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PostPosted: Wed Sep 18, 2013 1:49 pm 
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So, I nvr thought I'd post in one of these forums but im kinda scared. My longtime physician has moved his practice from the clinic to overseas . I actually grad from asas at that clinic many years ago and have been doing fine ever since I was on suboxone. I live between NYC and AZ. I recd my rx from n y and I would come back @ every 4 months to see my m d. At the meeting I had today the new medical director , who is familiar with me from asas, would not come up to see me and told the p a that i was with that he would give me a 30 rx and that I was to come back every 30 days . For obvious reasons I can't accommodate this and no, I can't switch to az for my tmt or rx., for other reasons. I feel I've gotten caught up in a bureaucratic storm here and due to hasty decisions with regard to rx suboxone to non compliant pts it's now being put under the penal system method of maint used for meth. Basically I'm frightened because I've nvr messed with my meds and I'm going to be detoxing in 30 days . The pharmacy that sends me my rx 's messed up once and I was without suboxone for almost 4 days . It was not pretty so pls don't say detox is a breeze . Thanks for listening whomever .


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PostPosted: Wed Sep 18, 2013 4:11 pm 
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Hey quinnisme,

Nobody here will ever tell you detox is a breeze! It sounds like you are in a really tough spot! I would like to offer you some encouragement, but let me be sure I'm understanding what you need from us.

I'm assuming you have exhausted all options as far as transferring your care to a doctor near where you live now. I'm not sure why you can't do that...but it's fine if you don't want to share. If your only option is to quit, then I would immediately start tapering your dose. What dose are you currently on? I would be happy to help you figure out a taper schedule if you can share that information and let us know how much medication you have to work with.

I would recommend that you go to our stopping suboxone section. There are a ton of helpful threads there that will give you some ideas on the different methods people have used to taper from suboxone.

I'll reserve any more suggestions until I hear back from you. But please know that we will be here to help you as much as we can.

Q

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PostPosted: Thu Sep 19, 2013 11:19 am 
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thank you for your concern and your reply. Having spent many years doing advocacy for others in this same field,( and now doing it for myself which never seems to crossover well), it would appear that adamance has made a breakthrough . The reason I cannot simply switch to a local provider is because the state I receive all of my primary medical care in is not the one that I reside in the most. You will have to interpret that as you are able. The city I receive my medical care in is the largest one on the east coast. I spent all of my post grad years and professional years in and around the field of addiction in this city. Unfortunately, this has lead to some conflicts and boundary issues and simply mistrust and bad blood as well. along with seeing someone at the clinic where i normally receive my suboxone I also had a primary medical care appt. yesterday , where there are physicians who also rx suboxone. Their prior stance about switching providers seemed rather intractable at the time 4 months ago. i knew then that my suboxone provider was leaving his position and practice in the u s a. My primary care provider is not able to rx suboxone as he is a P A. I went there to make a last ditch effort with his support and simply by accident we ended up crossing paths with one of the prescribing physicians. We were introduced and I explained my situation but at that point with much less fervor than i had begun with earlier in the day at another clinic. i began to realize that I had become embroiled in a huge snafu < more on this later! At that point in the day I was cold, hungry and even more jet lagged and ,having very little patience as it is with the overwhelming ignorance amongst professionals regrading the guidelines for suboxone tmt and delivery was ill prepared for what the M D happened to say: "well, I don't understand why you can't just receive services in your area but.....suboxone cannot be rx'd for more than 30 days....." I responded by saying that suboxone can be rx'd with up to 5 refills. He took umbrage to the fact that I questioned his medical knowledge as a physician ( something that I don't feel has been relevant since the 1980's) and I thanked him and my provider for their "help" and replied directly to him that I did not write the guidelines and I would imagine that something as rudimentary as the refill regs could be found through google. I then went home . When I got home I had a msg from my primary care provider that the physician wanted to apologize to me and that he was incorrect in his assumptions and that he'd be willing to " accommodate me". Primum non nocere wins ! At this point I am waiting for whatever it is that I need to do to facilitate this transfer which I hope can only happen .
Now as to your questions which I'm sure some of the users are not going to be too happy about: my dosage is 2 mgs. I had started at 6 and brought myself down to 2 in the course of a year. I had absolutely no problems until I went from 4-2 and I simply dealt with them for the duration. This however, was many years ago. I have been on 2 mgs for about 5-7 yrs. (yes, my provider and I had talked in the past about going off but I simply did not see the need. I'm sorry, but that's as far as I think about that issue). My history of tmt is a long one and varied as are all. I started out on meth maint and it was through these professional acquaintances that I learned of suboxone. At that juncture I was on a very low dosage of meth (10mgs) having brought myself down from the ludicrous dose of 200. i had had a contra indication and/ or interaction that caused certain meds that i take regularly to not metabolize well with meth. after some trials my provider and i worked out a new regimen and i began my taper. i should point out that the clinic where i received meth maint was very opposed to my " coming down" and made me jump through hoops. The last 50 mgs i did without their knowledge ( no, I do not advocate attempting this on your own as each person is different much to the consternation of those in the addiction field). At that point i knew i was not long for meth maint and feared being thrown off their program. Through another professional acquaintance I was asked to look into switching and also becoming the first patient on a drug i had little knowledge of: Buprenorphine at this new clinic and also to go through their A S A S program. I acquiesced and became a consumer there; graduated and continued on outpatient tmt. I was the " model" pt. A term I have come to loathe. I started to see a massive switch over of patients from meth maint to suboxone after about 2 some years. I felt this was a huge mistake. Suboxone was never meant to be for the non compliant pt and unfortunately, due to the disease , there are many more of those . I feel that i find myself , yet again, lumped into a category which i don't belong through no malfeasance of my own. In my opinion the switch over happened too swiftly and with negative repercussions. I won't enumerate all of those because they are redundant to the same problems as exist with meth maint. As I presaged, suboxone in this state at least, is now being brought under the same penal model of distribution as meth. I realize that writing this might spark anger amongst the users(and other who may read this) and for that, as a new person, I empathize, but unfortunately what I have written bears out with the stats. I no longer practice social work and haven't for 7 + years. I am in the real estate business which is the polar opposite from what I used to do and was a welcome change. I will keep you posted on what transpires . The idea of a taper down schedule would be most appreciated if you're a provider and since I tend not to believe what I don't actually see has happend , ie , my new suboxone provider. Even though my dose is low I had been without my meds for 4 days a couple of months ago when my pharmacy messed up a delivery over a holiday wknd. It only took a day and a half for me to feel like I hadn't felt in over 15 years or more. Thank you again for your concern and kind offer.


