It is currently Thu Aug 24, 2017 7:12 am



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 15 posts ] 
Author Message
PostPosted: Sat Apr 28, 2012 8:36 am 
Offline
Average Poster
Average Poster

Joined: Mon Feb 27, 2012 1:18 am
Posts: 21
I consider my pharmacological knowledge to be both deep and broad, although let it be said that a horse has four legs but still can trip. I have found that the doses used around the world for addiction are far too high, as buprenorphine is a very strong drug and one milligramme thereof is equivalent to a half-grain (thirty milligrammes) of morphine over twice the duration. It seems that nearly everybody in the United States of America that has a mild-to-moderate hop-habit receives sixteen milligrammes, a dose equivalent to eight grains (480 mg.) of morphine. The average 100 mg. stamp bag is thirty per cent. pure, and so it contains thirty mg. of morphine; this can be multiplied by four, since morphine by injection is four times as potent, and we arrive at two grains of oral morphine equivalent.

If we accept as true that an addict uses the entire stamp-bag at once, the number of times he doses can be multiplied by four to get the right dose.

For pain, the dose is rather lower, but not as low as Reckitt says it should be. The doses for pain according to Reckitt are 200 µg. (microgrammes) and 400 µg., but these are woefully inadequate for very strong pain. For a migraine, they would work quite admirably; but I think that doses of one, two, and four milligrammes could also be indicated for stronger pain, especially cancer pain. The dosing frequency is also different, as one must dose two to four times per day rather than the once only indicated for addiction-only therapy. The different frequency applies whether the patient has a habit or no; as long as a patient has pain, he must receive two to four doses per day, regardless of any habit or addiction. The dose in addiction must, of course, be greater for reasons of tolerance.

My own personal dose is sixteen mgm. per day, although my doctor does not know the appropriate pain dose of Subutex and is making a guess as per what I report, which always seems to be, "I have pain, give me more," even though my pain disappeared at eight mgm. per day and the other eight goes into my bedside drawer stash :-)

I find it sad that my doctor in the UK must prescribe the addiction formulation of buprenorphine (Subutex) rather than the pain formulation (Temgesic) even though the prescription states "for pain". Although let it be said that I did give my grandmother, a woman accustomed to low-dose morphine only, a 4-mg. dose of Subutex under the tongue and she overdosed enough to nod out.

How much does everyone else take? Both pain and addiction uses are good to know.


Top
 Profile  
 
 Post subject:
PostPosted: Sat Apr 28, 2012 9:57 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Wed Apr 29, 2009 12:55 pm
Posts: 4933
Location: Leesburg, FL
Keep in mind that addicts who are also on suboxone/subutex for pain already have an extremely high tolerance and started out on sub for addiction. Sub is meant to be used in high doses for addiction treatment and that's why it's often referred to as "high dose bupe". In order to treat addiction as it's meant to, it needs the high doses to saturate our receptors at the tolerances we have and to block our cravings, withdrawals, and especially to block other full opiate agonists should we relapse.

The bupe that's used for pain - not addiction purposes - is intended for opiate-naive persons, including your grandmother, which by the way, was very dangerous for her to take (as you saw in her reaction to it). Bupe in microgram doses are more appropriate for said opiate-naive persons.

Personally, I have been on suboxone for 3.5 years for both addiction and pain. I am prescribed 2-3 8mg tablets per day, to take for my pain. Generally speaking, I usually take 2 per day, one in the morning, one in the afternoon. That third dose is for when my pain is really bad. My doctor knows I don't always use that third dose, but he still writes my scripts for 90 tablets.

I've tried to lower my doses to 4 mg instead of 8 mg , but it doesn't seem to treat my pain as well as the 8 mg. Now others seem to do fine on lower doses, so it just goes to show you that everyone is different. I do know many others on this site take about the same dose as I do, if I recall correctly. I'm sure others who dose for pain will come along and weigh in with their experiences.

_________________
-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

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


Top
 Profile  
 
 Post subject:
PostPosted: Sat Apr 28, 2012 1:54 pm 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Wed Dec 28, 2011 8:47 am
Posts: 939
Location: Southeastern US (Alabama)
2 1/2 film per day --- 75 per month (8mg - 2mg)...same for me for the past 1 1/2 year.


Top
 Profile  
 
Our Sponsors
 Post subject:
PostPosted: Sat Apr 28, 2012 3:19 pm 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Tue Nov 01, 2011 11:48 pm
Posts: 1346
Location: oregon coast
Im perscribed for addiction first I guess you'd say, and pain issues second. I mean pain is the reason I first dabbled in the pills to begin with.

