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PostPosted: Tue Dec 08, 2009 10:11 pm 
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Hello Everyone,

I am REALLLLLLY freaking out here. I just started on Suboxone on Thanksgiving day - TODAY is only day 13!

I went to my doctor for my two week follow-up after taking 24mg for the past 13 days. He said I'm doing well and I'm ready for a taper.... are you ready for this..... down to 6mg per day! :shock: A drop from 24mg to 6mg after only 13 days?!?! AND he said when I come back in two weeks, he is dropping me to 3mg per day. :shock:

I was taking oxy's for three years and was up to 130mg per day.... does that make a difference? I don't know...

I'm sorry but I'm freaking out. Isn't that too fast? He doesn't see me on Suboxone treatment for more than maybe two months tops. I don't know what to do. I don't think this is going to work. There's no way! I'm so upset. I was literally speechless when he told me this and my mind went crazy with a bajillion questions and the only thing that came out of my mouth was "Won't I get sick dropping this fast and low?" and he said "No, but I'm going to give you Buspar for anxiety." I wanted to cry... I don't know why really other than I am just scared out of my mind and I'm paying a fortune for this treatment and I just feel like I'm being rushed into getting sick anyway and I'm terrified if we rush through the treatment that I will end up failing in the end and more than anything in this world I don't want to fail!

Somebody talk me down out of the rafters - tell me it's going to be ok or tell me what is really going to happen - just be straight with me. Isn't an 18mg drop a bit tooooo much? Should I be looking for another doctor?

Thanks all,
OxyFreeAngel


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PostPosted: Wed Dec 09, 2009 2:51 am 
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I'm in a similar situation as yourself, but not because of my doc. My doc wants me taking three 8mg subs a day. 24mg a day. But not only can I not afford that much suboxone, I just plain don't want to be on that much, plus I don't really see the point, being that there is a ceiling on suboxone.

I started suboxone the saturday after thanksgiving. That puts me at 10 days strong! Like I said, I started at 24mg for the first 4 days or so, then dropped down to about 8-12 for a few days, then right down to 4-6mg. I've been taking 4mg for the past few days and have felt fine, not a *wink* of WD. Today I took 8mg, which is probably more than I need, but I was getting some serious cravings and it can be scary.

If you are wondering, my history isn't far off from yours. I used oxys, till I got up into the 200mg+ daily range (then I couldn't afford em anymore), so I moved on to heroin, and finally to methadone, and was on about 50mg methadone for the last few months on my 2 year stint (after being sober for 2 and using for 3 previous).

Suboxone is a EXTREMELY interesting drug. Personally, I find faaar too many people are taking faaar too large amounts of suboxone. It is unnecessary. If you do some researching (as I have done tons, always do when it comes to drugs) you will find that many people on suboxone state that "less is more". And from my limited experience with the drug, I have to agree, it seems to me that the dose range of 2mg-8mg is FAR more effective than that of the 12mg-32mg. I don't know, just been my experience and many others.

I honestly don't expect you to have any withrawals, had you been on the 24mg dose of suboxone for a few months, then you would have reason to worry, the fact that you have been on suboxone such a short time is a good thing, this means your body hasn't grown accustom to it, and therefore addicted to it yet. I say, get your dose low while you can, because the longer you wait to drop, the harder it will be. I wish my doc was as quick to get me off this stuff as yours. Seems from talking to other patients this doc has no intentions of getting anyone off, ever. That is something you have to do on your own.

Anyways, I hope I helped somewhat. It's late... so I might have rambled a bit more than needed. Please let me know how you do, if you experience any physical withdrawals.

PS 13 days should've been more than enough to get ALL of the oxy WD over and done with. You should have no fear of WD from that anymore (oxy is a very short acting opiod). You've only been on suboxone 13 days, not long enough to form any sort of a serious dependence. Relax, I'm sure you will be fine. :D


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PostPosted: Wed Dec 09, 2009 1:19 pm 
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Hi OxyFreeAngel -

I understand your concerns! I was on at least 100mg's a day of oxy. It grew from lortab's/codiene 7-8 years ago to 100+mg's a day of oxy.

I am on 12 mg's of sub now - ready to go to 8mg soon. I went on just before thanksgiving and the doctor right before thanksgiving talked similar to yours, that we'll begin a taper after Christmas.

I think from a purely 'physical' position, you'll be fine. That is, if you look at this from your - opiate receptors - you will be fine. What I am concerned for you is how you are handling the other issues that trigger your use?

Here's what I mean. First, relax - as I think you'll handle the decrease of Suboxone - with the ceiling effect. Ensure that you do the best method (read through the forum) for sub-lingual absorption with your dose.

