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PostPosted: Fri Jul 05, 2013 5:18 pm 
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A little back history-9 years of Heroin addiction followed by 11 years on Methadone Maintenance, started taking Subutex in March of 2012. Here's my issue.

My dose doesn't hold me all day. If I take the whole 24mg in the morning, I'm sick by late afternoon. If I try to split it in half, I have a few uncomfortable hours between doses. I wake up sick every morning. Anxious, runny nose, body aches...general malaise. I have to take 8 mgs right away just to get going. I then take the rest of my days dosage in 4mg increments throughout the day. Over the course of a normal day I spend a couple hours feeling crappy because it's not time to take another 4 mgs. I'm considering increasing to 32 mgs, but am struggling with it because my logic tells me there is a ceiling, and that perhaps my withdrawals are psychosomatic. Could be chemistry be that compromised from such a prolonged period of Opiate addiction that I really need 32 mgs? Could I be metabolizing my dose this rapidly? I have an appointment to speak with an addiction medicine specialist on Monday, but thought I'd ask around here first. Has anyone had similar experiences? The truth is I have never felt 100% well since I stared taking the Buprenorphine. I feel like I'm on a withdrawal roller coaster, and I get headaches almost daily that began when I stared on the Bupe. I'm confused & just want to do the right thing. Any help would be greatly appreciated!


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PostPosted: Sat Jul 06, 2013 2:04 am 
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Sounds like phantom wd.
This is why other recovery outlets are so important.
So you can talk to someone else about it when you want to take more.
Then it will go away.

I promise it's not wd.

If you are taking 24mg in the morning and getting legit wd in the evening... I'll never post again.

I'm just pointing out that you are taking a ton of bupe and should feel nothing unless you skip a couple days.

Look up the equivalent in oxy or even diacetylmorphine... Aka heroin... You are still on a hefty dose of opiates that have a lot longer half life.

I know I come off mean or whatever but I promise I mean well. I just don't know another way to say things when it comes to suboxone and recovery. With addicts you have to be honest and straightforward for change to happen.

Patting you on the back and lying to you would do nothing fir you.

Just like cheering someone off suboxone... But that's a story fir another day.

Hope things work out fir you man. Again. I have only the best intentions for you. Promise. My delivery is just forever tainted here lol.


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PostPosted: Sat Jul 06, 2013 8:51 am 
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Tsktsk,

Sorry, hun, but gauging from the very high dose you are on, it is virtually impossible for you to be experiencing wd throughout the day. Especially since you do say that it helps directly after you take your dose, or part of your dose. The half-life of sub is VERY long and you should not experience genuine wd for a few whole days. I agree with Movie that you may be experiencing phantom wd - that your mind may very well be doing a number on you. =(

One of my very first thoughts was if maybe you were mistaking some things you are experiencing for wd: for example - I do sweat much, much easier on Sub than I ever have before. For me this is a side-effect of Sub. Also, do you have any history of any sort of anxiety disorder? Perhaps this might be what is striking you randomly throughout the day? (Although for many, Sub actually HELPS with anxiety symptoms - at least the ones brought about by regular ole wd's)

I would recommend you read up a bit more on the half-life of Sub and maybe your mind will stop trying to play tricks on you. You SHOULD be able to take your dose ONCE per day and have it hold you until the next day. That long half-life is part of why Sub is an effective tool for recovery - it makes it possible for you to break the cycle of taking something multiple times a day,like every time you feel stressed, bc that is, of course, addict behavior at its best.

Sorry if this doesn't sound very nice, I mean no harm. I sincerely hope that you can get this all squared away. Good luck to you!! =) =) =)

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PostPosted: Sat Jul 06, 2013 10:45 am 
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I'm gunna disagree with the other members opinions. I believe it is possible for people who've switched from methadone to experience withdrawals like you describe even on high doses of Sub. Reason is that people who switch from methadone often have a really high tolerance to opioids, so high that even high doses of Sub don't fulfill their needs. These people often do better on methadone treatment than Suboxone simply because bupe's partial-agonist effect just ain't enough. What was your highest dose of methadone?

