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 Post subject: excessive dosage?
PostPosted: Sat Jan 25, 2014 8:10 pm 
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Thanks for this forum and your videos.
I have been on Suboxone maintenance for about 9 years. I've been clean and sober for the last 3 1/2 years. I am prescribed 32 mg per day. I am 5'11" and weigh about 200 lbs. My wife, who is shorter and a little over half my weight (I think) takes 4 mg. She seems to think that my dose is too high. She won't admit it, but in her mind she equates it to using.

Is 32 mg excessive? I don't think so. I increased my dosage 2 years ago because there were frequent waves of withdrawal that would occur during the day. Not severe and perhaps psychosomatic, but they stopped after the increase.

We both attend AA regularly. I don't advertise the fact that I take Suboxone because there are always those with negative opinions (uninformed opinions, I think). Perhaps my wife is influenced by those attitudes whether she admits it or not.

I'd like to be free of the physical dependence on Suboxone, but it saved my life. It's not broke, don't fix it is what I say.


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 Post subject: Re: excessive dosage?
PostPosted: Sat Jan 25, 2014 10:01 pm 
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Jaybird, ya, if it aint brpke dont fix it".You are working a recovery program with bupe and AA. I think as addicts we need others in our recovery life.Like this forum too..
I know for me, 32 mgs seems very high.very. I wont speak for others on this forum, but many here may agree. Others will come aloug with there views. I would suggest going over to Dr junigs Talkzone and read about dosages and ceiling effect..try it.
And yes it is to bad we cant talk openly about our way of staying "clean".i like the term "clean enough"..3 years at 4mgs....but like you said "if it aint broke"....good luck and keep reading here and posting jay........razor...


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 Post subject: Re: excessive dosage?
PostPosted: Sun Jan 26, 2014 1:34 am 
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Yes its excessive, to be on such a dose for several years is not only ridiculous it most likely means your doctor is a buffoon. I'm pretty sure the dosing guidelines regarding bupe have changed or are in the process of being changed so that 16mgs would be the maximum dose given. I could be wrong but I thought I heard that on this very forum. I was started on 16mgs and Ive experimented on every dose in between and settled at 3.5-4mgs for the majority of my 3.5 years in treatment and it does the same thing that 16mgs does just minus lots of side effects and I feel good vs bogged down. And sorry man but no one gets "waves of withdrawal" while they are on large doses of bupe just suddenly out of nowhere. Sure you can will yourself into feeling like you are withdrawaling mentally but you can't just out of nowhere start getting WD when you are stable on subs unless you just stop taking them.


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 Post subject: Re: excessive dosage?
PostPosted: Sun Jan 26, 2014 9:36 am 
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hey jaybird,

thirty two mgs does seem like a very high dose, but we are all different. I am prescribed 24 mgs a day. I've been on subs almost four months and I've played with my dosage a little due to the cost because I pay out of pocket. at 24mgs I have no real side effects to speak of, but it's expensive so I tried 16 and felt exactly the same as I did at 24. then I tried 12, I felt a bit different for a ccouple days, but not what I'd call bad. I'm doing fine at 12 mgs now and will save money too, and have been able to stock pile the extra films. it's always good tohave some extra subs on hand also, in case of emergency situations like Dr. leaving, bad weather, no transportation,etc. anything can happen and you don't wanna be caught without your medication. many patients do need doses higher than 16mgs. some are faster met abolizers than others. yes,16 mgs is enough for many patients but not all. do what's right for you, but give going down a little bit a try and see how you feel. Try going down to 24mgs, and see how you feel, you probably won't even notice any difference at all. then you can continue down a few mgs at a time. lowering your dosage well give you a chance to put some sub away for a rainy day and save you some money. amd of course if your not comfortable, you can continue to take the 32 mgs that your are prescribed.

my doctor had many patients who take more than 16 mgs a day, because that's what they need. he's not a buffoon and neither is your doctor if you are happy with him/ her and are meeting your treatment goals. if you feel fine, and are not using other drugs, doing worry about what anyone else thinks. this is your recovery, and only you know how you feel. perhaps discuss this with your doctor at your next appointment


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 Post subject: Re: excessive dosage?
PostPosted: Sun Jan 26, 2014 4:38 pm 
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Interesting responses so far. Pretty much all over the board - even within the same post! LOL I don't want to jump all the way to bafoon but 32 mg is a total waste and not doing anything but wasting large sums of money. You see yourself how your wife does just as well as you do on about 15% of your dose. Have you realized that? Why is that? You can't be that much different than her nor the average sub user.