Did your doctor set you up with other support mechanisms? I mean you are here on this forum, but do you have a counselor, or are you a member of a 12 step program or any help for the non-physical things?

Let's face it. Unless this is your first attempt to get 'clean' (? maybe ?) then you know what happens if you get you opiate receptors free. You get cravings - typically (for me - and my opinion here only) - they are triggered by events or stress. I need more time to both taper and to deal with alternative ways to handle stress.

I don't know about you, but if I don't learn/change me..... then the bottom line is that when I'm clean from w/d's (regardless of sub or not) - then I'll return to the lie of oxy... and back on the merry-go-around.

I would encourage you to talk very candidly with your doctor about your support. Talk about getting help for a relapse. Talk about timing those with the taper. If the doctor isn't willing to work with you with your support system - then I wish you well - maybe you can do it - but it sounds like you don't feel like you will. That's a bad place to be.

Hope this helps some. Physically I don't think you'll get really sick. Remember the drug has 30+ hour half life, so it takes a while to level out as you go down. It also doesn't work like full agonist opiates (oxy, heroin, etc.) - it stops its opiate effects - and more than that level (different for each person based on absorption rate) will not make an difference. That is probably around 4 mg's maybe less if absorbed properly. I think suboxdoc has a youtube about the ceiling effect of suboxone - good to watch.

Best wishes - I think you can do it - I personally believe our health care is as good as you participate in - and ask questions, and work through your issues. Otherwise it's like a drunk-tank. Just get sober'd up and later - can't wait for the next drink.

BEST TO YOU! Please keep us posted.


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 Post subject: A few thoughts
PostPosted: Wed Dec 09, 2009 3:53 pm 
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In reading through this thread, a few thoughts came to mind that perhaps will be helpful to others.

1. I see so many people that seem to be afraid of their doctors. That is not a good situation to be in and not healthy any way you look at it. Your doctor should be your partner in your care. He should not be the enemy. Now, I fully understand that there are all "grades" of doctors out there. Refer to the old joke that asks "What do they call the guy who graduates last in his class in medical school?" ANSWER: They call him "Doctor" Keep in mind that it is very much your responsibility to do all that you can to hold up your end of the partnership. I understand getting taken by surprise in the doctor's office, but if your doctor is suggesting things that you either don't agree with or just don't understand, ASK - TALK - SPEAK! Tell him/her of your concerns. Ask questions. Negotiate a different course. Don't get pushed into stopping, starting, dropping, increasing, etc. with any medicine without at least understanding or hopefully agreeing. If nothing else, ask what "plan B" is if you encounter problems dropping your dose. It's great to try to get help on boards like these, but much of everything that you said here, should have been said to your doctor. I'm not at all beating you up here. Just give it some thought and perhaps also think about you and your doctor being the best TEAM that you can be in helping to fix YOU.

2. I also see a lot of people speak of Suboxone withdrawal or dependence as if your body has the capacity to sense the specific drug "Suboxone". By this I mean, people who are fully dependent on opiates somehow believe that Suboxone is a whole other dependence or somehow your body develops a special addiction or dependence to Percocet separate from Vicodin separate from Suboxone. That is not at all true. When your body is SCREAMING for opiates, it does not care and cannot tell one from the other. The fact that you are having your drug of choice replaced by Sub does not mean that your body knows this. Very true each drug has different strenghts, half life's, etc. But all of them simply hit the receptors and your body responds in kind. In other words, you body will not develop any sort of special connection or bond to Sub. The bottom line of all of this is your body is dependent on opiates - plain and simple. Any of the various forms present in your system will (should) keep you from going into withdrawals. They each have their own characteristics for getting you high, etc. They all have their dose range, time spent active in the body, etc. They all differ in these respects. However, they are all the same when it comes to stopping the process of you getting sick due to lack of their presence in your system. So long as you have some form of opiate in your bloodstream, in the required dose (according to your body) you will not get sick from withdrawal.

Hope that helps.


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PostPosted: Wed Dec 09, 2009 5:39 pm 
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I agree with donh regarding the opiate receptor point of view. OxyFreeAngel, though, you really do need to be engaging with your doctor about this.

Anyone who reads this really needs to understand what donh is saying about the receptor end. The only danger in looking at it clinically like this - is that often we addicts tend to minimize our cravings, and using of opiates to deal with problems, stress, etc.

I have been 'clean' before by brute force / cold turkey. I failed. I relapsed. If it was as easy as clinically getting my opiate receptor empty and everything was normal - many of us here on the forum would be clean. It's not that easy. Our body chemistry and brain have changed due to our usage. It will never return 100% back to the way it was before we took an opiate. Some of us can learn and change and live chemical free over time, and some may find they need to be on a maintenance dose of suboxone for their life. As long as we all find peace in our lives, there should be no judgment that one way is better than another.

