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PostPosted: Thu Aug 12, 2010 10:42 pm 
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You def. did NOT hurt my feelings. I never said you did. I just didn't agree with you and was challenging you on some things you said and you turned it into feelings and "I didn't do anything wrong" stuff. Whatever. Good night.

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PostPosted: Thu Aug 12, 2010 11:43 pm 
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Setmefree,
I've reread your post a couple of times and I don't think you said anything antagonistic. You stated your opinion and isn't that what this forum is about, sharing our experiences and expressing our opinions. It certainly wasn't "screaming debate". I don't know where the line is for breaking the rules on this forum but a little disagreement and some back and forth every once in a while can be a good thing. I've always enjoyed your comments and opinions, if I agree with them or not.


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PostPosted: Fri Aug 13, 2010 12:36 am 
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Interesting I should happen upon this post. I was just talking via e-mail with one of the execs here about why more people don't post and join in the discussions. Jeeze, based on what I just read, I can't for the life of me see why anyone would worry about sharing and posting their thoughts here. Oy Vey.

Sarcasm aside (and yes I was being sarcastic) I find this whole dose thing extremely interesting. It's really even more interesting that I was just thinking some of these things yesterday as I finally have landed firmly at 8 mg/day. What was I thinking? Well, what I was thinking was that now that I am finally here at 8 mg, it would seem that most of my struggle was all in my head. It had little to do with physical symptoms and reactions and much more to do with mental ones. And low and behold, it would seem that an honest to goodness research study seems to support my belief. I don't have any problem calling myself out and admitting that my "need" for extra or higher doses was more in my head than in my body. I further believe that I'm likely one of those people who if somehow could take a sugar pill rather than a Suboxone every other day I would probably do just fine - so long as I thought I was getting Suboxone every day rather than the sugar pill.

None of this is to say that what I was FEELING was not real because it was. It's just all part of the struggle of addiction and I am in a place where I'm able to admit that both to myself and to others.

I just don't get how this statement could be made:

"While I recognize that everybody is different and occasionally there will be an exceptional case, most people are taking more buprenorphine than 'needed"

and it is really not challenged, nobody gets upset or takes it personally, and actually the poster is thanked, but if a statement is made questioning why doctors would even then prescribe more than a patient needs, it somehow becomes an issue. I just don't get it. No one takes Dr. J to task but anyone else is fair game. Hmmmmm.

Coming from the medical side of the house, I have to completely agree with SetMeFree in that there are just no two ways about it. The least amount of medication that gets the job done is almost always the best option. Hell, even the recommended dose for aspirin for someone having chest pain is two baby tablets. Very often, "less is more". Just in side effects alone, that is often the case. In my own case, $$$ is one of the over-riding motivators for me to lower my dose. Not only do I "think" that I feel better on 8 mg than I did on 16 - especially not being nearly as tired - I'm saving somewhere around $200 a month in Suboxone costs. Imagine what I can do with an extra $2,400 a year? Talk about an economic stimulus plan that actually works - unlike the crap Washington D.C. continues to spew. So I get the exact same results, if not better, for half the price. Talk about a win-win.

For me, knowing full well that much of it is in my head, can only serve to help me continue to stick to my lower dose - and continue to taper. It's almost like a child and being afraid of a monster. "It's not real", "It's not real", "It's all in my head". I would think that it would be great to have read Dr. J's and SMF's comments. It does not at all mean that I don't feel the way I do. I don't think that Dr. J or SMF said that at all. The feelings of withdrawal, craving (or whatever) are very much real. The whole point is, if I just keep telling myself it will pass and it's all in my head, I'll push through. On top of it, we have increasing amounts of SCIENCE (rather than feelings) to support all of this. It really is in my head. That is very powerful knowledge.

Hell, I wish this were the case when getting below the 4 mg or so range. Unfortunately, at that point, it will no longer all be in my head. At that point it actually will be honest to goodness physical symptoms that I'll be going through and feeling. Hopefully I'll be able to make it through all of that someday as well. Ironic how rather than fighting off the fact that it is only in my head, I'll actually be wishing it really was only in my head.

I guess I have to pretty much agree with Smoothy as he states "I don't know where the line is for breaking the rules on this forum but a little disagreement and some back and forth every once in a while can be a good thing." I could not agree more. I sometimes only wish there was a drug like Suboxone that would help those who take it to develop a thicker skin. Maybe one of the big drug companies will work on that one next.


