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PostPosted: Sat Jul 06, 2013 1:53 am 
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I have been taking 12mg suboxone for the last 4 years and finally being trusted with ritalin again for adhd add. I truely need it to calm me down and help me focus and not be so unorganized and to stop racing thoughts and worry . My question is,, i know because I'm on the suboxone the Dr will give me the lowest dose possible to be cautious as they all do. Instead of giving me a therapeutic dose that will work. When they do that it creates the addict mind again to try to want the right dose that will work. That i know will work. The Dr always almost gives you just below the right dose that almost works then i am treated like a addict again for it not working. Can i remind and explain to the Dr that maybe she should check with my addictions counselor to find out what my tolerance levels are? or will that make me seem like drug seeking behavior. I'm just super received and excited to be trusted with add meds and get some relief forr my anxiety and pore focus. And dont want it taken away. If i posted this in the wrong section, sorry and thanks for any help


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PostPosted: Sat Jul 06, 2013 2:09 am 
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So. You have been on 12mg for 4 months and you want more?

Why?

What are you feeling aside from just wanting to take more suboxone?

I get it. I do. But do you think you are legit just being an addict?

Another prime example of why we NEED other recovery outlets to allow us lots of time to look at ourselves on a mental, emotional, and spiritual level.

That early on... My first round of suboxone... I was sounded just like you. I needed more because I still "didn't feel good enough". I just wanted more suboxone and couldn't just admit that to myself.

Just like the guy in wd by the evening taking 24mg.... Look really hard and honestly at this.

12mg is way above the ceiling and a hefty hefty dose still.

All I'm saying is... Think about it. Honestly.


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 Post subject: drug seeking behavior???
PostPosted: Sat Jul 06, 2013 2:28 am 
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I'm sorry for not explaining my question correctly. i meant what if my Dr gives me the lowest dose of add rx, ritalin? Because of the suboxone?


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 Post subject: It's your recovery
PostPosted: Sat Jul 06, 2013 1:47 pm 
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Either your doctor has a great deal of experience, or is quite reckless. When I have a patient on Suboxone I don't prescribe or allow another controlled substance. That means no benzo's or stimulants. When I review the prescribing history from the state and find another provider involved they have to choose. The risks of cross addiction are too high for me to support this. I know others do, just my practice. My patient's know this, part of the signed agreement prior to induction so they aren't surprised months later when this comes up. Treat the ADD with someone else or the addiction with me. Same with anxiety or panic disorder. There are non-controlled medications and effective therapies for these conditions that I will steer people towards.
PAX


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 Post subject: docm
PostPosted: Sat Jul 06, 2013 3:07 pm 
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hey docm, what would you suggest as an alternative-non-controlled-medication for add/adhd?

just curious, and maybe the op could benefit.


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 Post subject: Re: It's your recovery
PostPosted: Sat Jul 06, 2013 5:31 pm 
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docm wrote:
Either your doctor has a great deal of experience, or is quite reckless. When I have a patient on Suboxone I don't prescribe or allow another controlled substance. That means no benzo's or stimulants. When I review the prescribing history from the state and find another provider involved they have to choose. The risks of cross addiction are too high for me to support this. I know others do, just my practice. My patient's know this, part of the signed agreement prior to induction so they aren't surprised months later when this comes up. Treat the ADD with someone else or the addiction with me. Same with anxiety or panic disorder. There are non-controlled medications and effective therapies for these conditions that I will steer people towards.
PAX


Wow, docm, that's awfully rigid! Why and how do people usually abuse ritalin? They are usually not people who have ADD/ADHD. They are usually using the drug to be super energetic, enhance their study abilities, etc. People who abuse ritalin are not using it to combat their ADHD symptoms. If Thankyou has a documented history of that disorder, what is wrong with treating it, even while also on suboxone? Obviously, Thankyou has earned a level of trust from the doctor over time. Wanting a therapeutic dose of the medication is not addict behavior.

I receive alzaprolam from my suboxone doctor as needed. Now, for me, as needed means that 30 .5mg pills will last me at least 6 months. Should I not be able to treat my anxiety and panic attacks when xanax has NEVER been a problem for me, even in the midst of my addiction? And think about why many people abuse drugs in the first place. It's to self medicate problems like anxiety, bipolar, ADHD. Suboxone is not going to improve all of those underlying disorders. I think it's a terrible idea to give a patient the option of: either I can treat your addiction or I can treat other problems you have.