The reality is that this is a disease. We can learn to control the disease with tools. Suboxone for some may be a long term answer, and others may be able to change their responses to stresses, and triggers with behavior modification and use Suboxone to feel 'normal' why they change and learn.

Suboxone is a partial-agonist opiate - and has other chemicals to avoid abuse. Suboxone typically doesn't give the same feeling to a person as did their drug of choice. It also doesn't seem to need MORE AND MORE to keep you feeling OK. In that area, it is unique.

Back to your original issues. I pray you can ask your doctor to TEAM up with you as donh suggests. Please use those words - or similar. Address that you feel your support - outside of medicine (sub) - needs time to be established. You can taper and build that support - but if you don't do both - .... well best of luck to you - I can't myself, that is why I am here.

My doctor did not do everything by the book. I listened to suboxdoc, the pharm company video/brochure, etc. I did not get induced at the office. I did not get a variable dose. He said - here, 12 mg should be enough for now, see you in a week. I talked to him and we made a plan within that scope and I'm OK with it. I'll shoulder my responsibilities to get help - if he will help me with the medical end. ONLY because we talked about it.

I wish that for you as well! Please keep us posted, and we are here to support you in your treatment.


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PostPosted: Sun Dec 13, 2009 1:35 am 
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So I called the doctor's office to let them know that this dose was not working for me and I felt that the drop was too much too quick - I needed to speak with or see the doctor...

The woman on the phone asked my name and pulled up my records. She could see where I was prescribed 24mg per day for two weeks and then dropped to 6mg per day for the next two weeks...as she repeated to me over the phone... followed with "So what seems to be the problem, I'm one of the providers here - I just so happened to answer the phone because the front desk staff is busy" I explained that I was back to having symptoms, such as crawling skin, heart pounding, cramps, and worst of all CRAVINGS.

AND SHE SAID "Well you should consider yourself lucky because normally, the dr just gives you the lowest dose possible for two weeks then you are on your own." WTF!?!

I could not BELIEVE the way she was treating me! I explained to her that NO ONE was forcing me to do this - I don't HAVE to do this - A medical condition put me on pain medication and I can KEEP on taking it if I want to - I CHOSE to do this and I chose to do it in a HUMANE manner and avoid illness and suffering and THAT was why I was willing to PAY out the rear end to hire this doctor to provide that care.

She asked me what my symptoms were again and I repeated it. She said "Well I see he prescribed Buspar for you - aren't you taking it?" I said "No, I have not had any anxiety attacks, therefore I haven't taken it" She said "Well, you need to take that medication because it will get you through this hard part" I said "Get me through it or knock me out through it?" She said "It won't knock you out" I said "Ok, I would really like to talk to the doctor. Can you please give him the message to call me so I can discuss this with him?" She said "Well, I can let him know that you called but he isn't going to call you back - at best you can come in to be seen but that won't be until tuesday or later." I shut down at that point. I was D-O-N-E! I said "Ok. bye"

NO F-ing way is this Dr getting another penny of my money. What a scam. I had the protocol right in front of me. I know what this doctor is NOT doing that he SHOULD be doing. I know what he SHOULD have learned in the training to be certified to prescribe/dispense this medication.... and he AIN'T doin' it! I read the printouts they gave me from my appts. They said he checked my vitals, felt my abdomin, all kinds of physical exam elements were conducted on that paper - they have not touched me one single time! They have not checked ANYTHING. I am SO DONE with this guy.

I called the Carol Porto Center, which was where I originally wanted to go - the first people that I spoke to - the people who referred me to this site. They were wonderful. I misunderstood them - the inpatient treatment had a waiting list, the outpatient did not. My "induction" appt is with the Porto Center on Tuesday, although my appt won't be quite as long or involved as a real induction, since I am already on the medication and transferring my care. BUT I'm so impressed with this place because they seem to care about the WHOLE person.

They care about your job and family. They care about your state of mind.... heart, body, soul.... Mind..... the complete person. With this place, I get time with the medic for medical evaluation, time with a counselor, education through various tools, DVDs, literature, booklets, and group therapy with other suboxone patients such as myself - all in addition to seeing the Dr. there. And it's $55.00 cheaper per visit and closer to home!!

And the lady I spoke to at the Porto center was very well versed in the proper protocol... the need for stabilization, maintenance, taper, healing....all without judgment ..... with a very caring attitude and tone. THIS is what I expected and more.

