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 Post subject: Hello.Need advice.
PostPosted: Fri Dec 09, 2016 1:32 pm 
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Hello my name is Geoff and I am an addict/alcoholic.
I am a veteran and was injured pretty severely about 7 years ago. I was prescribed pain meds and well... You know what happened. I got up to like 20 percocet a day and finally 5 years ago had enough. I was prescribed suboxone which absolutely saved my life. I started going to meetings and got a sponsor and have been clean ever since. I went off the suboxone a year after starting, so 4 years ago. It made me feel buzzed and I felt like I had a good system in place and I didn't want to feel buzzed whether placebo or not.
well The VA finally decided I could have a much needed surgery last ,month. My sponsor and I had a great system in place, the Dr's and nurses were all informed I was not to be given narcotics unless I asked for them specifically.My sponsor was with me. Well I had my surgery and was anesthetized. I woke up from a very very deep sleep as soon as one of the nurses put an opiate in my Iv after the surgery. I sat straight up and I knew what had happened. it was a younger nurse I dont really know what happened or why but I am not going to dwell on it. mistakes happen. Any way that started a 2 month binge. I am still going to meetings and still have a sponsor, I primarily go to AA meetings because my first drug was alcohol. I still have a great support system and I am not angry at myself or blaming myself for this. Its unfortunate but I am human.
Now to my question.I hope this isn't controversial. I have been taking about 6 10/325 Hydrocodone a day.mostly within a 3 hour period.I have skipped 2 days, even 3 days at a time but the last couple weeks its really gotten its hooks in me. I want to take suboxone again to avoid withdrawals.I have the tools and support Ineed. I would just cold turkey it(and maybe I will) but my physical issues from my injury make that a scary option.I would like a sort of soft landing so I can reset. I KNOW that's not what suboxone is used for. I Just want to know if it can be done. I thought I would induct myself at like .25 or .5 mg and use it for like a week or maybe less and then stop or taper down to a small amount. Will this work?I have tried asking people at my meetings but they dont really know and I met with 2 different drs who tried to sell me a lifelong membership.I am just ready to move on.
Thank you for your support
Geoff


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 Post subject: Re: Hello.Need advice.
PostPosted: Fri Dec 09, 2016 2:40 pm 
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Hi Geoff, Welcome! I do not have an educated answer for you and hopefully Dr. J. will respond with expert advice. I would think that you would need more to not have symptoms of withdrawl. I have found that suboxone helps with the pain from osteoarthritis. So, you may want to consider a dosage of suboxone that will help with both. Again I am not the expert on this but I am sure someone with more experience will respond soon. Have a good day!


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 Post subject: Re: Hello.Need advice.
PostPosted: Fri Dec 09, 2016 3:00 pm 
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Hi! thanks for the info and support Michelle.I know everyone is different I can deal with my pain. I have lots for other things to get through that part.Suboxone is an invaluable tool. But one I dont need anymore.I know with my program and steps and sponsor I can get through the cravings. The only other thought I had was to have my sponsor taper me off the hydrocodan. But If I could use a low dose suboxone For however much time is needed I would prefer that.Its pretty strong from what i remember. I was on like 1 mg before and it worked fine. But I think the induction was like 8 mg. I just cut down quickly to save on costs.I'm basically taking 50 mg of hydrocodan a day. Not sure what dose I would need of suboxone or how long to take it for to avoid withdrawals. Hopefully someone does. I dont have the money right now to find a Dr and get a script of suboxone but I do have enough leftover from when I tapered last time. I really Just want to get back to being sober me. I am ready for it.I haven't had any drugs in 24 hours so that's great.
Geoff


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 Post subject: Re: Hello.Need advice.
PostPosted: Sat Dec 10, 2016 7:43 pm 
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Can any one offer any suggestions?

Geoff


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 Post subject: Re: Hello.Need advice.
PostPosted: Sun Dec 11, 2016 2:25 am 
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My concern is that buprenorphine is very potent, probably more potent than 60 mg of hydrocodone per day even with tiny amounts of buprenorphine. So I don't know if you would be 'tapering down' if you took bupe. You might actually move UP the tolerance ladder.

