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PostPosted: Fri Oct 18, 2013 1:18 pm 
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Hello all, I need your help! I'm in pain management and would like to quit all of the opiates that my Doc has been prescribing to me.
He was giving me 300 Methadone pills 10mg, I got down to 30-40mgs from 80mgs a day; 40mgs of ER Oxycontin 3 times a day, 10mgs of Oxycodone for breakthru pain, 4-6 a day, 40mgs a day of Valium, Temazepam and a couple sleep meds (trazadone). Ugh. I used the Oxycontin to help go down on the Methadone. Last Methadone was 10 days ago, I have a half a bottle left of that med.
Here is what happened: I did not take any opiates for a day and a half, saw the Doc, he gave me 90 subutex and told me to take 16 (mgs?) or 3 pills a day of the generic subutex (the 8's). After 15 min I went into the worst withdrawls or sickness I've ever experienced in my life. Almost called 911. When the effects started to subside to the point where I could talk, I called my Doc and told him what happened and what should I do. He said something like " well 1/2 of a dozen or another" What???? Gimme a break! He was no help, I asked my pharmisist and he had no clue. Called my Doc again and asked him for some opiates to stop the withdrawls and that I would try again next month. Been in hell for 5 days now. I read a dozen posts about other people that went thru this. I really don't know what to do next in my case tho. My plan was to use the the new Oxycodone's and oxycontin's and wean myself down, but I'm not sure I can do it. Then I thought I could use my leftover methadone and wean myself to a real low dose of the Oxys and then slowly go down in dose of the mdones and try the subs again. Can someone please give me some advice. Should I go back and use the Mdones or stay the course and just use the Oxys? What should I have done about the sickness, should I have kept taking the subs or stop like I did and go back on the opiates and try again down the road. Sorry, if I ramble but I'm still sick since I took the subutex...Thanks in advance!!!---Hoople


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PostPosted: Sat Oct 19, 2013 7:23 am 
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Hi Hoople

I have no experience with methadone but do know someone (my granddaughters dad) who went from methadone to sub & it was not an easy transition.

Here are my thoughts....Stay away from the methadone this month. Use the oxycontin if necessary & taper (somehow) to oxycodone only. Give yourself at least 48 hours away from ALL opiates (the more time opiate free the better) & try to get on sub again. I don't know how much sub you took this last time but when you try again take 2mg & wait about an hour & if you don't feel crappy you can take more suboxone.


My experience was switching from 80 mg oxycontin three times a day with 30 mg oxycodone for breakthrough pain to suboxone. My daily intake was 360-400 mg a day. I had a rough week & also some health stuff popped up but it still took me a month to feel "normal". I know i am still on an opiate but i feel clearer than i have in 5 years. For me it was the long acting oxycontin that was the issue.

I hope you make the switch & give it time. Some people feel great right away & some (like me) have to stick to it & give it time before they feel ok.

In closing, I am glad i stuck it out because i feel better & find it much easier to taper the sub.

Hope this helps

Tiki


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PostPosted: Sat Oct 19, 2013 9:32 am 
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Hello Friend . It sounds like you had opiates left in your receptors . The subs stripped them out and put you into the worst withdraw you can have. Heroin is the easiest to switch over from. It lasts in the receptors for 24 hours for the most part. I generally wait 36 hours before taking my first half strip.

He instructed you to take way to much subs in the first place. I start with half a film to start and go from there. Having you start with 3 is not very smart. If I took 3 even after waiting the 36 hours id be sick too.

To me it sounds like you still had methadone in your system. when I switched from 30mg of methadone years ago to subs he made me wait 5 days before he gave me my first dose. I started to feel better 20 minutes later.

I hope this helps.


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PostPosted: Sat Oct 19, 2013 10:16 am 
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Hoople wrote:
Here is what happened: I did not take any opiates for a day and a half, saw the Doc, he gave me 90 subutex and told me to take 16 (mgs?) or 3 pills a day of the generic subutex (the 8's). After 15 min I went into the worst withdrawls or sickness I've ever experienced in my life. Almost called 911.Thanks in advance!!!---Hoople



Hello Hoople,

Welcome to the forum!