So I'm not freaking out anymore. In fact, I feel relieved and much safer. I have really really struggled with the cravings since my dose dropped to 6mg and those cravings were so intense that I took extra money out of the bank "just in case" - my mind was already setting me up for the fall or bail out or whatever you want to call it. I haven't fallen yet - I'm holding on... and knowing that I just have to get to Tuesday helps maintain my focus and gives me enough hope to NOT give in and fail for right now.

Hugs to all,
OxyFreeAngel


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 Post subject: Great to hear
PostPosted: Sun Dec 13, 2009 6:45 pm 
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It's great to hear that you were able to make some changes with what's going on. It is really amazing - and very, very sad - how many people seem to be treated like you have been. I won't even go into all of the potential reasons and how busted our healthcare system is. What I will say is in my opinion you have done exactly what has to be done - and what more people need to do. And that is grab control of THEIR healthcare and get what is needed. Regardless if it is addiction or high blood pressure, a partnership has to be formed with the treating physician. If he or she puts you on blood pressure medication that causes a whole host of other problems, something needs to be done. The type of medication, dose, or whatever needs to be altered. That is absolutely no different than the dose of Suboxone when treating addiction.

It sounds like you found a provider where the "culture" of the treatment center was not what is should have been. By that I mean that it sounds like the people that work there have developed a certain mind-set or "culture" of how they treat people and operate. You seemingly have now found a place with a much better "culture" in place. I'm betting you'll find things much better at the new place. I can tell you that I pretty much went through the same thing going from a doctor that left me in withdrawals for nearly 72 hours before giving me my first dose - which then pretty much put me to sleep. He didn't seem to care that the prescribing best practices said I should be in mild to moderate withdrawals for 12-24 hours and then get 2 mg or at most 4 mg at a time for a total of 8 mg for the day. He treated everyone the same regardless of their history, etc. and blasted me with 16 mg in the first 24 hours - after I had been through hell for nearly 72. I now have a doctor who is awesome along with a staff who is wonderful - including doing whatever they had to in order to get me in before running out of Suboxone and then treating me wonderfully once I was there.

Be proud for standing up for yourself. It has to be done. Hopefully others on the board will learn from this thread and have it help them in their lives as well. You and your doctor HAVE TO BE PARTNERS in your treatment. Please let us know how things go on Tuesday. And in the meantime, did you get enough Suboxone that you can take more than 6mg a day for the next two days? It would seem to me that regardless of what you have been prescribed, if you have enough pills, you really do need to take more than 6 mg and that's exactly what's going to happen on Tuesday. If you have it - take it. If not, just hang in there the best that you can until Tuesday.


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PostPosted: Mon Dec 14, 2009 1:09 am 
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Thanks Donh. I do have enough to last me to Tuesday. The new place did ask me if I had enough when I was on the phone with them. I think they would have given me enough to cover the time till my appointment if I had told them I didn't have enough. The first doctor gave me enough to take 6mg per day for two weeks. I've got myself down to about 12mg per day comfortably (which is half the dose I was on starting out).

I've certainly learned a few valuable lessons in all of this. One is that there are two different environments. One that is conducive to change and healing, and one that is not - and it all comes down to culture as you describe. It would have been nice to know how the first doctor actually perceived the patients in need of suboxone treatment beforehand. I felt like a bad person, unworthy of help, deserving of the punishment of paying such a high fee, deserving of being told that it didn't matter how miserable I was - I brought this on myself, right? Yeah, I deserve to be treated like a hoodlum, right? Yeah, I'm lucky to find someone to take my money at all, right? Pssssshhhtt!!! I think NOT. ABSOLUTELY NOT.

I didn't plan on having four back to back surgeries or living with a lifelong painful condition. My preference would be to go back to living in my pre-surgical state of health. But I don't get that option. I didn't plan to be prescribed opiate pain killers for over three years. I certainly didn't plan to become physically dependent on them. Never in a million YEARs would I have thought something like that would happen to me. I am a wife, a mother, a professional, and a God fearing woman. I have a home, cars, boats, etc... I am not a destitute and my husband and I worked hard and honestly to earn all of it. I volunteer to help others and I donate whenever I can. I am a good person. I am an educated person. Certainly not the "scourge" doctor #1 would like to believe or would like make me believe.

As the saying goes, "If it happened to me, it can happen to anyone." It's true. I get annoyed with the prejudice. When a person seeks help for addiction, the last thing they need to meet with is prejudice.