If I was your doc and we decided to use buprenorphine as a taper, I'd recommend using either a 2 mg strip of Suboxone film and taking a small piece a couple times per day-- on the order of a 0,2 mg or less. Another option, if you are a pain patient, is to use Butrans or Belbucca, both of which provide doses of buprenorphine below 1 mg per day.


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 Post subject: Re: Hello.Need advice.
PostPosted: Sun Dec 11, 2016 2:35 pm 
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Geoff1, thank you for your service.
Some, (maybe most) of the VA's now have pain programs and Suboxone providers.
Could you at least get comfort meds, gabapentin, clonidine, trazadone to help through the withdrawal? Perhaps they would even admit you for a few days for detox?
Do you have a PCP at the VA that can advocate for you, or even try the patient advocate or your service provider.
Sometimes negotiating the labyrinth of mental health, CD, primary care can be daunting.
At our VA we have an assigned go to person to assist. I used to have an RN but now it is a Social Worker.
I too think a taper starting above the ceiling (8 mgs or more) would probably be more difficult that tapering or cold turkey with assist from the hydrocodone.
Maybe I am missing something but if you had a service connected injury with Surgery at the VA I do not see how money or access should be an issue.


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 Post subject: Re: Hello.Need advice.
PostPosted: Sun Dec 11, 2016 6:04 pm 
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Hello again. Thank you guys so much for your responses its really helpful.I didn't even realize There were Dr's here that posted. I am very grateful for that. So here is the deal for me. I have physical and mental injuries, and withdrawals make the mental injuries severe.That is why I want a soft landing so to speak. So from what I gather I would have to take very very small doses of suboxone to go down the ladder of tolerance.
Here are my options as I see them Please help me decide

Option #1 The last dose of suboxone I was on was .12 before I stopped taking it and it was really not hard to go off from that. If I go this route how long should I take the suboxone for?Could I start at the .12 twice a day then after a few days go to just one dose a day then go off a few days after that? So 7/10 days total?

Option #2 is to taper the hydrocodan with my sponsors help. Currently I can go about 24 hours before I start to feel noticeable withdrawals.I am not really sure what that means. In the past I would have withdrawals after about 8 hours of no pills.Does that mean I am not completely dependent yet? If I were to go 36 hours and then take a very small amount of hydrocodone, say 5 mg then try to go another 36 hours and do the same thing and then try to add a few hours every day would that work? Or does that just put on hold the withdrawals? I guess I dont understand if tapering the hydrocodan lessens withdrawals or are they a set thing? I have only been using for a short amount of time so i wonder if this would work.I am sorry for the questions I just dont really understand all of it that well.I dont mind being in some withdrawals I just cant handle getting slammed.

I do have access to the comfort meds you suggested Docm2.. When you say cold turkey with assist from the hydrocodon do you mean like scenario #2 above?
Thank you guys from the bottom of my heart.
Geoff


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 Post subject: Re: Hello.Need advice.
PostPosted: Sun Dec 11, 2016 6:49 pm 
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I do have access to the comfort meds you suggested Docm2.. When you say cold turkey with assist from the hydrocodone do you mean like scenario #2 above?
Geoff1, my thoughts:
If you can go 24 hours before any withdrawal I think you should try just using comfort meds. Lots of distraction, baths, whatever you can do to assist the process. If it doesn't work you can go back to a plan B and that would be to use a rare hydrocodone to blunt the worst of the withdrawals but only a few times. If A and B don't work then you can go the longer Suboxone taper that Dr. J describes:

If I was your doc and we decided to use buprenorphine as a taper, I'd recommend using either a 2 mg strip of Suboxone film and taking a small piece a couple times per day-- on the order of a 0,2 mg or less. Another option, if you are a pain patient, is to use Butrans or Belbucca, both of which provide doses of buprenorphine below 1 mg per day.

If you have chronic pain and it is going to be a trigger for use in the future I like the Butrans - Belbucca route.


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 Post subject: Re: Hello.Need advice.
PostPosted: Mon Dec 12, 2016 1:44 pm 
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Docm2,

Thank you so much for taking time out of your day to help me, I really appreciate it.
I am going to take your advice and try to CT it. it seems like I am able to get to around 36 hours when I get RLS and since I only have part of my right leg its a weird phantom RLS that could make any one go absolutely insane. If at 36 hours It gets too bad I will take 2.5 g of hydrocodan to make it bearable, and hopefully that doesn't reset the whole process.

