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PostPosted: Thu Jun 03, 2010 9:04 am 
Hey everybody. I recently posted a couple of things at the bottom of other people's threads, and wanted to bring them to the top in the hopes of getting some comments. The first is about high dosage written in response to Fiddlah:

"This situation really bothers me, and I've seen it with many other people (myself included). You were only on 30-45mg oxycodone a day. Now the doc prescribes you up to 24mg bupe a day to get off of it. Dr J himself said that bupe for pain is prescribed in microgram doses, so any dose measured in milligrams is considered "high dose buprenorphine". My PDR says that 0.3mg bupe = 10 mg morpine. So about 1mg bupe is a little over 30mg morphine. Let's just say for argument that Fid was on 30-45mg mophine a day. 8 mg of bupe is like 240mg or morphine! Of course the PDR is talking about IV doses, so lets say you lose 50% by taking it sublingually. It's still about a 120 mg dose of morphine - for a 30-45mg a day oxy habit!

I have been taking 12 mg a day, so according to my logic it's about 360 mg mophine. I took no where near that much opiate when I was using. Not even half that. Yet a few months into my treatment (as I confessed before), I went off Sub for a few days and tried getting high again. I ended up taking 135mg oxy in one day. I don't think I was up to half that much when I was using. So bupe has driven my opiate tolerance sky high. I guess that's good as a deterrent to using, and like I said last week, I had oxy's and hydro's after my car accident, and even taking 4 at time didn't get me high. But my worry is that I'm afraid that getting off of bupe is going to be much more difficult that I thought. I didn't realize how powerful bupe was when I got on it. I've actually INCREASED my opiate consumption in a sense."

The second was about my near relapse:

"After my car accident I used oxy and hydro for a week (reasonably) and went back on my sub. But then the following week I went to the doc and he gave me more vicodin. So I decided to use it to taper off the sub. (I posted under teoj's introduction about how uncomfortable I was that the amount of Sub I was taking was was like 10X the amount of of opiate I was originally taking). Well, like a good addict my "tapering" didn't go well. At one point I took about 16 vicodin at once, which is basically a fatal overdose of tylenol. Then of course I got to suffer withdrawals again. Needless to say I'm back on the sub.
Any addict who's been around the block can see that my downfall was using drugs sucessfully and "responsibly" for a week. I thought I could handle it, that I was "better" and that I could taper off sub. Now I have to face the fact that I'm a sick addict that's not "better" by any stretch of the imagination - and what am I going to do to effect real recovery?

Sorry, thespaw, I got way off or your topic, but I really needed to get that off my chest. I had a really strong recovery in NA 12 years ago, stayed clean on my own for 6 years and then it took another six years from when I picked up to get bad enough to seek recovery and eventually get on Sub. Now I just feel lost, I don't belong in the real world, I don't belong in NA and I don't even really belong here because I have strong doubts about sub."

I guess the two posts taken together indicate how much I need Sub for addiction remission, yet how much I am constantly fighting it. Any comments are welcome. (And thank you, thespaw, for your kind and helpful comments in the other thread).
Thanks,
Lilly


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PostPosted: Thu Jun 03, 2010 9:35 am 
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Lilly:

I feel the same way about "needing sub" and in fact, I have no plans of coming off it. It's either suboxone or methadone for me. I can't risk any more relapses given that I have HepC and even my gastroenterologist told me I need to stay on either sub or methadone long term, probably for life. This is fairly common with people who have HepC.

I cannot be trusted with narcotics. Period. This has been proven time and time again.

It's like this: My addiction is a bell. Once you ring a bell, you can't "unring" it. It's been rung. The sound waves have been heard. They can't be "unheard" I am an addict. Addiction is a potentially fatal disease. My wife's sister died from this disease. I cried at her funeral. I was devastated by her death, because I was in the throes of active addiction when she died and I did not have the capacity to reach out to her. This shit kills people. Every day. And I REFUSE to let it kill me. Especially if all I have to do is take this medication and stay on top of my mental state to stay in remission.

Lilly, don't beat yourself up. And don't fight it. Because it is what it is. Acceptance, I think, is an extremely important component to this recovery thing, especially medication-assisted recovery. We have to accept the situation we are in for what it is and work within the framework of that situation. So here's how I see it:

1. I am an addict
2. Suboxone keeps my obsession and compulsion to use at bay
3. Having been an addict for more than 3 decades, I have likely irreversibly altered the chemistry in my brain
4. Therefore, I require Opiate Replacement Therapy to remain in remission from active addiction

Now, #3 and even #4 may not apply to everyone who is on suboxone, but #1 and #2 most certainly do.

