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PostPosted: Sat Jun 05, 2010 2:42 pm 
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Well, hello again everyone. Has been an interesting ride these past 23 days. Currently I am 10 days from my next scrpit and I have 11 8mg pills left. Yes I did it, took too much and now am worried I won't make it last. However, yesterday at regular 16 mg felt fine, believe I took so much on memorial day that I may have precipated WD. Now, that it not as bad as it sounds, I got on the kick of taking 3 pills a day when I was suppsed only take 2, consqntly prblem. Also, had severe panick attcks last two days, feeling much better today on 10 mg so far. Got on forum last night, not this one, and was kinda freaked out about WD horror stories. I am high strung anyway, I don't anymore anxty. All an all, I am discovering, that old addictive behavior will not work with sub, and kinda wierd but it seem the less you take the better it works. So many things going through my mind right now, Oh I forgot......I am also taking Cymbalta and Propananol, forgot my propananol this week for two days and I think that what in conjntin with 24 mg sub caused panic. This withdrawl thing is biting at me.

HELP!!!

Would love to talk to Dr. Janig sometime. Like the videos.


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PostPosted: Sat Jun 05, 2010 3:00 pm 
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Hi headswater,

So am I to understand that you think you can't make it on 8 mg a day? Obviously I can't say for sure, but going down to 8 a day shouldn't cause withdrawals. 8 mg is still at or above the ceiling, meaning your receptors should still be saturated. (That said, I'm no doctor.) Now that's not to say there won't be some psychological issues. And going without the propranolol might indeed raise your anxiety.

I would advise you to stay away from the subsux websites/forums, they're just a bunch of haters who believe that withdrawing from bupe will make your eyeballs pop out. Seriously, you should be fine at 8 mg a day. But you need to put the bat down and stop beating yourself up about it. It's done and yes, once you're back on track you'll need to get a handle on the active addictive behaviors. But for now, ease up and don't EXPECT some hellishly crazy withdrawals, because you'll find them. Dr. Junig often says that as addicts we're way to aware of how we're feeling. Always constantly assessing this ache, that pain, or some slight depression in our mood. Don't get me wrong, I'm not making light of your situation, I'm trying to arm you with the tools to get though it and maybe give you a different perspective.

It is my opinion (so take it for what it's worth) that you CAN make it until your next script. Hang in there and use this forum to vent when you're not feeling well. It's what we're here for and we want to help you through this. Consider this forum part of your support system (I know I do) and remember, you turned to us - your support system and that's a really good thing.

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PostPosted: Sat Jun 05, 2010 3:18 pm 
Hey. I re-read your post three times trying to get a handle on what you were saying. What I'm getting out of it is that you were taking 24 or more mg a day to try to get high off the sub? If so, you're not the first to have tried it only to find out it doesn't work. My doc said that something like 94% of your receptors are bound at 16mg. Anyhow, you will be fine for the next 10 days at 8 mg. Not only is it above the ceiling like Mel said, but your system is also loaded with bupe right now, and it has a really long half life. So you will be on the 8mg + whatever remains in your system. Also, I agree with the concept that less is more with sub. The problem is, being addicts, most of us have to find out the hard way. Good for you coming back to the forum to post. It's helpful to share with other supportive addicts.
Good luck,
Lilly


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PostPosted: Sat Jun 05, 2010 5:20 pm 
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1st of all, if all you are taking is sub, you can't get precipitated withdrawals from it.

2nd, you won't get any true withdrawal on 8mg per day until your script either. You will feel psychologically uncomfortable to some extent, but if you keep yourself busy and distracted (avoid down time) you probably won't even notice it. You could probably go 48 hours without sub without any real withdrawal.

I have been in your shoes before. A few times at least. Nothing bad has ever happened. You will be fine, so long as you don't keep taking more than 8mg per day and wind up with NONE prior to your next script. Try taking only 4mg every other day and you will probably still be just fine. Seriously.

