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PostPosted: Mon Apr 28, 2014 6:33 pm 
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I originally began taking Suboxone in order to treat addiction to opiates. I've remained on it because of chronic back pain. I've requested that I be prescribed 80 per month rather than the 75 I've been taking in order to take that edge away on some of my longer work days. That breaks down to 2-1/2 a day, and of course would give me 5 days where I could add an extra half. I personally believe that it has done wonders for me, regardless of the naysayers that would state that it's all in my mind. Truth is, it's in all our minds since without the receptors in my brain telling me that there is pain, I simply wouldn't know it existed. Sorry to get off track there. My question/statement of understanding; I am under the impression that 3 films strips per day is the maximum and was told that the only reason someone is given that much is to wean them off of the opiates. I was furthermore informed that after two strips it really doesn't help the person with pain. I must be one of those individuals that is easily manipulated into believing that more than two does actually help because I know personally, when I take that extra 1/2 at the end of a day, the pain subsides...whether its all in my head or not is yet to be determined. I firmly believe that everyone's dosage amount is going to vary...(some will need the same amount as another individual, I know that) and that for many of us addicts we do require more to actually get the same results as those who are not addicts. The physiology of an addict often is different from the average person due to their abuse and as a result more drug is often needed than what the "average" would require. Please understand that I'm not trying to only justify being able to take more, I sincerely wish to determine what the science is behind it and whether I'm fooling myself or I'm being told something that isn't entirely true. If you can make a question out of my rambling please provide an answer based on either your own experience or direct knowledge from a professional.


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PostPosted: Mon Apr 28, 2014 7:17 pm 
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I don't believe I can explain this with the scientific clarity you might be needing, but I can tell you what I know. It is true that for most people 20mg of sub a day is over the ceiling limit and that you won't feel any different (certainly not higher) on 24mg. I say this with one caveat, however. People who are using sub for chronic pain as well as addiction often dose around 4 times a day. Apparently, although the sub is covering the opiate receptors the entire day, there is an analgesic effect from sub that wears off in 4 to 6 hours. Therefore, if you are taking an extra dose of 4mg on some days, you could definitely be feeling some analgesic relief from that dose, as long as it has been over 4 hours from your previous dose of sub. Does that make sense to you?

I hope that Dr. Junig comes by and clarifies what I said, because he is the real expert!

Amy

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PostPosted: Mon Apr 28, 2014 11:19 pm 
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Yes, I completely understand what you shared...thank you. I've never really felt "high" from taking suboxone, I can say that the first time i took it or more precisely, the first week or two, there was a feeling of wanting to get things done, similar to a speed rush but nothing like what one would attribute a high to such as taking several lorcets 10 together would do if you've not taken anything for some time. When I first began taking opiates to alleviate pain there was a euphoria or well being and I can say that when I first stated taking Suboxone there was that initial sense of euphoria as well, but nothing like the other. My dentist spoke to me in a very kind manner when I first came to him, he asked some personal questions regarding my use of substances for pleasure or recreation purposes, such as drinking or use of opiates, he went on to share that his line of questioning was purely professional in that it would help him to assess the needs for numbing my mouth. He further went on to explain that when people choose to use opiates or alcohol for a sustained amount of time, especially in there early adult years they are actually mapping their sensory system in such a way as to create extremely large amounts of receptors to receive the extremely large amounts of "feel good" dopamine released that we achieve when we imbibe. The system becomes an extremely large super highway of feel good sensors otherwise known as developing a "tolerance" and in order to achieve the same amount of good feeling as was achieved in our early using years more substance is required. In addition, the addicts body become very proficient at ridding it of the "excess" substance. This of course does have it's limits and as the alcoholic or drug addict continues to use their tolerance can actually go in the other direction whereby they can black out with just a small amount of alcohol or OD on a small amount. The primary point I was trying to share is that we addicts have these super highways of sensors that do require more of a "prescribed" substance to achieve what a smaller amount would do for the Non-addict. We see this in everyday life where the larger man just by the shear volume of his physical body is able to consume extremely large amounts of alcohol without succumbing to its effects as would the normal size person. Many factors of course come into play with all substances and each person is physiologically different in their ability to process whatever substance they've ingested. The bell curve is another example that shows the mean of a population and that for most people the effects of a particular drug is going to affect them in a similar manner but as one observes there are those few individuals that can get drunk off of one beer or perhaps high from one toke of pot, alternatively there are those that it will take extremely large amounts of the substance to achieve the same effect. I have to believe that many of the doctors that prescribe suboxone believe that all their patients fit underneath the bell curve without any outliers...unfortunately, I believe there is a great number of individuals that do not precisely fit and do require "more" than the norm. Bottom line, I learned through real life circumstances with my dentist that more is required, to numb me that is...and here's the kicker, I've never abused the numbing agent they use and it takes double the amount used with the average non-user. While there is a correlation to my dentist visit and even what he shared I also realize that it is more complex than my understanding or his simple model used. Any input is always helpful. Thank you and good night.


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PostPosted: Mon Apr 28, 2014 11:23 pm 
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I agree with Amy. In general, the mu receptor effects of buprenorphine reach a maximum when people are taking lower doses of buprenorphine--- somewhere around 4-8 mg for most people. But the efficiency of dosing really varies from one person to another; on average people absorbe 1/4 of a dose of buprenorphine, but some people absorb more, and some absorb less. The absorption depends on the amount of saliva, the way the medication is distributed in the mouth, the blood flow to the oral mucosa, etc.

But for pain, all bets are off. Remember that nobody has studied the effects of high doses of buprenorphine on pain. Besides the mu receptor effects, buprenorphine has actions at other opioid receptors, and the effects of those actions on pain have not been defined.

Does the doctor know best? Probably not. No doc can duplicate a patient's experience. But when one observes many patients over time, it is clear that there is a very strong psychological component to pain relief. Your pain relief may be 'real', or it may be 'psychological'-- although I don't know if there is any difference between the two, for practical reasons.

But... there are many other factors to the equation that patients may not be aware of. Doctors who prescribe buprenorphine are watched much more closely than the docs who prescribe oxycodone, for some bizarre reason. Some states have enacted rules, limiting the amount of buprenorphine that can be prescribed. The rules are silly.... but they are the reality that we all have to deal with!


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PostPosted: Tue Apr 29, 2014 9:43 am 
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I take sub for both pain & addiction. Got addicted big time to oxy's because of the chronic pain. I personally take 4 small doses a day. I was taking 12 mg total then i had some painful health issues pop up & now i take up to 16 mg a day. I am working my way down again because the cause of the severe pain is gone (at least for now).

I have only been on suboxone for about 6 months so my experience is limited. Just wanted to share my experience & welcome you to the forum.

Em


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

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