I was just noticing that you said the doctor told you take take 16mgs, or 3 of the 8mg pills a day. Well if you take 3 of the 8mg pills that is 24mgs and not 16mgs.

I agree with juttsdm6 that you most likely had opiates (Methadone) left in your receptors/system, and you took too much sub at induction. Even 16mgs was probably too much in my opinion, and if it was actually 24mgs that would even make more sense that you were as sick as you were at the time.

Methadone is so hard, and so tricky to make the switch to subs from. It hangs in your system for days, and in some cases weeks depending on how high the last doses were that a person was taking.

Juttsdm said their doctor had them wait 5 days before taking the sub. That worked for them, but I believe there is a much better way to make sure the time is right to induct. Use what is called the Cows (clinical opiod withdrawal scale) that will give you the best time for induction. It places a number score on your symptoms at the time, and you will know you are ready for that first dose of sub. Get to a score of 25 or higher coming from Methadone and you know your ready for induction.

Here's the link for the Cows Sheet below.......
http://www.naabt.org/documents/cows_ind ... _sheet.pdf

I wouldn't suggest you begin induction with any more than 4mg of sub either. Build up the dose slowly and once the withdrawals stop you will be on the lowest dose necessary, and not be taking more than needed. Take 4mg and wait about an hour. Keep repeating until withdrawals stop. Just stop taking everything and take nothing while withdrawal symptoms begin. It's not fun of course, but you only have to do it one time if you do it correctly the first time. Get to a score of 25 as I mentioned, and higher if you can hang on longer, and then it's safe to induct without worrying about being sick again with those PW's.

You said you have had no Methadone for 10 days and that's great! I wouldn't use the Oxy's or anything else to help either. I would stop taking ANYTHING that might help you feel better, get to that score of 25 or HIGHER on the Cows, then begin taking 4mg of sub an hour apart. You have to get sick (with withdrawals) before you can begin to feel better once taking the sub. It works great if you can stay committed to not take anything and allow yourself to get into the moderate to severe withdrawals required before induction.

That's my suggestion, and what I did when going from Methadone to subs. It can take 3-5 days to get to the target score. Might take less as everyone is different, and I certainly hope it does for you Hooper. That's why the Cows works so well....you know when your ready by the scoring of symptoms and there is no guesswork involved. I highly recommend using the Cows to everyone, even other opiates when using subs for the first time.

Hope this helps and best wished to you. Please keep us informed how your doing.

Karen xoxo


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PostPosted: Sat Oct 19, 2013 12:59 pm 
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Thank you my dearest friends. There seems to be a clear consensus of what I should do and what happened to me. I now have a plan and a much clearer understanding. Excellent info!!

I'm dumbfounded and upset that my Doc put me on such a high dose and did not know what I should do after I got sick. He dodged all my questions.

BTW, I must not have communicated properly about my first sub dose, it was one 8mg generic and the Doc wanted me to take 3 a day. I stopped at one and was fearful to take another...I was horrifically sick and just wanted it to end. Geez, It has been about a week and I am still feeling the after effects from the sub. I've been taking Valium and sleep meds but they don't seem to work too well.

He was giving me the long acting "contin" and I'm sure now that it was still in my system and probably the Dones too. I was not in uncomfortable withdrawls when I took the sub. I just followed my doc's instructions. Lost trust in him now.

Glad I found this forum, I am serious about quitting the opiates and will try again using COWS.

This sure taught me some valuable lessons.

