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 Post subject: Help for my Husband
PostPosted: Fri Jan 14, 2011 4:13 pm 
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My husband his an oxycontin addiction from me and his friends for many years....finally....when items started missing from my house....unexplained disappearances...it all came to fruition that he had an addiction and he came clean and seeked help. This was 3 years ago. Upon going to the doctor for help, he recommended Methadone. He started at 30 mg and was only able to taper down to 15. Anything lower than that, and he just couldnt physically do it. After researching suboxone, he decided to make the switch, for a variety of reasons, namely with methadone we were and still are having grave difficulties concieving a child and would like to start a family.

He went off methadone on Tuesday, today, being Friday, he went to his doctors for his first suboxone treatment. He was excited, he really felt this would work for him.....and...sadly....it isnt. Mind you his first dose (4 mg) was only at 10 this morning 5 hours ago, but he has become violentally ill. Nausea, throwing up...sweats, irritability. It is literally like dealing with a different person.

His doctor will only see him again on Monday. he is struggling. What can I do? is this the norm?

Any and all input is very much appreciated.


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PostPosted: Fri Jan 14, 2011 4:48 pm 
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No, this isn't the norm. In many cases of going from methadone to Suboxone, people don't taper the methadone enough, or wait long enough before induction and go into precipitated withdrawal. This doesn't sound like the case with your husband if he was only on 15mg and he waited 3 days. Was he in withdrawal when he started the Sub? Maybe after being on only 15mg the Sub is too strong for him. This is why I believe it's safer to induce in a doctor's office. Can you call the docs emergency number? I think if he's vomiting after only 4mg of Sub it warrants at least a call from the doctor.
Sorry for what you're going through. Maybe others will have better advice to offer. Please let us know how it turns out.
Lilly


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PostPosted: Fri Jan 14, 2011 4:55 pm 
I disagree it is most definitely precipitated withdrawal, even tho it was only 15mgs of methadone it still has a monster half life and 4mgs of sub is not "too strong" for someone on 15mgs of methadone. No matter what dose of suboxone it is said that the addiction level maxs out at around an equivalent of 30mgs methadone in terms of the withdrawal you would feel. The sub ripped whatever methadone was remaining off his receptors and made him very sick. Whatever he does dont give him more sub until the precipitated withdrawal is over. Methadone withdrawal wouldnt even begin until day 3 possibly even day 4 or 5. When starting sub it is imperative that you wait until you feel the withdrawal not just counting how many days have passed, you must feel the classic symptoms of withdrawal start before taking it. OP when your husband started methadone just curious did the doctor that recommend it to him actual dispense it to him in a precription or send him to a methadone clinic?


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PostPosted: Fri Jan 14, 2011 5:12 pm 
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I have to agree that he's probably suffering from precipitated withdrawals. The methadone is just simply too long-acting. Some people actually stop their methadone and switch to vics or oxys for a week before inducing on sub. Like suboxowned said, DO NOT TAKE ANY MORE SUBOXONE until the P/W symptoms are gone. Taking more and more sub in his state will just make him sicker. Beware though, there are sites that actually instruct the person to take more sub until they feel better, but that's just wrong. He's got to wait it out before trying to induce again. I also agree that he needs to contact the doctor because he/she needs to know what happened and can direct him on how/when to re-induce.

I'm so sorry to hear that this happened. I'm curious, did the sub doctor have him take his first suboxone at home or did he give it to him in his/her office? Usually inducing with the help of a doctor is the way to go to be sure to avoid P/W, but obviously that didn't help in this case.

I hope he can re-induce without further incident. Please do let us know how he's doing.

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PostPosted: Fri Jan 14, 2011 5:21 pm 
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thank you all so much for replying. Your support and kindness has been outstanding.
My husband (Mike) made the request to switch to sub with his methadone doctor, at a methadone clinic. There is no take home prescription (unlike carries for methadone), he is expected to go to the clinic daily in the early stages to administer his dose. Today it is 4 mg. And after speaking with the doctor, he will only increase his dose to 8 mg, on Monday, not sooner. No explanation provided, that was the decision he made.

So yes, this did indeed happen in the doctors office.

So do you mean to tell me that he should potentially discuss NOT taking a dose tomorrow if he is in a precipitated withdrawal with his doctor?

