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PostPosted: Sat Oct 31, 2015 9:30 am 
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Hello, this is my first post and I will be brief. Suboxone saved me from my xxx relapses. I live in Canada and I have to go to the pharmacy every day for my 8 mg dose. I am currently looking for a job and this makes things much more complicated. My doctor suggested another method that would help me in this matter: 16 mg every two days. Is anyone in Canada following this treatment? Does it work well, any withdrawals in-between doses, cravings, etc.? Another treatment would be 24 mg every three days but I find the gap possibly risky. I would truly appreciate inputs to make the better choice!


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PostPosted: Sat Oct 31, 2015 12:11 pm 
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Hey Zag, welcome to the forum!!

I'm not from Canada, so I'm not familiar with the way things are done there unfortunately. Is it just absolutely not an option for u to go to ur pharmacy every day? I'm sure that would have been extremely aggravating, I get that 100%. But if it were me, I'd do whatever I had to do to take my dose, because it's extremely important for ur recovery. That being said, if u absolutely cannot go every day, if I were u I'd do the 16mg every other day. I'm not sure how that would make u feel because it's meant to be taken every day but if there's no other choice then that's exactly what I would do. I do think that since sub has a long half life, u won't go into withdrawal, but I'm not sure about the cravings part. I wish I could be more helpful to ya, but there is definitely ppl on the forum from Canada and maybe they'll weigh in on their opinions and experience.

I'm just glad u found us and good luck no matter what u decide :) please let us know how it goes and what ya decided eh.

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PostPosted: Sat Oct 31, 2015 4:49 pm 
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To me, your Dr. is an idiot! I know that is harsh, but you need to take your meds everyday. If you had a job, they should be more forgiving on their treatment , like giving you a 3 day supply, or even a 5 day supply, or is it a law in Canada. How long have you been on Subs?
Sorry I didn't catch your name. I read your post and instantly got furious! lol
Happy


Edit) I just don't understand why they have to put people through the ringer with this stuff instead of helping someone who is working and struggling with addiction and trying their best to cope.
These stupid laws have got to change!


Last edited by happyg1961 on Sat Oct 31, 2015 5:33 pm, edited 1 time in total.

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PostPosted: Sat Oct 31, 2015 5:14 pm 
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Now, Happy, why would you say that? Especially calling this doctor an idiot? Would you say that to his face?

In any even the suggestion your doctor gave is very valid and may work well for you. Is it as good as taking 8 mg everyday? Perhaps not but if 8 mg holds you for 24 hours, it is reasonabe to try double that dose every 48 hours. We know that most people don't start to feel withdrawals until they hit about 4 mg. we also know that the half life of bup is around 36 hours or 75% of the time frame needed. That means you'll likely be between 4 to 8 mg when you hit 48 hours and take your next dose. Finally we know that most people who just stop bup at 16 mg day feel no changes for the first 72 hours. They often post how good they feel even though they have not taken any bup in three days. Of course that doesn't last but it tells us they make 72 hours just fine. If they can make 72, you very likely can make 48.

So put all of this together and I'd say it's worth a try and may work for you. Clearly it's a good suggestion regardless of what some may think. If I'm wrong I'd love to hear the science and reasoning behind why - and for why this doc us an idiot?


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PostPosted: Sat Oct 31, 2015 5:22 pm 
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Donh,
We are talking about a mental part of this, not physical. 3 days is a long time to not go without meds, especially if you are new to this. I know about having to have to go to a clinic everyday. I drove over a 150miles a day to the clinic and to work everyday. I had to get up at 1AM and get to the clinic by 3:30 just so I could be one of the first ones in line to get my meds and then speed to work just so I could get there by 7AM. Everyday! And if I had a drug screen, I was late for work. It caused me a lot of problems at work and I about lost my job many times for being late. So this kinda struck a nerve with meI had to do for a few months until I just could'nt do it anymore and the clinic decided to start giving me week take homes because they could see the damage it was causing to me.
And yes, I would tell him he is an idiot to his face!
That is just ridiculous making somebody wait 3 days. 2 maybe, but not 3.
Sorry I ruffled your feathers, but that is how I feel. Everyone has their own opinions I guess.
But what you are saying, doesn't make any sense. There is a ceiling affect. Remember? So it doesn't matter how much you take. You are only gonna get so much benefit.
I don't know why they have to put people through the ringer with this stuff.
Happy


Last edited by happyg1961 on Sat Oct 31, 2015 5:42 pm, edited 1 time in total.

