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 Post subject: My Girlfriends induction
PostPosted: Mon Dec 13, 2010 3:52 pm 
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So my girlfriend started taking suboxone yesterday. She is coming off of heroin and has a pretty high tolerance for opiates. She waited until she was in mild withdrawal, or so she thought. She went into precipitated withdrawal and wants to know what to do. Some message boards said to take more sub until she levels out but reading what Dr. junig wrote she has to wait it out. What do I tell her? Rapid response would be very appreciated.


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PostPosted: Mon Dec 13, 2010 3:59 pm 
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I would NOT suggest taking more. Wait it out, as Dr. Junig recommends. I have a friend that went through the same thing and she took that very bad advice of taking more until she felt better. She didn't feel better and was sick for a while! So I would suggest waiting it out and then trying to induce again later. Has she contacted her sub doctor (I'm assuming she has one)? S/he should be able to advise your friend.

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PostPosted: Mon Dec 13, 2010 4:06 pm 
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She does have a doctor but he is out of town. So she just took 12 mgs about an hour and a half ago. when should she dose again? Thank you very much for the reply, she is sick and is understandably irritable.


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PostPosted: Mon Dec 13, 2010 4:20 pm 
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Man, what a sucky situation. I'm so sorry you both are going through this. I honestly can't give you an answer as to when she should try dosing again. I would call the doctor's office anyway and leave a message. Perhaps his staff can contact him.
I wouldn't take anymore until the current symptoms go away. When did she last use her DOC and when did she dose with the suboxone? Also, hopefully others will come along with more specific info.

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PostPosted: Mon Dec 13, 2010 4:26 pm 
Whats up!!


Do you know exactly how long she waited before she took her first dose? Whats the last opiate she used? Im not really sure how to answer without knowing these 2 things i've ask. I would probably say at least 24 hours but that depends on what the answers are to the questions.


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PostPosted: Mon Dec 13, 2010 4:29 pm 
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She last used yesterday she did a rinse of some cottons around 11ish I told her not to cause its still heroin even though a minute amount. She dosed 4 mgs around 6:30 pm thinking the rinse didn't count. Well I guess it did and she has been in hell ever since and has used 36 mgs trying to feel better, but nada yet. I only use 2mgs twice a day and when I took my first I was 15 hours without my doc. I didn't get pw but my habit was literally 1/4 the habit she had.


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PostPosted: Mon Dec 13, 2010 4:33 pm 
This is such a tricky situation now because its gonna be so hard to distinguish whats actual withdrawal and whats precipatated withdrawal. Are you sure its precipatated withdrawal and not that she started withdrawaling really bad from her last opiate? I know the questions arent giving you answers but your answers are gonna help us give you the help you need. So i do wanna apologize for all these questions.


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PostPosted: Mon Dec 13, 2010 4:38 pm 
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How soon after she took the sub did she get sick? If you can differentiate between the P/W and her "regular" withdrawals, then I would wait until these current symptoms subside, then she should wait to go into mild-to-moderate withdrawals. Did you use the COWS worksheet to help gauge the state of her withdrawals? I will, however, stress again that I'm no doctor and this is based on limited knowledge about P/W. Others may very well know better than I.

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PostPosted: Mon Dec 13, 2010 4:47 pm 
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It was definitely pw because it was about 15-20 mins after dosing the suboxone when the bad stuff started. She has taken suboxone before with success, no pw, but this time the new doc let her take the first dose at home so no test to determine withdrawl symptoms. As far as DOC it's heroin and its straight from mexico (higher quality) she can use 5 dimes or bags and not be high, but she was only using 2 about 3-4 times a day to stay normal. She last did 1 and a half dimes Saturday night and a rinse of a bunch of cottons around 11 am Sunday morning. She dosed sub at 6:30 that same Sunday. thanks for the help you guys.


