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 Post subject: Re: Checking in...
PostPosted: Tue Sep 22, 2015 11:49 am 
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Hey searching,

I think it's smart to listen to ur body and not rush this process. Maybe that's why ur doing so well at 2 mg. Great job!! I have zero experience with sub and that low of dose. I've been on suboxone about the same amount of time as u and I'm at 8 mg still, and I'm just not ready to go any lower. I think we all have our own journey and seeing ur journey is very inspiring to the ppl who are ready now but to scared to do it. Great progress and please keep us updated :)

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 Post subject: Re: Checking in...
PostPosted: Sat Oct 10, 2015 6:43 pm 
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Thanks for the accolades (I'll take them when I can get them!). So, since last seeing the doctor, he did in fact reduce my dose to 2 mg, at which I stayed for about ten days before alternating 1.5 and 2. I experience no w/d effects, whatsoever, so after one week, dropped to 1.5. This is where it gets tricky - cutting a tablet into quarters is not an easy feat, even with a pill splitter. When you try to cut them into 1 mg (half tabs), one is invariably bigger than the other. This also occurs when you cut the already "I might be one mg half tab" into "I might be around a 1/2 mg quarter tab".

This is exactly why I had inquired about the liquid taper model - it seems more precise.

I told my doctor that I had read about it and he was quite dismissive. His reasoning was that you couldn't ensure consistency in reconstituting the fluid. So, should I embark on that model, I won't be doing so with his consent. Then again, I've only been successful at tapering thus far because I've done things without his consent.

This is only day 3 at 1.5 mg, so I'm not out of the woods, yet. I've had w/d set in on day four, and expect it might occur, but I am armed with Clonidine, so if it happens, I'll take Clonidine for a day or two while my body adjusts.

Now that I am below the ceiling, I must admit that those creeping thoughts of "Well, I could take a bit extra one time." have popped into my head, but I dismiss the thought with knowing that I have been tapering for well over a year. Why would I work backwards? It is insensible.

So, that's my status. Hopefully, the next time I check in, I'll be alternating 1.5 and 1 mg, but, who knows? Only time will tell.

Have a great Canadian Thanksgiving weekend, for those of you in Canada!


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 Post subject: Re: Checking in...
PostPosted: Sat Oct 10, 2015 10:03 pm 
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Is it possible for your doctor to prescribe the 2 mg films? You would only need to buy 7 or 8 to get through the month and they would be much easier to split. That's one alternative to the liquid taper method.

Amy

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 Post subject: Re: Checking in...
PostPosted: Sat Oct 10, 2015 10:04 pm 
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Congrats, you are doing great! I wanted to share a suggestion I read a while back. The woman was tapering as you are & when she got low she crushed her pill. After it was fine she put it on a plate & made 4 lines from the "powder. From there she continued to divide the lines for the amount she needed. From the plate she took a book of matches and scooped up her dose and deposited it under her tongue. Honestly, no matter which method you use its not going to be exact.

Wishing you continued good results as you continue your taper.


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 Post subject: Re: Checking in...
PostPosted: Sun Oct 25, 2015 5:10 pm 
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Thanks for the tip. I've actually considered this, although weighing a crushed powder on a scale seems to be 100% contrary to my objectives! But, how else could I ensure consistency, with the exception of the water taper method?

I am now down to 1 mg. It happened a lot faster than I thought it would. I was at 1.5, and read some post somewhere about how being on the lower doses, it's better to extend the taper and go current dose - 4 days, desired dose - 1 day, current dose - 3 days, desired dose, one day, current dose - 2 days, desired dose - 1 day, then to desired dose for seven days before commencing the next drop. It sounded great in theory, as it seemed that it would have a nominal effect on my serum levels. But, I found keeping track of which day in which cycle I was to be beyond onerous. I decided forget it, alternating has worked thus far. I needed three doses at 1.5, three at 1, and I encountered LIGHT withdrawal one day. This was easily repaired with one dose of Clonidine. I find that if I take it closer to bed (assuming the withdrawal is light and I can handle it until then), one dose is all that is necessary, as it hits me around day 3 or 4, but isn't hard enough to go for days. I imagine that will change if I get to zero and suddenly have NOTHING on my opiate receptors. But, that's a different story… Anyway, I have to back into my doc and "ask" him if I can reduce to 1 mg, so I'm not paying for twice the Suboxone I need. As previously indicated, he loses it and will dismiss me as a patient if I drop my dose without his consent, which is really silly, given that he seems to know so little about Suboxone.

