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PostPosted: Fri Feb 05, 2016 8:45 pm 
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I feel guilt about it and I don't understand why. I am prescribed 3 to 4 mg a day of Subutex, as needed -- the amount of pills allows for 4mg/day or even slightly more, but I have been taking 3mg most days for the past year or more. I've been on subs for almost 2.5 years and at the beginning I was on 2mg only to realize I needed 3mg (or three separate 1mg doses) per day.

Now I find I need 4mg, 4 separate doses, on many more days than I'd like. Typically, in the past year or so, I keep the 4mg to just Fri and Sat, but in the past few weeks it's been often more like 4 days a week instead of just 1 or 2. This is especially the case on long days when I wake up early, or stressful days, which are increasingly common unfortunately. So why can't I be fine with taking 4mg on whichever days are long and/or stressful, take 3mg on the days I can bear it, and let things be? Somehow it nags at me, having to raise it again.

And yet even 4mg is such a small dose. And my doc has no problem with it. Yet I feel bad? I wish I could only take 2mg per day. Having to take 4mg makes me feel like I have a problem, an escalating problem or something. I don't know why. Has anyone else felt guilty about having to raise their dose?


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PostPosted: Fri Feb 05, 2016 9:28 pm 
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Hi! I am currently experiencing the exact same thing right now, I came to this forum to see if anyone else was having this issue. I also started taking more here and there and unfortunately it turned into a routine every day, no matter if it was a long or stressful day. I'm chalkng this one up to the fact that we're addicts. We start to do something and if done long enough, it turns into a routine. I know for myself, I have to realize that I'm not going to get an effect for taking more, and I should know that by now. Maybe we can get through this together? I'm thinking I have winter depression, need to find a hobby or something to look forward to instead of reaching for suboxone. Do you have any ideas as to what is making you do it? And 4 mgs is not bad at all, of course getting back to 2 would be better.

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PostPosted: Sat Feb 06, 2016 12:12 am 
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I agree with pugmommy (II have a puggle, by the way). I hear the same thing from most of my patients-- that staying at the same dose requires a constant amount of discipline, and it is hard to maintain that discipline ALL of the time. When I think about how I am-- how my mind is made up-- I realize that deep down, I believe that I have the right to do what it takes to feel like I'm feeling as good as 'other' people. The think most addicts recognize, eventually, that they do not feel as happy as other people... and they believe that they deserve to feel a little 'more normal'.

I do have people who seem to have lost that feeling; who never take extra, and who seem to be content with how they feel, experiencing 'life on life's terms'. I presume that those people are in a deeper form of recovery.... but maybe they just need less buprenorphine, and their receptors are fully saturated at a lower dose.

If bupenorphine had dose-related toxicity, all of this would be a bigger issue. But it doesn't. So my personal opinion is that people should just find a comfortable dose, and stay there-- and work on dropping the guilt. What sense does it make to go through life, constantly pushing yourself to stay in a state of deprivation?

Although as I write that, I realize that I have MANY patients in my psychiatric practice who 'get off' on feeling like they are more displined than they need to be.

Interesting topic.. not sure if there is an answer though!


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PostPosted: Sat Feb 06, 2016 1:45 pm 
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Like Dr J, I don't think u should feel guilty either. It is what it is and we have to be comfortable on our dose. I think 4mg is a pretty good dose honestly. U should be proud of urself for being low regardless if it's 2, 3 or 4, those are still good low doses. I understand what ur saying but looking at the big picture, ur doing great. We've guilt tripped ourselves enough throughout the yrs, now it's time to enjoy life free from cravings :)

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PostPosted: Sat Feb 06, 2016 6:03 pm 
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Thank you jennjenn you may have just solved my problem. It seems I'm not happy unless I'm down on myself for something, even before the opiate problem.

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PostPosted: Sat Feb 06, 2016 7:45 pm 
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Thanks very much for the replies everyone. I suppose it isn't a question that has a real answer... Except that I don't have much good reason to make myself feel guilty. I guess the guilt probably stems from the fear that I will continue to have to raise my dose until I get to 8mg or more, and I just want to be on as low a dose as possible. I know how hard it is to lower one's dose when you've been on the same amount for a long time, and so I don't want to get to the point of no return, so to speak. I can't see why I'd ever need to take more than 4mg/day, though, unless I had relapsed and my tolerance had ballooned back up. So it's my hope that 4 is the maximum for me.

BTW, I have a fast metabolism and have always had a naturally lower tolerance to all drugs than anyone else I've met. So even after 2.5 years of being on subs, I do get kind of a buzz, or a high sometimes, when I take my doses. Not every dose, but I would say every day, usually the first dose, I get that feeling. It's generally very energizing more than sedating, which is exactly how opiates always were for me, I might nod but I always stayed up all night doing various tasks. So I'm kind of an unusual case.

But this also relates to the fact that I am definitely still struggling with addiction, in the sense of seeking a high of some sort. If I were to not experience the mild high that I do, if I felt completely sober every day and doses had no mood-lift effect at all, as so many sub users attest to, then that would be difficult for me. I accept the fact that I may need to be on sub, or something like it, for the rest of my life; if it (as it does) makes my life better in every way, makes me not relapse and kill myself or ruin my life, then it's worth it... that's my way of thinking.

So I guess I shouldn't feel guilty about needing to take 4mg instead of 3, if that's what is needed to combat cravings and get me through the day. But I can't quite get the fear out of my head of "what if" -- what if I just keep going up and up? Just as I went up from 2 to 3 and then from 3 to 4. I only hope that that doesn't happen... and I kind of doubt it would. For one thing, taking more than 4 1mg doses a day would be very excessive for me in all but the most extreme cases -- even taking 4mg a day is more than necessary on many shorter and less stressful days.