Thanks again to everyone for the definitive answers to my questions. I'll welcome any other thoughts or advice.
I wish the best to everyone, I can't tell you how appreciative I am to you all - Hoople


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PostPosted: Sat Oct 19, 2013 2:52 pm 
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Happy you understand Hopple! There are many of these sub doctors that really don't understand how this drug works, or should work properly. They only have to take an 8 hour online course, and then they are allowed to prescribe this med. The drug reps come in and tell them it's best to get the patient on large doses of sub, for usually long periods of time, and that's what these doctors try to do. And most of the sub doctors haven't used Suboxone/Subutex themselves so they really have no idea how it feels to be on it. They do their best most of the time, but that doesn't mean they do it right, or in the patients best interest. And of course there are some really great sub doctors that know the system very, very well.

If I could give you one suggestion that I personally believe is very important, I wouldn't be taking anything that makes you "feel better" before you induct. Take no comfort meds or drugs of any kind, or any kind of otc meds that will make you feel better. The entire point of getting ready to induct and use that Cows sheet score is to get into moderate to severe withdrawals as quick as possible. If you take something that makes you feel better it only delays your progress. Hope that makes sense to you Hopple?

But remember, you only have to do it once if you do it right!

You have not taken any of the Methadone for quite some time now (10 days) and it shouldn't take too long to obtain that score of 25 or higher on the Cows. But like I said, if you are moving along and your score gets to say for example a 10 or so and you have a bad headache, or some kind of pain, and you take some Tylenol, or Motrin for example, it could set that score backwards and take much longer to get to the score needed for induction. I did that, so I know it can happen.

This is only my opinions here, and my very best suggestions to you based on knowledge and experience Hopple. Others may offer you different suggestions and advice and that's fine of course. Just be committed to your plan and everything will work out fine for you I'm sure.

One more thing if I may. Once you get to he score of 25 or higher, you may be surprised at how little sub it takes to get you feeling better. As I suggested before, I would try taking doses of 4mg until you are stable and the withdrawals are gone. It may take 6-12mg to do the job, or you may be feeling great on 4-6mg or so. Everyone really is different, and you have to find the best dose for you to be on.

Also, make sure you score yourself honestly on the Cows. You will be feeling terrible as the withdrawls get more and more severe. It will be easy to "fudge" the score, or make symptoms seem more severe than they really are. Just score yourself accuratly, or better yet have someone you trust score you themselves. Either way just make sure it's an honest score.

Keep us informed along the way how your doing please.

Karen xoxo


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PostPosted: Sat Oct 19, 2013 6:18 pm 
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Thanks so much Brown eyed girl, You have been awesome! I read your posts very carefully and you are an inspiration to me. I felt so alone, hopeless and utterlly confused until now. I know I did not start the sub right. I was too eager and I just did what the doc told me to do. You are so right about Doctors, especially mine. I'm still angry at him; I trusted him. And I was wrong to take the med without doing my own research first. I don't have anyone to lean on for help or support. My wife doesn't even care, and she is a nurse! At first she was on board with my desire to quit opiates, then she did an about face right when I was at the height of sickness and needed her. She just ignored me... She thinks I should be back on methadone of all things.??? She reminds me of nurse Ratchet. To hell with my wife, I am determined to quit with or without her support.

I get my only solace from people like you that really seem to care. I'm in the house all alone, wife is visiting relatives over the weekend. I don't care. I'd rather be alone than have someone in the house that is a constant critic. I guess the words "in sickness and in health" don't mean anything with her. No fairytale marriage for me.

Well, I had to get that off my chest, I guess, so you know my situation. I know others have gone thru withdrawls all alone, retching there guts out in much worse situations and conditions than mine. My heart goes out to them all. I hope when I quit that I can help someone.

I will take your advice and really try to stay away from all meds before I try again. I failed the first try, but I'm going to try again. I've read about people that followed COWS and had no withdrawls, I hope my next try will be like that...

BTW, on a minor side note; do you know if the generic is any different than brand name subutex? Have you heard anyone complain about the generic?