And my 'habit' certainly wasnt small. I hardly ever took morphine, but I did when I couldnt get what I wanted, especially since my friends mom got them Rx'd to her every month, and she had me sell them. Anyway, when I did have the misfortune of having to take the morphine, I'd snort 300mg at a time, when I started to IV, at the end, I was dilluting two 60mg tablets.

When I went to my first appt, and saw the suboxone doctors assitant, she had me write down everything I'd taken in the last 10 days. How does anyone remember that??
Anyway, at the time, an average dose of methadone thruout the day was around 180mg.
Or, oxys was 3, 80mg in the morning, and 3-4 more by night. I had the 'liquid' oxycodone for awhile, and didnt need nearly as much.

Anyways, wanted to add the 'backstory' there. Had an MRI about 3 months after starting suboxone, and the doc says my cartlidge is pretty much gone in between the vertebrea of my lower back, which is what causes me pain daily, and once in awhile, (depending on what I do at work that week, construction) sends sharp pains down my ass, into my legs, sometimes into my ankles.

The doctor started me on 16mg of sub. After about a week, I still felt pretty miserable, so I took it upon myself to try 24mg. That did help, but not as much as I wanted, i guess.
At the next appt, I explained, and he seemed okay with it, maybe thats why we did the MRI??
Anyways,
Ive gone to 8mg before, I even stopped the suboxone for about 8 days once, just to see if "i could do it"
I average the same as Hat Id say,
most days Im great with 16mg,
but alot of times I take 24mg too. It does help with the pain and stiffness in my back, and shoulders but I dont "feel anything" other than pain relief/being able to lay down in bed without the shooting pains. oh yea and its been a year. no relapses.
I just had 10 molars pulled on the top, and when I got that same amt pulled on bottom, my doctor said it was "ok" if I wanted to take one xtra for pain, if it helped. since Im taking nothing but sub, motrin, tylenol for pain.

AND I do have to agree, that it seems sometimes, Many people are perscribed WAY to high of a dose. I dont know, just some of the stories Ive heard, where doctors use this "16mg" as an 'average' dose. I dont know if there is such a thing as an "average addiction"

_________________
anyone can give up,
its the easiest thing in the world to do, but to
hold it together, when everyone would understand if you fell apart
That's TRUE STRENGTH
http://almostoneyearclean.blogspot.com/


Top
 Profile  
 
PostPosted: Sun Apr 29, 2012 5:02 am 
Offline
Super-Duper Poster
Super-Duper Poster
User avatar

Joined: Thu Jun 16, 2011 7:57 pm
Posts: 311
honeywhite wrote:
I consider my pharmacological knowledge to be both deep and broad, although let it be said that a horse has four legs but still can trip. I have found that the doses used around the world for addiction are far too high, as buprenorphine is a very strong drug and one milligramme thereof is equivalent to a half-grain (thirty milligrammes) of morphine over twice the duration. It seems that nearly everybody in the United States of America that has a mild-to-moderate hop-habit receives sixteen milligrammes, a dose equivalent to eight grains (480 mg.) of morphine. The average 100 mg. stamp bag is thirty per cent. pure, and so it contains thirty mg. of morphine; this can be multiplied by four, since morphine by injection is four times as potent, and we arrive at two grains of oral morphine equivalent.

If we accept as true that an addict uses the entire stamp-bag at once, the number of times he doses can be multiplied by four to get the right dose.

For pain, the dose is rather lower, but not as low as Reckitt says it should be. The doses for pain according to Reckitt are 200 µg. (microgrammes) and 400 µg., but these are woefully inadequate for very strong pain. For a migraine, they would work quite admirably; but I think that doses of one, two, and four milligrammes could also be indicated for stronger pain, especially cancer pain. The dosing frequency is also different, as one must dose two to four times per day rather than the once only indicated for addiction-only therapy. The different frequency applies whether the patient has a habit or no; as long as a patient has pain, he must receive two to four doses per day, regardless of any habit or addiction. The dose in addiction must, of course, be greater for reasons of tolerance.

My own personal dose is sixteen mgm. per day, although my doctor does not know the appropriate pain dose of Subutex and is making a guess as per what I report, which always seems to be, "I have pain, give me more," even though my pain disappeared at eight mgm. per day and the other eight goes into my bedside drawer stash :-)

I find it sad that my doctor in the UK must prescribe the addiction formulation of buprenorphine (Subutex) rather than the pain formulation (Temgesic) even though the prescription states "for pain". Although let it be said that I did give my grandmother, a woman accustomed to low-dose morphine only, a 4-mg. dose of Subutex under the tongue and she overdosed enough to nod out.