Cherie


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PostPosted: Sat Jun 05, 2010 6:53 pm 
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Thanks for responding, I am really not as bad as that post sounded, but I think it is interesting that addictive behavior always finds a way. Has anyone else experienced panic attx, what I had was not fun. Wierd, it is the only word I can find. I came off of xanax twice, I panic attx in my sleep, night terrors. Sometimes I think I chose the wrong profession. After all this experience counseling sounds so enticing. Thanks again!!!


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PostPosted: Sat Jun 05, 2010 8:34 pm 
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I have not experienced the anxiety thing but I have read that high doses of suboxone can in fact cause anxiety. So it doesn't surprise me. I think most of us have had this addictive behavior creep in at one time or another. I have done it and laugh at myself over it because extra suboxone doesn't do anything more than meditation does and then I just get stressed out because I know I haven't changed my thoughts or behavior much. I beat myself up over it. It sucks. And then when you are taking lower than what is prescribed in order to stretch it out till your next appointment, you psychologically don't feel as good for an entire week or whatever. I will tell you that if you can, try dropping down to 4mg for just two days. Then, on the 3rd day when you go back up to 8mg, that whole psychological thing kind of goes away. You are better off with only the 2 days of feeling uncomfortable.

Oh....and if you haven't already, look around for the posts on how to take your suboxone. There are some great tips on getting maximum absorbtion and if you aren't already maximizing it and then start while on this lower dose, you could probably get the same effect as your full dose anyways. I believe you generally only absorb about 1/2 the bupe when you take it normally but if you use a few of the techniques listed, you can absorb more of it.

That is the best advice I have. Good luck. Be careful this week.

Cherie

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PostPosted: Sat Jun 05, 2010 9:50 pm 
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I think that you will find that you will do pretty well going down to 8mgs a day till your next script. Def won't have withdrawals on it. Good luck!

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Of course there's such a thing as angels. Only sometimes they don't have wings... and we call them mothers. -Unknown


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PostPosted: Sat Jun 05, 2010 10:20 pm 
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Headwaters, I too think you'll be ok if you just take 8 mgs a day, or maybe like suggested, take less for a couple of days and then back up to 8 mg. But.......I myself have run through my "script faster than I was supposed to every single time (except the first time, when the doctor told me to taper off and stop but instead I kept taking it until I'd used up all 3 of the refills that were written on the original "script.") Every time I got down to the last few pills I thought "I can make this last a long time if I only take a quarter of a tab a day, or even every other day." I made up little taper plans for myself too. But then I never followed through, I always ended up taking the last pills at no less than a half tab (4 mgs) a day. Last time when I ran all the way out I used the dust from the empty bottles (true addict behavior) when I was just starting to feel any physical WD and I swear it worked. Also, any time I've had any WD symptoms at all, taking subox has taken care of it right away--I never tried waiting a certain amount of time after a relapse (and I've had a lot of relapsing, I'm sorry to say).

I don't understand how to find the right dose either. I re-read this explanation by Donh in a recent thread called "dose is overkill and close to relapse":


"So if we take 1 mg of Bup we may only be getting 0.25 or even 0.1 mg into our system. So while the numbers will still climb to pretty high levels, it's not going to be as bad as perhaps we may first think.

"That is a smaller portion of all of this, however. The bigger piece is that with Bup, the often talked about ceiling effect kicks in somewhere around 4mg. After we reach the "ceiling" it doesn't matter how much more Bup we take, we will get no more effect from it. So, if we take 120mg of morphine, all of it will hit the receptors and have an effect. Taking 120mg of Bup will provide no more effect than about 4mg does. All of this is why the precipitated withdrawal phenomenon is able to take place. It is why Methadone patients are often tapered down to 30mg before inducting on Bup. It is because that the "strongest" that Bup can get is roughly equivalent to 30 mg of Methadone. That is why if a person is used to high doses of opiates, when those opiates are replaced by Bup, if the difference between the two is too great, the person goes into withdrawal. No matter what, Bup can only be so strong and provide so much opiate effect.