I was hoping to clarify one thing. When talking abut using the suboxone, if I was forced to go that route, would I use 2mg total? and just use .2 mg or less twice a day until that 2mg strip is over? Thats roughly 5 days worth,or longer if I cut it to once a day after a couple of days. I guess my question is how long would I stay on the suboxone?
Thank you !
Geoff


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 Post subject: Re: Hello.Need advice.
PostPosted: Tue Dec 13, 2016 8:20 pm 
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Any one around to answer? I would really appreciate it.
Thanks,
Geoff


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 Post subject: Re: Hello.Need advice.
PostPosted: Tue Dec 13, 2016 9:00 pm 
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Geoff1,
If you are already going 36 hours before the withdrawal really sets in then start in with the comfort drugs or chip away with the hydrocodone. Using opiates for detox is really difficult and takes great discipline. Maybe if you are a marine or special forces, REMF - no way. I am generalizing of course.
Consider loading up on Gabapentin 900-1800 mgs a day. (300-600 mgs three times a day). It should help with the RLS and maybe the phantom limb pain. That has got to be incredibly frustrating to experience RLS and the damn limb isn't even there.
Any chance you have some PTSD in the mix? I have found CBT (cognitive behavioral therapy) very helpful (personally and clinically)
Even at 1/8 of a strip (0.25 mg) would probably be more than you need and would delay or postpone the inevitable.
In my opinion Suboxone tapers for detox, historically, have not been all that successful.

I have seen some blocks done by anesthesia or pain interventionists help as well.
Again, thank you for your service and I hope the VA is doing well for you. They have been amazing for some and a great disappointment for others.


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 Post subject: Re: Hello.Need advice.
PostPosted: Thu Dec 15, 2016 7:14 pm 
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Doc,

REMF haha that made me laugh man.Not REMF.The discipline part wont be a problem for me. Coming up with a plan is hard though because I have very limited knowledge of how the body works.

I do have PTSD as well as all the other BS that goes along with it.I am terrified of the withdrawals. I have gotten down to 20 mg hydrocodone a day over the last few days and It wasn't that hard but I was hoping you could help me with some questions You seem to know your S.

Should I keep tapering the hydrocodone? if so to what dose? I take it once every 24 hours. I didn't want to spread it out over the day because that's not how I was using and I didn't know how that would effect things

When I do jump off I am going to use the comfort meds as you described.How does clonodine factor into that? I have some 0.1 left over from a good while back. If the withdrawals get to intense I plan On taking 2.5 mg of hydrocodan. I hope this wont restart the withdrawals? I just have to be careful with my brain.

Can you help me figure out a timeline? I see a bunch of generic timelines everywhere for withdrawals but I feel like it will help me if I had a better understanding. I never really used hydrocodone so I dont know what to expect and that fear is making this all so much worse. I'm not sure how long withdrawals last.My usage went like this : Used every other day/3rd day until a couple weeks ago then used every day dosing at the same time.Im in ok shape do cardio often (before the surgery). at what hour mark will I know withdrawls wont get worse? like 48 hours? My understanding is 24-48 is sort of the "red zone" then it sort of starts getting better but I could be way off.
Thank you for your help. Its people like you that made me want to serve my country, helping people out of the kindness of your heart.
Geoff


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 Post subject: Re: Hello.Need advice.
PostPosted: Fri Dec 16, 2016 3:57 pm 
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Doc

were you part of a SFG?


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 Post subject: Re: Hello.Need advice.
PostPosted: Sun Dec 18, 2016 6:37 pm 
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Any body around?

I have another question. With the comfort meds do I need to actually have high blood pressure to take the clonodine? My BP never really gets high.So what do I do? should I cut the .1 clonodine into four pieces and take a.025? Does the clonodine work by lowering blood pressure or is that just a secondary effect? I take the trazadone/gabapentn at night so how long before I take my night meds should I wait to take the clonodine?
Any info is very helpful I am sort of stuck waiting to hear from somebody
Thanks
Geoff


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 Post subject: Re: Hello.Need advice.
PostPosted: Sun Dec 18, 2016 7:34 pm 
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Hello Geoff1,
Didn't want to leave you hang in here. Hopefully Dr J or Docm will come by and answer your new question s. It ks Sunday and Id guess that this evening one of them may appear. It isn't an everyday thing with them or other members.