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PostPosted: Fri Aug 13, 2010 3:13 pm 
Thanks Smoothy and donh. I appreciate your comments. I try to be careful with what I say and the way I say it as this is not the first time I've been "taken to task." I know how things are done around here and I've taken a lot worse than this in my time on this forum. The thing is, I do still learn and grow by participating here, so I keep hanging around. Like donh, I too was contacted via email regarding the forum and how it is being run. It is a shame that some of us have to worry that we may unwittingly say something that someone doesn't like, or perhaps just happen to be someone that somebody doesn't seem to like, or disagree with someone else's opinion and therefore get shot down or have your post deleted or edited. Diversity keeps things interesting. It should be welcomed here, not discouraged.


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PostPosted: Fri Aug 13, 2010 4:47 pm 
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I think some back and forth is good as well. That's why I was challenging some things that were said. Knowing a few people, and two of them are close to me, who are on Sub for pain, things that were said rubbed me the wrong way and I wanted to talk about it. I never said my feelings were hurt. Good grief. Touchy, touchy. I guess some of you need a background to see where I was coming from.

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PostPosted: Thu Aug 19, 2010 11:41 pm 
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We all have to find a way to express ourselves and listen to each other- without being so quick to be offended. Otherwise nobody on this forum will ever say ANYTHING, for fear of offending others! I don't want to be treated differently from anyone else; I don't want one person to be criticized for saying something but then have me be ignored for saying the same thing. THAT SAID.... I don't see why anyone should be 'offended' by what I said, or what anyone else said, for that matter, about dosing. I mean really, people-- I did NOT write 'anyone taking more than 16 mg is an idiot.' THAT would have been offensive, and untrue. When I re-read what I wrote, that is NOT what I said-- I said that in most cases, people are taking more (buprenorphine) than NEEDED. I did not say that they are taking more than they SHOULD-- or that they are taking TOO MUCH-- I said more than they NEEDED. Those are different things, and I hope that everyone involved in the debate over who offended who work to understand the difference in those sentences. I even went on to explain my meaning; i.e. the receptors are bound up at much lower doses than people are taking. For buprenorphine to work, the person must take enough that the receptors STAY bound up-- so that requires taking more than needed. The question, of course, is how MUCH more than needed SHOULD people be taking? And if you read my comments, I did not even weigh in on that issue! Instead I wrote about the phenomenon that I see over and over where psychological factors influence the perceived need for buprenorphine.

I wanted to share some important bits of information, and I can't do that if people are looking for reason to take offense. I would like people to know what I wrote, as I think it is important to know, for example, that docs and pharmacists receive monthly warnings about prescribing over 16 mg per day. I just received another one in the mail yesterday, by the way; if you want to see the exact message, I have one on my blog a few months back-- I linked to the entire letter, with the color-coded warnings-- green for up to 16 mg, yellow for up to 24, and red after that-- with comments saying that doses over 24 mg should NOT be prescribed, and that doses over 16 mg should be used in exceptional situations, and only for short periods of time. This is not a matter of opinion; I am not even commenting on it. I am just stating the facts-- that docs and pharmacists receive warnings from RB and from the DEA (and from SAMHSA and NIDA) stating that doses over 16 mg increase the risk of diversion, serve no purpose, and should not be used. I would think that especially for people taking over 16 mg, that information would be important to hear-- not because it means you are doing something wrong, but because PERHAPS your DOCTOR is doing something wrong. Or perhaps not. But if your doc is being cavelier about dosing above those levels, you should be aware of what is really going on, because that doc is putting himself at risk of losing his ability to prescribe buprenorphine-- and that would affect YOU. In other words, please don't blame the messenger-- I am telling you what is happening, and YOU are free to decide what to do with that information. In any case, I don't understand cause to be 'offended' over the issue.

My comment also shared the simple facts about what happens when higher doses of naloxone are ingested, including how naloxone in SMALL doses is destroyed by the first pass effect, but in HIGH doses may leak into the systemic circulation-- especially if an antidepressant is taken that blocks liver enzymes.