I think that we, as patients, need to rally against RB and demand that physicians and pharmacists become better educated on the drug, or they shouldn't be able to prescribe or dispense it. At one point, I was in emergency and my dose back them was like, 12 mg. They decided I needed morphine for pain. I said, I'm a Suboxone patient, so I will literally need exponentially more morphine than you would normally administer. They didn't want to go higher than 2 mg. I started to laugh and asked that they not bother with opioids and try a really strong NSAID instead.

I have NO clue as to how to approach drops below 1 mg. If anybody has a suggestion, please speak up!

Once again, many thanks to those of you who have taken the time to respond; it is so very much appreciated.

Love and Light


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 Post subject: Re: Checking in...
PostPosted: Sun Nov 08, 2015 10:23 pm 
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So, no major updates. Still at 1 mg. I don't feel "adjusted" or "stable", yet. Last week, I went to bed with my eye makeup on. My eyes watered so much that night that when I woke up, I had not even a spot of eye makeup on my skin by morning. At least the symptoms surface during the night and are not intense enough to be unmanageable. Once I go seven days with no symptoms, I will look at my next drop, which I foresee as being to .9. I'm not making any major moves at the lower doses - I've read too many horror stories.

I happened upon a site that is dedicated to defaming Suboxone (not going to bother naming it so that it doesn't get any hits via this rant). I was furious. I have a hard time understanding how people are not grateful for a med that gives them an opportunity to have their lives back. Perhaps they expect the Suboxone to do all the work? No personal investment, whatsoever - as though they played no role in arriving at a state where Suboxone became necessary. Like most people, I became addicted via prescription drugs. But, I knew that I got ornery and spiteful without them. The simple solution seemed to be to take more (vicodin, at the onset, in my case).

So, I will stay at 1 mg until I have gone a period without w/d symptoms - let's hope it happens soon!

Have a great week!


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 Post subject: Re: Checking in...
PostPosted: Tue Nov 24, 2015 2:50 pm 
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As I noted in another area (surgery), I saw an anesthesiologist on Thursday for surgery the upcoming Wednesday. She suggested that I alternate 1 mg and .5 mg to reduce tolerance. Dr. Junig was kind enough to respond (I swear, there is a luxury suite in heaven waiting for that man - but not anytime soon!), and was not convinced that even by d/c buprenorphine, my tolerance would drop in time. So, I am taking .5 and have been given liberty to take as much Clonidine as I feel I need. This is day four at .5, and I actually feel not too bad! Haven't exceeded one dose of Clonidine per day (I find it loses its efficacy if it is taken too often, but that's my thing).

They will use Dilaudid in hospital for pain control, but continue to administer Suboxone. I am thinking I will need the whole mg as the Dilaudid will be competing for my opiate receptors. Then again, the Dilaudid is what will give me pain relief.

I am concerned that, after taking full agonist opiates for a few days, my buprenorphine levels will drop, and I will need a "loading dose" to avoid w/d. I also stated in the other forum that when I was on five mg of Sub, I had four, five mg IV morphine shots, and I was in withdrawal big time. It took three days of Clonidine and Zofran (and Subs, evidently) to straighten that mess out.

Anyway, I feel good knowing that, having stayed at 1 mg for one month, .5 will not be a horribly difficult achievement. And from there, the journey continues.


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 Post subject: Re: Checking in...
PostPosted: Sat Jan 23, 2016 12:45 pm 
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Happy Saturday, everybody!

So, I noted that at 1 mg Suboxone, my back pain was no longer manageable. On Thursday, I went for my customary "check in appointment" with my Suboxone doc, and brought this up to him - my back pain is severely affecting my quality of life. He responded with, "There are other meds out there - Gabapentin, Lyrica, Cesamet, and NSAIDs." I gave him a nod when he said to follow up with my family doctor, but I already had a plan in mind.