I'd like to tell the world: "Give this person some credit for realizing they need help. Give them credit for having the strength and wisdom to seek help. Understand that there are underlying reason's for this person's condition. Reasons that they had to take the medication and reasons why they could not stop. Understand that not everything in life is controlled simply by flipping a switch in the brain. Suddenly stop your heart medication and see what happens. Suddenly stop your blood pressure medication and see what happens. Suddenly stop your insulin and see what happens. Suddenly stop with many medications, and the body is going to react. Look at the intent of this person: they don't want to live this way anymore! Give them some credit for that!" and "Don't you know the damage you can do to a person who is desperately seeking help with a condition that they are ashamed of?" "Do you not know how hard it is to speak about having this condition that they are so ashamed of - just to get the words out at all?! Do you know that the emotional toil of being so ashamed of one's self has led to suicides? Do you know that your words and attitude towards this person are often critical to the path that person's life will follow when they leave the conversation that you are having with them right now? Will they live? Or are they now so ashamed and feeling so worthless, that they feel they need to relieve the world the burden of their existence? Or are they so ashamed now they can no longer face the world? How would you want to be treated if it were you?" There's a lot I wish I could say to the world on this topic... for what it's worth anyway.

My first doctor (the one that prompted my original post here) didn't induct me according to protocol either. I went into the office in full blown withdrawal after not taking oxycodone for the previous 9+ hours. I was completely miserable and obvious. I thought he would give it to me in the office. Even the contract I signed said that it would be. Instead, the Doctor's assistant took me in the back and entered all my questionnaire answers into the computer. Then the doctor came in and scrolled through the questionnaire. He then asked me to verify the amount of oxycodone I had been taking and how long. He never touched me or examined me or collected any specimens from me. He wrote out a prescription for 24mg of Suboxone per day for two weeks. I asked if I should run up the street to get it filled and come back for the initial dose and he told me "No. Don't take it until tomorrow morning, 12 hours after your last dose of oxycodone." I said "By the time I get back here from the pharmacy, it will have been 12 hours." He said "No I want you to start in the morning. You will be fine. Here's a script for Buspar in case you have anxiety."

By the time I left that appointment, I was so frustrated and angry about the way it went, miserable in withdrawal and desperation. I went straight to my car, poured myself a fistful of oxycodones, chewed them up like chocolate chip cookies, and swallowed them on down the hatch. I have analyzed that single action every single day since. WHY did I do that? I could have started on the Suboxone that night. The only thing stopping me at that point, was another man's words. (Later that evening I learned I couldn't pick up the medicine that night anyway - it would take two days of phone calls to get it authorized since it was more than 16mg per day - but I didn't know that at the time of shoving those pills down my throat). Each time I've looked back on doing that, curious about the mentality behind it, I come up with the same answer. Complete desperation. In a way, it was like screaming out "If you don't want to help me today, neither do I! To hell with all of it!" It was an act of giving up. Senseless looking back because I had the help, just not when and how I needed it. Is desperation really that finicky? I don't know. I do know that within 20 minutes I felt healed, normal, and complete ashamed of myself. This is how I know I need more than a "script man." I need all of the other tools to heal me, the WHOLE me.

I'm really looking forward to Tuesday. I'm looking forward to the counseling, the group therapy, the education and discussing everything with the doctor. I didn't realize how spoiled I had become with our own family doctor. I've gone to our family doctor for years and can discuss anything with her. She does work with me, talk with me about all options, gives me a say, listens to my input. It's a great relationship. She has known for months about my desire to get off the pain medication. She expressed some concern about the timing in the beginning, only because I was having some physical problems and a lot of testing being done. We agreed to wait a couple of months to get passed all of that and we did. When the subject came back up, we discussed replacing this pain medicine with something non-narcotic. She agreed that it was a good plan but she admitted that there's a plethora of alternatives out there that she doesn't know anything about because pain management is a specialty of hers. I appreciate her honesty and respect her for telling me so. She gave me a list of names to call - all pain specialists. I have not gone down the entire list. The more I thought of it, the more I thought I should get off all pain medicine and after doing so, re-evaluate the need for taking it at all! Perhaps my abdominal pain at this point, was merely a fallout of not having oxycodone - ironic because it's the very thing that caused me to take oxycodone in the first place. I discussed this with her and she agreed that it is possible and warned me that there would be no pain relief in the Suboxone treatment, and let me know that she was not able to dispense it due to not completing the training. She gave me a few names to get started and off I went. I plan to follow up with her in a few weeks and I will definitely let her know what I've learned along the way. Hopefully, my experience will save someone else a little aggravation and disappointment.

It's helpful to have support of any kind. Online support groups such as this one are wonderful and the reason I haven't repeated my behavior in the car the day of my first appointment.

OxyFreeAngel


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