It is currently Tue Aug 22, 2017 5:05 pm



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 6 posts ] 
Author Message
PostPosted: Thu Jun 02, 2016 3:38 am 
Offline
Average Poster
Average Poster

Joined: Mon Aug 26, 2013 12:19 am
Posts: 16
hi all. i'm 20yrs old with a full time 40 hr job. i'm in recovery from opiate and benzo addiction. i've been on bupe (suboxone/zubsolv) since getting clean about three years ago. this past year i got addicted to xanax (6-10mg/day) after my anxiety went off the rails and it really screwed things up. i had to admit to a psych ward for detox for a week. i had to take three months off from work and completed two IOP programs during this time. during all this i was also tested for ADHD and turned out that i was ADHD combination type, which made a lot of sense when it came to the terrible anxiety and stress i was having before i got hooked on xan.

anyways, i've been back at work full time since january and have really been struggling with my current medication situation. i switched from ritalin IR to vyvanse (currently 70mg) because the ritalin while it calmed me down and provided great focus, caused terrible crashes. vyvanse has been less crashy, but the focus level is super low. i get better results from caffeine.. it's really frustrating because i cannot get in a groove at work. my current doc is a GP who also does suboxone treatment and is the one who suggested we try vyvanse. however, almost every month i've given him the same update: "doc this isn't working, not even at 70". he refuses to try something else because he says he feels that i should see a psychiatrist to solve this issue, as it is now out of his scope of expertise. i totally respect that and understand (even though he had no prob switching me from ritalin and also upping my vyvanse dose every month? hmm). but that's fine, if i have to find another psych or go back to my old one in order to fix this focus/attention deficit issue, that's what i'll do. even if it means i have to see two docs every month for awhile.

well, my first attempt at finding a psych to help with this issue was a complete failure and waste of time. i should have listened to all the bad reviews online. he was close to my house, younger, seemed sharp from the website and was a suboxone doc as well so i thought if he could help me with the focus issues i could just see him for all my meds. i had to sit on his wait list for a whole month before i got an appt. what a waste of time! i filled out four pages of psych history beforehand as well, which i don't think he looked at for more than 30 seconds..

this is how the appt went:
1. "i won't be prescribing any stimulants as you have a history of drug abuse. i would only prescribe strattera or wellbutrin for ADHD and that's after i test you again." ....WHAT THE HELL? yea i have a history of drug abuse, however it's very specific to DOWNERS... i've never been into abusing uppers, and the few times i did in high school all that resulted was a calmed down, better focused brain. not to mention i've been prescribed two different stimulants for the last 7 months and again, they have never pumped me up or given a sense of fun, speedy euphoria. the only issue is that i haven't had enough focus with vyvanse even at the highest dose and so i'd like to try other options. wellbutrin? don't insult me. i was given that for depression/anx in HS and it not only did NOT help but it increased my focus issues.. and strattera? i'm not saying i would never give it a chance, but i'd much rather try the many more proven and established drugs for ADHD before we go there. plus, i KNOW that ritalin calms me down and gives me great focus when it's active. to totally just dismiss all stimulants because i'm a recovering drug addict is so fucking annoying. anxiety and depression led to that addiction, and you know what greatly contributed to that anxiety/depression? my focus issues!! if i had known then that my racing thoughts could have been greatly helped by an ADHD med, i might not have had to quiet my brain with so many damn opiates. ugh. so this was the first piece of unpleasant nonsense i had to listen to after having hope that i'd receive some relief from this appt. that was the deal breaker right there as this was the main reason i came to see him. it obviously wasn't going to work out, but when we went over a couple other things he made sure that i would not trust or pay for his treatment.

