who abused opiates. I am a junkie. If you are not, why do you take Suboxone?

If you tried it and you feel better at 16 mg, do what works for you! I can't say for sure that what works for me is best for everyone. I just know that the less I take, the better I feel, and many agree, but their doctors just want to keep them on a high dose. When I switched doctors, he asked me if I wanted a dosage increase, and I was like "why??" I have relapsed less on <2 mg than on any higher dose, and I believe that people should know about it. I didn't decide to try lower doses until I read about it online, and looked at info other than RB information.

Many people say differently and are never even given the chance to try it.

More people's opinions who have seen the light. I know this is not a scientific source, just people like you and me, posting on a forum.
http://forum.opiophile.org/showthread.p ... LY-is-MORE

Also, "you never respond to what I say." Yes, I do. You kept talking about 4 mg being a "ceiling dose." I proved you wrong with cited information. That was definitely an exchange where I responded to what you were saying.


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PostPosted: Sun Oct 02, 2011 9:58 pm 
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The problem here, I believe, is the use of the word "euphoria". It's not really a euphoric feeling. It's more that a person MIGHT be able to feel their dose - they might feel kind of "off" or perhaps a bit high (but I wouldn't say euphoric) when they FIRST go on suboxone for the first FEW days ONLY, but not more than that; AND possibly as they taper down and get below 4 mg. Under 4 mg the receptors saturation levels are going up and down and with that, it's said that suboxone "acts" more like a full agonist, for the reasons stated above. I hope this helps. Oh, and I hate to do this again, but I gotta - Dr. Junig's blog and videos.

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PostPosted: Mon Oct 03, 2011 12:41 am 
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Ok, this my last post because this going no where. You did not prove me wrong. We were talking about doses above and below 4mg. 4mg is a ceiling level at which the receptors are saturated. Once again you yourself said so and that doses below cause more of an euphoric feeling, your words not mine. You assumed we were talking about the ceiling at which a person gets no more benefit from sub, why I do not know because that has nothing to do with our discussion. We were simply using the same word for two different ceiling properties the med has.

I read thru everyone of your sources and not one says a patient on maintenence for addiction would do better at a lower dose. You mainly posted about a study using bup on non opiate tolerant people for depression. We are not taking it for depression, we are taking it for addiction. In one of your links it even says people who taper and feel fine at .05-1mg and can feel fine are no more addicted than a non opiate tolerant person and are merely using it for depression. Your clinks also say that Bupe is only a powerful agonist at low doses because when it reaches the "ceiling" I was talking about it does not continue to get stronger like full agonists, therefore Bupe does not raise your tolerance above that level unlike full agonists that will increase tolerance. They even have a graph that is exactly the same as Dr. J's.

So I saw nothing in any of the links you posted that remotely suggests what you are saying is true. Infact I found the opposite, everything on the NAABT link you posted follows exactly what I was saying and what Dr. Junig says. Did you watch the links I posted. I assure you that you will not find a Dr, more educated on bup than Dr. Junig.

Like I said I am done with this thread because it is like walking in a circle, I wish you the best on you low dose and hope that one day you will see that what people need out of sub is as individual as anythin else about us.


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 Post subject: Lots of questions
PostPosted: Mon Oct 03, 2011 2:02 am 
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Hey, this is Anita and this thread is really relevant to me right now especially. I have found that while I am at 4 mg ( for pain management) for now.... I am having some weird effects, and maybe I am dipping below the ceiling. So, here is the question. Since my husband got cancer I am not continuing the taper and I have yet to find a dose that feels comfortable. Meaning, one where I am not having cravings upon awakening or mid-day. Now, I don't know exactly what ya call it- but I am having lots of tinnitus- ringing in my ears and these internal body tremors/twitches. They dont' always go away in response to a dose or a dose increase. I have just now increased from 4-5. I tried 6 and I got stupid sedated. But I am feeling a little better meaning, less true w/d kind of stuff, but I still always have the tinnitus and the muscle vibrations. Any thougths ?
Anita

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 Post subject: @Ironic
PostPosted: Mon Oct 03, 2011 10:09 am 
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Ironic wrote:
<snip>
Also, I don't want to put words in exorphins mouth, but it seems that he agrees with me, at least about the ceiling dose.



Well, if you don't want to put words in my mouth- then DON'T.

I was simply presenting information that I had found on the internet-
I did not even say whether or not I had agreed with it...

Oh, and BTW- I am a female.

Thanks,

-ex-

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 Post subject: Re: Lots of questions
PostPosted: Mon Oct 03, 2011 11:54 am 
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Anita wrote:
Hey, this is Anita and this thread is really relevant to me right now especially. I have found that while I am at 4 mg ( for pain management) for now.... I am having some weird effects, and maybe I am dipping below the ceiling. So, here is the question. Since my husband got cancer I am not continuing the taper and I have yet to find a dose that feels comfortable. Meaning, one where I am not having cravings upon awakening or mid-day. Now, I don't know exactly what ya call it- but I am having lots of tinnitus- ringing in my ears and these internal body tremors/twitches. They dont' always go away in response to a dose or a dose increase. I have just now increased from 4-5. I tried 6 and I got stupid sedated. But I am feeling a little better meaning, less true w/d kind of stuff, but I still always have the tinnitus and the muscle vibrations. Any thougths ?
Anita



Hi Anita,

I am so sorry to hear about your husband. I sincerely hope that he will be ok, my thoughts and prayers are with you both.