While I was reading this thread I was going to say that I'm 100% positive if you were somehow given 16 mg but told it was 32 mg you would not notice ANY difference. Noda - NONE. But then Lizzie pretty much confirmed it. There is a very good reason for this. It is because Bup stops increasing effect at about 16 mg. you can take 100 mg and it won't do anything more. This is what many call the ceiling effect.

A doctor can prescribe any amount he or she wishes. There are no federal laws against it. That said, the manufacturer has placed the recommended top dose at 16 mg day. Some insurance will not cover/pay for more than 16 mg day. Finally a few states have limited doses to 16 mg in some instances. They have done this for very good reason, based in science - more than 16 mg a day does not do any good, costs much more and potentially puts more Bup on the black market.

Just give it a try like Lizzie did. Just try it. You'll find that anything different is all in your head. It really is. Hell just try 24 for a week. Then try 16. I'm not saying you gave to drop to 4 mg and certainly not without at least a little taper but 32 is not needed. I promise you it is not.

Now I also can't post without a comment about all of these "whatever feels right" comments. Seriously people? Have you not learned anything about your disease of addiction? Doing what feels right or what we think we need is what got many of us here. C'mon. Just because you FEEL you need something does not make it so. Dr J could comment much better than me but that just jumped out at me. Don't enable people like that. Science has proven that 16 mg is the standard max. Just because someone feels otherwise does not make it so. You are always entitled to your own feelings. You are never entitled to your own facts. Please use your brain to think and reason - not go with your feelings. - sorry, just had to say that.

Good luck Jaybird. I am positive you can cut your dose in half just like many, many others have. What will you do with all that extra money? :)


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 Post subject: Re: excessive dosage?
PostPosted: Sun Jan 26, 2014 6:47 pm 
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just to be clear donh, the poster asked if we thought 32 mgs was excessive. my response was that I thought it probably is a bit much, and that he MAY do just as well with less. on the other hand, I've read on this forum about several people who metabolize sub more quickly than others and maybe that's the case with this person. I just recommended that he give lowering his dose of a try to save money and save some medication for emergency, and that if he didn't feel well, he should take what is prescribed to him by his doctor. I wasnt suggesting that he just Willy nilly do whatever feels good to him. I was saying that if advice he got from an internet forum didn't work out for him it would be best to follow his doctor's instructions.

donh, your posts are well written and you give good advice but you also pick other people's posts to death. I don't think my reply was all over the place or in any way enabling, and I stand by it.

To the original poster, give our suggestions a try, and you may find you don't need as much sub as you've been taking. I hope you do well on a lower dose, but if you feel unstable or have thoughts of using, take what your doctor prescribed.


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 Post subject: Re: excessive dosage?
PostPosted: Mon Jan 27, 2014 7:06 pm 
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Lizzie, please don't take my comments as some sort of personal attack. In fact I did not even refer to you with those comments like I did when commenting about the success you have had at lowering your dose. I don't get any kick or thrill out of challenging other posters comments into question. My concern is all of the people that may read them - often looking for an excuse and then finding it in the "support" of others.

I'll try to explain using an example many if not most of us can agree on. Imagine if an addict said they are abusing oxy a couple times a week and are in complete control of it. They say they can use like this and it won't become a bigger problem. Most would disagree but some may say "if that's working for you, just keep doing it." Others can disagree but the person wanting to used will focus on those people making comments that support what they want to do - even if we all know it's dangerous. That is a huge problem with the Internet in general. This can really breed misinformation. It's very important comments based in feeling are challenged with those based in fact and science. If someone tries to say "thousands of people abuse oxy several times a week for years and never develop a problem." If they say that, we then need to challenge them to prove it. Back up that statement with fact. I know I can present facts that show pretty much no one can ABUSE oxy on an occasional bases for a long time. Medicine, including addiction, is judged in fact. You can feel one treatment is better than others. It is then science and fact that will prove if your feeling is valid or not.

When it comes to a doctor saying something. That too may need to be questioned. Dr. J questions the practices and advice of many doctors all the time and with good reason. What if a doctor said to his patient "you can just stop Bup at 16 mg. You may have a few days of moderate discomfort but you'll do just fine." Would we then say, well he's a doctor, listen to your doctor. I'm betting we'd point out all of the evidence and reports that stopping bup at such a high dose is very painful and will not be over in a few days. I feel it's very important to contradict such a statement. I've been in healthcare over 25 years and have dealt with countless doctors. Some are great. Some not. Some are spot on most of the time but then will do or say really strange things at other times. Perhaps the best example of that I've ever heard comes in the form of a riddle:

"What do they call the guy who barely made it through medical school, just squeaked by on his board exam and graduated dead last in his class?"