I relapsed earlier this year, and in that time I was using huge amounts of heroin. My tolerance went up considerably. Since returning to Sub, I've noticed the same dose hasn't been holding me as much as it did before, and I'm noticing withdrawals emerge approx 8 hours after I dose. Symptoms are goosebumps, runny nose, chills, cold hands / feet. I take my Suboxone, then interestingly the symptoms get worse for 15-20 minutes (naloxone?), then they disappear for a few hours. Rinse and repeat. I actually came close to switching back to methadone. Got the script and all, but I changed my mind at the last minute when I remembered how freakin' hard it is to get off the 'done. I considered it a step backwards in my recovery.

There are also people who are ultra-rapid metabolisers of buprenorphine. Sub's half-life does vary a lot from person to person, and there are a number of factors that can influence how fast you metabolise bupe. Certain medications, genetics, body type etc - these all affect how quickly we burn through our dose. Years ago I had a blood test to see if I was an ultra-rapid metaboliser, and the test came back positive. My old prescribing doctor said he would get special clearance so I could be dosed over 32mg, so a single large dose could hold me over the full 24-hours. I actually refused, because I didn't like the idea of being on such a high dose. Nowadays I'm on 12mg daily, 6mg morning and 6mg evening. Splitting my dose in two has really worked wonders. ie due to my rapid metabolism, for bupe to hold me over 24 hours, I'd need 16-24mg a day in one dose for me to be held over 24 hours. But by splitting my dose in two, I only need 12mg (6mg morning / evening). I've also found that Depakote (mood stabiliser) makes me burn through my bupe really fast.

If I were you, I'd wind back and dose just twice daily, taking the same amount in the morning and the evening. Try taking it at the same time each day, 12 hours apart. Keep taking 24mg's at for a while until you get into a routine, then try pulling it back to 16mg's. Because your brain's adapted to being saturated with a strong-agonist like methadone 24/7 for 11 years, it doesn't surprise me that Sub's partial-agonist effect has left you feeling less than 100%. But if you plan to get off maintenance one day, you're going to have to get used to it sooner or later.

Can I ask if you've been using at all since you've been on Sub? This would definitely make it more difficult to stabilise, even if you've been taking Subutex for a year.


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PostPosted: Sat Jul 06, 2013 2:52 pm 
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@TeeJay- (and everyone else!)

Nope. No drug use AT ALL. My highest dose of Methadone was 180mgs, (during pregnancy) but my normal dose was 80-100. Titrating was painful & I gave up and walked off at 50 mgs. I will NEVER go back to Methadone. EVER. While it prevented me from feeling dopesick, it also prevented me from feeling a number of other things, like a libido, lust for life, etc. I had no idea how much it was "dumbing/numbing" me until I came off of it entirely, and it was as if some shroud had been lifted. Buprenorphine has never made me feel loaded or compromised emotionally. As for the the issue with my dosage, I think I may be experiencing a certain degree of phantom withdrawal. Distraction DOES seem to work somewhat. I notice that when I am really busy, I'm not thinking about it as much, so it's not until I slow down that the urge hits me to take another chip. My addict mind does like to play tricks on me. I will try splitting my dose in 1/2 over 12 hours. I don't think I've ever dosed "correctly" from what I've gathered from this awesome forum. The information here has been invaluable! I am going to tough this out and remain at my dosing level for now. Ah yes, ANXIETY! I DO have PTSD, Anxiety disorder and Panic disorder. I was a victim of a brutal attack 20 years ago (abducted from a bus stop, stabbed 24 times, gang raped & left in a dumpster) & my psyche has never fully recovered. I was taking a host of Psych meds, but when I got on the Buprenorphine program, it was a "complete abstinence" model, so I stopped taking the Benzos and soon after thought it might be a good time to stop taking everything else mind & mood altering. (Effexor & Nortriptaline) The fact of the matter is that I don't want to take this drug (Subutex) for the rest of my life. Cravings are virtually a non-entity for me after an extended period of sobriety, so I don't really need the Bupe to address cravings. If I was in the least bit worried about relapse, I would have no problem taking Subs for however long, but that isn't the case for me. I'm just an old dope fiend who doesn't like to be in any discomfort, ever. 1,000,000 thanks for talking some sense into me.


