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PostPosted: Sun Jan 08, 2017 11:33 am 
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Hey gang,

So I started at 32 mg's and now down to 8. I tried 6 for a couple days, then freaked myself out and scrambled back to perceived safety with a return to 8 mg. Which seems to be working well. I'm honestly not sure if there's any difference from the higher doses. I'm not even sure 6 was different. I sometimes wonder if i could just safely slide down to 4mg in three or four weeks, which I believe is where the ceiling effect begins.

I'm not going to do that as I'm not wanting to take any chances with my new found sobriety, but I still can't help wondering. But I think I probably could, if I felt emotionally ready that is.

My question, has anyone been on 8mg's for a while, then gone back up and noticed any difference? These things can be so subtle, and the mind is ever ready to play tricks (which I'm ever ready to fall for). So hard to tease out what's real.

My best guess is there's no major therapeutic difference between 8 and 24, but then again Dr. Junig writes that 16 mg is the safest dose in terms of preventing cravings. So obviously he thinks there is a difference. And if so, I'm not about to argue :shock:

Interested in any and all opinions...

Many thanks,
Godfrey


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PostPosted: Sun Jan 08, 2017 4:47 pm 
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Hey Godfrey! Good question and 8mg is my dose that I've been at for a while now. At 16mg I was good and later my doctor asked me to go down to 12mg. Later, I tapered myself, with his knowledge of course, to 8mg and that's where I've stayed. I'm very happy and content at 8.

Now there's times that I've tried 6mg. That's where my mind plays tricks on me....or I really feel kinda crappy and emotional. The ceiling level is supposedly between 4 and 6mg but who knows if it's different for each individual. There's ppl who can taper and say they felt easy breezy, and ppl like myself who swear that it effected them. I don't know why that is, could it be that ppl like myself just isn't emotionally ready yet? Could it be I'm not strong enough to deal with much of a drop yet? I don't know the answer, but I wanted u to know that when I've tried to go to 6mg, I become emotional and feel bad.....but I'll tell ya, I was that addict that worried over being sick constantly. I couldn't face the day if I didn't have my opiates that day. Some ppl could still work and stuff....not me, I was unfunctional. So I sometimes think that my personality and my sensitivity keeps me wanting to stay in my happy place. It scares me to death to think of tapering if I'm not ready to.

So I haven't went up past 8mg but I have tried to go below it and I wasn't ready to face the changes. I hope that helped u a little bit :)

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PostPosted: Sun Jan 08, 2017 5:14 pm 
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For me, and this is me, I believe the ceiling for most people is around 4mgs. Meaning that anytbing above it there are not real wd simptoms That is a sbort answer,but from all ive read here for years,4/8 mgs . is the zone.
The drop i made after about a year at 16mgs was down to 8. Over night. I felt much better and was ready for it. That is the key as you said Godfrey, gota want it or better, understand the med and how it works. You ve learned so much in a short time,hats off to you.
Also,after 6 months at 8 I dropped to 6mgs,stayed there over a year but then a bad stressor put back to 8. Silly because this ,was two yesrs ago.
Imo, if you want to get to 4mgs it could be a tad early. Thats up to you. Maybe change it up every other day or two day? 8 on monday, 6on tues. Etc.
There different ways to get there .
But that
was my experience.
I agree, Im 58 and have a concern that one day Ill need surgery, planed or worse unplanned.


Razor


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PostPosted: Sun Jan 08, 2017 5:36 pm 
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Hi Godfrey!

I can't remember any history you shared about your active addiction or your recovery. How long have you been on Sub maintenance?

I know everyone is different and everyone has different goals. In my opinion, (unless you're ONLY using Sub for short term detox purposes) I believe it's a good idea to NOT give yourself a timeline or to focus too much on what mg dosage you're taking.

For ME, it's always been about fixing/healing all the things I broke, ruined, made unhealthy while in active addiction....while simultaneously doing the really deep hard work of understanding why I began using in the first place. I've always felt that's the beauty of this medication....it gives us time to really grow and change.

I started out on a high dose of 32mg as well. I quickly reduced to 24mg. But, I went up & down as needed the first couple years due to "life".....family deaths, pregnancy, intense psychological therapy.
Over the past 7.5yrs I've been on Sub, I've tackled some pretty deep issues. I've reconnected and flourished many relationships & bonds. I've become MUCH stronger mentally, emotionally, and physically. And, I truly feel I'm currently the healthiest Ive ever been in my life...and that I become healthier and more fulfilled everyday.

I'm currently taking 3.5mg. Some of my reductions were very hard mentally. When I look back on them all, I'd say I didn't truly notice any "physical" difference until I reduced from 8-6. And, I can easily report that my reduction from 6-4 has been my most difficult.

It was never my choice to reduce. But, I'm happy I did. Although I'll never give myself an end date, I do now feel it's probably best to be on the lowest dose possible while still addressing your needs.
And, this is where my point comes in. I feel like it doesn't really matter what mg dose you're taking. The key is....is it WORKING for you. So many docs force their pts to reduce. And, I read about lots of people being shamed into reducing....or, feeling like tapering off (when you're truly not ready) is just the right thing to do. I think many of us quickly forget how miserable we were in active addiction and how close we came to death or jail.

Now I'm starting to feel like I'm rambling. For a long time, I was hung up worrying about my dosage. I remember being petrified to be under 8mg..because not taking a whole 8mg tablet felt so scary! When I began forgetting about the numbers and started focusing more on feeling healthy & strong....I believe lots of growth occurred.

Hope this helps in some way!!