One thing that I have noticed is that whenever I have the craving that I need to take my next dose, even though I know it's too soon, if I just keep myself occupied with something -- distracted, really -- I can make it an hour, or two or three+ and then be fine and ready to take it at the proper time. Kind of common sense but if you just get distracted on the internet or by anything really that holds your attention or amuses you, it kills the time and makes you forget you felt that craving in the first place.


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PostPosted: Mon Feb 08, 2016 4:43 am 
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Sounds like dose-creep. Any drug that creates tolerance and dependence invokes a need to take more. The effect is much more pronounced with methadone than Suboxone, but it's still there with Sub.

I wake up every morning experiencing mild withdrawal symptoms. I know if I increased my dose, this would provide a temporary solution. But eventually I'll likely suffer the same problem later on, and the same thing will happen. It's for this reason I only take 4mg and refrain from acting on the urge to take more.

Is there any reason you take multiple doses throughout the day instead of all at once?


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PostPosted: Mon Feb 08, 2016 5:00 pm 
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TeeJay wrote:
Sounds like dose-creep. Any drug that creates tolerance and dependence invokes a need to take more. The effect is much more pronounced with methadone than Suboxone, but it's still there with Sub.

I wake up every morning experiencing mild withdrawal symptoms. I know if I increased my dose, this would provide a temporary solution. But eventually I'll likely suffer the same problem later on, and the same thing will happen. It's for this reason I only take 4mg and refrain from acting on the urge to take more.

Is there any reason you take multiple doses throughout the day instead of all at once?

That makes sense. The thing is, I have basically always experienced a kind of mild withdrawal virtually every day since I've been taking suboxone. Really, it dates back to when I was using opiates, methadone in particular (I found it extremely recreational) -- I'd get this bad back pain in the morning which would typically fade away after 30-45 min and especially with movement, but which could be pretty bad sometimes. And so I still get this most days to some extent, sometimes with watery eyes too; and I feel that raising the dose, from 2 to 3 and then 3 to 4, hasn't really helped. It's pretty mild overall, though, so it's not a huge deal.

I just have a very fast metabolism, especially by now with sub, and so even if I took a relatively big dose like 4mg all at once in the morning, it wouldn't hold me all throughout the day. My 1mg doses typically hold me for 4-5 hours at most -- it's not that I get physical w/d after that, usually just that I start to feel anxious/irritable/depressed, until I take my next dose. So for me dosing 3 or 4 times a day is my preferred method, the only way I can really make sure I feel it the whole day. I may experiment with two 2mg doses/day instead of four 1mg doses/day sometime soon, though...


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PostPosted: Mon Feb 08, 2016 8:00 pm 
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For what it's worth... I didn't at all bat an eye upon reading you've gone from 3 mg to 4. I was more expecting, based on the title, you were going from 12 to 16 or something more like that. You are still at a pretty low dose.

Thing is, what did catch me was your dosing 4 times a day. To me that seems like a bigger red flag. You may very well need 4 mg but rarely does anyone need every 6 hour rising. Why do you think that you do? I do t want to guilt you in another direction but I'd say that is more important to look at not the modest mg increase.

Again, just for what it's worth


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PostPosted: Mon Feb 08, 2016 8:39 pm 
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Okay, so I fall into that weird territory. My first year started at 24 mg's and then worked my way down to 1 mg. Then I realized just how powerful this medication is. I got down to .50 and stabilized. Then if I took just .50 more to = 1 mg, I felt it. So it appeared to me that the lower I got the more potent it was. That didn't make any sense. Then I got sick and am now on a comfortable dose of 6 mg's and have been for 3 years. No desire to go up or down. If I need to stretch my meds because of a vacation, going down to 4 mg's means nothing. Then I go back up.

I keep waiting for that urge to stop the Bupe but don't ever get it.

We are all truly individuals.

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PostPosted: Tue Feb 09, 2016 1:56 am 
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donh wrote:
For what it's worth... I didn't at all bat an eye upon reading you've gone from 3 mg to 4. I was more expecting, based on the title, you were going from 12 to 16 or something more like that. You are still at a pretty low dose.

Thing is, what did catch me was your dosing 4 times a day. To me that seems like a bigger red flag. You may very well need 4 mg but rarely does anyone need every 6 hour rising. Why do you think that you do? I do t want to guilt you in another direction but I'd say that is more important to look at not the modest mg increase.

Again, just for what it's worth


Like I said in my last post, I have a fast metabolism and I often feel anxious/irritable/depressed or not fit to be out in the world exactly if it's been more then 4-5 hours since my last dose. It all depends on the dose and the day, though, and is pretty variable. But generally, the doses just don't hold me for nearly long enough so where I could take just one or two doses a day. I may see what it's like taking 2mg twice a day, but just from past experience it didn't hold me long enough. I will say though that on some days, shorter or less stressful days, 4 1mg doses does seem excessive and so on those days I may take 3 doses instead of 4.


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PostPosted: Wed Feb 10, 2016 8:12 pm 
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So on "less stressful days" the medication lasts longer? Does that suggest anything to you? It certainly makes me wonder even more if its not the med at all but how you believe you are feeling.

As for the fast metabolism thing, I have no doubt that is the case for some people and you may well be one of them. It just seems like so very many people have posted here that they are a fast metabolizer. How were you diagnosed with that? We're tests done? Did a physician diagnose that for you? Or is that self diagnosed? Again, I have no way of knowing. I just know a huge amount of people seem to think this is the case - far more than statistics would support. The mind is a very powerful thing. In the end, bup works the same for the great majority of patients.


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