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PostPosted: Sun Jul 07, 2013 4:12 am 
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tsktsktrixie wrote:
While it prevented me from feeling dopesick, it also prevented me from feeling a number of other things, like a libido, lust for life, etc. I had no idea how much it was "dumbing/numbing" me until I came off of it entirely, and it was as if some shroud had been lifted. Buprenorphine has never made me feel loaded or compromised emotionally. .


I felt exactly the same after I switched from methadone to Suboxone a few years ago. It's interesting that many members of this forum have felt the same way when they finally get off Suboxone and abstain from opioids completely - it's like they've come out of a fog, and they once again can experience feelings that the opioids long suppressed. The fog / numbing of ORT (opioid replacement therapy) is of those things that's difficult to identify when you're in the middle of it. Like you said, you can only really gauge how numb you were once you get off it.

This is one of the bigger reasons why I don't want to stay on Sub for life. Compared to being in recovery and off all maintenance drugs, Sub makes me feel like I'm floating through life emotionally detached. Things that excited me while off maintenance and in recovery. I've been scuba diving, skydiving on Sub and the excitement just wasn't there. Methadone was worse for me than Sub in this regard, but Sub also makes me feel numb compared to when I've been 100% clean in the past.


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PostPosted: Tue Aug 06, 2013 4:00 pm 
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tsktsktrixie wrote:
A little back history-9 years of Heroin addiction followed by 11 years on Methadone Maintenance, started taking Subutex in March of 2012. Here's my issue.

My dose doesn't hold me all day. If I take the whole 24mg in the morning, I'm sick by late afternoon. If I try to split it in half, I have a few uncomfortable hours between doses. I wake up sick every morning. Anxious, runny nose, body aches...general malaise. I have to take 8 mgs right away just to get going. I then take the rest of my days dosage in 4mg increments throughout the day. Over the course of a normal day I spend a couple hours feeling crappy because it's not time to take another 4 mgs. I'm considering increasing to 32 mgs, but am struggling with it because my logic tells me there is a ceiling, and that perhaps my withdrawals are psychosomatic. Could be chemistry be that compromised from such a prolonged period of Opiate addiction that I really need 32 mgs? Could I be metabolizing my dose this rapidly? I have an appointment to speak with an addiction medicine specialist on Monday, but thought I'd ask around here first. Has anyone had similar experiences? The truth is I have never felt 100% well since I stared taking the Buprenorphine. I feel like I'm on a withdrawal roller coaster, and I get headaches almost daily that began when I stared on the Bupe. I'm confused & just want to do the right thing. Any help would be greatly appreciated!


Is it possible you're taking too much suboxone it that what you are feeling is due to too much suboxone n NOT withdrawal????

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PostPosted: Wed Aug 07, 2013 1:17 am 
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tsktsk,

You say you were inducted onto Subutex from methadone in March 2012, and are now taking 24 mg bup w. no naloxone, even after all that time. Well, that's the maximum dose that any insurance company would cover, and it's the absolute maximum under the FDA labeling, which strongly encourages Suboxone after induction unless you're pregnant. Not being nosey, but are you pregnant?

It's extremely unusual for them to allow anyone to stay on Subutex that long without requiring switching to Suboxone. You didn't say generic Subutex, which many report is grossly inferior to name-brand.