And I firmly believe that, given the statistics, most addicts are probably better off WITH suboxone than they are without it.

I think it's counter-productive to beat ourselves up for being sick. We're sick. We're not morally bankrupt.


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PostPosted: Thu Jun 03, 2010 9:36 am 
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Lilly -

I'm having a hard time grasping your issue because I don't recall the original context of the comments. But if I understand correctly, now that you had the need for pain pills you feel you're on too high a dose of bupe and you fear being unable to taper off (or that you'll have significant difficulty)? However, because of your near relapse you feel that you still DO need to be on the suboxone? Please correct me if I didn't get the gist of what you were saying.

It sounds to me like you're being awfully hard on yourself. For the benefit of new readers, how long have you been on sub and how long at 12 mg? Do you feel you are stable on it? Are your cravings under control? You can always taper lower - WHEN YOU ARE READY. Many people on this very forum have felt they were on too high of a dose and tapered down to 4 or even 2 mg for maintenance. You could be one of those people. But after your close call, I feel the need to tell you to give yourself time to re-stabilize, so to speak.

Again, I apologize if I'm not understanding your concerns, but at the very least I wanted to give you some support and tell you to try to ease up on yourself. Hang in there.

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PostPosted: Thu Jun 03, 2010 12:04 pm 
Hi Lilly. I posted a reply to one of your posts on the other thread and was actually hoping that you might do what you've done here and open a new thread to post about what's been going on with you.
As I mentioned in the other thread, I am impressed that you recognized that you were getting into trouble with the hydro and went back to your doctor and got help. I do understand where you're coming from in terms of feeling like you have somehow made things 'worse' by being on Suboxone. Worse, in terms of what you said about pushing your opiate tolerance even higher and so forth. You're not alone in your thoughts. I have wondered the same thing, still do sometimes. What I have to do is kind of remind myself of a few things. Firstly, in my opinion, trying to compare buprenorphine to full-agonist opiates is rather like comparing apples to oranges. I know we can draw comparisons in terms of dose equivalencies and such, but to what end? The facts remain the same.......it takes whatever dose of bupe it takes to keep my opiate receptors loaded enough to keep me out of w/d and keep the cravings at a manageable level. If that dose is 'higher' when compared to how much of my drug of choice I took before......all that tells me is that I have done just that much damage to my brain that it requires that much bupe to stabilize things. The other thiing to keep in mind is that with the full-agonists, if we were to continue on in active addiction, our tolerance is going to continue to increase and we'll almost certainly wind up requiring much higher doses of that drug as time goes on anyway.
Another thing I have to remind myself is that I was unable to stop to taking full agonists for any sustained period of time on my own. I just couldn't. Do I wish I could? Did I try? Did I make it for a while? Yes to all of those questions. Was I able to stay off long enough to get to a good, stable place in my life? No. So for me, I have to remember that when I started Suboxone, I felt pretty confident that I had two choices: Try medication-assisted recovery OR keep doing what I was doing and cycle back further into active addiction all over again. I really didn't like the thought of cycling back. And I knew I would. At the time I started Sub though, I wasn't even using every day again....only a few times a week and only 30-40mg of hydrocodone. Not very much.....certainly not the equivalent of 16-24mg of bupe! But that's how much it took at first. If you've kept up with my story at all, you know that now I'm at the 11 month point in my treatment with Sub and am now taking only ~1mg/day with plans to taper on off over the next few months. I have needed every bit of these months to get to the place where I feel I may have a chance of coming off Sub. Now, I do sometimes question myself about things you're questioning.....If I had just stayed off everything, would I be fine by now and completely drug free? Then reality again......I could NOT do that! I needed this medication. I needed this time with my receptors 'happy' enough to allow me to function well enough to get my feet back underneath me, to work on my issues, and gain some ground.
I don't know if any of that helps you at all, Lilly. But I do understand what you're saying. I feel for you. Just remember that you've just gone through a really rough patch with the accident and the pain pills. It's probably a time in which you feel unsteady and unsure about it all. That's totally understandable. Maybe you could look at this way too.....you need to take a higher dose of Suboxone just for now, until you get yourself restabilized. Then you can work on decreasing to a dose you feel better about. For me, reducing my dose of full-agonists was nearly a complete impossibility. At least with the Sub, we have a chance at that!
Let me know if there's anything I can do to help.


