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PostPosted: Sat Jan 02, 2010 10:56 am 
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Hi I was wondering if im going crazy and really dont need suboxone. I will start by telling you that I was prescribed fentanyl 8 months ago starting at 25 mg every 72 hrs. It was increased to every 48 hrs because I wasnt getting any releif for pain I was having. About 4 - 5 months into it I was always feeling weird and could never put my finger on why. I was just jumpy all the time. My pain was still bad so my pain doctor increased me to 50 mg every 48 hrs. For about 2 months I still felt very weird all the time and still hurt. I started to figure out that I was feeling weird on day 2 after putting on a new patch. I couldnt be still, couldnt sleep, my legs were restless, I felt starnge sensations in my legs and body and it was driving me crazy. I was having really bad mood swings and started to think about suicide. I couldnt quite figure out what I was going through. I finally went to my pain doctor with my wife so maybe she could understand and help me explain to my doctor what was going on. Basically my pain doctor told me that she thought I had a high metabolism rate and went through the fentanyl too quick and was having wd's the second day. My body was just getting to use to fentanyl and she wanted to increase me to 75 every 48 hrs. I freaked out and totally went nuts thinking I had to just keep going up. I told her that I just want off the patches completely. She told me that I had to see another pain doctor and use suboxone to get off the patches. She said I was probally addicted and I had to see a special licenced doctor to get off these patches. I am 44 yrs old and have 4 boys and never in my life used any drugs nor do I drink or smoke. I tried marijuana once in highschool and didnt even like that. So basically I just followed my doctors orders and did what she recommended. She dropped my dose to 37.5 every 48 hrs and gave me a referral to see another doctor to start suboxone. My question is that ive been on 37.5 for 2 weeks now waiting to see the new doctor and on the day I put my 37.5 on im good about 1 hour after its on and then im normal for about 24 hours, then around that time I start feeling bad and watch the clock and can't wait until my 48 hrs coms up. I start pacing, jump in and out of a hot bath 20 times my legs are moving contantly and my body just feel weird. Im not getting bad cramps, worse pain, nausea, but just strange feelings that are driving me insane. Does anyone think maybe I was always going into wd's because my bodies craving a new patch. Im so scared and dont know whats wrong. I have a new appointment on Jan 4 too start on suboxone and im confused. Am I a junkie, did my pain doctor make me a junkie. Im scared and dont take any other medications other than 37.5 fentanyl now and supposed to start on suboxone and then I think there going to ween me off suboxone in 3 months to a year. Do I need to be on that that long. Im so confused and scared. Maybe the wds are just anxiety, but im not sure. Any help from anyone will be appreciated. Thanks


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 Post subject: Everything will be OK!
PostPosted: Sat Jan 02, 2010 1:11 pm 
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Hey boxingofficial -

Thanks for your story! I think you will find great help here not only for suboxone, but to understand what is going on with your body. Here's the scoop.

1- You must have been in pretty good pain to have the doctor give you fentanyl patches. It is seriously, mg - to - mg like 1000 times stronger than morphiene. That's why it's in mcg dose.

2- The patch is supposed to transdermally (throught the skin/fat) absorb slowly into your body. It could be thought of like taking oxycontin in a way - the idea it to trickle a little into your body for up to 3 days, then replace the patch and get relief around the clock again.

YOU ARE RIGHT! Metabolism is everything. So is absorption. That is true with any med, but especially with patches, and suboxone (sublingual - under the tongue).

I can tell you from your postings that you are doing the worst roller coaster many of us have had. That is you get the drug in your system, and then your body eliminates it too fast. What is the result? Withdrawal.

Common Symptoms of cold-turkey withdrawal. Runny Nose, sneezing, chills, muscle pain, jumping legs, insomnia, diarrhea, sometimes nausea and vomiting... Any of these sound familiar?

You care about these because, these are used to score you on a COWS scale (google it for opiate withdrawal) - and that will tell you if you are in mild, moderate, full opiate withdrawal.

Yes, you are what we all have, 'dependent/addicted' to fentanyl (opiates). Otherwise you would not be going through the above in between patches. You are not a 'junkie' in the term of a street user, you are a person who has become dependent upon a pain medication, and now to get off - needs help.

Things to really think about here for you:

Do you know what suboxone is?
*Suboxone is not a full-agonist opiate like fentanyl, hydrocodone, oxycodone, heroin, etc. It will block your receptors - limit or stop the withdrawal roller coaster you are on.

**What it is not - is a very good pain killer. It helps some (many can tell you) but it is not as effective as other opiates for pain relief.

Why do you care?
* Suboxone is strong/long acting medication. Fentanyl's half life is like 4 hours. The patch gives you a small dose over time. It can build up in your fat - but in your case it sounds like it get's absorbed and then eiminated much faster. Suboxone's average half life is 37 hours. Big difference.