"My whole point in all of this is that while patients may take 16mg of Bup or more, that does not mean that their tolerance has been moved up to the equivalent of 100s of MGs of a full opiate medication. We always have to remember that the "race" between Bup and a full opiate is somewhat even in the low doses but Bup will soon run out of gas and hit the point where a higher dose does not result in any additional effect.

"All of this is why many patients are able to reduce from double-digit doses by large amounts without really feeling much in the way of withdrawal. I agree with you that the typical 40mg oxy user very likely does not need 24mg of Bup daily, it seems like the medical community is finding out (many have already decided) that the 400mg oxy user doesn't need 24mg of Bup either. I have read reports from patients who were induced at only 2 or 4 mg but did just fine even after having been high level opiate users. "




I also re-read another thread called "the more I know, the less I get, ceiling effect for dummies." If the ceiling effect kicks in at 4 mgs or so, as Donh said in the post I quoted above, why would anyone need a dose higher than 4 mgs? Then, I heard someone say that there is talk of making 16 mgs the maximum allowable dose. People have mentioned, well, different people metabolize it differently, etc, but I'm still really confused about the ceiling level and dosage issue in general. Another question is, why do most people take it every day, since it has such a long effect? And then there's the question of how much are you actually absorbing each time you dose, when there can be variables with that too....

Sometimes I wonder if withdrawal actually starts before the noticeable physical symptoms show up.

Now, I will say I also feel like an idiot for continuing to take more subox than I need to. I am sure now that the ceiling effect prevents me from feeling any extra effect. I can't get high by taking extra subox. But I have been having a hard time keeping myself from taking it "as needed " for my depression and mood swings. I'm really struggling to stablize my dose (and my dosing habits) now. My doctor has encouraged me to take as little as possible, but I now realize that my doctor apparently does not know all about the ceiling effect and a lot of other things about suboxone too. It IS really confusing. Can anyone answer the question of why some people are prescribed as much as 24 mgs or even more, to start? In Donh's explanation it says that after 4 mgs it doesnt' matter how much more you take--no further effect. Well, maybe Donh was pointing out that maybe higher doses arent' necessary but....it seems like a lot of people are on higher doses. I also remember someone telling me that their doctor told them to take one 8 mg tab when they felt WD starting but that if it didnt' take care of it, he might want to take another 8 mgs later that day.....would that have to do with, at the beginning of suboxone treatment you might have to take more in order to make sure those receptors are full?

As for how bad withdrawal from suboxone is--I dont' know because I don't think I've gone through more than the beginnings of it. My doctor told me, when she started me on it, that it was not addictive and would be no big deal to discontinue--taper off in about 4 days and then you'll be fine. But...in reality, you might not even feel the withdrawal from subox UNTIL 4 days after discontinuing! Actually, after I ran out the first time, I did feel fine in about 4 days...but then I relapsed.....

AT this point, I am actually wondering if my unstable dosing habits are contributing to my mood swings.

Anyway, everyday I'm resolving anew to try to stablize my dosing. I didnt' do that great today, but tomorrow I'll try again to do it right.

Good luck to you Headwaters, I'll tell you the way I've been doing it has not worked out that well for me, obviously I wish I'd been taking my suboxone properly all along. However, I'm determined to try to straighten my dosing out now, and to take it properly AND to try to stay off the other drugs.


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PostPosted: Sun Jun 06, 2010 7:28 am 
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It is my understanding that most suboxone patients are put on higher doses of bupe at induction to ensure that their cravings are satisfied. Many people, once stabilized, will then taper down to their regular dose. And again, everyone is different. We've had discussions that started out this way on here before. What it comes down to is that we're all unique and a dosage is just a number. People have to do what's best for their recovery - regardless of what others may think.

As for me, I take up to 24 mgs per day - BUT, I also take it for pain control. Bupe's pain properties only last 4-8 hours, so I dose at 8 mg up to 3 times a day. When I tapered down temporarily for surgery I found out first-hand just how much my dose really does help my pain.

Just my two cents.

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


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