Question: before your methadone treatment did you ever experience Temgesic or Buprenex? Their dose is 0.2 mg per tab or ampoule, or 1/120 your daily intake of buprenorphine from the Subutex. The tabs used to be very easy to obtain by mail from Thailand or at Mexican farmacias. Even some brave US doctors used Buprenex off-label for opiate detox before DATA 2000, risking their licenses. Did you ever use buprenorphine previously and if so what effect did it have?

The data you read in the product insert at AUCmax and T1/2 are for an average person, which is a theoretical construction. Everyone is different. It's possible that your biochemistry is such that you're either not absorbing it sublingually, or you're metabolizing it very rapidly or into something that's causing dysphoria, or you might just not have mu-receptor sensitivity to buprenorphine. Everyone is different.

If you've been following your drug treatment program faithfully for 14 months and yet 24 mg/day of s.l. buprenorphine without naloxone is giving you no benefit and you're still craving opiates and don't want to go back to methadone, then my best advice would be for you to try switching to Suboxone (under guidance of a competent physician!), because the naloxone might benefit you. Low-dose antagonists can act as opioid potentiators, per work by Crain & Shen, basis for old clinical trial drug Oxytrex, from Pain Therapeutics.

Be careful and slow with Suboxone, and your (new?) doctor should start it from zero as an induction from the very beginning. You're either extremely lucky to be getting all that Subutex more than a year after being on methadone, or, you're unlucky to have a doctor that doesn't know any better.

Temgesic tabs contain only 0.2 mg of buprenorphine, and many people with no tolerance obtain analgesia from just one tablet. Your daily dose is 120 tabs of Temgesic, which is HUGE!

More that I think about it, I'm coming to agree with the poster who suggested that you could very well be overdosing on Subutex and you need to find a more knowledgeable addiction specialist for your treatment.

First thing I'd do if I was you is to see what happens if you REDUCE (not increase) your Subutex dose, because you can always go back to what you're doing.

If you feel better at a lower dose, then keep cutting back until (or if!) you experience REAL withdrawals and then maybe titrate up (working with your doctor!). You might not need anything and are simply poisoning yourself with buprenorphine in some kind of pseudo-addictive syndrome where you're so fearful of withdrawals syndrome that you're overdosing yourself out of fear.

If you still feel lousy, find a better doctor and go from there.

I also agree with poster above that you should get a workup for psychiatric disorder, focusing on mood and anxiety disorders. This especially so if you have or any close blood relatives have such history of anxiety or depression.

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PostPosted: Wed Aug 07, 2013 1:46 am 
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So.
24mg...you probably feel lousy because it's so much bupe.
Or.
It's mental. You have convinced yourself that because you were in methadone... You need more sub to be comfortable than others... Possibly.
Don't go looking for some other diagnosis to explain anything here...
Sounds to me like you just need some good old fashioned recovery. Because sadly this is what happens.

You can't just take suboxone... At any dose... And expect it to work as it always has forever...

I'd reduce to half of that dose and get to some meetings.

If you don't want to do that... Cool.

But like it had already been said... After this long, you don't need that much... No matter how bad you think you do. You aren't going into wd after taking 24mg in the morning... No way... Just isn't going to happen.

Even RB says that this medicine is intended to be taken in combination with a working recovery plan... Picking up a new hobby or staying home all the time to avoid old habits is not a recovery plan. Going to meetings regularly (not ALL the time), therapy sessions, counseling, Ect. These are parts of a solid recovery plan. Of course other things are more based on the individual. But. You have to have these things. Even with sub. Even just having another addict that you meet up with to chat from time to time to keep up your accountability.

Unless you add one or more of these things you will just stay on the path you have started down. No way around it. It happens too often not to tell you.

Do whatever you feel is best for you. Trust me, don't trust me. I'll be okay. Promise. But if you want to feel better bad enough you will give some recovery and a dose reduction an honest thought. Don't focus so much on the drugs side of this stuff and look further.