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PostPosted: Mon Dec 13, 2010 5:02 pm 
I think the best advice i can think of is to wait until she feels the PWD's go away, then re-induce. Because i believe its been enough time since the last H use. Man i hate that this has happened. But like i said, i definitely believe its been long enough since the H and if she can wait until she feels the PWD's wear off, then i think she would be in the clear but it seems that by then her H withdrawal will be kicked in and thats what i was saying is gonna be hard to determine which is which. As hat said, im also not a doctor and i have actually have no experience with PWD's but im just trying to help. Let us know how things work out and whats going on.


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PostPosted: Mon Dec 13, 2010 5:21 pm 
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So I just got off the phone with the doctor and he bitched her out for using more than recommended and she does not have enough to last until the 20th and she is now wondering how much H she would have to do to feel better. She still very much wants to quit but due to circumstance, job, mother, etc... she thinks she might have to do some for about 3 days so she will have enough to make it till the 20th. I feel bad for even asking this but if she did get heroin now around how much would she need to do to feel better. And is it even possible? Once again I'm sorry for asking but I have to I just don't want anymore pain to come to her. Please, please help. Thank you




- one stressed out dude...


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PostPosted: Mon Dec 13, 2010 11:08 pm 
This is an f'd up situation, and it makes me wonder why docs let patients self-induce. Any responsible doctor would have first of all made her wait if she had taken even a small amount at 1:00, and MORE IMPORTANTLY would only have given her 4mg and then WAITED to see which direction she was going. PW's occur when the bupe rapidly displaces the full agonist from the receptors. Your girlfriend took 4mg , then took another 12 making the situation much worse. If she has now taken 36 mg (!) PLEASE advise her NOT to try to do heroin. She could kill herself trying to shoot through that much. She has already suffered through the worst of it. She might as well go all the way and get on the Sub. And maybe she should look for another doctor.


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PostPosted: Tue Dec 14, 2010 9:28 am 
Honestly, i think that makes the most sense at this time. Since she has already taken 36mg's and its been close to another 24 hours, i think she could probably go ahead an keep taking the sub. The H is probably just gonna prolonge things. Hopefully you will come an update us on whats going on. Take care!!


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 Post subject: ouch!
PostPosted: Tue Dec 14, 2010 4:59 pm 
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Damn that sucks....Im sure shes thru the worst.....I went thru 2 precipated wd's over the past 2 wks trying to get back on my subs... Heroin is also my doc, I waited 7 hrs the first time which was not even close to enough time even though i felt a lil shitty. The second time i waited 18hrs!!!! and that also wasnt long enough. I have been terrified to try again and am risking losing my entire script because i have made the decison to tell my Dr, even though she told me i will lose my script if i were to ever relapse...... To get back to your question about what to do, well time is the only medicine for a wd like that....I feel her Pain. Im a grown man and have suffered my share of pain throughout the years. I would have taken my broken jaw, broken arm, tailbone etc anything rather then suffer that hell. Mine lasted about 7 hrs of intense wd! rls being the worst and anxiety feels like its gonna kill u> Just be there for her, I know i would have paid big money for someone to massage my muscles thru it. like i said my rls was almost unbearable.. I took up to 32 mgs and it did absouletly nothing. So for me waiting it out was the only answer. I will see what happens with my dr, but personally i would wait at least 24 hrs the next time i try inducing.............Goodluck keep us posted


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PostPosted: Tue Dec 14, 2010 9:22 pm 
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Please - EVERYONE - stop with the time already. Time really doesn't mean much of anything. There are just way too many variables involved. That's why induction does not go by the amount of time since the last opiate intake - it is based on the level of withdrawal that the patient is in. 24 hours may be fine for the user of 50 mg/day of oxycodone while it's not nearly enough for the 200 mg/day user of methadone. It is all about the level of opiates in the bloodstream at the time the suboxone is introduced. Think of it as a volume control on your sound system or radio. Most volume controls go from 0 to 10. Zero is no sound and 10 is as loud as it can go. Suboxone can only be turned up to about a "3". If the amount of opiates in your system is above a "3" on the scale, that is where precipitated withdrawal can happen. If you are at a "6", for example, as soon as Sub gets into your system, it immediately "turns down" the opiate level from a 6 to a 3. Your body feels that change. Imagine if you were at an 8 or a 10? You are being slammed from that 8 or 10 down to a 3 over a matter of minutes. That is precipitated withdrawal - PW.