2. "also i'd want to start you on a taper of your suboxone to get off it, you've been on it too long. you know it's just replacing one drug for another right? and then after you're off i would start you on naltrexone." :roll: is this guy REALLY an addiction doctor?! how does he have such a long wait list? is it full of people like me who think that they're gonna get help from this doc so they make an appt? i know there A LOT of addicts who are able to only use suboxone to detox and then get off of it and stay clean, and that's great. that's ideal. good for those people if that's what they want and it works for them. however there is another group of us addicts who would be miserable and hopeless from cravings/depression/anxiety without this medicine, or would be leading the same reckless and unhealthy lifestyle of using opiates every day without this medicine, or in a lot of addicts cases, dead from an overdose without this medicine. i cannot stand doctors who force patients who NEED daily maintenance doses to stay clean and healthy, to get completly off the drug due to their outdated and false belief that "it's just trading one drug for another". bullshit. this is DANGEROUS for patients and quite frankly sad to think there are doctors who have degrees in addiction medicine that convince their patients that they are not sober on suboxone and need to get off, and so they take them off of it and a week later the patient is dead from an overdose. sure that's the extreme possibility of doctors doing this, but i'm sure that it happens just like it does because of 12 step meetings. this kind of philosophy does not fall under addiction medicine, it falls under addiction pseudomedicine. sorry for the rant, but needed to get that off of my chest as it's been bothering me since the appt. you know what happened doc the last two times i was forced to get off? i relapsed each time and dropped hundreds of bucks on blues, morphine, even coke cause it was available and i just wanted drugs in my body. luckily i was able to get back on subs before it escalated. and i'm sorry, but for me, naltrexone doesn't do shit for cravings and the only somewhat benefit is that i wouldn't be able to get high. but since the cravings would be terrible, i'd stop the naltrexone long enough so that i COULD get high eventually.

3. "why are you on a benzo? we would need to get you off of that and i would up your prozac to cover your anxiety." sure, it's definitely not widely accepted in the addiction medicine world to prescribe patients a benzodiazepine for obvious reasons we all know. however, in my situation even with the past xanax abuse, it was agreed upon by my doctor and i that a low dose of a benzo (not xanax that is) dispensed by another member of the house who keeps it locked up would provide more pros in my situation than cons for now at least. we agreed that my xanax habit might not have gotten out of hand in the first place had my doc at the time been more open minded on this topic.. after months of about five different meds failing to work and the anxiety getting worse and worse, suicidal thoughts becoming more and more common, i gave in and asked him for a low dose benzo so i could calm down. after i was rejected multiple times, i irresponsibly took matters into my own hands and said to myself "fuck it then, i've tried everything to calm down, none of these meds work, if no one will help me legally and safely then i'll just have to get some relief on my own". anyways this was again a bad sign from this doc that he had not even heard the whole story about my prescription and anxiety and already had his mind made up that i shouldn't be on it no questions asked. i would understand if he said "if your GP continues that that's fine. i won't prescribe that, but i'm okay treating these other issues" but instead it was "that will be stopped regardless". AND i had already told him that the only reason i'm on prozac is because it was one of the drugs that was tried for anxiety and by the time i had given it enough time to take effect (and didn't help), i was on it long enough where i couldn't just stop it cold turkey so i've been stuck on it. i'm trying to get OFF of prozac as it has no benefit and nasty side effects, not up it even more. but like a lot of psychs, anti-depressants are the only answer for anxiety? not working? up the dose! i'm already at 40mg, i'm not going anywhere but down.

in conclusion, i told him on the spot that this wasn't going to work and he agreed. at least he was up front about his intentions so i didn't waste anymore time or money there. it's been a frustrating few months and i was hoping this appt would help. feeling somewhat hopeless about my situation. after last year being awful i set some big goals for 2016 regarding my health. the thing is, i can't start those medication goals until the ADHD med is figured out. it's too big of a problem that if i started on my other goals before it was fixed, i would end up way stressed out and in over my head.

my goals:
1. i'm currently on 16mg/day of suboxone, and i would really like to get back down to 2-4mg/day because i felt much better with that dose range. only reason it's so high now is during the xanax binge, i was also upping my dose for sub... causing me to become stuck here after my doc upped the dose himself since i was running out early and he perceived that as "oh, you must need more, 2mg isn't helping your cravings." of course at the time i didn't object. now i wish i had.

2. like i mentioned before, i want to taper off prozac completely. it was prescribed for anxiety which it does not help. instead anxiety is it's main side effect it has on me so i'd be much better without it. the less medicine the better. it's the second time in my life i've been on it and both times it was unsuccessful. same with the 10+ other anti-depressants/psychotics that doctors have given me over the yrs for anxiety.