To answer your question, and this is just my opinion. I do believe you are having these ups and downs at 4mg because your blood level is dropping below the 4mg ceiling at times and not all of your receptors are staying saturated. Do you dose multiple times a day or once a day? When taking sub for pain it is recommended to dose multiple times per day because the pain relieving properties of sub only last around 6 hours. It is normal that you would feel a dose at 6mg. When you are taking 6mg all of your receptors are being covered all the time, within a week or two your body will adjust to this and you will simply feel normal, there will be no more highs and lows.

As for your side effects. I do get jerks as do others here, there is a thread about it in the side effects forum. I am not sure if the ringing ears are caused by sub as I have never heard of it, but it is possible. I and others have also posted about having joint and muscle aches. Side effects sometimes can improve with a lower dose but you said it didn't seem to make a difference.

I suppose if I was you I would try taking 6mg a day, either 2mg 3x a day or 3mg 2x a day for a couple weeks and see how I was doing. You should have no cravings while on sub maintenance, if you are then it kinda defeats the point.

This is just what I would do, I am sure others will come along with their advice. Again my thoughts and prayers are with you and your husband. Keep us posted as to what you decide to do and how you are feeling, it sometimes takes a bit but you will find the correct dose for you.


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 Post subject: Re: Lots of questions
PostPosted: Mon Oct 03, 2011 4:43 pm 
Anita wrote:
Hey, this is Anita and this thread is really relevant to me right now especially. I have found that while I am at 4 mg ( for pain management) for now.... I am having some weird effects, and maybe I am dipping below the ceiling. So, here is the question. Since my husband got cancer I am not continuing the taper and I have yet to find a dose that feels comfortable. Meaning, one where I am not having cravings upon awakening or mid-day. Now, I don't know exactly what ya call it- but I am having lots of tinnitus- ringing in my ears and these internal body tremors/twitches. They dont' always go away in response to a dose or a dose increase. I have just now increased from 4-5. I tried 6 and I got stupid sedated. But I am feeling a little better meaning, less true w/d kind of stuff, but I still always have the tinnitus and the muscle vibrations. Any thougths ?
Anita


Maybe you could try dosing 2-3 times per day?

Contrary to someone else's advice on here, if >4mg made you feel too sedated, I wouldn't suggest going up 2 mg every dose. That is counter-intuitive. Especially because you have already said that the tinnitus and body tremors do not always go away with a dose increase.

I would try to adjust to a dose (1-2 week long period) and see how you feel, while trying to choose the right dose for yourself.

Personally, lowering my dose did not increase my cravings, but it did decrease the negative side effects..however, many on here do not agree with me about that. The majority of the people on Opiophile do agree..so I guess it just depends on who you're talking to.


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 Post subject: Re: @Ironic
PostPosted: Mon Oct 03, 2011 4:48 pm 
exorphin wrote:
Ironic wrote:
<snip>
Also, I don't want to put words in exorphins mouth, but it seems that he agrees with me, at least about the ceiling dose.



Well, if you don't want to put words in my mouth- then DON'T.

I was simply presenting information that I had found on the internet-
I did not even say whether or not I had agreed with it...

Oh, and BTW- I am a female.

Thanks,

-ex-


Okay. I recant, exorphin does NOT agree with me, but did support some of my claims with further citations. Thank you for that, the more information, the better!


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PostPosted: Tue Nov 01, 2011 3:40 am 
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hatmaker510 wrote:
OK, this is getting old. I'm not going to argue with you. Everyone on this site and Dr. Junig and I are all on the same page. Maybe he'll pop in and explain it. But what I'm thinking is perhaps you came here trolling, so it wouldn't matter what he were to say anyway. This site is for support and it seems that maybe you've just come here to stir up shit. Maybe just ease up on the argumentativeness?

Oh and BTW, opiate receptors cannot be "permanently damaged". Remove the opiates and in time they will return to normal. Again, refer to Dr. Junig.
[font=Tahoma] [/font]


Ok no offence but even though i don't agree with the other poster who is saying the ceiling effect is 16-32mgs and i read the link he posted and can see he has misunderstood i do think you can calm down, no need to get all edgy, both of you are breaking the rules on this site which say ''Please do not debate'' and ''please do not discuss the pros and cons of suboxone''.. Just because you both believe in seperate things doesnt mean you can bark off a additude, just ignore it. You seem to have a large ego or something, why do you get so offended? Maybe i suggest not participating in forums if you can't handle it? If theres one thing i know about the internet,, its that EVERYONE has there opinions, EVERYONE is judgemental and EVERYONE just lovesss to debate and argue. He isn't a troll, he hasn't done anything but comment on what he believes to be true and because he hasn't ''dropped it'' you get all upset. Noone has to believe you just because you said something. If you can't take the heat, get the F out of the kitchen.


Oh and btw to all the Users, Not ALL Dr's/Sites are 100% correct, Just because Dr's have there varying opinions doesn't mean its the truth. Just like scientists, etc.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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