What do they call that person?

They call him doctor!!!!!!!!

These docs are out there. They have the same medical certificate as the near genius who graduated top of his class.

So. My point is, I mean nothing personal. I just cringe at decisions based on feelings rather than facts. God gave us all a brain. We need to use it. By all means use your heart to love and feel compassion for anyone posting here. Just please use your brain for making decisions. I'm only asking a poster to stand behind, backup and provide supporting evidence for their claims. If they cannot back up what they say, they are presenting their feelings on the subject. That is fine to do. Just don't claim the comments to be based in fact. Don't say "most men wear pink underwear" when in fact it is only your husband who does so you assume everyone else does as well, when there is nothing to support that thought. I see this a lot. "Thousands of people do X, Y or Z when in fact they have no proof of that whatsoever.

Hopefully that all makes sense. Also my use of the word "you" was in no way meant to mean you personally, Lizzie. I really intend nothing personal to anyone who posts here. I very much value what most have to say. That does not mean I won't challenge it from time to time. And if I do, I'm challenging the statement not the person. I can still very much like a poster while challenging or disagreeing with them.

Don


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 Post subject: Re: excessive dosage?
PostPosted: Thu Jan 30, 2014 4:24 pm 
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Hi my name is Stephanie and I have been on suboxone for a year and 2 months now. I am currently taking six milligrams that I have been taking for 4 months now. I am concerned because the last couple of days to a week after I take it I feel lightheaded, anxious, nauseous, very tired and abdominal cramping. I have had a bunch of blood work dine and other tests and everything came back normal. Do you guys think it is time for me to lower my dose. I want to go down to 4mgs. Can I do that from 6mgs right away and not get sick? I am scared to take my nxt dose today due to the way it has been making me feel but I can tell I'm starting to feel sick so I need to take something. PLEASE HELP.


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 Post subject: Re: excessive dosage?
PostPosted: Thu Jan 30, 2014 4:26 pm 
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My doc thinks I am on 4 already but j felt she was dropping me to fast so stayed at 6 for awhile and just got the extra somewhere else. Stupid huh. Now I am stuck and wondering if physically will it hurt me to drop from 6 to 4mgs right away.


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 Post subject: Re: excessive dosage?
PostPosted: Sat Feb 01, 2014 12:38 pm 
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I know here in Canada the max does they are alowed to prescribe is 24mg. From what my doc tells me anything over that is a waste.

The U.S. may have different guidelines.

Your receptors are fully blocked and covered to the maxd. Sorry for my terminology but that's how I remember him telling me (in my own version.)

At the beginning for me I needed the max, that was 5 years ago. Since then in the last 5-6 months I decided to taper. Getting down to 4mg was not that hard, if I had know I would have done that earlier. At the time I was too scared to reduce at all because I thought that if I did I would start getting withdrawals.

I know everyone is different but this is how it worked for me. As of now I am down to 1mg and preparing to jump soon.


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 Post subject: Re: excessive dosage?
PostPosted: Sat Feb 01, 2014 4:07 pm 
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Steph12fan wrote:
My doc thinks I am on 4 already but j felt she was dropping me to fast so stayed at 6 for awhile and just got the extra somewhere else. Stupid huh. Now I am stuck and wondering if physically will it hurt me to drop from 6 to 4mgs right away.


Hi Steph! It definitely won't hurt you to try to drop to 4 mg from 6 mg. The worst that will happen is that you may feel some mild withdrawal symptoms. But I want to tell you that I went through the same experience and dropping to 4 mg from 6 did not bother me at all. I encourage you to try to go to 4 mg, and from then on be honest with your doctor. Let her know that you're not ready if she tries to drop you more right now. If your doctor is any good, she wants you to succeed and still feel comfortable. If your doctor is unreasonable and insistent, tell her that you have started to have major cravings again for your drug of choice, or that you came close to relapsing. Hopefully those statements will cause her to slow your taper and give you time to find another sub doctor who will respect your timeline.

If you have any other questions it would be a good idea to start your own thread. People will be more likely to answer you.