I was fortunate enough to have an appt with my PM doctor immediately thereafter, so I didn't get my Suboxone filled, as I wanted to discuss the Butrans patch with him. I didn't even have to bring it up; he did. He suggested that we start at 5mcg/hr, but advised that I should take Suboxone for two more days as the patch takes a few days to "kick in". He also told me to change the patch every five, versus seven, days. I said, "But, Dr. xxx, I am currently taking 1000 mcg/day. How will 120 mcg/day work if 1000 aren't?" He said the delivery is different, and that I needn't worry; if 5 mcg/hr doesn't work, we will bump it up to 10 mcg/hr. Mathematically, I had assumed that I would need the 20 mcg/hr patch, which would work out to 480 mcg/day, which I figured would be pretty close to what was bioavailable from whatever I was absorbing from the 1 mg. He laughed when I said this and said I would be knocked out cold on 20 mcg/hr. This didn't make sense, mathematically, but I trust that this doctor knows what he is doing. He's the first PM who hasn't thrown full agonist opiates at me, saying that I would be on them for life.

Ecstatically, I called my Suboxone clinic, and asked if I had to continue taking Suboxone, or if I could get discharged from the program in good standing. They said that I had weaned low enough to discontinue, but that I might need something for sleep, and to go in if I found this was the case. I already have sleeping meds, and really don't want any new ones started.

At home, I furiously looked online for anything that discussed transition from Suboxone to Butrans, and initially, could only find other patients expressing the same fear I had - mathematically, it seemed illogical. But, I was fortunate enough to come across a PM doc discussing this very issue. He stated that 20 mcg/hr is sufficient pain relief for patients at about 16 mg Suboxone (where I started, ages ago). He furthered that Suboxone patients at lower doses will generally require 10 mcg/hr. This gave me some hope.

That night, hesitantly, I applied the patch. I actually woke up the next morning with MARKED decreased back pain. I still had to use some Aleve and Robax throughout the day, but it was basically 1/4 of what I was taking. I took .5mg of the Suboxone in the morning, and .5 about six hours later. I was quite pleased, except that I had immense difficulty sleeping. This didn't surprise me; in the past, if I had taken Suboxone too late in the day, I always had a hard time sleeping (even with sleeping meds). So, a continued release of Buprenorphine keeping me awake was not unexpected, albeit a bit disappointing.

Today is the second day of the two days that I am to continue with Suboxone. I took .5 in the morning, but am not certain that I need another dose - it seems that I am getting a fair amount on the patch.

In summary, as of tomorrow, I will no longer be on Suboxone. I realize that the medication is the same thing (minus the Naloxone), but am no longer on ORT. In a way, I feel like I'm cheating, because I am on Butrans, but with all honesty, I believed that if I discontinued Buprenorphine completely, the pain would become excruciating enough that I would agree to a full agonist - a road I never want to go down again.

The purpose of this post is two-fold: first, as I mentioned previously, it is a diary of sorts, and allows me to look back and see my progress (as slow as it has been); and secondly, to assure other ORT patients that the patch does not equate mcg per mcg to Suboxone, should they be faced with the same predicament. My thinking is that the majority of us got here because of chronic pain treated with opiates, so I am certain I am not the only member who will face this transition.

Thus far, the patch seems to be working. I am armed with Clonidine, should I go through any withdrawal, but I have a feeling I won't need much, if any. I will post in about a week and let you know if I am dragging myself across the floor or actually living life as I should be.

That's my update! Have a great weekend, everybody!


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 Post subject: Re: Checking in...
PostPosted: Sat Jan 23, 2016 2:37 pm 
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Thank you for sharing that with us. I've never really done any research on the bupe patch or whatever it's called. I think everyone should be aware of it in case something happens in the future. Please keep us updated, I'm very interested in how well ur transition goes. Good luck!

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 Post subject: Re: Checking in...
PostPosted: Sat Jan 23, 2016 6:39 pm 
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Thank you for the detailed post! Great information in general, and especially for those dealing with chronic pain. I am happy for you that the new medication seems to be working!

Amy

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 Post subject: Re: Checking in...
PostPosted: Wed Feb 17, 2016 8:56 pm 
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Good luck! Sounds like you're on your way!

Interested to know how the surgical recovery goes.

I'm terrified to go off Suboxone because I have a major ankle surgery looming as well as major dental work. I don't want to ever feel opiates again! I'm afraid that I'll feel *that numb high* and start craving it. I don't crave it now. (and that's aside from take home meds- I still don't trust myself after 5.5yrs- at least not without suboxone.)

I don't have any answers, but wanted to let you know you've got company & I wish you the best!

Be well,
B


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

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