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PostPosted: Tue Nov 22, 2011 1:26 pm 
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Hey guys,

This is my first time posting on this forum and wanted to see if anyone has had a similar experience. I was a heavy oxy user (up to 1200mg/day) for about 5 years and I tried quitting a number of times on Suboxone. I saw a bunch of different doctors and each time I was never able to make it past 3 days because I always felt like crap. Eventually, I was able to break that 3 day mark and I've been sober for over 5 months using 16mg a day (8mg x 2 doses per day) of Suboxone.

For a number of reasons I want to eventually stop taking Suboxone, but the primary reason is Suboxone has makes me a little lethargic which is something I really don't like. I don't plan on quitting Suboxone any time soon, but I just want to get my dose to around 4mg a day.

I did a hard switch (no tapering) to 8mg a day (4mg x 2 doses per day) four days ago and I've been feeling a huge burst of energy without any side effects or withdrawal symptoms. I plan to stay on 8mg for a couple months and then do a hard switch again down to 4mg in March or April.

Has anyone felt a lot more energy without withdrawal symptoms from a large drop in dosage?

Thanks :)

Michael


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PostPosted: Tue Nov 22, 2011 2:37 pm 
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i dropped my dose by .4 and i feel like complete shit.


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PostPosted: Tue Nov 22, 2011 3:31 pm 
Hello MichaelS. Congratulations on making it five months on Sub! I've been on Sub for over 2 years and I've done a lot of dose adjustments and tapering during that time. In my opinion, what you're experiencing with your big drop in dosage is not terribly uncommon. You'll hear/read that some people have a difficult time with even small dosage drops, but a I'd say that the majority probably do not have much trouble with dose reductions (even large ones) when they're still above ~4-6mg/day. The reason (at least in part) has to do with the fact that doses above that level are generally accepted as being above the "ceiling" dose of buprenorphine. If you're not familiar with that concept, just do a quick search here for "ceiling effect" and read all about it. Essentially what it means though, is that with bupe (unlike full agonist opiates) there is a dosage at which there is not an appreciable change in the effect of the drug. With agonists, like oxy, the more you take, the more you 'feel' and the more at risk you are of respiratory depression, etc. With bupe, once you've taken enough to be at that 'ceiling' level (usually ~4-8mg/day) you don't 'feel' any increased opiate effect, nor does your risk of respiratory depression, etc increase. Therefore, doses above that ceiling level are generally not viewed as being that much more effective in terms of physical symptoms unless you're dosing for pain relief. Dosing at higher levels does tend to be necessary for a lot of people, especially at the beginning of treatment to keep cravings under control, and certainly, there are people who maintain at doses higher than 4-8 mg/day because they are stable and doing well and not having any side effects. I have come to appreciate that 'individuality' in dosing with bupe cannot be understated. It's just something that each of us must work with our doctors on to achieve that 'just right' dose for us as individuals. I hope that makes some sense!
Having said all that....Personally, I have made big drops in dosage without experiencing anything negative pretty much all the way down to ~4mg/day. After that, it does tend to become a little more tricky. However, in hindsight, I can say that as far as experiencing anything even resembling withdrawal from full agonists, it took doses under 1mg/day before anything like that kicked in. I believe the reasons for that have to do with (again) the ceiling effect of bupe and it has to do with the stacking effect of bupe, as well as the extremely long half life of bupe. In your case, after being on 16mg/day for several months, you've got a good amount of the drug in your system. So much so, that there is a good chance that your body may not have really even felt the full effect of your dose drop even at 3-4 days post drop. It honestly can take up to a week to bring your actual blood level of the drug down around your current 8mg/day dose. Even at the point that your blood level decreases, I doubt you'll notice anything more than perhaps a little bit of a runny nose and/or possibly a tad bit better GI motility. Another thing that might possibly occur (hopefully not) is that you may notice a return of cravings.
In any case, I basically felt as you did when dropping from higher doses.....I felt more energetic and just felt "better" in some ways with the dose reductions. I've heard similar from many others in this regard as well.
So again, to answer your question....Yes, many others have experienced more energy without w/d symptoms from large dose drops. Not everyone....but many. As I said before, it's a highly individual experience! What works for some absolutely will NOT work for others. But in general, dose drops (even big ones all at once) don't tend to be too difficult until you get under that ceiling level, which can vary somewhat from one person to the next. I will add that it is generally NOT recommended to make that dramatic of a dose reduction all at once. It's just bound to be easier on us to take our time with dose reductions to sort of give our system a chance to adjust more gradually. Although so far, you've found this big drop to work in your favor, that doesn't necessarily mean that it will be just as easy to make the next drop from 8mg to 4mg. In fact, almost always the reductions get more and more difficult the lower you get. Personally, I'd recommend that your next drop be from 8mg to 6mg (rather than all the way to 4mg.)
I hope that helps you some. I'm not a doctor or an expert and these are just my opinions based upon my own experiences and what I have read of the experiences of others. You should always be in contact with your doctor when adusting your dose. Above all else, take care to protect your hard-won sobriety! But, in my opinion, if you feel better on lower doses....all the better!