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PostPosted: Thu Jun 03, 2010 2:28 pm 
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I too think this topic is an important one to many if not all of us on subox. Thanks to all of you for your input. Me too guys, I wasnt' using every day when I got on the subox either, and I am pretty sure I was not addicted, if I was, just barely at the edge of it...and it took almost NOTHING for me to get high on H. But I knew that wouldn't last. AND I was in a situation where I could get my DOC without much hassle, a situation I could not AVOID, my jobsite. I considered quitting the job, now I've lost that job, (not due to anything about my addiciton or job performance) and looking at that as an opportunity to stay off my DOC. what's really hard for me though, is that I've ended up on suboxone AND using my DOC and now I'm surely addicted to some kind of opiate, I dont' think it helps anything that I've switched back and forth. After well over a year on subox I haven't stablized on the subox OR gotten off the DOC (well, now I've gone one week on just the subox--I have done better than that at times over the last year.) Worse for me is that my doc said "I think it was a mistake prescribing you suboxone." But..I just dont' think I would have done better without it, and I'm pretty sure I would have done worse. What SETMEFREE said in one paragrpah really sums it up well, I think, so I copied and pasted it:

"Firstly, in my opinion, trying to compare buprenorphine to full-agonist opiates is rather like comparing apples to oranges. I know we can draw comparisons in terms of dose equivalencies and such, but to what end? The facts remain the same.......it takes whatever dose of bupe it takes to keep my opiate receptors loaded enough to keep me out of w/d and keep the cravings at a manageable level. If that dose is 'higher' when compared to how much of my drug of choice I took before......all that tells me is that I have done just that much damage to my brain that it requires that much bupe to stabilize things. The other thiing to keep in mind is that with the full-agonists, if we were to continue on in active addiction, our tolerance is going to continue to increase and we'll almost certainly wind up requiring much higher doses of that drug as time goes on anyway.
Another thing I have to remind myself is that I was unable to stop to taking full agonists for any sustained period of time on my own. I just couldn't. Do I wish I could? Did I try? Did I make it for a while? Yes to all of those questions. Was I able to stay off long enough to get to a good, stable place in my life? No. So for me, I have to remember that when I started Suboxone, I felt pretty confident that I had two choices: Try medication-assisted recovery OR keep doing what I was doing and cycle back further into active addiction all over again."

So I really agree with that. So, if one decides to try "medication-assisted recovery" as SMF put it, the options currently are suboxone or methadone. And I think most of us agree that suboxone has a lot of advantages over methadone (not to put down methadone--if it is your best option and it works for you, I'm all for it--it didnt' work well for me when I tried it in the past, and dosing at a clinic every day is much less convenient, and not cheaper (for me anyway) than the suboxone option.)

Anyway I continue to be impressed with the quality of discussion on this forum. For me, I hope to stablize on suboxone, and like most people, eventually taper down. For now, I'm on it, adn I thin I would probably be worse off if I wasnt' on it. There is no knowing for sure "what might have happened" if different choices haad been made.

I do have one question nagging at me though...when reading aobut various people tapering off subox, some of them take soem kind of opiate at some point to get through the final detox--like a vicodine or such. Can switching around different opiates really keep a person from getting addicted? That is, like some people who use subox just to taper while they detox from their DOC--does that work because they never get addicted to the subox? Or...when in the final stages of a sub detox, taking a couple of vicodine or other opiate wont cause a "set back" in the detox process?

In any case, for me, the physical WD is only part of the problem. It's a big problem of course, when it's bad, but even when it's mild, it's the depression and the cravings that make it hard for me to detox on my own and to not relapse as soon as there's an opportunity.

I hope I didnt' get too far off the real topic there. I think the bottom line is that suboxone is a relatively new option to treat opiate addiction--and, among the available options, it's a good one for a lot of people. Not perfect, and not without danger of being misused--but that's true of most medications isn't it? My doc (though I think everyone who's read my story has concern that my doc is under-informed about subox if not mis-informed) ended up calling it, in my case at least, "harm reduction." Personally, I'm all for harm reduction, though it too is not a perfect option, it is better tahn NO harm reduction. Ultimately, if you can live without a certain medication, most people would want to, like, someday I might be able to stop taking my antidepressants too, but if a medication is helping a serious condition that you weren't managing well otherwise, and doesnt' have side-effects that are unmanageable why be against it? One thing my doc said that is really true is "heroin addiction can just RUIN your life." I don't think suboxone is going to ruin my life, I think it's more likely helping to save my life, even though I havent' been using it properly and have been struggling so much.