Thank you all for your help, Im so used to being the rock in our relationship, for the first time, in a very long time, I feel helpless. So you have all been great! Really. God im terrified this is going to be a long night....
Lynn


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PostPosted: Fri Jan 14, 2011 5:46 pm 
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It's my understanding that if Mike is still sick from this tomorrow, then he should NOT dose with suboxone. He should wait until the P/W subside.

May I speak freely about this doctor? Because, wow - it sounds like this doctor leaves MUCH to be desired. Have you two discussed getting a "regular" suboxone doctor? (I'm assuming you're here in the US...?) Suboxone was approved for office-based treatment and here in the US, suboxone patients don't have to go in daily for their dose. (I understand this is different in other countries though.) To be frank, it sounds to me that this doctor doesn't know much about suboxone at all - for example, s/he should have known that 3 days off methadone - even a low dose - wasn't sufficient to prevent P/W. If it were me, I would be pissed off!

Regardless of my opinions about his doctor, it would be best to at least tell the doctor what happened and hopefully s/he will know how to handle it and can instruct you on taking further doses.

Hope this was a bit more clear.

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PostPosted: Fri Jan 14, 2011 5:58 pm 
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we are in Canada.

Toronto specifically.

Sub only became available here in October 2010. So its very new, and this is why methadone users are eager to try it in hopes of breaking the liquid handcuffs of sub.

He doesnt know what to do. We have several carries of methadone in the fridge still. He is tempted to drink it, although I have insisted that it wont work anyways, and is likely dangerous at this point to be mixing anything at all. I have now hid it in the car for fear he may try to go for it in desperation.

He has to go to work tomorrow. has to. he took the last 3 days off in fear of withdrawal symptoms, and with the methadone, the only feeling he had was last night some mild cramping and sweats. Thats the issue, I think your all right, 3 days was obviously not enough.


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PostPosted: Fri Jan 14, 2011 6:51 pm 
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Ah, the trials and tribulations of finding suboxone providers in Canada! I know the struggle well...my best friend is from Ontario and lost her doctor and is having a hell of a time finding a new one. If I recall correctly, in Canada suboxone does require daily visits for, I think, the first 3 months. So you might be in a situation where this is the best doctor you can find. Let's just hope he knows more about sub than it appears. Either way, if I were you I find everything I could about suboxone just so YOU have the necessary education/knowledge.

I honestly don't know how long it will take for the P/W to cease and when he should try taking sub again. Anyone else know more on the subject? Wait - I just found something you should read from Dr. J:
http://suboxonetalkzone.com/2008/12/07/ ... -now-what/

That should help you understand what happened a bit better. I hope it helps.

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-I'm only responsible for what I say, not for what you understand.


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PostPosted: Fri Jan 14, 2011 7:19 pm 
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OK, I just found Dr. J's post on P/W. Here's what he says:

Quote:
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.


Dr. J advocated for going ahead and completing the induction (I bolded that part of the text.) I hear where he's coming from. If you don't continue to induce, it places the person at risk of using, then they would try to overcome the blocking effect of sub...and it could get dangerous. This makes sense to me. Yes, he will be sick for longer, but he'll be on the sub and on his way.

See, I said I was no expert! I'd listen to Dr. J on this subject more than little ole me. I really hope this helps you figure the whole thing out.

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-I'm only responsible for what I say, not for what you understand.


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PostPosted: Fri Jan 14, 2011 7:51 pm 
I understand what the doc is saying and he obviously knows way more than me as he is a Dr. but I dont know if I could do that to myself. Im a baby when it comes to withdrawal and I would rather ride out the short but more intense PW than to keep taking the sub and prolonging. To each his own though I just dont think i could do it. But @torontogirl I would follow what the doc said dont let what I said confuse you im just talking about my personal preference.


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PostPosted: Fri Jan 14, 2011 10:29 pm 
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Thank you all for your words of wisdom! after hours of having him in a bath...Ive managed to get him to sleep, he is in and out of sleep, but resting and not restless and aggitated as he was earlier, the nausea has stopped as well.
Now after reading Dr. J's advice, I must ask, is it possible Mike wasn given enough suboxone? His induction phase seems to be at 8 or 16 mg, Mike got only 4. And was told its going to be 4 until Monday, then they will assess and if they feel he needs more. Also, is this what is described as dope sick? (Im sorry, forgive me, I know alot about methadone but his transition to sub was a very quick decision and took me by surprise as this all transpired this week).

How horrible, its like the flu. Times 20.

I fear the doctors in Ontario are not entirely familiar with the proper procedures....I fear this is indeed going to be an issue.