My life and many hundreds of others lives I've been in.. Have been exactly like where you are now at one time and it never changed until we did.

So. Don't always look for blame in things around you until you have looked at yourself first.

Just saying. I've been there.

Hope b things get better. Good luck.


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PostPosted: Wed Aug 07, 2013 1:54 pm 
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I know this post is old but I'm with TJ.. switching from methadone to suboxone is a whole different beast. Something that no one can understand until they've gone through it. I can relate 100% to the OPs post.

You simply cannot relate if you went from Oxycodone or the like (or even heroin) to suboxone and felt good immediately or soon after. This is not the case for methadomne to subs, it's a brutal transition and one that is hard to even out. Split dosing is necessary in these cases, IMO.


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PostPosted: Wed Aug 07, 2013 4:13 pm 
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tsktsk has been on the maximum allowable dose of SUBUTEX for well over a year and is already using spilt dosing. And SUBUTEX is NOT Suboxone.

The transition from methadone to pure buprenorphine takes at most a few months. It's during that induction that the naloxone in Suboxone often causes so much SHORT-TERM discomfort.

It seems that some posters on this thread don't know the difference between Subutex and Suboxone. The difference is huge. Subutex is only labeled for ORT in pregnant women, and, in rare cases where Suboxone cannot be tolerated, with objective clinical evidence of such. Otherwise, Subutex is preferred to Suboxone for induction from methadone, but, after induction, long-term treatment needs to be using Suboxone except during pregnancy.

I strongly agree that there is no magic pill to treat addiction, and it's often practically impossible for long-term Suboxone patients to find qualified behavioral support.

In this case, it seems there is an undue reliance on pharmacy, judging from use of maximum allowable dose of SUBUTEX for over a year with no reporting of any psychosocial or psychiatric evaluation and/or treatment of comorbid psychopathy or "pseudo-addiction."

Applying Occam's Razor, it seems like the change which could be made most easily and with zero risk of harm is to slowly reduce the daily dose and see if symptoms abate. It seems that tsktsk maybe has substituted a Subutex addiction for their 11 years on MMT. Sorry, but it's the simplest and most likely explanation. The point of ORT is not to get legally high every day and always be craving.

If so, then it would be a good idea switch over to Suboxone because the antagonist effects of naloxone are proven to reduce opioid cravings. Suboxone is the preferred drug for ORT, not Subutex. Subutex is much more of a euphoriant than Suboxone. In many cases, Subutex is more abusable than weak opioids like propoxyphene and codeine, both of which can be used to self-detox from methadone (but not legally by physicians under US drug law).

On the remote chance that this person has no sensitivity to buprenorphine for some biochemical anomaly, and SUBOXONE is ruled out after inducting from ZERO, and psychosocial interventions are either unwanted or ineffective, then the only legal treatment available is to go back to methadone (MMT).

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PostPosted: Wed Aug 07, 2013 6:02 pm 
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We know the difference.. Just miss-typing as suboxone is more widely used, as you so generously shared yourself. The active ingredient is still the same and the dosage is still the same mg per mg.. I'm not sure if the amount of naloxone in suboxone is proven to do anything for cravings. It's the bupe that fills the receptors. Also, the only reason suboxone is more preferred over subutex is because of marketing and politics. RB-BS.


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PostPosted: Wed Aug 07, 2013 7:03 pm 
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Occams Razor is also generally understood to say "all things considered, the simplest explanation is usually correct."

Trampy, unless you're tsktsktrixie's doctor and have her complete medical background, you haven't considered all things, so your Occams Razor reference is moot.

If I were to use Occams Razor in the manner you did, I would say tsktsktrixie needs to increase her dose, not lower it as you suggested.