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PostPosted: Sun Jan 08, 2017 6:19 pm 
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Wow, what thoughtful responses. Every one of them. Very very much appreciated. Marie, I'm a brand new babe in the woods with a grand total of 6 weeks under my belt (too many cliches in just one sentence, please forgive, :o

Razor, you've nailed my issue (there's another one), especially given that I'm 7 years older than you. It's all well and good to read Dr. Junig's suggestions about what to do if some sort of surgery becomes necessary. I trust him completely and have no doubt that cutting down to no more than 4 mg's will allow the opiate block to be displaced, but that assumes you're going to find a cooperative surgeon or anesthesiologist willing to move the decimal point when it comes to the amount of opiate to be given... which is an assumption I don't feel comfortable making.

And then there's emergency surgery, or some sort of accident. Life happens. Accidents happen, which is why
they're called that. You can't prevent them. When I first understood the ramification of daily buprenorphine, I was pretty close to horrified. "What? They won't be able to treat my pain if I need surgery or get cancer? Are you kidding me?'

It took me a couple more years to accept that it was just something i have no choice about. I tried weaning my way off the poppy tea many times, but of course ultimately found that impossible.

So now I'm juggling my two competing needs, first...always first, to stay sober, second to live with something close to peace of mind. If I'm getting no therapeutic value from the additional subs, or very small value, then it makes sense to just cut down to 4 and be done with it. At least then I've a fighting chance should some emergency come up.

And jenn, if you're still reading, I'm also something of a hypochondriac. Were I a decade or two younger i'd just chalk it up to that and tell myself to quit worrying. And for the most part I don't. But I do think of it from time to time, that's for sure!


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PostPosted: Sun Jan 08, 2017 6:45 pm 
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Uno,
I try remember that the professional s will do the right thing. But your so right that
when we get wheeled in there that the first few faces we see will make the right call with
understanding how Buprenorphine works. I see it as a 50/50 chance. So.....
where does that leave me? Having faith. I look at it this way too, Ive gotten this far in all of this mess,
why can't it not continue.? It has been proven and shone to me many times these past 6 years.

But ,ya...ya just hope the first doc knows the score on bupe!!


Razor


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PostPosted: Sun Jan 08, 2017 11:13 pm 
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The only difference I really notice on doses over 4mg (ie 4-8mg's) is that on doses below 8mg I do experience mild withdrawals when I wake up before I dose. The other notable difference is I start to experience some cravings edging their way into my consciousness, especially under periods of stress or illness, when I'm on doses 6mg and below.

I think the "ceiling dose" is so variable from person to person, and the first thing a person notices when their dose drops below the "ceiling effect" is that they might start to experience mild withdrawals as their dose wears off. This is usually around the 18-24 hour mark post-dose, when levels of buprenorphine / norbupe in the blood / plasma are at their lowest.

In my experience, 8mg is a good dose to be on for maintenance. It's so convenient. One strip. It's also a good dose to minimise side-effects while maintaining safe levels that keep cravings at bay.

Good luck!


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PostPosted: Mon Jan 09, 2017 1:17 am 
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Hey TJ,

Thanks for the reply.I was in a great deal of pain today, and finally gave in and took an additional 16 mg's even though I knew it wouldn't do much if anything for the pain in a direct sense. But perhaps it would get me feeling a little better, with a slightly more user friendly brain chemistry. Someone put up an
intersting post yesterday....was it Lilly?....about how bupe might well have a beneficial effect on stress hormones, which naturally increase as a consequence of pain.

All I can do is report what I felt. First I had a return of the nausea I'd experienced in the early days
of subs, before I adjusted to it. I'm not used to 24 mg's anymore (I"d had my daily 8 mg this morning.)
That passed after a couple of hours as I was lying on the bed trying to keep still, which helps a bit. Suddenly
the pain was a good 60-70 percent better. These headaches of mine pass gradually, most often overnight. So this was unusual

Whether it was a one time thing, or a placebo effect, or something I can do on an occasional basis going forward, I don't know. All I know for sure is I'm feeling much better right now. I even went down and had a
little food, which would have been the last thing I'd want to do a few hours ago.


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PostPosted: Mon Jan 09, 2017 6:16 am 
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Godfrey, the analgesic effect will be noticeable from much lower levels than 16 mg. 1 mg extra every few hours should suffice.

Amy

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PostPosted: Mon Jan 09, 2017 9:35 am 
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Amy[/quote]
Amy-Work In Progress wrote:
Godfrey, the analgesic effect will be noticeable from much lower levels than 16 mg. 1 mg extra every few hours should suffice.

Amy



Hi Amy,

I figured 8 mg is so far into ceiling effect, that I can't expect any analgesic effect
by increasing from that level.

Left open despite all these thoughtful responses...though I might have missed something....is the question
as to whether there's any perceptible increase at all in any beneficial effects bupe might have in terms of brain chemistry, to be had by moving up from 8 mg on an occasional basis. These possible beneficial effects in my mind would be in lessening depression and perhaps anxiety.

If the answer is not really, then I'm not clear why these higher doses,,,more than 8 say... are prescribed in the first place. Again though, Dr. Junig clearly states his belief that 16 mg is the safest dose for cravings protection.

I've pretty much decided to continue descending on down to 4 over the next month or two, leaving open the option of slowing down if I have any problems of course.


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PostPosted: Mon Jan 09, 2017 8:32 pm 
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I do not believe that science has provided the answer to that question. Part of the problem is that the study of pharmacokinetics, which includes absorption, distribution, metabolism and excretion of drugs, is complex and changes from individual to individual.

Amy

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

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