And in summary, I must ask, is this really, I mean really, a better option than methadone?? I just want him to be comfortable, we have worked very VERY hard together as a team to get him through this. I cant imagine him going back to his preferred opiate (oxy) but I cant help but feel very frazzled.

Thanks for the vent, and input, will be online all night researching everything I can! You have all been so kind!


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PostPosted: Fri Jan 14, 2011 10:49 pm 
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Yup, that's what being "dope sick" means. If it were not precipitated withdrawals, then he would've felt a little bit better from the suboxone and if he needed more, he would have had lingering withdrawals, but he would not have gotten violently ill. (Was he even in withdrawals when he took that first dose?) Based on what you've told us - him being off methadone for only three days and the severity of his symptoms, it sure seems logical that it would be precipitated withdrawals.

While you're doing your research, be sure to check out Dr. Junig's videos on You Tube...He calls himself "suboxdoc".

No one can tell you that suboxone is better than methadone. It's better for some people, but nothing is one-size-fits-all. Suboxone is a different kind of opiate from methadone - it's a partial agonist, where methadone and other opiates are full agonists. Suboxone has a ceiling that full agonists don't have. You don't grow tolerant to its effects and so you don't need to increase your dose over time, like with most full agonists. Methadone, like other full agonists, give that "high" feeling...whereas suboxone does not. At worst they might feel a bit dizzy or loopy the first few days, but never high. These are just differences between the two. Only you guys can decide what's right for you. All I can say is for me, suboxone was the right answer. I know I would have tried to abuse the methadone and with sub I simply can't do that. Oh, and while you're on suboxone, it blocks you from feeling any high from other opiates. So it's another deterrent to relapse - you won't feel it anyway, so why waste the money trying to chase that high again?

I could go on, but I feel I've already inundated you with a lot of info. Just ask if you need further info or clarification. I know

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PostPosted: Fri Jan 14, 2011 10:53 pm 
Its hard to answer if its a better option than methadone, if you want my opinion (and I hope others dont get mad as its just that, my opinion) than no sub is not better than methadone, I dont look at them as one better than the other. Its which ever works best for the individual is what counts. Im on sub but have considered going on to methadone and I actualy will be sometime in the future when I can make it possible to work daily visits to the clinic in my schedule. Sub withdrawal is no picnic either, its a strong opioid and alot of people are misinformed when they get on it thinking it wont have any withdrawal or very minimal compared to THE BIG BAD METHADONE because of all the stigma and propaganda out there over methadone. If methadone works for someone and they are leading a productive life I dont see any logical reason for them to rush in some big hurry to switch over to suboxone. Methadone also in my opinion would handle cravings alot better than suboxone since its a true opiate and suboxone is not. I still crave quite a bit on suboxone its just not as bad as craving without subs. I can honestly say that if methadone were dispensed like suboxone is here in the US in a doctors office I would of chosen methadone hands down. This is just one persons opinion though, but to me suboxone is way over priced and touted as being so much better than methadone when in all actuality its a bit less effective for addicts with a large habit. It works for lots and lots of people but then there are some (me included) who struggle alot with it.


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PostPosted: Fri Jan 14, 2011 11:07 pm 
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Thanks again, your replies are most helpful.

I would say Mike wanted a feeling of normalcy again. He has told me time and time again, that methadone, never made him feel normal. So he felt the need to try something different, and the fact that he had grave difficulties getting under 15 mg was an issue for him. The most he got to was 13 mg and it was very very difficult. The doctors in Ontario also appear to dissuade their patients from lowering their dosage. Strange but true. So in essence, there is no end to methadone here, some of the people Mike have met in the clinic have been there for a decade, and the doctors have never tried to encourage them to lower their dose. Its a never ending cycle.

Our family doctor really felt that methadone was the reasoning behind our fertility issues (impotence). Thus why Mike went full speed ahead with another alternative, he was told there are less instances of impotence via sub vs methadone. So thats almost all he needed to know to give it a try.

Methadone does indeed handle cravings. I have seen instant relief over his face the minute he drinks it. Could be psychological, but that euphoric look is certainly there.

I am going onto youtube right now to view the video! thank you!


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PostPosted: Fri Jan 14, 2011 11:10 pm 
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hatmaker510 wrote:

I could go on, but I feel I've already inundated you with a lot of info. Just ask if you need further info or clarification. I know


and you can never inundate me with too much information! I am absorbing everything eagerly. Thank you...you have outdone yourself today with all your replies.