How much does everyone else take? Both pain and addiction uses are good to know.





I came into the program as an addiction pt. only. I still believe that is what I am. I am on 16mg. of course. One day I happened to mention to my Dr. that my back occasionly hurt..and boom..MRI requested...I did not feel I needed it..I tried to explain that I had been there and done that in the past and had some buldging discs.which did not bother me that much..
I could not make them understand...so did the MRI and results showed a bad back in the sacral area and t5...Their main concern was how to "label me" as a Pain addict Pt. or an Addict pt.??? Now they have labeled me as a pain addict pt. which meant filling out tons of more paperwork...perhaps this is a law they have to abide by...seemed like it..plus they upped my sub dose to 24 mg..to take the extra if needed and spread the dosing out throughout the day...they also said my back might be hurting me worse than I knew and the sub was masking it...
So...that is pretty much where I am right now..

Slipper

_________________
"For evil to flourish, all that is needed is for good people to do nothing." >> Edmund Burke


Top
 Profile  
 
 Post subject:
PostPosted: Sun Apr 29, 2012 1:55 pm 
Offline
Average Poster
Average Poster

Joined: Mon Feb 27, 2012 1:18 am
Posts: 21
hatmaker510 wrote:
Keep in mind that addicts who are also on suboxone/subutex for pain already have an extremely high tolerance and started out on sub for addiction. Sub is meant to be used in high doses for addiction treatment and that's why it's often referred to as "high dose bupe". In order to treat addiction as it's meant to, it needs the high doses to saturate our receptors at the tolerances we have and to block our cravings, withdrawals, and especially to block other full opiate agonists should we relapse.

The bupe that's used for pain - not addiction purposes - is intended for opiate-naive persons, including your grandmother, which by the way, was very dangerous for her to take (as you saw in her reaction to it). Bupe in microgram doses are more appropriate for said opiate-naive persons.

Personally, I have been on suboxone for 3.5 years for both addiction and pain. I am prescribed 2-3 8mg tablets per day, to take for my pain. Generally speaking, I usually take 2 per day, one in the morning, one in the afternoon. That third dose is for when my pain is really bad. My doctor knows I don't always use that third dose, but he still writes my scripts for 90 tablets.

I've tried to lower my doses to 4 mg instead of 8 mg , but it doesn't seem to treat my pain as well as the 8 mg. Now others seem to do fine on lower doses, so it just goes to show you that everyone is different. I do know many others on this site take about the same dose as I do, if I recall correctly. I'm sure others who dose for pain will come along and weigh in with their experiences.


Yes, that's what I meant, that you personally may need to take a total of sixteen to twenty-four mgm. per day, but it's absurd that someone who has a habit of thirty to sixty mgm. morphine is prescribed the same dosage of sixteen mgm. per day. It seems like sixteen is the "default" dose and unless you ask for more or less, you'll get sixteen.

I am relatively opiate-naive; no addiction exists, but I still think that microgramme doses won't put a dent in my pain. Two miligrammes don't even cut it. I need four. This is why I specifically ask for Suboxone in Great Britain, where Temgesic is also widely prescribed and appreciated. By the way, British Suboxone comes in 400 µgm. strength as well, since doctors are more cognizant of its strength there. Temgesic only comes in 200 µgm., which is too weak for my pain. In America, Suboxone is overprescribed to the point that people may go in for treatment and end up with a bigger habit than they came in with.

Many others may be prescribed the same dose, because of the common "default dose" myth, but they might not need it. If someone takes five milligrammes of oxycodone four times a day, they don't need 16 milligrammes of buprenorphine. Taking less buprenorphine also frees up some receptors, so they may—if they wish—continue to take a small amount of oxycodone in addition without it being blocked.


Top
 Profile  
 
PostPosted: Sun Apr 29, 2012 2:03 pm 
Offline
Average Poster
Average Poster

Joined: Mon Feb 27, 2012 1:18 am
Posts: 21
slipper wrote:
I came into the program as an addiction pt. only. I still believe that is what I am. I am on 16mg. of course. One day I happened to mention to my Dr. that my back occasionly hurt..and boom..MRI requested...I did not feel I needed it..I tried to explain that I had been there and done that in the past and had some buldging discs.which did not bother me that much..
I could not make them understand...so did the MRI and results showed a bad back in the sacral area and t5...Their main concern was how to "label me" as a Pain addict Pt. or an Addict pt.??? Now they have labeled me as a pain addict pt. which meant filling out tons of more paperwork...perhaps this is a law they have to abide by...seemed like it..plus they upped my sub dose to 24 mg..to take the extra if needed and spread the dosing out throughout the day...they also said my back might be hurting me worse than I knew and the sub was masking it...
So...that is pretty much where I am right now..