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PostPosted: Tue Nov 22, 2011 4:44 pm 
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setmefree wrote:
Hello MichaelS. Congratulations on making it five months on Sub! I've been on Sub for over 2 years and I've done a lot of dose adjustments and tapering during that time. In my opinion, what you're experiencing with your big drop in dosage is not terribly uncommon. You'll hear/read that some people have a difficult time with even small dosage drops, but a I'd say that the majority probably do not have much trouble with dose reductions (even large ones) when they're still above ~4-6mg/day. The reason (at least in part) has to do with the fact that doses above that level are generally accepted as being above the "ceiling" dose of buprenorphine. If you're not familiar with that concept, just do a quick search here for "ceiling effect" and read all about it. Essentially what it means though, is that with bupe (unlike full agonist opiates) there is a dosage at which there is not an appreciable change in the effect of the drug. With agonists, like oxy, the more you take, the more you 'feel' and the more at risk you are of respiratory depression, etc. With bupe, once you've taken enough to be at that 'ceiling' level (usually ~4-8mg/day) you don't 'feel' any increased opiate effect, nor does your risk of respiratory depression, etc increase. Therefore, doses above that ceiling level are generally not viewed as being that much more effective in terms of physical symptoms unless you're dosing for pain relief. Dosing at higher levels does tend to be necessary for a lot of people, especially at the beginning of treatment to keep cravings under control, and certainly, there are people who maintain at doses higher than 4-8 mg/day because they are stable and doing well and not having any side effects. I have come to appreciate that 'individuality' in dosing with bupe cannot be understated. It's just something that each of us must work with our doctors on to achieve that 'just right' dose for us as individuals. I hope that makes some sense!
Having said all that....Personally, I have made big drops in dosage without experiencing anything negative pretty much all the way down to ~4mg/day. After that, it does tend to become a little more tricky. However, in hindsight, I can say that as far as experiencing anything even resembling withdrawal from full agonists, it took doses under 1mg/day before anything like that kicked in. I believe the reasons for that have to do with (again) the ceiling effect of bupe and it has to do with the stacking effect of bupe, as well as the extremely long half life of bupe. In your case, after being on 16mg/day for several months, you've got a good amount of the drug in your system. So much so, that there is a good chance that your body may not have really even felt the full effect of your dose drop even at 3-4 days post drop. It honestly can take up to a week to bring your actual blood level of the drug down around your current 8mg/day dose. Even at the point that your blood level decreases, I doubt you'll notice anything more than perhaps a little bit of a runny nose and/or possibly a tad bit better GI motility. Another thing that might possibly occur (hopefully not) is that you may notice a return of cravings.
In any case, I basically felt as you did when dropping from higher doses.....I felt more energetic and just felt "better" in some ways with the dose reductions. I've heard similar from many others in this regard as well.
So again, to answer your question....Yes, many others have experienced more energy without w/d symptoms from large dose drops. Not everyone....but many. As I said before, it's a highly individual experience! What works for some absolutely will NOT work for others. But in general, dose drops (even big ones all at once) don't tend to be too difficult until you get under that ceiling level, which can vary somewhat from one person to the next. I will add that it is generally NOT recommended to make that dramatic of a dose reduction all at once. It's just bound to be easier on us to take our time with dose reductions to sort of give our system a chance to adjust more gradually. Although so far, you've found this big drop to work in your favor, that doesn't necessarily mean that it will be just as easy to make the next drop from 8mg to 4mg. In fact, almost always the reductions get more and more difficult the lower you get. Personally, I'd recommend that your next drop be from 8mg to 6mg (rather than all the way to 4mg.)
I hope that helps you some. I'm not a doctor or an expert and these are just my opinions based upon my own experiences and what I have read of the experiences of others. You should always be in contact with your doctor when adusting your dose. Above all else, take care to protect your hard-won sobriety! But, in my opinion, if you feel better on lower doses....all the better!


Thanks for your insightful reply. I really believe the idea that Suboxone has different effects for different people. My first time taking Suboxone my doctor told me to take 32mg and I got really sick. It wasn't until my last time taking it where a new doctor told me not to exceed 16mg. It's fascinating that so many people have different experiences with the drug and so many doctors give differing opinions on how to effectively take it.


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PostPosted: Tue Nov 22, 2011 5:11 pm 
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I too had the same expierence. I most certainly felt no different and certainly no worse on 8 mg than I did on 16. I am currently at 6 and while I did have some very minor withdrawal symptoms - mostly anxiety - when I first dropped from 8 to 6, I feel just fine on 6 as well. So I am not at all surprised at you reporting how you feel.

I also wanted to really call the attention of other readers here to your expierence. While yes, everyone is different and everyone may have their own individual reaction to Bup, I can't help but believe that your expierence is the rule rather than the execption. It just seems to be the case. I don't at all want to start a debate or have people become defensive about their current but higher dose, but it just seems so clear after all of have read and what I have expierenced myself, that far more people than many might think don't need to be on 16 mg or higher doses - they just don't. That said, I'm talking only addiction here - not for pain. Pain patients, to the extent that Bup even works, do often need higher and more frequent doses. But those of us only need to stay out of withdrawal and in remission can often do that at lower doses and often feel better at those lower doses.

Again, please don't feel the need to defend those high doses - rather, perhaps, just perhaps, consider that a lower dose will do the job just as well or even better... just ask MichaelS, Set Me Free or myself!


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PostPosted: Fri Aug 19, 2016 11:44 am 
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Just a quick correction... The Ceiling for Suboxone is 32 mg, Not 4, 6 or 8.


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PostPosted: Fri Aug 19, 2016 1:29 pm 
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32mgs may have been the ceiling for RX, but the ceiling as far as opioid effect is in the 4 to 8mg range.

There are plenty of posts by Dr Junig and threads on the flrum that will back this up.
Talkzone post "Ceiling Effect "is the best lf them all.


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