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PostPosted: Sat Jan 15, 2011 12:15 am 
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Thanks for the kind words. Everything I know about suboxone I learned from this site.

I just wanted to add that I have zero cravings on suboxone. I may experience triggers from time to time, but no cravings. And most of the people I know the same experience. It's when you're on too low a dose that the cravings start coming back.
I'm constantly hearing people describe starting on suboxone and very quickly feeling "normal". I know I feel fine - normal. It sounds like, based on what you're saying, that sub might be a really good fit for him. It just sucks that happened when he tried to induce. Hopefully one of our members who have also gone through P/W will come along and chime in.

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 Post subject: dont stop the sub!
PostPosted: Sat Jan 15, 2011 6:32 am 
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i know its late,but i can't sleep and i might as well chime in. I went through the same thing when induced from methadone to sub, and it was'nt pretty. i was in methadone limbo for 6 years and on oxy's for 4. i started @ 20 mg and kept increasing my dose till i was @ 240mg and it was very easy to abuse or sell my extras. I'm sure there are good clinics out there, but over the years i havent talked to 1 person that was successful with meth. anyway, to make a long story short, i started sub on friday may 6th @ 8:00 pm after tapering down to 40mg methadone from 240mg .last dose was on tuesday @6:00am. my sub doc told me i would get sick no matter what and he was right! about 25 min after taking the sub i went into pw and it was the worst night of my life but i finally got a couple of hours of sleep late sat. morning and felt better after that. i managed to get to work on monday and havent missed a day since. it took a week ar so till i felt normal @ 16mg. I'm @ 0.5 mg now and in no hurry to get off. idont care what anyone has to say about sub, its resurected my life and i could wright for hours how good i'm feeling. Keep taking the sub as prescribed and he'll be fine, everyone that switches over from meth goes through some level ofPW.........sorry this was so long! good luck!.....Pete


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PostPosted: Sat Jan 15, 2011 8:32 am 
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Thank you very much Pete....I appreciate your thorough response.

Im saddened that the doctor did not forewarn him of the possibilities of feeling ill, Mike has no idea what premeditated withdrawal was until I read it here. His doctor doesnt know what the is. And this is the danger, its too new here, Mike is going to be a guinea pig. I dont want to ask the doctor to raise Mike's dosage but I cant help but notice most people are on 8 mg a day? We will bring it up this morning when we get to the clinic in the next hour.

Thanks all!

Lynn


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PostPosted: Sat Jan 15, 2011 9:03 am 
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and the drama continues....he wont get out of bed. Poor thing. the moaning and groaning, hes never been like this before, even when he broke his ankle in 3 places and had surgery (thats when the painkillers were first prescribed, and the addiction began)

I dont know what to do at this point, he wont move...hasnt had a thing to eat or drink since Thursday night.

Ugh. I feel totally helpless.


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PostPosted: Sat Jan 15, 2011 9:11 am 
Hey how are you? I hope things have gotten better!! I dont know much about Precipitated Withdrawals but i did switch from 30mg's of methadone to sub. I had to wait 6 very long days before i could even get an appointment to see the sub doctor. Luckily i really believe that was to my benefit because everything went really smooth. I didnt take anything in those 6 days either. This definitely sounds like PW's. I will say that in the beginning their were days where i would wake up throwing up back to back to back to back and this was a couple weeks or so after induction. I guess my body was getting rid of the methadone. Methadone stays in your system a very long time especially if you've been taking it for a long period of time. The sickness i felt when i woke up was like pure hell. I was the most nauseous i believe i had ever been in my life. I would most likely follow the doctors orders. One thing that im wandering is if that dose will be enough. Because i actually started out at 24mg's an then went down to 16mg's over time. Now im at 10mg's. I've been taking it for 20 months. Havent relapsed not once. I do have bad days though to when it just seems like the med doesnt work but it passes. The one complaint that i have about this medication is the route of administration. The fact that it has to absorb into the inside of your mouth. You can never know if you got your accurate dose or not. You may go a few months getting perfect absorption but then for whatever reason your mouth waters up more than usual and you foul up your dosing which to me explains why their are days that it just seems to not work. In my opinion, methadone would work better only because its a full agonist and a real opiate. I know for me, methadone always worked the exact same everytime i took it. Their was no up or down or in between. It was very very effective in my opinion. Im just rambling here but i wasnt home last night and didnt get to comment here so i wanted to leave my thoughts and also wanted to see how things are going???? I hope he is doing ok!!


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