Of course, all that said, it might not be the right choice for everyone.

Again, thanks everyone.


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PostPosted: Thu Jun 03, 2010 3:08 pm 
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Lilly, I wanted to comment a little bit on the whole dose thing and actually, in the end, it may make you feel a little bit better. I don't profess to be any sort of an expert on all of this but hopefully I can at least explain a couple of points.

Part of the problem is that in many ways Bup is not like a full opiate drug such as morphine. So while the PDR states that 0.3mg of IV Bup is equivalent to 10 mg of morphine, several things change when we take the Bup sublingually and in much higher doses. For one thing, the amount that gets absorbed and into our bloodstream is quite a bit less than 50% of IV morphine and that is actually a good thing. Even with Morphine, an oral dose is often two or three times stronger than an IV dose to achieve the same effect. 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 fear that I didn't do as good of a job as I had hoped in explaining all of this. I hope my point did make it through. I hope that you'll see that while you may be on a high dose, it's not as high (when compared to a full opiate) as you may think it is. It also will not be overly difficult to reduce your Bup dose into the single digits when/if you chose to do so. If done slowly, further lowering your dose and even stopping the medication can be done with minimal discomfort - as multiple people here have proven just in the past month or two alone.

I hope this adds a little bit more perspective and makes you feel a little bit better.


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PostPosted: Thu Jun 03, 2010 3:28 pm 
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Actually Donh, I think you did a good job of explaining. It's really a confusing issue. I can read about it again and again and I think I have some understanding of how it works, but I don't think I could explain it well to someone else. But I have been wondering, why are some people on a higher dose? And the issue of cravings is different form the issue of WD. I think cravings are worse when one is in WD but they can be bad without any physical WD. Depression (also a symptom of WD and PAWS) can cause really bad cravings too. And it does seem like sub helps with cravings as well as with physical WD. Well, in fact, the mind and body work together and the two cannot be completely separated. It seems like taking the right dose of sub is important to reduce cravings. But...taking a higher dose may produce a psychological boost or, to put it bluntly, what about the placebo effect? I'm all for the placebo effect actually, but I dont' want to take more and more sub trying to get it. Anyway, it's easy for me to get off the subject, I really jsut wanted to say thanks Donh, your explanation IS helpful.


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PostPosted: Thu Jun 03, 2010 4:31 pm 
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autononymous wrote:
I too think this topic is an important one to many if not all of us on subox. Thanks to all of you for your input. Me too guys, I wasnt' using every day when I got on the subox either, and/ I am pretty sure I was not addicted, if I was, just barely at the edge of it...and it took almost NOTHING for me to get high on H. But I knew that wouldn't last. AND I was in a situation where I could get my DOC without much hassle, a situation I could not AVOID, my jobsite. I considered quitting the job, now I've lost that job, (not due to anything about my addiciton or job performance) and looking at that as an opportunity to stay off my DOC. what's really hard for me though, is that I've ended up on suboxone AND using my DOC.....

How long did you go without your DOC before you inducted? If for some reason you weren't physically dependent on your DOC, if you couldn't stop using you were most likely addicted. There is great thread somewhere around here discussing the difference between the two.

Are you sure you are dosing properly? How much are you taking now (24mgs)?



autononymous wrote:
...... and now I'm surely addicted to some kind of opiate, I dont' think it helps anything that I've switched back and forth. After well over a year on subox I haven't stablized on the subox OR gotten off the DOC (well, now I've gone one week on just the subox--I have done better than that at times over the last year.) Worse for me is that my doc said "I think it was a mistake prescribing you suboxone." But..I just dont' think I would have done better without it, and I'm pretty sure I would have done worse. What SETMEFREE said in one paragrpah really sums it up well, I think, so I copied and pasted it:


If you've been taking Subs and/or your DOC for well over 1 year I'm fairly certain you are physically dependent. What is making you change back and forth? How long have you gone on the subs without going back to your DOC? I had a hard time stabilizing on Suboxone myself, albeit with a very high oxycodone habit (480mgs/day), but I DID stabilize. My experience made me interested in why others are struggling to stabilize. I think we can all use as much knowledge about how to manage ourselves before we start our tapers.