So you see, time has far less to do with it. My example used a volume scale. When inducting onto Suboxone, the COWS scale is what should be used. Google COWS scale. It looks at a variety of signs and symptoms that the patient is experiencing and applies a number to these different items. When that number gets high enough, it is then safe to take the Suboxone. If the COWS scale number is too low, the risk is high for precipitated withdrawal. That's what happened in this case. There is just simply no way that you can ever take enough Suboxone to overcome PW. It just makes things worse. Again, that's what happened in this case.

If indeed a Suboxone physician did not provide the appropriate information or oversight, I agree that he/she may not be the person to see for treatment. I just have a feeling that this is a pretty big if. Given what we know, I'd be hesitant to blame the doc at this point. PW is no fun. If nothing else this is a great lesson for readers - not to mention this patient. The good thing is, it's not dangerous and it will end. It's just a whole lot of no fun to have to go through.


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PostPosted: Tue Dec 14, 2010 10:04 pm 
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Dannybk24,

Are you sure the heroin isn't Fentanyl?

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 Post subject: Dnt beleive so....
PostPosted: Tue Dec 21, 2010 7:31 pm 
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I dont shop around and get my stuff from the same hook, but who knows really whats in the shit! Its like mexican mudd.....Thank god I'm not there anymore....I induced successfully 2 days ago and feel great!, I was hopeless just 3 days ago and in big trouble, It was really weird going into those P.w'd 's since H is supposed to have a short half-life, but there's no telling for sure what went wrong, the whole suboxone crutch thing is over for me, back to planet EARTH.....


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PostPosted: Tue Dec 21, 2010 8:09 pm 
Amanimal wrote:
It was definitely pw because it was about 15-20 mins after dosing the suboxone when the bad stuff started. She has taken suboxone before with success, no pw, but this time the new doc let her take the first dose at home so no test to determine withdrawl symptoms. As far as DOC it's heroin and its straight from mexico (higher quality) she can use 5 dimes or bags and not be high, but she was only using 2 about 3-4 times a day to stay normal. She last did 1 and a half dimes Saturday night and a rinse of a bunch of cottons around 11 am Sunday morning. She dosed sub at 6:30 that same Sunday. thanks for the help you guys.
Not to be glamourizing drug use but if you have to shoot 5 bags that is not "high quality". Of course she went into PW waiting only 7 hours before dosing last thats pretty much a given. What is with the flood of people posting lately about getting PW from sub. Withdrawal fucking blows I know but it is much smarter to just wait until you know you are sick enough to take the subs. My opiate of choice was poppy pods which are said to be are said to be only second to methadone in terms of the worst withdrawal imaginable since the poppy contains numerous active alkaloids aside from morphine that you get addicted to which is why it makes the withdrawal so bad since you are coming off all of the alkaloids instead of just one so trust me I know how bad withdrawal sucks. Poppy pods have a half life of 48 hours so I had to wait 2 full days in unbearable withdrawal before I even dared to take suboxone. If I can make it two days people should be able to make it freakin 12 hours cmon. And also if you are going to push it and take it to soon after your last use then you should start off with a small dose like 1mg first and see how you feel and work your way up not take 12mgs so it just absolutely rips the remaining opiate off your receptors leaving you completely in agony. Not to be rude but people need to use common sense when inducting, your doctor isnt going to help you you have to do it yourself. My doctor said when I told him I was worried I wasnt sick enough yet that all PW does is make you puke and then you are completely better after you puke he obviously doesnt know anything about it so I had to use my own discretion and I was damn sure glad I waited 48 hours before dosing because my induction was painless and I started feeling better like an hour or 2 later


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