You are a pain patient first and an addict second. The paperwork is a good thing, since it legitimises your case. Suboxone is a painkiller second only to fentanyl in its efficacy; I begged for Dilaudid and got Suboxone instead, which I hated the thought of, but loved the effects. Suboxone is far, far stronger than Dilaudid and helps very well. So if your back is hurting after 24 mgm. of buprenorphine oral (I assume you do not inject or use nasally—I find a nasal spray works better) you have a big pain problem, one that would take 400 mgm. of morphine to cure to the same point that you are at now.


Top
 Profile  
 
 Post subject: Over Prescribed
PostPosted: Sun Apr 29, 2012 2:07 pm 
Offline
Moderator
Moderator
User avatar

Joined: Sun Jan 02, 2011 12:35 am
Posts: 2803
Location: Southwest
I agree that our Suboxone doctors are over prescribing the medicine. But in their defense, that is what they were taught during training. If you read the information pamphlet supplied by Reckitt Benchiser it says the maintenance dose is 16mgs. So if it says that, what is the Dr. supposed to do? Plus, my Dr. constantly had the company rep coming in almost weekly so it was always reinforced. I actually sat and talked with her about Suboxone and was she surprised to hear what I thought about it. It was a constant battle with me and my Dr. about how much I should be taking. He kept getting mad at me for tapering down w/o his permission. I agree that he should be in control of my dosing, but I couldn't keep my eyes open with the dose prescribed.

Maybe in time they will change the prescribing amount but I doubt it. The money they are making is huge. $$$$$$$

_________________
Don't take yourself so damn seriously


Top
 Profile  
 
 Post subject: Re: Over Prescribed
PostPosted: Sun Apr 29, 2012 5:28 pm 
Offline
Average Poster
Average Poster

Joined: Mon Feb 27, 2012 1:18 am
Posts: 21
rule62 wrote:
I agree that our Suboxone doctors are over prescribing the medicine. But in their defense, that is what they were taught during training. If you read the information pamphlet supplied by Reckitt Benchiser it says the maintenance dose is 16mgs. So if it says that, what is the Dr. supposed to do? Plus, my Dr. constantly had the company rep coming in almost weekly so it was always reinforced. I actually sat and talked with her about Suboxone and was she surprised to hear what I thought about it. It was a constant battle with me and my Dr. about how much I should be taking. He kept getting mad at me for tapering down w/o his permission. I agree that he should be in control of my dosing, but I couldn't keep my eyes open with the dose prescribed.

Maybe in time they will change the prescribing amount but I doubt it. The money they are making is huge. $$$$$$$


So I was right that there was some sort of "default dose", and I was even right about the amount. The only thing I didn't know was who instituted it. Now I know who, and I think I even know why: if the dosing was adequate, Reckitt wouldn't be making as much money as they do: about $5 per 8mg pill, translating to $300 per month.

He should not be in control of your dosing in any way except providing a maximum dose. The dose you actually take, as long as it is below the maximum, is your choice to make. Don't let your doctor step on your head. My doc (for pain, though!) gave me a maximum of 16 mgm. as well, but here it is coincidental: I asked for more and more just so I could get enough pills to last me a life time, until he said enough at sixteen.


Top
 Profile  
 
   
 Post subject:
PostPosted: Mon Apr 30, 2012 7:30 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Wed Apr 29, 2009 12:55 pm
Posts: 4933
Location: Leesburg, FL
Honeywhite said:

Quote:
In America, Suboxone is overprescribed to the point that people may go in for treatment and end up with a bigger habit than they came in with.


Please make sure to present your opinion so it's clear that it's just that: your opinion. This is being presented as FACT, when it is debateable. Are you here in the US to actually KNOW how it's prescribed all the time to make a factual statement like that?

When it comes to treating ADDICTION with suboxone, it's also referred to as HDB ("High Dose Bupe") and it is given in high doses and one's tolerance WILL likely go up. But the high doses are necessary for suboxone to do what it's meant to - stop w/d, cravings, and to block full opioid agonists should the person relapse. What one person needs is not the same as what another person needs.

Now all that said, I'm not saying there aren't some doctors who give way too high of an induction dose to people who have a very, very small habit. But that doesn't mean it's some kind of "American" tradition or something.