Amy

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 Post subject: Re: excessive dosage?
PostPosted: Sun Feb 09, 2014 3:11 pm 
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I just started suboxone 3 weeks ago. So far so good. My doctor started me out on 3 8mg strips a day-24 mg. After two weeks I finaly felt stable and have ever since. I went to my two week follow up appointment yesterday, because I had the flu this past week, I had to set up a new appointment. With the new appointment comes a new doctor. This group has several offices in our area and they have quite a few doctors that rotae around. This new doctor looks over my chart and because I have pain issues too he bumped me up to four 8mg strips a day. I did not ask him to ok-he offered and asked my opinion. I talked about the plateau with this medicine and his response was yes there is. But in dealing with pain this is a valid option. I agreed to try this for the next month, also I get my suboxone free thru Here to Help, they will only supply at most 90 strips a month, so here is my delima-my medicine is free and I am ok with just the three, so many times in the past I have played doctor and either self medicated outside their advice or not medicated at all. I feel this doctor is legit and so is their entire group. My quack doctor spidey senses alarm isn't going off. I want to once trust someone else besides taking the wheel and driving the bus myself-so many times this has backfired and caused great harm to myself and others. I look forward to trying the suboxone program and putting down that syringe. Ten to twenty self injections a day was killing me-over dosing, infections, and nodding off while driving has to stop, I will die if I do not try something different. If you all think this is to high a dose thats fine. I understand we are each different and drugs have affected us all differently. Right now I have no option but to put some trust and faith in these doctors-it is truly a life and death issue for me. This does not mean I can't try and educate myself as much as possible by other resources. Thanks for this forum, God Bless and good luck!!


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 Post subject: Re: excessive dosage?
PostPosted: Wed Feb 19, 2014 5:02 pm 
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Lizziehugs, I really liked your post and thought the advice you gave was valid. Particularly when you articulated that some people may metabolize their doses at different rates, I haven't heard that elsewhere or at least not in this context but I found it very interesting.

Dakota, I would say that if 24 mg is working just fine and you feel stable so far (this would include your chronic pain issues under control), then there's no reason to increase the dose if you're functioning and content. I'm not gonna tell someone their dose is too high because I don't have first hand experience being you or your doctor but I do know what it's like to be stable on 24 my and feel that increasing my dose is not necessary, so if 32 is gonna cause financial problems that may make it harder to manage your budget and by extension, your recovery I'd say stick with the magic number.

To the OP, due to reasons others have mentioned on here if you really need to be at 32, then stick with what's working but I'd say anything greater than that would be a waste. If the disapproval you're sensing from your wife is causing you stress, shame, or reluctance in your recovery then I think it'd be worth it to try going down to 24, just to see if that's a sufficient dose. If it is, and only if it is, then you may be benefitted by taking some of that pressure off if she sees you decreasing from a dose she may not be able to understand, to one that may be seen as more reasonable. Again, if 32 is what you need and all you need while you're also working a recovery program, then that should take priority. I just don't want you to deal with any foreseen or unforeseen consequences by trying to please others, so make sure you're not facing any that are counterproductive to your treatment before deciding to make the change permanent.

There is a ceiling with buprenorphine, but with that being the case its something that can kinda be made an argument for either side. The ideal is to be on the lowest mg and number of doses per day that keeps you well, so while doses above the ceiling may be unnecessary and therefore going above that minimalist standard, on the other hand, if going by the generally accepted scientific research that says it'll be the same effect on you whether you're stabilized on 32 or 24, then research implies that there's no harm AS LONG as you're not obsessing or showing addictive behavior. I'd also say that "if it ain't broke" include the condition that you're not experiencing any side effects that could be reduced or eliminated at 24.

Once per day dosing is optimal, because its preferable to multiple doses in regards to fighting against addictive behavior, our old habits. This way the dosing can feel less like a controlled substance we used to abuse and more like blood pressure medicine or diabetes medicine we need to take each morning. However, this does not always work for everyone based on their circumstances. Before I give any more advice here is the obligatory "I'm not a doctor or medical professional" statement and truly I'm not. But all that being said: considering that you said you used to feel withdrawal at a certain point of the day, whether it was somehow physical or psychological because a higher dose was better for reducing cravings for your DOC, maybe you could discuss with your doctor dosing twice per day if/when you try a lower dose than 32 mg. So like if you were to try 24 mg, you would take 12 mg in the morning and 12 mg in the afternoon/evening and see if that stabilizes you. Or whatever dosing schedule you and your doctor discuss.

I wish you and Dakota the best of luck in your recovery and your home life. I may not have been able to tell you exactly what's best for your recovery, but I can assure you that recovery is what's best for you right now. Keep living well and communicate with your doctors. Nice to greet you! :)


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