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PostPosted: Sun Jan 01, 2012 12:59 am 
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Happy new years everyone!! Too bad me and my bf is celebrating at home in bed.. so heres the thing... my bf last took his shot of H on thursday night 830. He was prescribed subs 16mgs/day, induced at home yesterday night (friday) at 500pm first 8mg, then at 600 another 8mg. I believe it precipitated wds becuz he vomited 3 times through the night and he stayed in bed tossing and turning, answering my questions with only nods or head shakes.. he tossed and turned without sleeping last night, and haven't ate since Thursday night :cry: ... he was a heavy user but he cut down to half a gram the last two days of using. It was only 3 hrs short of 24hrs since last dose when beginning of induction. I guess it wasnt sufficient amount of time to lower his tolerance before induction...
Its been over 24 hrs since his last dose of subs but he hasnt taken his subs today bc he is afraid it will make his withdrawals worse. Would it?? I'm thinking that since its been 48hrs since the last H shot, the subs would actually help him today... am I wrong???

I know everyone's one is celebrating new years.. no one would prob respond to this til tomrw.. sigh lol
This is a great site btw.. lots of information and it gave em a better understanding of how subs work..any help is much appreciated. Thank you!!!! ^^


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PostPosted: Sun Jan 01, 2012 1:41 am 
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Hey whisper,

Induction onto Suboxone is not so much about how much time has passed, but much more to do with how bad a state of wd you're in.

Google search COWS scale. It will help you "score" your boyfriend on how bad his wd is. It's suggested to be in mild to moderate wd before taking that first Suboxone.

Now, with all that said, I'm not completely sure if the fact that he's already taken some Suboxone hasn't already knocked most of the H off of his recpetors and he may be fine to take more Suboxone right now?? I'm just not sure about that one??

I'm gonna say he can take 2mg of Suboxone right now and he can see how that goes. 2mg should not be enough to really send him into precip. wd., if all seems well after an hour or so, he should be good to go??

I'm sorry my answer is kinda all over the map, but I just now saw your post and wanted to offer at least some advice.

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PostPosted: Sun Jan 01, 2012 1:59 am 
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Thanks for replying!!

I was thinking the same.. giving him 2mg to see if he feels any better.. I would think that yesterday when he took the 16mgfor induction it threw off allor most of the Hoff this receptors too. If so, those that mean it won't trigger worsening of withdrawals if he takes some now? I don't know if its pointless to check the cowsscale now, but I think its around 25..


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PostPosted: Sun Jan 01, 2012 7:24 am 
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How's your bf doing today? Did he take anymore Suboxone? Did he get any relief?

Some of us have a rougher time getting onto Suboxone than others. My induction went beautifully, I was lucky.

I certainly hope he doesn't give up on Suboxone. I abused the hell out opiates for 10 years and Suboxone is what FINALLY enabled me to stop the madness, it is a great medication that certainly has the potential to help your bf.

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PostPosted: Sun Jan 01, 2012 9:36 am 
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He's still the same.. I cut up the 8mg strip into 2mg pieces. Then I took one of those 2mgs into 1mg pieces because he is worried that they might make him worse but he still havent taken any.. I don't know if its best to wait til his withdrawals get better or what. I read that its best to wait til the precipitated wds to subside to start induction over but then how would you know the difference if you're having your regular withdrawals or not? He's worried that taking more will make him throw up and make things worse but its been 36hrs since he had his first suboxone and I'm thinking he threw off all the h off his receptors already... ugh not sure what to do.. feel like if he's going to wait til he feels better then by then he will prob be done with his withdrawals anyway..??


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PostPosted: Sun Jan 01, 2012 9:48 am 
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You're very lucky the induction process was smooth for you. What kind of opiates were you using prior if u don't mind me asking? My bf used to do opanas, oc, roxis, and h.. I'm really sick of watching him being a slave to this.. its not just him that goes through hardship BC of it, I'm going through it too and I'm so tired of this life.. I used to use with him a while back but I stopped and never went back BC I felt like I can't help him if we are both like this.. but even now its hard I feel powerless to his addiction..
I wake up several time a night worried that he might have stopped breathng and I put my hand on his chest to feel for his chest rising...


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PostPosted: Sun Jan 01, 2012 10:13 am 
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Hi and sorry your boyfriend is having such a difficult induction. I am no expert and basically everything I know I learned here. From what I've read taking more sub now shouldn't make him feel worse but it just might take a little time to make him feel better.

I agree with Romeo and would try giving him 2mg, if it doesn't make his symptoms worse after an hour then I would give him 4mg and so on. Don't expect the 2mg to make him feel better, just see if it makes him worse. Again I am definately not any type of medical professional, this is just my opinion.

Let us know how he's doing and don't hesitate to ask any other questions you may have. There is usually someone out there that can answer.


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PostPosted: Sun Jan 01, 2012 11:15 am 
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Hey whisper,

I used any kind of pain pill I could get my hands on. For the most part, that was Lorcet (Vicoden) and OxyContin. At the height of my addiction I could snort an OC 80 and barely get a buzz.

