It is currently Wed Aug 23, 2017 7:56 am



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 12 posts ] 
Author Message
PostPosted: Tue Sep 17, 2013 10:14 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Fri Mar 08, 2013 1:02 pm
Posts: 1342
Location: West Tennessee
Hello all of our fabulous members!

This section of the forum is frequented by people who are new to suboxone treatment, and I have noticed an increase in the amount of questions we are getting from people who are sent home with their prescription to induce at home. Very frequently someone will link to the COWS sheet in their response as a way to help the new patient to induce safely. I thought it would be a good idea to place the link to it here as a sticky to #1-make it a little easier for those members who want to point a new member to this information. And #2-to make this information more accesible for those "lurkers" who don't feel comfortable joining the forum or posting quite yet.

As an explanation to those who aren't familiar with this. The COWS sheet is designed to aid physicians in knowing when it is safe to begin treatment with buprenorphine, the active ingredient in suboxone/subutex. It is recommended that you be in moderate/severe withdrawal before taking your first dose of buprenorphine to avoid the dreaded Precipitated Withdrawal (PW).

It is best if you have another person score you while you are using this flow sheet, as we addicts tend to want to rush things a bit and bump up the score a little so that we can get relief a bit faster. It's incredibly hard to honestly score yourself.

The sheet is pretty self explanitary. It can be printed out and used as you are going through the process of WD in preparation for your induction. If you have any questions, please feel free to start a new thread and ask away!

Here's the link...

http://naabt.org/documents/COWS_inducti ... _sheet.pdf

Good luck on your journey to sobriety!

Qhorsegal2

Moderator

_________________
No one can make you feel inferior without your consent. ~ Eleanor Roosevelt


Top
 Profile  
 
PostPosted: Wed Sep 18, 2013 2:55 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4140
Great idea, Q! Thanks for thinking of that!

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Fri Nov 22, 2013 9:35 am 
Offline
Average Poster
Average Poster

Joined: Fri Nov 22, 2013 8:18 am
Posts: 5
Ok. Kinda like CIWA for etoh.

Next , once in moderate WD score. What's next info flow sheet etc for sub induction. Based on cows and current like weight, if even matters, current opiate dose. Etc. and like taper schedule. For sub. .

Thks.

I told my dr I was gonna "handle myself'. He just really blew me off. I Cudnt believe it.....his suggest. Call me in week to 10 days if cant do on own wtout anything. Really? Me, doc were both profs here , really ? Or do u just not want "risk". Wever,

I just wanna b safe. I'm not stupid, but sometimes knowing just enuf makes a person stupid. N stupid gets you really messed up. Or possibly dead. I just want success here. Peeps. That's- all safe, success wth least discomfort possible. Noting least. I know absence of discomfort is,,,, well just not possible. ,,,,


Top
 Profile  
 
Our Sponsors
PostPosted: Fri Feb 21, 2014 12:14 pm 
Offline
Super Poster
Super Poster

Joined: Tue Jan 28, 2014 3:41 pm
Posts: 178
Location: Canada
This is a great post from Qhorsegal2

Talking from experience, anyone who is wanting to switch from methadone to Suboxone should take this very seriously. Tapering down to 30mg and waiting up to 96hrs before starting a Sub maintenance program is very important.

Don't do what I did. It almost killed me. I didn't or couldn't or just didn't quite get the importance of tapering down. I half heartedly attempted but gave up early on the taper attempt and decided to jump at a extremely high dose (200mg). By day 5 I was in heavy WD. My doc decided it was time to start the subs.
This put me in PW. I thought the WD from 5 days off methadone was bad. This was hell for a week or more.

My point is you have to taper down to 30mg before hand coming off methadone and wait it out as lng as you can. It will make the transition easy.

I can't help much transitioning from Oxy to subs but I'm sure the COW sheet should will give you your best hope. There's a reason they came up with the COW sheet, it works.

Suboxone saved my life.

Best of luck to everyone considering the change in life Suboxone can give you from our addictions.

My intentions are not to scare anyone but to point out how important it is to have some facts on how not to do it.


Top
 Profile  
 
PostPosted: Fri Feb 21, 2014 2:46 pm 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Sat Jul 27, 2013 10:28 am
Posts: 666
iwilldothis wrote:
My point is you have to taper down to 30mg before hand coming off methadone and wait it out as lng as you can. It will make the transition easy.
Well said and I hope everyone reads your post that's considering switching from methadone to suboxone. I made the huge mistake of not using it the first time I tried to switch and paid for it dearly. I've heard many people say PW's only last a short time, but for me it went on for a few days. Horrible, horrible symptoms that had me going to the ER. Lessoned learned.

I would just add that when tapering the methadone, it's best to get to at LEAST 30mg, and lower is even better. The lower the better, and I personally believe it takes less time to be ready for induction if a person can taper lower than 30mg. There was a fellow here several weeks ago I posted to that had to wait 96+ hours before he inducted. He thought that was extreme, which may seem so, but anything to avoid those PW's is so worth it!