Apparently, some people feel that their docs have underdosed them, and that by sharing this info I am somehow 'offending them'. I don't get it. I don't believe in 'under-dosing' people. And yes-- there are many docs who underdose people out of silly fear of getting them hooked on buprenorphine (under-dosing, if anything, probably increases addictive thinking and behavior-- it doesn't reduce it!). Writing about the psychological drive to over-use buprenorphine, or about the warnings that docs get from several agencies, or about the problems of taking too much naloxone-- none of that means that I am discounting the feelings of those of you who believe you were 'under-dosed.' Although if you want to challenge your own thought process-- something that I think all addicts, including myself, should strive to do-- you MIGHT want to consider that some of your feelings of being 'under-dosed' are coming from psychological, not chemical, processes.

I ask everyone to PLEASE save 'offense' for things that are REALLY offensive. Let's work from the premise that nobody is trying to offend, OK? Let's start with the assumption that 'if I am offended, I must be reading something wrong.' If, after several readings you are STILL offended, consider asking someone you trust for a second opinion-- 'is this offensive'? again, not LOOKING for offense, but with the assumption that the writer was NOT trying to offend.

Note that I am not saying we need to 'debate'-- I think that it is best if people recognize when they are stating opinion and when they are writing. For example.... I get nauseated two hours after I take Suboxone (FACT) vs. Suboxone makes people nauseated (OPINION). Studies show that in most people, 16 mg of buprenorphine prevents cravings for 24 hours (fact), I get cravings even after 24 mg of Suboxone (fact), 36 mg of buprenorphine is a stupid dose (opinion). The reason it helps to know fact from opinion is because there is no need to waste energy debating the 'facts', and it is not appropriate to be offended from someone reciting 'facts'. Opinions are a different matter-- some people may enjoy debating opinions... although frankly I'm not sure how useful it is to have such debates, as people rarely change their mind after such debates...

The reason I want to avoid a debate over 'should people take buprenorphine' is because it is just a silly debate, in my OPINION... (and as the person setting this thing up that is the ONE opinion I get to have!) Besides, people already feel conflicted over taking buprenorphine. We ALL want to be 'normal' after all, whatever the heck 'normal' is.... and I want at least ONE place on the net where people don't have to hear that subsux. As for those people, more power to 'em-- I wish them well. Their opinion is just not relevant here.

Done with my speech... don't be offended! Let's allow for freedom of expression and ASSUME that we are all friends.

JJ


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PostPosted: Fri Aug 20, 2010 8:59 am 
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suboxdoc wrote:
I ask everyone to PLEASE save 'offense' for things that are REALLY offensive. Let's work from the premise that nobody is trying to offend, OK? Let's start with the assumption that 'if I am offended, I must be reading something wrong.' If, after several readings you are STILL offended, consider asking someone you trust for a second opinion-- 'is this offensive'? again, not LOOKING for offense, but with the assumption that the writer was NOT trying to offend.



Having just begun my 12th year as the Director of Information Technology at my job, and having, in those 12 years, deployed well over 100 web sites, I can tell you that this FACT -vs- OPINION thing is exceedingly common on internet message boards. One of the primary issues is the fact that human beings communicate just as much with body language and facial expressions as they do with words. Here on an internet forum, you have completely removed the facial expressions (with the slight exception of these guys :shock: :? 8) :twisted: :roll: :wink: ) and body language, so it is very, very easy for people to completely misconstrue the true intent of someone's comments.

Think about it. If you and I were sitting across from each other at a table and having a conversation, at any point in the conversation, I could inject something like "hey, you're an idiot!" and depending on the look on my face and my body language when I say that, you could either respond by laughing or by getting up and leaving.

What we have to do here on a message board is take what is written at face value and try not to assume the worst about the intentions of others.

I understand why the rules of this forum prohibit debate about the value of treating opiate addiction with buprenorphine. And I agree with the premise. And I believe it has produced a very healthy and supportive environment for discussion that results in a very supportive and uplifting impression, and that's a GOOD thing for people like us who are struggling with such a stigmatized condition.

Thank you, Dr. Junig for providing this forum and for being a voice of reason.

I'm not a moderator here, but I do run several message boards and I know it can be a thankless and difficult chore at times. No one wants to tell adults how to behave. I'm pretty sure we can all agree that none of us, particularly the regular posters (I'm looking at you, SetMeFree, RTLMom, Hatmaker, donh, smoothy, etc) have any conscious intent to insult, disparage, or otherwise harm anyone else. So I think Dr. J. is right on the money in suggesting that we should all endeavor to read what is posted here from that perspective.


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

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