I know of a member of this forum who is also being treated with suboxone and an ADHD medication and she is doing fine. In fact, she often tries to go without the medication on weekends because she wants to make absolutely sure that she needs the ADHD medication. When she doesn't use it, she cannot focus, and that would significantly affect her ability to do her job. If we want people to succeed in treating their addiction and live functional lives, sometimes other problems need to be addressed.

So, maybe consider treating more than just addiction, but still do your due diligence. Watch for behavior such as constantly running out of meds too early, make sure you are urine testing for the drugs that should/should not show up in a drug panel, require at first that the patient come in once a week to get their prescription. Most people who are on suboxone are truly trying to better their lives and be good patients. I bet you have good enough radar to weed out those that aren't taking their recovery seriously.

Thankyou, I had no problem figuring out that you were talking about raising your dosage of ritilan. Don't worry about any folks who didn't read your problem thoroughly.

Amy

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 Post subject: drug seeking behavior???
PostPosted: Sat Jul 06, 2013 6:08 pm 
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Thank you Amy! perfectly said. i currently am on zoloft and buspar and have tried several non - stimulant add meds. My recovery is very important to me. If my psychiatrist prescribes me a very low dose, i think I'm going to call my addictions counselor and tell him what i said in my original post. I keep obsessing over this issue and I'm tired of worrying about whether I will get a therapeutic dose or not. i was going to jump the gun and tell the psychiatrist before I picked up my new rx. but I'm going to do something I'm not used to and wait to see what she prescribed. I'm just afraid that she will start me on the lowest dose possible and I will get a taste of what being able to calm down, focus and organize thoughts and quiet my brain will feel like then will want to take the right amount to get thereputic effect. or be depressed because I'm not getting thereputic dose. i am smart enough to know that if i take extra i will suffer when i run out. I don't need a obscene amount, just the same amount that anyone else would need with my symptoms. i am willing to show the Dr daily, weekly or whatever how many pills i have left to show Dr I will be only taking what i am prescribed, just like suboxone. Im not looking to get high just some relief. thank you for your support. This is exactly what made me the addict i am today, by trying to self medicate anxiety, add, depression and Ocd. I have finally built trust with my medical team. in 4 years i have never had a dirty UA and Suboxone has saved my life. I wish everyone well on this forum and deeply appreciate your insight and support. :D


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 Post subject: Push back
PostPosted: Sat Jul 06, 2013 6:40 pm 
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Thank you for your thoughtful reply Amy. I knew I would get some push back with my reply, and not in a trolling manner. I think I am in the majority or at least a significant plurality of prescribing habit. When I go to addiction meetings the consensus seems to be to not coprescibe these meds. Perhaps with experience I will loosen up. I will allow 2-3 doses of a benzo per month, for keep you out of the ER type panic attacks. There is no place for routine use, IE, 'I must have 4 mg Xanax a day' to control my anxiety. Dr. J has a blog post about this.
There are effective treatments for Adult ADD/ADHD that can be safely used. Strattera, Buproprion, TCA's as well as CBT, and other therapies can be used.
PAX
P.S. In our state, one of the quickest ways to get a call from the medical board is to have a patient on multiple controlled substances. That is a rather chilling conversation and not one I want to repeat.


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PostPosted: Sat Jul 06, 2013 7:11 pm 
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I want you to know that I completely understand the predicament that doctors are in and I recognize that the scrutiny you are under is intense. My own doctor comments on new procedures he implements because he sees the writing on the wall at the DEA and wants to stay ahead of the curve. I think that is one thing a doctor can do to stay on the good side of regulating agencies. I don't know how my doctor makes these determinations, but he has been successful at keeping the DEA from breathing down his neck. He does a few things that might be considered questionable besides co-prescribing addictive substances. He has also continued to write suboxone prescriptions for 6 months for his patients that move to a different state. My doctor's name is Andreas Edrich and his practice is Heritage Hills Family Medicine in Greenwood Village, CO. I'm not suggesting that you need his advice, but he's a friendly, open person and I'm sure he would give you good input if you were to need it.

I have a feeling that the reason most doctors decide not to co-prescribe addictive medications because they fear interference by the DEA and their state medical board, not because it is the best medical practice.