Thanks for your post, I like conversing with you. You give concrete advice. God Bless you, Hoople


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PostPosted: Sat Oct 19, 2013 9:33 pm 
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Hey Hopple,

I'm sorry to hear the wife is not being supportive at the time you need her the most most. I for one know how important the person your living with can be at times like these. But you keep fighting, and keep right on getting all the held in emotions out you need to right here. Use this thread as a journal to put those thoughts down at times like this. It really does no good to hold them in, and makes a huge difference in how you feel getting them out.

Thanks for the kind words. I really do appreciate it, and I do care about you and want this to go as smooth as possible for you. This forum has members with very valuable information and they have a wealth of knowledge and experience. The weekends tend to be a little slow sometimes, but things pick up during the week. I'm sure others will be here soon with more advice, suggestions, and support.

About the generic subutex....I have heard it both ways Hopple. I've heard it's basically the same and works just as good for some, and just the oppostite from others and the generic doesn't work nearly as well. I myself only used the name brand pills and film at the time I was on the subs so I have no direct experience with the generic. I know that every pharmacist will swear there is no difference in any generic pill of most any drug. As a rule the active ingredient doesn't change, which happens to be Buprenorphine in this case, but only the "fillers" in the generic may be different. With the active ingredient being the same all druggist say they all work the same. But some will argue that some generic meds work no way as good as thier counterpart. I myself personally believe if I'm getting the main ingredient in a drug then it would probably work good enough for me. I personally would never worry about it, but some do, and may or may not have good reason. Maybe someone that has used the generic will stop by and offer some answers to your satisfaction.

Hang in there my friend. Everything is going to be just fine for you. Keep your attitude positive, and you really have to want this to be successful for you. Try not to let the wifes lack of support get you down too much. I know that is easier said than done, but you can do this without her if you had to.

Karen xoxo


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PostPosted: Sun Oct 20, 2013 9:34 am 
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Hi Bown Eyed Girl,
Again you have uplifted me and given me strength to get thru this. I'm so fortunate to have you in my life providing me with positive reinforcement, great advice and help!
Yep, I'm going to keep driving on, take your advice and try again. Now I know the proper way to use the subs. Its a great relief to finally get my questions answered. I don't feel like I'm in the dark anymore and you gave me a good plan to follow that has worked for other people, without getting real sick.
Thanks for giving me your insight about generic and brand name. I usually prefer brand name and will ask my Doc if he will give me a new script next month.
I'm currently weaning myself down on all the pills my doc has been giving me and I am making progress.
I'm anxious to try the subs again when the time is right. I'm absolutrly determined to quit the opiates with or without the support from my wife. At least I know there are people like you with a good heart that want to help.
Thanks for taking the time out of your day to reach out and give me comfort! You are wonderful!
xoxo - Hoople


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PostPosted: Fri Oct 25, 2013 12:04 pm 
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After my first unsuccessful try with subutex and the tortuous precipitate withdrawls, I tried again and was successful. Yea! I thought I had a chance of going into withdrawls again and was a bit fearful, but I tried to not let that fear take hold.
I had a copy of the COWS paper but scored pretty low. I was in minor withdrawls with bouts of sneezing and runny nose. I was very motivated to quit opiates. I was going to wait another day but just decided to take it at 1:00pm Thursday instead of Friday like I planned. And that no matter what happens, I will just keep taking the subs and deal with it.
I took a 4mg piece at first, no side effects, just felt strange. Vision kinda quirky. I could still feel chills up my back and the sweats so I took a whole 8mg pill. That seemed to stop my symptoms from opiate withdrawl. Took a half pill in another couple hours just to be sure. Didn't sleep too well tho, got up at 5:00, took a sub and got a couple hours sleep.

After my first try, and the awful, retching, running around, yelling, cold-hot sweats, aching, sneezing, off to the bathroom, and then start another round...Yeah horrible. 4 real bad hours of it and then a migraine all day. Thats what happens when you don't come to places like this and research first. Lots of friendly folks here willing to help us rookies. I had a bad habit and I am thrilled that I beat it. I hated living in a fog.
I learned not to fear the sub pill, but to get yourself into withdrawls and use COWS. You will know in 5 min whether you were ready for it. Everones experience seems different.

