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PostPosted: Wed Aug 04, 2010 12:36 am 
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So Ive been having a bit of an issue lately with my dosing. I had been taking 1.5 mg's per day for about 65 days. I was doing great for the most part. Maybe a little moody here and there. I have extensively researched this drug hours upon hours and found this site to be the most informative and caring. Well after looking into why I may be a little irritable I came to the conclusion that it must be because I was slightly below the ceiling level. This was based on discussions in the dosing section and Dr. Junig's blog on the "Ceiling Effect".. In Dr. Junig's blog and reponses to a post I made regarding this issue a few weeks ago I was also informed that doses below 2 mg acted as a full agonist as opposed to the partial agonist I thought suboxone was. I surely did not want to be taking a full agonist as that is the purpose of me being on this medication. Considering all of this I raised my dose to 2mg. Well I stayed on it for about 1 1/2 weeks. I was terribly lethargic, apathetic, depressed, irritable, you name it. I figured it was just me adjusting to the increase and that I would just grind it out until I stabilized. I couldn't take it any longer as the depression only worsened and my work performance was suffering and I was no longer capable of taking part in my daily activities. My doctor is horrible and I didn't know how fast I would get a response on here so I called the Suboxone hotline this morning that is on the pamphlet your Doc gives you when you start. The lady I spoke with on the phone was appalled to say the least as to where I was getting my information. She said that suboxone is a very personal drug and there is no specific dose and it ALWAYS acts as a partial agonist. She told me as long as it curbs my cravings and I seem to have done well on the 1.5 mg that there is no reason to increase my dosage. She said the ceiling effect is typically between 8-16mgs but that does not have to be the goal. I took a smaller dose yesterday and again today and I already feel 10x better. I am just confused because there is so much misinformation out there on this particular issue, as well as this drug. I am not discrediting this forum at all, just trying to get some feedback, maybe start a debate, and give a heads up to people out there who may be in my situation. This lady I spoke with may not have been completely correct with her information compared to what is on this site, but in my case it sure as hell makes sense. I really want to have faith in this forum and Dr. Junig because everyone here is so great and Dr. Junig seems like such a caring, knowledgeable guy.


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PostPosted: Wed Aug 04, 2010 9:57 am 
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My understanding is in line with yours. I thought the ceiling limit was about 4 mg as opposed to 8 or higher. All I can say is what I've learned from Dr. J. But I know that people get a sort of "high" at low doses, which backs up the notion that at low doses it acts like a full agonist. If I were you, I'd pay more attention to how you feel and choose a dose that feels "right". If you're going to try increasing your dose, you may have to give it more time than a day or two. But please keep in mind I'm not any kind of medical professional. I would, however, trust Dr. J's word over a customer service rep (or whatever they call themselves). Dr. J has a biochemistry degree or something similar, so I would say he has the education to back up his position. But again, that's just me.

I'm really sorry you're not doing well. Maybe Dr. J will weigh in on this subject for you. Please keep us posted on how you're doing.

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PostPosted: Fri Aug 06, 2010 12:24 am 
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Hey Hatmaker thanks for the reply and I appreciate your understanding.. I did actually stay on my increased dose for a little over a week. I figured I should definitely stabilize by then, especially considering the fact I only raised my dose .5 mg per day. I would very much like to believe Dr. Junigs credibility as well. He is the reason I started this medication as he made sense out of this complicated drug for me more than anyone else could and laid out the reasons why I should be on it. My mom has been a nurse for 25 years and I explained to her how torn I was between what to believe. She said that over the years the drug reps have always been more informed than most of the Dr.'s she has worked with. This is sad but true. I am not insinuating that Dr. Junig is wrong, but it is just very disturbing to me that a suboxone rep can speak to me with the same conviction as Dr. Junig, but give the complete opposite info. Yes they may be just some rep on the other end of the phone line, but they are getting they re info from people higher up in the food chain who I am sure have studied the drug just as much as Dr. Junig. I read a lot about Dr. J's addiction issues, but I never heard anything regarding him taking suboxone. Does anybody happen to know? I know you guys don't like suboxone bashers around here, and that is not what I am trying to do. My experience just hasn't been very consistent and pleasant so far. It def has its ups and downs, and most importantly has kept me sober. I understand that it could potentially be better if I were able to find the right dose, but that is kind of hard with all of this misinformation coming from sources which you would expect to be very reliable. I just wonder what can be done? Or if there is any ongoing effort out there to provide concrete, consistent evidence on this drug. It seems as though everyone just forms their own philosophy and then runs with it. Kinda like how religion has become so distorted and misconstrued with all the different perceptions of literature in the bible. It is just very scary and something people need to be aware of.