I like what they have said. As far as needing to have HP to take the Clonodine, no, you do not have to have HP. It is given freely by drs and ER staffer s as the first line of comfort meds. Why it works for the many i cant tella.

You know, and this is just my opinion, you have two great things going in your favor. One, your withdrawing off a lower dose of opiate. Comfort meds and time could get you though this ,at least the acute part.
And two, you have the fellowship in your corner with steps and sponsor at your side. That is huge imo.

I wish you the best Geoff1 and thank you indeed for your sevice sir.. hang in there , you ll make it.


Razor.


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 Post subject: Re: Hello.Need advice.
PostPosted: Sun Dec 18, 2016 10:08 pm 
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were you part of a SFG? No, but I did spend some time in one of their compounds doing an informal consult.
Please keep in mind that this is general advise.
Clonidine is often used in .1 - .3 mg doses every 6 hours for withdrawal symptoms. You do not need to have high blood pressure to take it. Just be cautious when up and about so you don't get dizzy. If you are taking 20 mg a day of hydrocodone you have a couple of options. Drop you dose by 5 mg a day every week. By the time you are down to 5 mg a day you really shouldn't have any physical withdrawal. Psychological perhaps, but not physical.
Just an aside, when a non addicted person is being withdrawn from their medication you are at the dose they usually just stop, with little or no withdrawal.
For the anxiety, RLS associated with withdrawal you could start the gabapentin at any time. It is often used as an adjunct (add-on) medication for PTSD anyway so you could get a twofer.
Sounds like you are going to be dealing with some other issues besides the acute withdrawal so it would be a positive to be under the care of a provider, medical and therapeutic.
Semper Gumbi - always flexible, I was in the Guard


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 Post subject: Re: Hello.Need advice.
PostPosted: Tue Dec 20, 2016 12:30 pm 
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Hey Doc

Thanks so much for all your time brotha. i really appreciate it.

Look man I am really struggling with these WD's. I think it would be better if I took a small amount of sub and weaned off that. the WD's from the sub seem much more mild.
The doc said to start at .2 or less twice a day, I can do that. However I have 2 questions
1. for how long do I take the sub? I want to be on it the minimum amount of time. I'm even going to try and take .12 or less per day. Just enough to brunt the WD's
2. is 24 hours enough time to wait after use of the hydrocodone?

I am anxiously waiting a response. Also thank you for your service. Also who knows, maybe we were in The same AO together somewhere :wink:
Geoff


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 Post subject: Re: Hello.Need advice.
PostPosted: Thu Dec 22, 2016 10:24 am 
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Good morning, the type of detox you are planning is out of my comfort zone and experience. I really cannot give advise that would be grounded with medical literature or experience.
http://www.naabt.org/documents/cows_ind ... _sheet.pdf
This rating scale is often used to determine whether it is time to start Suboxone. I like to wait until a person is 16 or better.
With hydrocodone 24 hours should be long enough.
PAX


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 Post subject: Re: Hello.Need advice.
PostPosted: Thu Dec 22, 2016 11:59 am 
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Hey Geoff,

COWS scale is the way to go. At least moderate withdrawal is the safest course. I think I was at 14...not high enough for me given my habit...and I had about 2 hours of PW. Not fun. But well worth it in the end.


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 Post subject: Re: Hello.Need advice.
PostPosted: Thu Dec 22, 2016 8:06 pm 
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Doc,Godfrey

Thanks for the responses I appreciate it.
Doc I was wondering is there a general rule of thumb for how long people are on suboxone?Is it uncommon for someone to stay on it for a just month or 2? I guess i never really thought about it. With hydrocodon would you say there is a definite safe amount of time I can wait to be sure of no PW? I know the half life is like 4 hours but that's about all.
Thanks and I hope you guys are having a good holiday season
Geoff


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