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PostPosted: Thu Sep 19, 2013 12:59 pm 
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Hey Quinn,

Wow, it sounds like you have really been around the block a few times with ORT. I'm compelled to tell you that our forum could benefit greatly from the amount of knowledge you have collected over the years!

First off, I need to clear up the fact that I am NOT A PROVIDER. I'm just a member here at suboxforum who has been through a taper myself (I'm currently taking 1mg but at one point got all the way down to .25mg before deciding I didn't want to jump yet). We have a lot of members here who have been very successful with tapers and there is a ton of good advice for how to do it in what IMO is a much easier way than just jumping from a high dose.

You are needlessly worried about what you said offending anyone here. We are all at different places in our recovery, and all of us have different needs. Actually, you and I are at a similar place dose wise. We have several members here who are maintaining on a low dose, and quite a few who have no plans on tapering any time soon at all.

I am so happy that you were able to find another doctor to help you! And, the fact that he was willing to admit his lack of knowledge (granted, not right away) and follow through with looking for the answers to help you speaks well of his character.

Let us know how it goes. And if it falls through, and you would like some advice from others here who have been there done that, we would be happy to share our experiences with you!

Oh, BTW, we do have a few doctors who are members here. Our founder, Dr. Junig is a huge advocate for suboxone and he comes here to post and answer questions as time allows. It's possible he may see this and jump in there for you.

Welcome again!

Q

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PostPosted: Tue Oct 01, 2013 4:15 pm 
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Well I had hoped to p m or email you but....I got a new m d at my p c clinic so things are good there so far. He's the most anal physician I've met in 15 yrs but whatever. So here's my latest issue : I just got switched to the film. In practice and theory I d g a f, however something I failed to mention earlier Just in case people were watching and reading this forum ( not too paranoid eh!) you and I are actually on the same dose . When my provider decided he was really going to move overseas he told me and we anticipated there'd be problems. I nvr told him officially so he would have plausible deniability but I took myself down to 1 mg. Here's my question: how do I half dose the film? I haven't even opened the box so I d k what it looks like. I have quite a bit of pills left but I'd hate for the film, when it comes time to actually start it, to put a snafu in anything that I've accomplished in the last month of battling and educating; not to mention the discomfort of my recent decrease to 1 mg. Thank you for your help and assistance .
Quinn


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PostPosted: Tue Oct 01, 2013 11:36 pm 
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Okay, so I'm assuming the doc gave you the 2mg strips? If so, they are very easy to cut in half and take 1/2 per day. There are no score marks, but you can fold them over in half and either tear or cut them along the fold line.

If you have the 8mg strips it's a bit more folding and cutting, but you can still get a pretty accurate dose out of them.

Once you look at them you will see what I mean. I don't think you will have any issues with it, but if you do I'd be happy to walk you through it.

Q

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PostPosted: Thu Oct 03, 2013 2:01 pm 
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Hi quinnisme,

Why don't you just take one film to how it works, then use up all the pills. The films are tightly sealed so they should stay good for quite awhile.

If you can get the 2 mg ones it will be very easy to fold and or cut them in ½ and then ½ again. We have a member here who sells a tool for measuring and cutting them down. Here is the website for it:
http://www.rxfilmcuttingguide.com I am not saying it is good or bad or even endorsing it. I just copied and pasted the link. That's all.

Once you get down to .50 and .25 mg's, they become very strong. Actually, for me they got strong once I hit 1 mg. A single .25 or ¼ mg got me a strong buzz going. Then I understood just how strong this drug is. That right there can trigger a craving for more so be careful. We addicts love that warm fuzzy feeling.

So what's the verdict? Is the detox completely off the table now?

rule

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PostPosted: Wed Oct 09, 2013 2:16 pm 
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Ok, thanks ! Yea they're 2 mg strips . So I'll just cut them when the time comes . I'm going to assume its the same procedure for 1/2 and 1/4? I haven't opened them because i still have 1 full bottle of pills and then like 30 days left in an open bottle. I'm thinking I might go down to 1/2 soon. It's just too much b s and I'm just too busy. Again, I sincerely appreciate your help .


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Dr. Jeffrey Junig, M.D., Ph.D.

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