I always recommend using the Cow's, even when inducting to subs from any other substance. It just gives you another measure of reassurance. I know many like to use the time format like waiting 12-48 hours to induct. But the COW's takes most of the guesswork out of it. Rate your systems honestly, get to the score needed, and the chances of going into PW's are practically nil. I wish every doctor, and every person inducting would use it.

Great post!

Karen


Top
 Profile  
 
PostPosted: Sun Mar 02, 2014 5:54 am 
Offline
Average Poster
Average Poster
User avatar

Joined: Fri Feb 21, 2014 8:34 am
Posts: 25
My phone doesn't support PDF or DOC files and I can't seem to find any way to view the COWS scale other than the two :(

_________________
-karma<3


Top
 Profile  
 
PostPosted: Sun Mar 02, 2014 10:01 am 
Offline
Super Poster
Super Poster
User avatar

Joined: Wed Jan 22, 2014 4:07 pm
Posts: 155
All I can find all DOC or PDF files on the net as well.. I will try to convert something to JPG (Image File) and post a pic or two up here. You should then be able to view on phone. Allow me sometime as I still need to make breakfast for the kids :)

I'll post it shortly.

_________________
" Each relapse starts with one thought— maybe, just maybe, this time will be different… that little thought has killed thousands and thousands of opiate addicts over the years."
- Dr Jeffery Junig (Subox Doc)


Top
 Profile  
 
PostPosted: Tue Nov 01, 2016 4:07 pm 
Offline
Long Time Member
Long Time Member

Joined: Sat Oct 29, 2016 9:34 pm
Posts: 614
iwdt wrote
Quote:
By day 5 I was in heavy WD. My doc decided it was time to start the subs.
This put me in PW. I thought the WD from 5 days off methadone was bad. This was hell for a week or more.


This is scary as hell. I get you were on a high dose, but you were also in heavy duty WD by then. I suppose methadone binds tightly and for quite a long time.

You've inspired me to put off induction for a week or so while I cut down on my opium levels more than I have. I've been told 24 hours should be enough, but the other parameter is also tolerance I'm now realizing. I've already cut my morning dose in half, but still taking a high dose in the evenings because otherwise I can't sleep. At this point though, the fear of PW is enough to accept a few nights of sleeplessness...

As the old saying goes, the only way out is through.


Top
 Profile  
 
PostPosted: Tue Nov 01, 2016 5:15 pm 
Offline
Moderator
Moderator
User avatar

Joined: Mon Sep 15, 2014 7:15 pm
Posts: 2313
Location: Tennessee
Coming off methadone is different than other opiates in regards to how long it's recommended to wait for ur induction. It's very difficult for ppl on methadone because of the wait time, but that's not the case for other opiates except for maybe fentanyl.

Just wanted ya to know that pw happens a lot more with ppl coming off methadone. Wait as long as u need to, nothing wrong with doing what ur comfortable with :) just wanted to tell ya methadone has unique circumstances when it comes to buprenorphine.

_________________
Jennifer


Top
 Profile  
 
   
PostPosted: Tue Nov 01, 2016 7:10 pm 
Offline
Super Poster
Super Poster

Joined: Mon Sep 19, 2016 2:48 pm
Posts: 115
I switched from 43mg of methadone to Suboxone successfully. I waited close to 90 hours, took 2mg of sub every few hours until I was at 8mg for the first day.
I went from sick as a dog to outside grilling within a few hours of taking the Suboxone.
The close to 4 days with no methadone was rough but I was determined to not get PW and wanted to do it correctly the first time.


Top
 Profile  
 
PostPosted: Tue Nov 01, 2016 10:55 pm 
Offline
Long Time Member
Long Time Member

Joined: Sat Oct 29, 2016 9:34 pm
Posts: 614
Thanks jenn (I'm assuming that post was directed to me). I'm at the point now where I'm starting to get sick of my own racing thought and worriess. What about this? What about that? What about something else?

My bottom line problem....other than being a drug addict...is anxiety. (You're probably thinking...wow, no kidding :-)


Top
 Profile  
 
PostPosted: Wed Nov 02, 2016 8:25 am 
Offline
Moderator
Moderator
User avatar

Joined: Mon Sep 15, 2014 7:15 pm
Posts: 2313
Location: Tennessee
It's ok Godfrey! I'm the biggest worrier there is. I said in a post awhile bk how I'll think of everything that could possibly go wrong and find solutions to them in case it happens....even though it hasn't happened lol! So I see myself in all ur worries, that's why I try to ease ur mind a little bit if it's possible, because I know how draining it can be. I didn't want ya to be worried about pw from a post that was about methadone because methadone switch to suboxone is a longer wait than normal. I don't know about poppyseed tea, but even heroin users (which is a pretty powerful opiate) wait around the same....24 to 36 hrs usually. So I think you'll be fine, but take it as slow as ya need to. I totally get the scared part. During my induction, I was extremely overwhelmed and scared to death to be in withdrawal but it all worked out great in the end. Hoping urs does too :)

_________________
Jennifer


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 12 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 0 guests


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

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

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

Powered by phpBB® Forum Software © phpBB Group