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PostPosted: Sat Oct 31, 2015 5:40 pm 
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I'm thinking, wow, I misread that. I thought it was every two days. So I re-read it and it actually is every two days. Where are you getting every three days from? It's EVERY TWO days. I would tend to agree with you if it was 72 hours but it's not.

And moderateors who would call a doc an idiot to his face? Oy Vey

So, um ,yeah re- read, it's every two. Glad to see you agree with every two days. Glad I could change your mind. :)


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PostPosted: Sat Oct 31, 2015 5:45 pm 
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Donh,
lol You need to re-read my friend. 3 days was the other option. lol


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PostPosted: Sat Oct 31, 2015 6:07 pm 
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But that would be at 24 mg. not sure that would work as well due to the ceiling effect. I was talking about every other day. Now why did I think you were a mod? I was wrong, but I do feel better. Lol

Zage, give every other day at 16 a try. I'll bet it works fine. If you do, let us know how you feel on it.


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PostPosted: Sat Oct 31, 2015 6:26 pm 
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Donh,
It's ok. I forgive you! lol
Let's just agree to disagree.
16mgs every other day is fine, but not 24mgs. I just don't think that is a very good idea, even for a Dr. to say 24mgs every 3 days doesn't sound very smart on the Dr's part. They should know better, especially dealing in the "addiction" department.
But I guess the guy or gal doesn't have any other options.
So the dr. deserves the "idiot" award if I was a judge. lol
Happy

Sorry OP for getting off track on your post.


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PostPosted: Sun Nov 01, 2015 4:26 pm 
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No, happy, in the end I think we do agree. I could not suggest anyone try every three days at 24 mg. I think it would be a little like the peak and troughs of using short acting opioids - just in slow motion. But I really do think every 2 days at 16 could work - as a plan B to daily dosing. So I think we sort of agree. I'd love to hear back from the OP as to how it goes if he tries it.

Or perhaps Canada could get with the program and at least allow a weeks worth of take home. Rarely does politics provide for good medicine. Thousands of people get a month or more in other countries and the world has not come to an end because of it.


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PostPosted: Mon Nov 02, 2015 7:31 pm 
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My doctor is not an idiot. He is actually quite emphatic. It properly proceeded to the induction over the course of 48 hours and he takes the time for the proper follow-up. It was very hard to find a doctor with a license to prescribe this medication. There is none in my city (the biggest agglomeration in a 300 km diameter) and my parents has to drive me 100 km away in some small village where he practices.

After 6 months, I get to bring 1 dose home every week (it's called a privilege). After a long time on the program, with clean urine tests and a good follow-up with my social worker, I would eventually bring 5 doses home. In Canada, suboxone is being prescribed in the same way as methadone, the same legislation applies. It has not been revised in a long time... I sure wish they did and allowed for a 7 days prescription every week.

Since my case is going well, my doctor agrees to give me my first privilege after 3 months. I have been on the program for 1 month. Unless I soon find a job that fits with my pharmacy schedule, next meeting, I will ask my doctor to give me that 16 mg every 2 days. It will allow me to function more easily.

I am quite confident it will go well because of the long duration of bupe and because I am managing my life in a very good manner. My lifestyle is balanced, I have my projects and I am proud of myself. What I have learned in therapy did pay off in the end!

It would still be great to get an advice from someone actually following that suboxone regimen.


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PostPosted: Mon Nov 02, 2015 9:18 pm 
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I hope you can find someone doing this type of dosing as well. The thing is, since many places, including the USA allow six months by law (not many docs do this but by law they could write 1 month with 5 refills) most don't have this problem. It's really sad and F'd up that someone doing well has their recovery made all that much harder therefore putting them at risk. I'll bet this same Doctor could prescribe a months worth of opiates to you but the treatment for that, a much safer drug, oh no, that has to be tightly regulated. Very sad and F'd up. Then again what else can we expect from government. I could not imagine having to go to a location (other than my bathroom) to dies everyday. It would seriously put my recovery at risk. I'm positive of that.

Thanks for clarifying g about your doc. I too cringed at that idiot statement, but we've already been over that.