My wife used to tell me how my addiction was hard on her and I just didn't get it. I was/am so self-centered that I just couldn't get myself to think of what she was going through. It's only been here lately that I've really come to understand just what she went through with me and you're right, it is very hard on the other people in an addicts life to watch them basically destroy themselves.

OK, I know your bf is terrifed of Suboxone right now, but like Breezy said, the 2mg is not so much to make him feel better, it's more of a test to see if it makes him feel worse, which it really shouldn't.

I absolutely do not mean to sound like an idiot, but he is placing the Suboxone under his tongue and letting it absorb there, right?? You are NOT supposed to swallow Suboxone.

I really hope he gets better soon, Suboxone can really change his life. It's changed the lives of MANY, MANY opiate addicts....hundreds upon hundreds of them are right here on this forum.

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PostPosted: Sun Jan 01, 2012 11:23 am 
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:!: I have spent the last hour trying to find the article or post I read here recently about just this thing I think it was this doctor's post or blog maybe someone else more familiar with this site can tell u how to find his (the docs) posts or blogs. But...IT SAID IF YOU START THE INDUCTION AND GET PRECIPD WITHDWLS DO NOT STOP THE INDUCTION Or you will give the something anothers a chance to build back up and the sanme thing well keep happening. It flat out said to keep taking the script as prescribed and very quickly the sub will knock the receptors in the head so to say and stop the withdrawals. Damn It could have been that Dr. Jana Bursons blog maybe. I don't do subs but I had missed an appointment at my done clinic onetime cause of snow days and because of that one day I was screwed for 4 days cause they gave out takehomes to everyone so they could be closed so a friend gave me a sub to get thru the night I thought I was dying. This was the reason I even read this article as I wanted to know what the f--- I had done. BREEZY OR HATMAKER how do we get to the blogs that this doctor junig has? I am pretty sure it was he that said what to do if this ever happens. I DO PROMISE it said to keep going on just as prescribed to get thru this mess up quicker if you stop or even try decreasing the subs it makes matter worse.

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PostPosted: Sun Jan 01, 2012 12:06 pm 
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At the top of the page is the Suboxone Talk Zone link, click it and it will take you to Dr. J's blog. I believe this is the article you are referring to:

http://suboxonetalkzone.com/precipitate ... -now-what/

According to Dr. J, he should continue to take his full dose every morning and should be feeling better in about 48 hours.


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PostPosted: Sun Jan 01, 2012 4:16 pm 
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:wink: BREEZY you're the best. I knew u would find it and yes that's it.

:!: WHISPER Please read the link/http address in the above post by Breezy. I knew she could find it as I just read it the other day. This article explains your situation perfectly. I know you bf is going to be scared to do it and it sounds insane, but this doctor knows what the hell he is talking about and if you don't listen I believe your bf will be laying around real uncomfortable for days. Now that you have started and the Precips have begun there really is no way to reverse it, but by listening to what the doc says in this article and doing the same the 16mg dose will knock that residual H out of his system. IT DOES MAKE SENSE.

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PostPosted: Sun Jan 01, 2012 4:42 pm 
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:arrow: I WENT AHEAD AND CONTROL COPY/PASTE THE ARTICLE SO EVERYONE MIGHT READ IT TOO. I went thru precipitated withdrawals because I took a sub on top of my 160 mg. I know I know it was STUPID I took it to avoid withdrawals and within 5 minures I was so sick I went to hospital in ambulance. When I got to the hospital none of the nurses nor the doctor I saw upon getting there even knew what precipitated withdrawals were. So guess what they gave me for pain without telling me tramadol which made it worse. My situation and/or reason for taking the suboxone was different. The precips are terrible. You take each and every withdrawal symptom you normally have and exagerate it by ten and thats exactly what it does it takes your usual symptoms and exagerates them. I sneezed and yawned at the same time. The yawns were so extreme my jaw would pop in and out. I threw up so hard and explosive I popped a blood vessel in my eye. SO FOR ANYONE OUT THERE THAT HAS NEVER EXPERIENCED PRECIPITATED WITHDRAWALS.... please note that these withdrawals are not the same ole' withdrawals you have had before.....they are ten times worse than the usuals. I am nor sure why, but they are.

Precipitated Withdrawal– Now What?

by SuboxDoc on December 7, 2008

I saw this question on another board– I didn’t want to add my reply to the other five answers already listed, so I’ll put it here for hopefully the next unfortunate person in ‘precipitated withdrawal’ to find.

For those who don’t know, precipitated withdrawal occurs when a person’s level of opiate stimulation is suddenly reduced by another medication blocking the receptor site. This occurs when an overdose patient is given an opiate antagonist such as IV naloxone. As soon as the naloxone hits the receptors in the brain, the oxycodone, methadone, heroin, or other agonist is ‘displaced’ and the receptor is ‘blocked’ by the naloxone. I actually did this to myself on several occasions back in my using days; once by out of desperation and stupidity using an unmarked syringe that contained naloxone, and two other times by ingesting naltrexone, an orally-active opiate blocker, in attempts to make myself ‘get clean’. Those experiences lead to my first comment about precipitated withdrawal: you won’t die… but you will wish that you did!