There is no doubt in my mind that you are a compassionate doctor who is prescribing subs for all the right reasons. I admire the fact that you are on this board, spending part of what is, I'm sure, a busy schedule to gain perspective from sub patients. I'm glad that you are open-minded enough to consider what I'm saying. To me, that implies good character.

Thanks, doc!

Amy

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PostPosted: Sat Jul 06, 2013 9:32 pm 
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I guess maybe I shouldn't complain about my doctor so much. If I had to choose to either use suboxone or control my anxiety disorder, that would be truly horrible. Have one problem being helped, but continuing to suffer from another? That doesn't seem very professional to me. I understand not going overboard and prescribing several different controlled meds. That makes sense. And I understand not prescribing high doses also. But to choose one or the other? That would make it very hard for me to live. I've read that technically antidepressants should be used for long term anxiety. But what about someone like me who suffers from tinnitus? Most ADs are ototoxic. The last AD I tried made my tinnitus way worse and I'm not willing to risk even more hearing damage. I know some benzos can cause that too, but for me klonopin hasn't had that effect. I take a low dose, as needed, but without it I would have a very hard time functioning at times. When I first went to my sub doctor I was on Xanax, and he didn't like that, but thankfully he had no problem prescribing me a low dose of klonopin. It just angers me that doctors have to be so afraid of the DEA watching every little move they make, to the point of them not being able to adequately treat their patients. It's just not right.


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PostPosted: Sat Jul 06, 2013 11:33 pm 
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I imagine this post of mine is going to go over like a turd in the punch bowl, but here goes.....if I were a doctor, I would be very hesitant to prescribe scheduled meds to known addicts. Prescribing a scheduled med to an addict is pretty much dancing with the devil. We addicts love anything that changes our state of mind and the chance of cross addiction to many scheduled meds is very high.

When I got off Suboxone my anxiety went nuts, but my PCP refused to give me benzo's and I'm so happy for that today. At first I was pretty bummed, but once I realized I had to deal with my anxiety on my own, I learned how. I really thought I needed something to help me, but it turns out that I was able to do it on my own.

IMO, Americans are the most over-medicated folks on the planet. Some of us really do need certain meds, I'm not arguing with that, but I'm also guessing than many of us could do without many of the meds if we took the time to learn how deal with ourselves and find other ways to treat our conditions.

BTW, I know all of that ^^^^ may come across as hypocritical when I had to take Suboxone to get a handle on my opiate addiction, but I had already tried quitting opiates many times and failed before I resorted to Suboxone.

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PostPosted: Sun Jul 07, 2013 8:38 am 
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Docm..I'm curious what state are you in? I see you ending your posts with PAX...reminds me of Pax Prentiss ...the real estate tycoon's brother who opened addiction centers in Florida...
I'm sure it's a coincidence...but had to ask...

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PostPosted: Sun Jul 07, 2013 9:56 am 
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the thing i was wondering, and im not trying to sound mean or harsh is...

thankyou, why are you worried that a small dose of ritilan wont work for you BEFORE you have given it a try? I know your main concer is that a small fose wont work and it will seem like your drug seeking behavior, but if you ask for a larger dose before you even try the smaller one out... i dunno if i was a doctor i might think that.

you said its been 4 years since youve been prescribed ritalin, so ya never know a smaller dose might just work for you. At least give it a try before you worry about getting a larger dose.


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PostPosted: Sun Jul 07, 2013 10:15 am 
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Romeo wrote:
I imagine this post of mine is going to go over like a turd in the punch bowl, but here goes.....if I were a doctor, I would be very hesitant to prescribe scheduled meds to known addicts. Prescribing a scheduled med to an addict is pretty much dancing with the devil. We addicts love anything that changes our state of mind and the chance of cross addiction to many scheduled meds is very high.


Agreed.

I'm extremely thankful that my psychiatrist was forward thinking enough to refuse to prescribe me benzos during ANY stage of my bipolar illness, no matter how sick I was. It's for this reason that I'm one of the few opioid addicts in my city who doesn't have a co-existing benzo addiction.

Knowingly prescribing benzos to opioid addicts is dangerous IMO. The vast majority of opioid overdoses involve benzos and / or alcohol. It's actually quite difficult to overdose on opioids alone without another depressant involved, but it's incredibly easy when the addict has some benzos on board.