Man, I almost feel like a kid again, clear headed, energetic... and recovering every day...It's great!!

My only minor complaint is that I also feel as if someone beat me with a baseball bat all over my bod. Geez. That is the leftover effect of precipitate withdrawls; avoid that experience at all cost.

Thanks for everyones help, could not of done it without you!!!! --- Hoople


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PostPosted: Fri Oct 25, 2013 7:54 pm 
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Good deal Hoople, I'm so glad you were able to make the switch successfully. I know it can be a hard transition for those coming from methadone. I'm so glad you tried it again and made it work.

As for the leftover achy feeling you described, I'm pretty sure you will start feeling better in a day or two. Sometimes it takes a few days for the sub to completely strip the leftover methadone from your receptors and cover them back up. Just stick with your dose as scheduled and I'm sure you will feel better soon.

Thanks for updating your thread. This very well may be just what someone else needed to hear to give them the courage to make the transition themselves.

Hope to keep hearing your good updates!

Q

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PostPosted: Fri Oct 25, 2013 8:34 pm 
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Hello Hoople,

QHorsegal is correct and you should be feeling much better in a couple more days. I'm so happy you were able to go through a successful induction this time around!

I wanted to add that you ideally should be taking the same amount of sub, at about the same time each day now that you have made it past the induction stage successfully. That keeps a steady and constant dose of sub in your system at all times, and makes it much easier to adjust the dose later if that's required at any time.

Looks like you took a total of 16mgs the first day to get yourself stable. You took 4mg, then a full 8mg pill, and finally another 4mg piece. That's not an extremely high dose, but you may be able to get by with a steady daily dose of a little less than that.

It usually takes a little more to get us stable at induction than it takes to KEEP us stable after the induction if that makes sense. Once you are completely stable on your induction dose, I have found the dose can be lowered a little bit and still keep you stable. You can probably get by with between 8-12mg of sub right now and feel just fine. You want to have enough in your system to keep you feeling good of course, but you shouldn't take any more than is needed in my opinion.

I'm not sure how much you have taken today and maybe you can let us know with your next update. But you might start tomorrow (saturday) with taking a dose of 8-12mg and see how you feel. You can always raise it up if you need to do so. But if it were me I would try to find the lowest dose possible that keeps the withdrawals away and continues to keep you stable. If it's still 16mgs then that's ok too.

Just my thoughts here Hoople and again congrats on a very successful induction. I'm sure your relieved at how well it went! That Cows Sheet is a pretty good measure to use for induction purposes. I always recommend it's use as a very helpful tool.

Please us updated with your progress as Q asked. Your helping so many others with your story. And it also helps if you continue to post so you have a record of your own progress along the way. It's up to you to decide how long you may want to remain on the subs. If at some point in the future you decide it's time to get off then we can help you figure out a taper plan that will work great for you at that time.

Take care and hope to hear from you again soon!

Karen xoxo


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PostPosted: Tue Oct 29, 2013 12:00 pm 
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Thanks for the replys! You were right qhorsegal2, Its Tues. and I don't feel the aches and beat up feeling as bad anymore. Last night I got my first real good sleep and I woke up for the first time without chills and sweating. So I am making good progress. The best part is the feeling that a vail of fog has been lifted from me. I am so clear headed! I'm happy now. I am reconnecting with old friends and socializing. It's and absolutely wonderful to feel alive again. While on drugs, I just wanted to stay home and withdraw.
Good advice about dosing, Karen. I have not yet been on a regular dosing schedule. Every day I take a different amount of subs and at different times thru the day. I'm trying to figure that out. One 8mg will not hold me thru the day, and when I start feeling bad, I would take a half pill, and later take a whole one etc...One day I felt as if I took too much. I know my body must be going thru changes and adapting to the subs... since I finally woke up feeling ok for the first time today, I bet I can try to start dosing properlly now. I know 8mg will not hold me thru the day. Around 5:00pm I start to feel kinda sick, 18-24 mgs a day seems to work ok. I read that alot of people get by on one 8mg a day. I hope I can get to that point.
Bottom line is that I feel clean and good with the subs.
Thanks again everyone, I could not of done it without your help!!!
Will update...Hoople