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PostPosted: Tue Aug 13, 2013 2:59 pm 
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tinydancer wrote:
We know the difference.. Just miss-typing as suboxone is more widely used, as you so generously shared yourself. The active ingredient is still the same and the dosage is still the same mg per mg.. I'm not sure if the amount of naloxone in suboxone is proven to do anything for cravings. It's the bupe that fills the receptors. Also, the only reason suboxone is more preferred over subutex is because of marketing and politics. RB-BS.


Read all the patents by Crain & Shen, the articles reference therein, and the NDA file on Oxytrex by Pain Therapeutics.

Naloxone and naltrexone have identical effects: only difference being T1/2 and oral uptake.

There is a vast difference between the abuse potential of Subutex versus Suboxone. Abuse by injection really has nothing to do with it in stabilized patients because buprenorphine binds so tightly that it is not displaced by parenteral naloxone because ".. those receiving prescription buprenorphine or buprenorphine/naloxone tablets who dissolve and inject their own medication ... would experience no antagonist effect from naloxone .." (SAMHSA 2004, TIP 40, p. 23).

However. Low-dose antagonists do greatly reduce cravings. The receptor sensitization mechanisms are quite complex and extremely difficult to for a non-specialist understand but Crain & Shen did a good job of explaining it. It's all there for your pleasure in their patents, the prior work they cite in support of all their patents, plus all the clinical data in the NDA file for Oxytrex by Pain Therapeutics.

FDA approved Suboxone with no references to receptor sensitization of antagonists maybe because Reckitt didn't want to confuse them with unnecessary information. To this day, FDA seemingly has no inkling of the full benefits to be obtained by adding naloxone to the formulation as they had done prior with Talwin/pentazocine. Stare Decisis is no way to do science, but that's what happened when Congress itself approved the drug, not FDA.

The 4:1 ratio FDA chose for Suboxone had no scientific basis but they were in a rush to satisfy DATA 2000 so they essentially pulled it out of their "backend" and approved Suboxone based on clinical data using ethanol solutions, not tablets.

It was pretty much a lucky accident that Suboxone patients benefit from the receptor sensitization effects of a low-dose antagonist, because the FDA was then and may still remain ignorant of the cravings reduction caused by the naloxone in Suboxone.

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PostPosted: Wed Aug 02, 2017 4:55 pm 
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Per the Indivior/Suboxone rep, you should not be having many (if at all) withdrawals while at 24mg. At 24mg (the maximum dosage), 97%+ of your receptors are being blocked. Taking 8mg 3x a day might work better for you. I've never heard of anyone taking 24mg at once. Most people even report 12mg at once being too strong.


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PostPosted: Thu Aug 03, 2017 10:42 am 
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Hey AddictionSpecialist. The last post on this thread was from 2013, I didn't know if u realized that or not, the op may not be around any longer.

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PostPosted: Mon Aug 07, 2017 4:39 pm 
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Many when I started Subutex took 32mg daily and did very good but many,many got by on much lower doses when state insurance got taken away.
Try a lower dose and see how you feel.


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PostPosted: Tue Aug 08, 2017 12:49 pm 
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rob500 wrote:
Many when I started Subutex took 32mg daily and did very good but many,many got by on much lower doses when state insurance got taken away.
Try a lower dose and see how you feel.


I am currently on state insurance and this is a fear of mine. I just got cleared for another year of coverage thankfully. I am going to school and about to start working again. 'Luckily' I am living with family and I will be intentionally working only very part time to stay under the margin of profit to keep my insurance. Having good insurance being a probability of life was one of the factors that weighed into deciding to go into something in the medical field. I am going to be doing my EMT Cert soon. That way I am always in a job where decent if not good insurance is a likely possibility, besides I believe doing something that helps others would be good for sobriety.

But I am afraid of being suddenly dropped unexpectedly without reason. I dont know why it may happen, but feel like it could since it is state free insurance. What dose are you at now? I am at 24 like OP. I have tested days on 16mg plenty of times and I feel fine but I also do not feel quite as all-around-well-and-stable like I do at 24mg.


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