** Suboxone won't let go of your receptors. So, if you (I think you will find great relief from your withdrawal symptoms by the way) get on suboxone - but you are still in PAIN - you have limited choices to help. You can put a patch on - but it's like wasting your money. Suboxone will keep the weaker fentanyl off the receptors for pain.

SUBOXONE IS FANTASTIC! For almost all of us - and probably you as well. What it does is it does NOT get you fuzzy/high/numb... you will feel 'normal'. In your case, though, 'normal' will likely still have pain, if you can live with ibuprophen or other nsaid's for the pain - you will be VERY HAPPY.

Suboxone on a typical person like me, dependent upon percocet - around 100mg's a day - suddenly stopped my roller coaster ride. I was no longer looking for my next pills in 4 hours. Analogy to 48 hours to you... I didn't feel OK, then like sh**, then sortof OK, then hot baths, etc.... The dependence on meds like that for us, is horrible.

You will hear terms when talking about suboxone that may not be familiar to you. You should go to youtube and look up suboxdoc, or go to his blog (linked in the title of this page). It is quite possible we share a disease that makes us susceptible to opiates. Some addiction behavior is worse than other, but the feelings are the same - exactly what you described.

I'm glad for your visit with the doctor. In very practical terms, it is best if you go into the doctor's office in mild to moderate withdrawal. Maybe about the time you want to take the first bath - you know your body. What you won't get, nor want, is to have fentanyl freshly in your system when you take suboxone. You need to be 'jumpy' as you put it, then suboxone will be like magic. It's simple logic - suboxone is stronger at the opiate receptor in your body - and if fentanyl is there, suboxone will 'kick it off' and you will get 'jumpy withdrawals immediately'... that is called precipitated withdrawal - and no fun from what I read.

If you start suboxone with mild to moderate withdrawal - you will feel normal after a few hours - and it will take a little time to adjust the dose for you. For me it was a gift from God.

Lastly, tapering... One step here at a time... First the 'jumpy' as you call it is withdrawal. The goal of tapering is to not get that way! There are no hard and fast rules. First, get stable - normal - then look, read, get support, and work on a taper plan. We are here. I'm stable right now, looking to start a taper in a couple months.

Your doctor didn't make you a junkie - he probably tried to help your pain. Many other doctors would have chosen other medications - and you may have your suboxone doctor change things too. Be SURE to tell your doctor EVERYTHING... and also to ensure he understands your PAIN (chronic I suppose?) - as it may help him make plans with you.

Hope these ramblings help! I remember being anxious too - and 'setmefree' helped me make it to the mild/moderate stage - and trust suboxone would help... For that I'm eternally grateful - I felt 'normal..' WHAHOO and keep us posted (Especiallly after the 4th). You will do great, and you are not alone.


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 Post subject: Not So Fast!!!
PostPosted: Sat Jan 02, 2010 1:34 pm 
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I don't have a lot of time but am concerned with some misinformation and such here.

1. Fentanyl IS NOT one thousand times stronger than morphine as LatheDude stated. It is 80 to 100 times stronger - which really only means you need much, much less in weight (milligrams or micrograms) to obtain effect. I just didn't want that wrong info (1,000 times stronger) out there.

2. You have a very complex case. I'm not so sure from what you are saying that you meet the definition or diagnosis of addiction. You are very likely dependant - but not necessarily addicted.

3. You also have a very complex case in that you still have legitimate pain that may need to be still be treated.

4. A fast metabolism would not likely cause what is going on with you. How fast your body uses the drug has nothing to do with how much drug gets into your system through the patch system. Let's say your body used it faster than normal - you would still only get so much medication from the patch - it's not like your body can "call" for additional medication and use it up sooner. That is all related to absorbsion.

5. Your doctor has stated and done some rather odd things - including telling you that you are addicted and need Suboxone. From what I am seeing, none of this is really adding up at all. My suggestion is that you need to get a second opinion. I really think it's time for a different pain management GROUP. Not another doctor form the same group. This just is all not making sense. You may well need to try a different drug other than Fentanyl. You might actually be experiencing "dysphoria" which is a known side effect with Fentanyl. I really think that you need to seek out and find someone that really knows their shit when it comes to both pain management and addiction. The last thing you want to do is end up on Suboxone for a long time when you are not an addict - only dependant. You also, as LatheDude stated, don't want to rely on Suboxone for pain relief, as it will not do a very good job at all.

Please try to find a doctor that can sort through all of this with you. Something here just is not making sense.

By the way, please try to avoid posting the same thing three times in three separate places. It really makes things confusing to other visitors. It's also not a good idea to "hijack" or post onto someone else’s thread and change the topic over to yours. Just a few items for "good manners" on any community board.

Good luck. I really hope you find a GREAT doctor to get to the bottom of all of this for you.


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PostPosted: Sat Jan 02, 2010 2:05 pm 
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donh wrote:
Please try to find a doctor that can sort through all of this with you. Something here just is not making sense.