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PostPosted: Mon Nov 02, 2015 9:52 pm 
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What your doctor's suggesting is called "double dosing" in my country, and it's a legitimate way to be dosed in countries where you have to pickup your dose daily, or in this case every 2 days.

I've tried double dosing myself years ago. I was on 12mg, then asked my doctor to be double dosed so I wouldn't have to go to the pharmacy as often. He prescribed me 24mg every 2 days. Now this should work in theory. Suboxone's half-life is extended significantly as the dose increases. However I felt that the double dosing regimen really wasn't working like it should in theory.

What I found was that over the 2 days, the difference in the levels of buprenorphine in my blood was significantly greater than if I was dosing daily. I got a significant peak after I dosed, and felt my dose was holding me through the next day as well. However by day two, when I was due to get my next dose, I felt my cravings were not being held enough, and there were times I ended up using.

Now bear in mind that I was a lot younger back then. I wasn't as motivated in my recovery. If I were faced with the same cravings today I may be able to manage them okay. But I do feel, looking back over my pattern of Sub use, that daily dosing works a lot better than double dosing. The times I've attempted double dosing I usually don't last very long on sub - ie I ended up using again.

Now bear in mind that this is also just my experience. Your mileage may vary. I've been known to metabolise my Suboxone faster than your average bear, especially when I've been on certain psych meds that seemed to make me burn through my sub faster. At one stage (while I was on a certain anti-depressant) I needed twice a day dosing because I was burning through my Sub so fast. This issue of mine is largely idiosyncratic I think, as others don't share this problem while on SNRI medications.

If I were in your boat, I'd hassle the doctor for enough take-away doses to make your dosing manageable with your job. If that fails, I'd give double dosing a try. But I'd have a plan to fall back on should it not work. Maybe see if you can be scripted for optional double dosing so you can switch back should you find it's not working without the need to make another appointment.

As for triple dosing. I seriously have some doubts about it. I wouldn't do it. Your levels would fluctuate even moreso. Even with the ceiling effect in play, I have doubts the levels would stay over the ceiling through the whole 72 hours. But that's just me. I have a fast metabolism.

In a nutshell, if you metabolise Suboxone quickly, double (and triple) dosing are less likely to work out. If you're a slow metaboliser, it might work out for you.

It also sucks that Canadian doctors seem to have harsher policies with take-away doses. I've been on Sub 2-3 months this time around and I already get 4 take-aways. They do make life a lot easier, especially when juggling work and / or study.


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PostPosted: Tue Nov 03, 2015 8:53 am 
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Is seems I read somewhere that when bupe was first being studied for ORT, it was determined that every other day dosing was effective. However, in clinical trials addicts didn't find that dosing method "acceptable" i.e. the blood levels were high enough on day two, but psychologically the addicts had difficulty with it. Never thought about it until now, but I wonder if the addicts in the study had previously been on methadone, and they judged their day 2 feeling on how they perceived missing a day of methadone?


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PostPosted: Tue Nov 03, 2015 10:59 am 
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I think physically you'll be ok going a day in between doses. Mentally, like TJ said, I do think that cravings will be an issue. I'd rather feel bad physically than the mental cravings (that's just me).

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PostPosted: Tue Nov 03, 2015 7:24 pm 
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Lily and Jenn both bring up s great point. Blood levels very likely are very adaquite but the it's still the mind. I remember dropping from 16 mg to 6 - not all at once but in steps. I was Convince it was a struggle, going first to 12 then 10 then 8 then 6. It was not until I felt the major difference of dropping below 4 mg on my way to 2 that I really knew what bup withdrawal was like. My issues were mental - not physical at these high levels. So when someone has it in their head that 48 hours may not work, any tiny little thing had us saying "see, I Can feel the difference". If you can Somehow go into this with a positive attitude that it will work, it likely will. Easier said than done - I know.


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PostPosted: Tue Nov 03, 2015 7:36 pm 
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Ok, ok, the "idiot" Dr. thing was a little much. lol
But my points I was trying to make still stands about the mental anguish of the thought of dosing every 3rd day is just not a very good Ideal. It is the mental thing that would bother me the most. Especially early in recovery. You are struggling with the cravings the way it is.
Every other day wouldn't be as bad, but still bad enough.
Happy


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