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PostPosted: Mon Jul 08, 2013 9:43 pm 
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Thank you everyone for all of your replies. Just to let you all know,, the Dr took me off all ADD Meds. What I didn't share with you all before was,,,,, I was finally trusted with ritalin again after I brought in my son to the appointment to explain my symptoms. But right before the appointment my sister told me about a medication i never heard of called concerta. So i suggested that to the Dr . She started me on a low dose of Generic Concerta 18mg on 04/03 . I have a bad reactions to Generic meds. But expected the same results as the ritalin i was on before. I had the same reaction to Generic Suboxone . Brain feels funny, headaches, nausea, just not right. I looked up both meds and it's made by the same company. Anyways i called 2 day's later and explained how i felt and that i had no reaction with the ritalin i was on before. She said to return the medication and do a UA then come get the new rx for the ritalin. I was just worried that the Dr would be like all the others and under prescribe witch would make me want more to work. All i wanted was to feel normal, be able to concentrate, complete tasks and calm my mind. Instead of being overwhelmed by my thoughts and not deal with anything. I also wanted to Be able to slow down and not interrupt people's conversations. If a low dose worked, awesome, but I wanted to have the same dosing as anyone else whether it be 5mg or 20mg. I never shared that worry with anyone but this site. Today i took a clean UA brought back my whole Rx minus the days I took. Gave the Dr back 43 left from starting at 49 pills from starting it 6 days ago . and I was told that she didn't want to keep me on them until she talked to more people. I was just devastated. Bawled my eyes out. Again because I'm on Suboxone i will not be treated for my aDD. I have tried everything. CBT, stratera, week in mental hospital while having several severe panic attacks with no benzo relief while being supervised. I've done everything they have asked. So yes, I will continue to get the suboxone treatment which has saved my life in more ways than i can explain and yes I have to continue to suffer daily with legitimate attention deficit symptoms. I kept thinking today I will get my new rx and be able to concentrate, think clearer, stay on task and not get so many anxiety attacks. I don't know what to say other than i am devastated and will try to train my mind to focus better out of sheer will!!!!!! Btw i don't take any benzos, never have


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 Post subject: I am confused!
PostPosted: Mon Jul 08, 2013 10:48 pm 
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If you are already talking over people, you are having panic attacks. Wouldn't that mean you are already over stimulated? Why would you need to be stimulated more? I do not have add so I am just confused. I do know Ritalin and Adderall the meds prescribed for ADD are stimulants relative to methamphetamine I have seen soooo many people that have taken those drugs from childhood turn into full blown addicts to way worse substances and lose their lives because of those drugs. My late ex-husband was on Ritalin from childhood. In his adult years battled meth, He lost the battle. I have never done stimulants because I already tend to have an anxious personality and I do not want anything to make me more stimulated than I already am, so I am confused as to why you would need stimulants for over stimulation.


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 Post subject: jonathanm1978
PostPosted: Mon Jul 08, 2013 10:57 pm 
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One of the definitions of PAX is peace. I also admire and support the work of PAX CHRISTI.
I am located in the Land of 10,000 lakes.
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PostPosted: Tue Jul 09, 2013 12:07 am 
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GL, in ADD/ADHD people stimulants do the exact opposite to what they would do to the rest of the population. In other words, if I took adderall or ritalin I would be hyper. When an ADD person takes those meds, they calm down and are able to concentrate. Their minds stop racing.

Obviously, it depends on what doctor you have as to whether they are will to treat co-occurring disorders. The doctors who are mistrustful of their patients, or who are cowed by the DEA and state medical boards are much less likely to stick their necks out for those patients who need more care than just suboxone. It's unfortunate.

If I were you I would probably call around for a more seasoned and less jaded doctor.

Amy

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 Post subject: Thanks Amy!
PostPosted: Tue Jul 09, 2013 3:12 pm 
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That just had me all confused.


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PostPosted: Wed Jul 10, 2013 8:04 am 
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i find this thread a very good one . thank you thankyou and Amyworkinpro". me and my doc have been fighting the right meds for me for over a year and came to the best that works for my adhd and addiction behave'er . he lower'd my suboxone and up't my adderal and trazadone for better sleep and daily focusing " and lexapro for depre- and it all works very well for me as long as i take the meds as correct as i am able. thankyou14 sounds a lot light how i was be for i got my meds better met. thanks thankyou14 and amyworkinpro!!

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