_________________
-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

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


Top
 Profile  
 
 Post subject:
PostPosted: Tue May 01, 2012 11:34 pm 
Offline
Average Poster
Average Poster

Joined: Mon Feb 27, 2012 1:18 am
Posts: 21
hatmaker510 wrote:
Honeywhite said:

Quote:
In America, Suboxone is overprescribed to the point that people may go in for treatment and end up with a bigger habit than they came in with.


Please make sure to present your opinion so it's clear that it's just that: your opinion. This is being presented as FACT, when it is debateable. Are you here in the US to actually KNOW how it's prescribed all the time to make a factual statement like that?

When it comes to treating ADDICTION with suboxone, it's also referred to as HDB ("High Dose Bupe") and it is given in high doses and one's tolerance WILL likely go up. But the high doses are necessary for suboxone to do what it's meant to - stop w/d, cravings, and to block full opioid agonists should the person relapse. What one person needs is not the same as what another person needs.

Now all that said, I'm not saying there aren't some doctors who give way too high of an induction dose to people who have a very, very small habit. But that doesn't mean it's some kind of "American" tradition or something.


It's just that 9/10 of the people here, who have habits and pain of varying severity, all get the same dose of 16 mg. On the other hand, the OxyContin community uses daily doses anywhere from 20 to 160 mg.


Top
 Profile  
 
 Post subject:
PostPosted: Wed May 02, 2012 9:28 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Thu Oct 21, 2010 10:39 am
Posts: 4028
Location: Sitting at my computer
9 out of 10 people here are on 16mg of Suboxone, where in the world are you getting your numbers from?? Are you pulling them out of your ass??

_________________
Be kind to yourself. Our character defects do NOT define who we are!


Top
 Profile  
 
 Post subject:
PostPosted: Wed May 02, 2012 9:39 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Wed Apr 29, 2009 12:55 pm
Posts: 4933
Location: Leesburg, FL
honeywhite wrote:
It's just that 9/10 of the people here, who have habits and pain of varying severity, all get the same dose of 16 mg. On the other hand, the OxyContin community uses daily doses anywhere from 20 to 160 mg.


Again, you are making what appears to be a FACTUAL statement. You didn't say, "from what I can tell", or "it seems to me", or "from what I have read", or, "based on....", or anything remotely attesting to the fact that what you're saying is NOT FACTUAL. Therefore, I must ask you to produce some source to back that number up.

This is not just a support forum, but Dr. Junig also created this forum to PROVIDE ACCURATE information about suboxone so that people have somewhere to go that they can trust. It is for that reason that we don't allow people to just spout numbers or data (including opinions) that are presented as fact when the person has nothing to back it up. So please back up your alleged figures and in the future, AGAIN, please refrain from making such claims unless you have data, scientific articles, journals, etc, - some kind of legitimate source to back it up. There are plenty of bullshit claims about suboxone floating around other sites; this site is different. We care about presenting accurate information for our members and we'd like to keep it that way.

_________________
-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

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


Top
 Profile  
 
   
 Post subject:
PostPosted: Wed May 02, 2012 10:53 am 
Offline
Long Time Member
Long Time Member
User avatar

Joined: Thu Jul 15, 2010 5:08 am
Posts: 1503
Reminds me a bit of someone who used to be a member :roll:


Top
 Profile  
 
 Post subject:
PostPosted: Thu May 03, 2012 12:17 am 
Offline
Average Poster
Average Poster

Joined: Mon Feb 27, 2012 1:18 am
Posts: 21
hatmaker510 wrote:
honeywhite wrote:
It's just that 9/10 of the people here, who have habits and pain of varying severity, all get the same dose of 16 mg. On the other hand, the OxyContin community uses daily doses anywhere from 20 to 160 mg.


Again, you are making what appears to be a FACTUAL statement. You didn't say, "from what I can tell", or "it seems to me", or "from what I have read", or, "based on....", or anything remotely attesting to the fact that what you're saying is NOT FACTUAL. Therefore, I must ask you to produce some source to back that number up.

This is not just a support forum, but Dr. Junig also created this forum to PROVIDE ACCURATE information about suboxone so that people have somewhere to go that they can trust. It is for that reason that we don't allow people to just spout numbers or data (including opinions) that are presented as fact when the person has nothing to back it up. So please back up your alleged figures and in the future, AGAIN, please refrain from making such claims unless you have data, scientific articles, journals, etc, - some kind of legitimate source to back it up. There are plenty of bullshit claims about suboxone floating around other sites; this site is different. We care about presenting accurate information for our members and we'd like to keep it that way.


I understand. Sorry. I will clearly indicate opinion statements so they are not confused with the factual kind. Thank you.


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 15 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 0 guests


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

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

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

Powered by phpBB® Forum Software © phpBB Group