The active ingredient in Suboxone, buprenorphine, will cause withdrawal if a couple things are present: first if the person has taken an opiate agonist recently enough so that there is still agonist drug bound to the receptors, and second if the person’s tolerance is greater than that associated with about 30 mg of methadone– equal to the opiate-stimulating activity of Suboxone. If a person just took his first 20 mg of oxycodone, I wouldn’t expect the buprenorphine in Suboxone to induce withdrawal because at his tolerance level, his receptors will see buprenorphine only as an agonist– not as an antagonist. The rules are not ‘hard and fast’, but depend in a complex manner on the interaction between recent use, half-life of the recently-used drugs, and the person’s tolerance. For example, if a person is used to 600 mg of oxycodone per day, but hasn’t used for 24 hours—long enough to get most of the oxycodone out of the system—I would still expect the person to have precipitated withdrawal– because even after 24 hours without using, the person’s tolerance level will still be quite a bit higher than the ’30 mg of methadone’ level of stimulation caused by buprenorphine. There is a bit of an art to avoiding the withdrawal, but sometimes it can’t be avoided. For example, in the 600 mg oxycodone case, I could tell the patient to go without using for three days; that would be enough time for their tolerance level to drop closer to the ’30 mg methadone’ mark… but the person will feel utterly horrible during that time, and sometimes it is obvious that there is NO chance the patient will stay clean that long. So there are two choices; schedule an induction in three days and then cancel when the person breaks down and uses something the night before the induction, or shoot for 24 hours of clean time and let the patient know that he/she is going to be a bit sick at the induction.


Eddie the Suboxone Puggle

The picture, by the way, is my puppie Eddie. A reader wrote that my addiction picture was ‘disturbing’– I replied that it is SUPPOSED to be disturbing! But I thought maybe a nice puppy picture would help everyone feel more comfortable. Moving on…

I should mention that the ‘proper way’ to manage the patient taking 600 mg of oxy per day is to taper the person down to the equivalent of 30 of methadone per day. This never works; first of all, it is illegal for any doc to taper opiates for the purpose of treating opiate addiction, unless the doc is part of a registered methadone center– and methadone centers, in my experience, are not interested in doing the work of tapering people off opiates. They tend to do what they want, and that is to increase the dose of methadone– not decrease it. But even if the patient found a doc willing to break the law and schedule a taper, the tapering schedule cannot be followed by the addict. I suddenly think of the old joke…’if I could walk THAT way, I wouldn’t need the talcum powder!’… as I think in a similar vein, ‘if I could do a taper, I wouldn’t need an addictionologist!!’

The good news is that precipitated withdrawal is much shorter than real withdrawal. IF you have precipitated withdrawal, all is not lost—providing you do the right things. First, understand that you are going to be sick for about 24-48 hours no matter what you do. Your choice, at this point, is: after you get better, will you be on Suboxone, or will you be using?

If you have PW (I’m sick of writing out Precipitated Withdrawal), the most important thing is to FINISH THE INDUCTION! Complete the dosing of Suboxone, as quickly as possible—take the full 8 or 16 mg. If you stop the induction early, after only 4 mg, you will likely end up using later in the day to try to overcome the block. That gets real dangerous, and only prolongs the misery– and in a few days when you finally have the Suboxone out of your body you will still be using. On the other hand, if you complete the dosing of Suboxone– take the full induction dose of 8 to 16 mg– you will be at a place where no amount of using will overcome the block (so don’t even try!). Try to deal with the withdrawal in the usual manner (clonidine, immodium, warm bath) and the next morning take another 16 mg dose of Suboxone. Keep dosing each morning—DON’T mess with multiple daily doses as they won’t help and they can potentially make it worse (if you take very large doses of Suboxone it becomes a pure antagonist). If you just keep dosing 16 mg per day each morning, by day two you will be much better, by day three you will be 90% better, and by day 4 you will be out of withdrawal. It’s fast—unless you play with it.

By day 4, you’re done with the misery and on Suboxone. Your addiction will be in remission, provided you do the other things required to get better—things which are usually fairly easy to accomplish if you have some level of desire for the sober life. And it is wonderful to have the chains removed! Once you are at this point, KEEP TAKING THE SUBOXONE! I read the comments at some sites about ‘coming off sub’—it is important that you understand that virtually ALL of those people—the ones who go on Suboxone, get their lives back, but then believe some idiot ranting that ‘they aren’t really sober’ and go off Suboxone— will only be using again, probably in a matter of weeks. It is so unfortunate… people go to these message boards and read ‘support’ and ‘encouragement’ to ‘get off Suboxone’, usually doing the taper wrong, suffering through unnecessary withdrawal, and blaming their misery on the Suboxone… Then they write with excitement how they are now ‘really clean’… But in a week they are gone from the message board, too busy to write, scrounging up money to buy dope—or more likely, selling their computer for the money for dope. It doesn’t work, people.

Is it ever possible to get off Suboxone? Yes– if you are willing to treat your addiction with something else, usually twelve-step-oriented recovery. Suboxone alone is not a cure– it is a means to induce remission of opiate addiction. For someone who got clean ‘the old fashioned way’, the glass is half full!

SD

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