3. and again the goal that i need to complete before i'm able to do the above: find the right medicine, dose and formulation of adhd med that will control my attention deficit which will in turn reduce my anxiety and depression which will, along with therapy and all the other coping skills i've learned, allow me to once again thrive at work and enjoy life

it felt good to write all of this down and also get a rant in about that doctor. i don't think he was a bad guy... but i do think he was very close minded and had a "i'm a doctor, you're an addict." vibe. very little bedside manner. ok, i'm just rambling now.. any suggestions, tips, experiences you can share with me? anyone have stories of how they weren't happy with their current medication regime and was able to improve it? it'd be cool to hear personal experiences with this, i think it would give me more optimism/motivation that it'll get better if i keep trying. thanks for reading... good vibes to all


Top
 Profile  
 
PostPosted: Thu Jun 02, 2016 10:51 am 
Offline
Moderator
Moderator
User avatar

Joined: Mon Sep 15, 2014 7:15 pm
Posts: 2313
Location: Tennessee
Hey Subisamiracle (which it definitely is a miracle to me too btw)

I don't have any experience with adhd so I don't know what to advise u on that. I do have experience with my sub Dr not understanding my anxiety though. I was on paxil for 10 yrs before I just up and stopped it during active addiction. I felt like I needed to continue it and last yr I asked my dr about it. Basically I was told that life is hard and addicts are used to focusing too much on feelings and yada yada yada. Honestly though it made sense lol so I just said ok and left it alone. I still think I need it though but ok. I guess what I'm saying is, we can't force anyone to understand and u definitely have a complicated situation going on that needs to be addressed but by the right doctor. Don't give up, keep looking. Weed out the one's that don't feel comfortable dealing with addicts and adhd. You'll find one, it just may take time. The one that told u suboxone is replacing a drug with a drug.....that'd been all I needed to hear right there lol I would've politely got up, pushed my chair in and walked out. Evidently some doctors see an addict coming through the door and alarms and sirens go off lol they're uncomfortable I guess, but this guy was a sub dr? U did good by leaving. It would have made me really mad.

My advice is, don't give up. Keep searching through doctors until u finally find the right one to help u. I couldn't imagine how difficult it'd be needing treatment for a condition and because of being an addict, it's tricky. Please keep us updated.

_________________
Jennifer


Top
 Profile  
 
PostPosted: Thu Jun 02, 2016 11:04 am 
Offline
Long Time Member
Long Time Member

Joined: Sun Feb 14, 2016 9:40 pm
Posts: 630
Hey, Sub,

Welcome here! Welcome! This will be brief as I am en route out the door but wanted to respond and say hi and ask a couple questions. More will come along! You provided lots of good info and I'm trying to catch it all.

First, I honor all your hard work you did to get on bup and Xanax detox work to taper down/off?

Sounds like you know bup is a good long term drug and per your history of 2 relapses after prior stops, bup is a good long term med for you. At 16 mg, it may be more than you need but its only harm might be in the pocket book. I'd set that one aside for now. On the Psyche MD, just plain wrong on bup. Ached when I read that part.

So you restarted a benzo? And a family/friend controls it for you? On benzo and bup combo, yep many will not prescribe both. Mostly bc the benzo dose escalates due to tolerance and becomes an addiction. Vyvance 70mg? Curious why a benzo to calm and then a stimulant also? On your Psyche saying no stimulants w drug abuse, yes, I've heard that here before. Bc you abused one drug they may assume you might another even tho its in a different drug category. Prozac 40mg? I know that really helped my anxiety when I was on it.

I agree w your GP that you need someone w expertise in polypharmacy. Sorry your consult did not work out. It can take visits w different Psyches to find a good fit for you. Wishing you my best, P

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Top
 Profile  
 
Our Sponsors
PostPosted: Thu Jun 02, 2016 2:22 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1544
You've had some bad advice from docs. You will likely disagree with some of my comments, but I can assure you that they are 'medical mainstream' and consistent with the science as we know it....

Don't get angry, because you have paid nothing for this advice-- and I don't even know you!!