If you continue to go back and forth you are probably going to stay in active addiction and have trouble stabilizing. Dr. Junig has written quite a bit on his blog about the tendency of addicts to "look inwards" too often to see if they need to "correct" any feeling. This is hard to get away from.....eg "Are my legs achy?", "Am I anxious?", "Am I groggy?". According to Dr. Junig's writings, the testimony of quite a few people here, and my own experience, it does take a while to make that break from that psychological self medication. Once you start to learn to not constantly check-in with yourself and once you also learn that you can't fix everything with a drug, those cravings start to go away.

Please don't take what I'm saying the wrong way. I wish you the best of luck and I think you'll find everyone here to be quite supportive and helpful, but I also think that if you stick on the subs and ditch the addict behavior, you'll have a much better time of it. I was hopeful before my induction, discouraged as hell a few days afterward, but I stuck to it and I'm sure glad I did. Things will get better.


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PostPosted: Thu Jun 03, 2010 5:28 pm 
Thank you all for your thoughtful, helpful, insightful and well educated comments. Junkie, it was funny that you said "don't fight it" because those were the exact words a doc used on me when I kept trying to get off anti-depressants a few years ago. I keep wanting to be OK without any medication, but I guess it's not realistic for me at this point. And Semefree, you pretty much hit the nail on the head, too. Whether I want to be on sub or not, I was not ABLE to get off of drugs on my own - try as I might.
Donh - your explaination was very understandable and makes me feel a little better about the dose. Actually since the Vicodin episode I haven't gone back up to 12 mg. So far 8mg or less a day has been keeping my cravings at bay. That and the fact that I had to re-learn for the umteenth time that the drugs just don't work for me anymore. It's like Junkie said, I can't undo the fact that I'm an addict.
Thank you all for being here and responding. It makes me feel a lot less alone.
Lilly


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 Post subject: answer to deemanchu
PostPosted: Thu Jun 03, 2010 7:22 pm 
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Hi again, Deemanchu directed a couple of specific questions to me about my personal situation so I just wanted to say, I decided to answer those in a PM rather than on the thread. I think the answers could probably be found in some of my other posts anyway, which I know some of you have already seen. Anyway I just wanted to let everyone know that I dont' take offense to Deemanchus' questions, I just didn't want to take over this thread (which has been a helpful one to me) any further than I might have already above with all my own issues.


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Lilly,

I am really glad you posted this. I didn't read all of the responses because I just don't have time these days. But I would like to say that I HEAR you. I also saw a recent post of yours where you commented you weren't sure you belonged here [either] because you question the sub. First, you DO belong here. Second, we ALL question the sub I think. But when we post responses to people, we are careful to post what we know. I believe it was your 1st response from Junkie which summed this up best when he gave the 4 thought processes re: his sub use. Although I question my sub use ALL the time.....when it comes right down to it, I go through the same process as Junkie does and that is the response I tend to give when people aren't sure if what they are doing the right thing. Ultimately I think it can come across as though we are all in love with our suboxone, when in reality, I think many of us are just doing our best to accept it.

I understand the feeling that you may have made things worse. But for me, how much worse could it have been really? I was totally screwing up my life and relationships and now I am not. Even if I am on a much higher dose comparitively, does it really matter? If I am doing better...does it REALLY matter? My alternative sucks.

When I question it, what it really comes down to is this. I think of being 60 and still being on suboxone. What will I think after 30 years of suboxone? Will I wonder if I "wasted" my whole life? Will I wonder if I could have done better? What if I have excruciating pain by then? Will I be able to get off sub? Will I be able to take pain killers instead? Will I look back and be disappointed with myself for not quitting? Will I have wasted a ton of money that could have otherwise been spent elsewhere on better things? Will I realize I could have just had the willpower to quit and be free of this whole addiction thing but instead took the easy way out and just took sub for my entire life? etc. etc. etc. My mind can go in circles over this shit.

And then......I realize.....my life is pretty damn good. I work. I have a great relationship. I have my family. I am not slowly dying. There is always a chance I could have done something differently being off sub and MAYBE I could stay clean without it and learn to have a good life. But that chance is so slim. How much different would it really be than it is right now? In reality, probably not much different.

So why do I still stress over it every so often? Because I WANT life to be different and I am jealous of those not afflicted by this disease sometimes. Sometimes I forget to be grateful for where I am at and what I have been given. EVERYONE who has a disease at times wishes they didn't.

The only difference with addicts, is that we trick ourselves into thinking there is a choice. There isn't.

Cherie


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