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PostPosted: Sun Nov 17, 2013 11:54 pm 
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here is what I learned. i was induced for the first time in 2008 was very sick for days. believed I was sufficiently sick to start the process, had been without opiates for about 17 hrs( I used every 2 hrs about) stopped at 9pm the night before, went to Dr at 3 pm. I was so sick, someone had to drive me home was bedridden for 2 days, then the suboxone started to work. fast forward to 2009 after stopping suboxone, getting readdicted and starting again. This time I had learned it takes me about 30 hours to get into REAL withdrawal so I waited till I was SO SICK that when I put that pill under my tongue, it immediately began to work, felt GREAT no sickness not high, just normal! Took it with NO problems from that point on. Took it for 20 months and tapered off in Aug 2011 been completely clean EVER SINCE! Something else I learned...The best success is to not SWALLOW 1 drop of the saliva containing the nalaxone for maximum effect. When my mouth watered with the pill/film under my tongue I would blot it out the side of my mouth or spit out the juices. I believe the smallest amount of nalaxone ingestion neutralizes the effect of the bup you want to absorb. This may not be true of all people but definitely was in my case. so in conclusion the 2 rules are:

1. wait till you are REALLY sick before starting !
2. Don't ingest any naloxone juice!


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PostPosted: Mon Nov 18, 2013 3:24 pm 
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Hey thanks stevu,
Yeah, I can definately relate to your first try with "subs". Geez, I don't want to go thru that again. Doc just told me to go home and take one...never mentioned that I should be in withdrawls first. Dang! I was so sick I could of done a colonoscopy the next day. I've lost 20lbs since starting subs which is good, I hope I can get down to 150, just another 15lbs or so.
Doc wanted me to take 3 subutex a day. But it made me feel too speedy and could not sleep at all, and I have insomnia anyhow... I've only been taking suboxone for a short time, and I take 2 a day. I want to get down to one per day. Around late afternoon I start to get a little drug sick so I take another one. I think it might be because I am taking 3-4 10mg vals at night before bed to help me sleep besides other sleep meds. I don't take vals during the day, but I think I should start taking a benzo in the mid morning and see if that helps to stop the sick feeling later in the day. I'm thinking that it might be benzo withdrawls so I need to figure that out.
Feels good to be clear headed again. I have a bunch of left over opiates and will not take them. However, I do want to hang on to them in case of an emergency; something unforseen. Like the boyscout's motto "be prepared".

Happy you are doing good. It gives me inspiration. I am determined to stay clean.

Well, your advice is well taken. Especially about the saliva and swallowing. I have been swallowing some saliva and if it gets real bad, I spit. I'm not going to swallow that stuff anymore. I know this is probably wrong, but if I have a dry mouth and the med takes too long to dissolve, I take a tiny sip of water and let it mix with the sub under my tongue. Sometimes I break the pill into pieces and then put it under my tongue to speed up the process. I wonder if anyone else does this. The med sheet says not to crush it and I don't, I just break it into 3 or 4 chunks. Doesn't make me feel any different doing that.

I pay way too much for subs and may ask my doc to give me the subutex again which is half the price of suboxone. My body likes the suboxone better tho. My doc wanted to keep me on subutex. Generic subutex makes me feel too speedy and I hate that feeling. Suboxone doesn't do that to me for some reason.

I just heard that there is a new type of suboxone called Zubsolv (menthol flavor). Supposed to dissolve quicker and get the bup into your body faster.Two different strengths. It came out in Sept.and is supposed to be cheaper especially after 6 months and the generic comes out...then the price should drop down more and more.
Thanks for the reply and good info. Take care,
Hoople


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