1. Prozac (fluoxetine) has a VERY long halflife, and is often used to get people off other SSRI's. If a person is stuck on Paxil, which has the shortest SSRI halflife, you can simply put the person on fluoxetine for a couple days, stop the Paxil, and after a couple weeks stop the fluoxetine. It tapers itself off over a month or two. A person COULD just stop at 40 mg, and the fluoxetine would be gone after a couple months.... but I usually have them reduce to 20 mg for a couple weeks and THEN stop it. But honest, there should be no withdrawal. It leaves the body VERY slowly.
2. Maybe you have ADD. Maybe not. It can be very difficult to sort out anxiety from ADD, as both cause the person to feel overwhelmed, with racing thoughts, difficulty getting started, a desire to isolate, etc. Realize that ADD 'testing' consists of self-identified symptoms. Most patients answer 'yes' to the questions in any ADD scale. Who doesn't lose things sometimes? Who doesn't procrastinate large tasks? Who doesn't start something and then start something else before finishing the first thing? ADD-type 'symptoms' are sometimes engrained bad habits, or bad practice.
3. If you do have a problem with your frontal lobe function that interferes with concentration, a benzo is the worst thing you can take. If benzos HELP, I can't imagine how you can have ADD. Benzos WORK by blocking-- guess what?-- attention, memory, and focus. That is what they DO, and how they reduce anxiety. You get midazolam, a benzo, before surgery, and that's the last thing you remember-- even though you talk with the nurses and anesthesiologist in the OR as they get you prepped for surgery. People on a benzo for more than a month or two become tolerant to ALL of the effects of the benzo, so they aren't impairing memory OR treating anxiety beyond that point. The person usually THINKS they are still working, because of the withdrawal and rebound-anxiety that occurs from stopping them. Read my comments about that issue here:http://patienttimes.com/twelve-problems-with-benzodiazepines/
4. Stimulants and benzos are exact opposites. Uppers and downers. One increases concentration, the other blocks concentration. One sedates, one activates. The main side effect of stimulants? Anxiety. The main side effect of benzos? Impaired cognitive function. So from a neurochemical perspective, you cannot be on BOTH at the same time and expect either to be very useful. Some people try to be on one, then the other, then back to the first.... but the long half-life of even short-acting benzos make that impossible. When good doctors see the chart of a patient on a stimulant and a benzo at the same time, they all think the same thing: 'this patient's doc is an idiot'.
5. Vyvanse consists of amphetamine. The lysine attached to the amphetamine inactivates it until it is in the bloodstream.... but the only active drug in Vyvanse is the same as what's in Adderall (Adderall also contains a second isomer of amphetamine, but the difference is very minor). Vyvanse is a GREAT med... but GP docs often use too little of it. This is important so I'll do this *********... Vyvanse is over 50% lysine by weight. So 70 mg of Vyvanse is equal to about 30 mg of Adderall. But remember that the 30 mg of Adderall is spread over 4 hours, and the 30 mg of amphetamine in Vyvanse is spread over 12 hours. All of this must be taken into account. But you cannot simply replace 30 mg of Adderall with 30 mg of Vyvanse. Many patients take 70 mg of Vyvanse and supplement with Adderall. The max FDA dose of amphetamine for ADD is 40 mg, which would require at least 85-90 mg of Vyvanse. And many adults take more than the maximum recommended FDA dose.
6. All of us who have suffered addictions struggle with life on life's terms, at least at some times. We all want things in our heads to calm down, and we all want to feel more confident and more 'normal'. ALL medications have side effects, and the body was designed over millions of years to work 'as is'. For anxiety, the best outcomes are produced by the hard work of living with emotions and learning from our mistakes. Sometimes that is not possible... but understand the downsides to meds for anxiety. For example, taking a benzo robs the person of the good feeling one gets from tolerating something new and challenging. Again, I can't speak to where your symptoms fall. And if you are on a benzo, it is EXTREMELY difficult to get off benzos and then learn to live without them. But realize that benzos have the same tolerance problem as pain pills.... so you will always be either raising the dose, or taking a med just to keep up with your tolerance.

Just like with pain pills, benzos are SO seductive.... they make us carefree about the most pressing problems for a few days... but there is no way on Earth to make the happen every day, because of tolerance. Good doctors know that-- and struggle to provide anxiety relief without allowing their patients to become trapped. For that reason, the outcome will ALWAYS be imperfect.


Top
 Profile  
 
PostPosted: Thu Jun 02, 2016 5:24 pm 
Offline
Long Time Member
Long Time Member

Joined: Sun Feb 14, 2016 9:40 pm
Posts: 630
Wow Dr. J, freaking amazing post on meds and interactions. P

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Top
 Profile  
 
PostPosted: Fri Jun 03, 2016 4:29 pm 
Offline
Moderator
Moderator

Joined: Fri May 01, 2015 9:58 am
Posts: 882
Pelican, I could not agree more! One of my first questions was going to be how the testing for ADD and/or ADHD was done? I am only aware of the questionnare type testing unless you have a cat scan or pet scan of brain activity which I have heard of people having done but again not a real reliable source as it can detect the activity but not the real cause of it! With that being said, Dr. Js post is factual and to the point. Thank you Dr. J. for your response! I learned so much!


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 6 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 0 guests


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

 
Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

Powered by phpBB® Forum Software © phpBB Group