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PostPosted: Fri Aug 06, 2010 6:28 am 
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I can hear the confusion and frustration in your words. And I don't blame you one bit. You're searching for answers and all you're finding is conflicting information. Have you tried sending a message to Dr. J? I know he get many emails, but it might be worth a shot.

I wish I (or someone) could explain why a dose increase of .5mg has given you so much trouble, but it obviously has. BTW, I don't think you come off as a sub-basher by any stretch of the imagination. You're just someone who wants to understand a medication that's going into your body (and brain). And that makes complete sense to me. Hang in there and please keep us posted on how you're doing as well as any more information you receive.

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-I'm only responsible for what I say, not for what you understand.


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PostPosted: Fri Aug 06, 2010 4:32 pm 
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I think it's worth clarifying something. This is how bad information is developed. No one has ever written or said, to my knowledge, that suboxone IS a full agonist at low doses. What I believe people have said and written is that it "works like" or "feels like" a full agonist at lower doses.

Yes, I am splitting hairs, but I think in this case they are worth splitting, because I don't think Dr. Junig's credibility is up for debate. I've read his blogs, I've watched his videos. The man knows what he's talking about.

And the people you are talking to at that "suboxone hotline" are most likely just reading from a script.

Yes, you got advice from them that appears to have worked for you, but I'm also not all that sure that you waited long enough when you changed doses for it to fully accumulate in your system so who knows. Besides, every drug affects everyone differently.

Anyway, I am definitely glad you are feeling better, that's what matters, right?


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PostPosted: Sat Aug 07, 2010 2:02 pm 
Rmac, I just wanted throw my two cents worth in here, for what it's worth. I agree with Junkie....I don't think Dr. J has ever said that buprenorphine becomes a full-agonist at lower doses. What I believe he has said is that it may act more like a full-agonist at lower doses.
It is my belief that this a very complex drug which seems to affect a lot of people in different ways. Sure, for the most part, the general 'rules' apply.....the ceiling dose effect, the lack of 'high' from the drug, its ability to stop withdrawal symptoms and abate cravings.....those things are usually a given for almost everyone. However, there are exceptions to every rule and some people just react differently. I've heard too many accounts over time of people experiencing some side effects, or some mood problems, etc at all different doses, for me to dismiss entirely that this drug always acts the same way for everyone. Obviously there are variables from one person to the next, so who can say what is attributable to the individual versus the drug?
In any case, I think it's becoming more and more obvious that the high doses that some doctors are prescribing are not necessary for most people. I believe the 'powers that be' have issued a statement of best practices advising prescribing physicians not to prescribe more than 16mg/day and it seems that most of what I read, in terms of personal accounts, that it's unusual for people to have any issues at all with a dose of 8-12mg/day. Further, in reading taper stories, it seems that very few people run into difficulty until reducing to under ~4mg/day. So, that tells me that a lot of people are being prescribed far more of this drug than is usually necessary for stability. Of course, there are exceptions....I believe when used for chronic pain, the dosages are generally kept much higher and for some people, it really does seem to take higher doses to stabilize at least in the beginning stages of treatment. Those are just my opinions, nothing more than that.
From my own experience, now holding at ~1mg/day (well below the ceiling dose) I can say that I have NEVER felt that my dose has 'acted' or felt like a full-agonist......never. I have never gotten a high from it at all. Now, I have at times during my taper noticed some sleepiness or a little bit of an 'off' feelings, but nothing truly resembling an opiate high. I wonder if the lower doses 'act' differently maybe in terms of the dose 'wearing off' sooner because it is such a small dose that even with the longer half life, the amount of drug in the system over time is way less than it would be at doses above the ceiling. I don't know, I just know that from my experience......no, lower doses do not 'feel' at all like taking a full-agonist.
As far as you feeling differently with a dose change of only 0.5mg, I don't doubt it. If you were only taking 1.5, adding another 0.5 is a significant increase, at least in my mind. This is a strong drug. Personally, I think if you feel pretty good and stable on a lower dose, that's great! If you ever do desire to stop the drug or even if you stay on it for life, your dose is low enough to be overridden in case of emergency and should make it easier to taper off if you should want to.
In any case....I'm glad you're feeling better. You are certainly not the only one who has struggled with moods issues and dosing issues with this drug. I have had my share as well. I will encourage you to also look to other things in your life, aside from your medication, that may contribute to what's going on. Sometimes for me, I've found that indeed there are other things going on my life that are contributing to my moods and need to be addressed, independent of my addiction history or treatment. So be aware of that. Some of this stuff has actually very little to do with our meds and much more to do with what else is going on in our lives. I don't know if that helped or just muddied the water, but I felt compelled to reply. Thanks for sharing what's going on with you and I hope you'll be back!


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

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