I have to agree with that statement! Something doesn't add up. Or, just important details have been left out. In any event, elaborate a bit more if you could/want to.

I am not a doctor or expert...just a recovering addict with chronic pain on suboxone. But from the sounds of it, you are not addicted per se, just dependent on the med. You should look into 'addictive behavior' and 'physical dependence/tolerance'. (Assuming you haven't already or don't know about it.....if you do, sorry!). If you are not an addict, and just are having some tough times getting decent pain control (but not abusing meds, not lying to obtain them, .....), you might want to consider a different pain med. Hydromorphone, oxymorphone are some very potent meds. Getting a second opinion never hurts!

Fentanyl is, according to online sources (and others of course), 80-100 times more potent than morphine by weight. I think 'sufentinil' or 'afentanil' (spelling??) is something like 1000 times more potent than morphine by weight, or 100 times more potent than fentanyl by weight.

Fentanyl DOES have a very short half life (1-6 hours? don't quote me here!!!) but that is if used by IV. If you are using the transdermal patch, a '72' hour acting analgesic (72 hr in theory of course), the drug does infact store in the skin/fatty tissue. So, when you apply the new patch, I guess technically there is still some fentanyl seeping into your system from the last patch. As far as the whole metabolizim thing.....I don't know if the problem is with absorbtion or just fast metabolizim, I am not commenting on that. Just the half life issues of fentanyl.

I think if you keep on investigating, you will come up with some info, also I'm sure others will respond. Good luck!!!!

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"The past is finished. There is nothing to be gained by going over it. Whatever it gave us in the experiences it brought us was something we had to know."----Rebecca Beard

"Have no fear of perfection - you'll never reach it." ---Salvador Dali


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PostPosted: Sun Jan 03, 2010 2:58 am 
Boxingofficial, welcome to the forum and I'm glad you found us and hope we can help you. I agree with the others - something about this picture isn't adding up quite right for me either. Fentanyl patches are to be used only in patients who are very opiate tolerant, in other words they have been tried and maintained on pretty heavy doses of meds like hydrocodone or oxycodone or oven lower doses of morphine tablets by mouth, before even considering a trial of Fentanyl patches. Good pain management docs will typically start you off on the lowest dose possible of Fent patches and slowly titrate you up as your tolerance to the Fentanyl builds. This method of pain management has worked well for a certain population of chronic or terminal pain patients. However, for those who are going to need pain control indefinitely, it gets a little fuzzier. Fentanyl absolutely is not well tolerated for everyone. In fact, I have know a few people who swear that Fentanyl made them "crazy"....moods all over the place.....no appetite....no interest in anything....zombiefied....miserable. They insisted the doc take them off and try them on a different pain regimen and they got a lot better. So perhaps Fentanyl + You = No good thing!
Without knowing more of your history, what your prior meds were, etc, it's gonna be hard to advise very specifically. But in general....yes some of what you describe sounds like break through pain which would indicate your Fent patches aren't strong enough or are somehow being metabolized too quickly (which I suppose is within the realm of possibility)
But then the question becomes - Are you in so much pain and distress because of your initial diagnosis and origin of pain, OR are you suffering because you are in withdrawals? Tough question. In order to answer that question you're going to need the help of a good doctor, probably a new pain mgmt doctor at this point. You need to know what's going on physiologically that's the source of your pain, is that condition improving or not? Are you making any progress in tackling these pain issues from any other angle other than drugs?
If in fact the source of your pain has been treated properly and effectively and your pain now mostly comes from problems with drugs, then Suboxone may in fact be the right route for you to take.
I'd say at this point, if you could elaborate a little more on your history for us, we may be able to give you some better more specific advice.
All I can tell you based on what little I know about Fent patches, is so avoid them if at all possible unless you are a terminal patient without much time left of this earth, otherwise these patches will be a fight for you that will be extremely difficult to manage. Just my opinion.
Bottom line, I care about you and I sense your confussion and your seeking answers. You deserve answers. You have the right to speak right up with your doctor and ask whatever you wish to ask and if you don't get answers that satisfy you, move on to a new doctor. But above all, do what's best for you. If pain-wise you feel like you could potentially make it without opiates and manage with other treatment modalities, then start Suboxone and you'll start to see some improvement over time. The other thing that's cool about Suboxone is that once you're on it for a couple of weeks, you will absolutely know how much of your pain was "real" versus how much was just rollercoaster opiate trails....pain - opiates - pain improved - opiates wear off - pain again - opiates - pain free--run out of opiates - pain again (or is it withdrawal pain) - Suboxone - no pain - no pain - no pain.....well I guess a lot of that pain was withdrawal pain not "real" pain. Does that make any sense. At that point at least you'll know where you're at without being loaded on pain killers all the time.
Sorry, I've had a busy day putting on a bday party for a buch of 15 yr olds so my brain is about fried! Hopefully some of my thoughts came across somewhat lucid! I want to help like everyone else here who has replied to you. Let us know what you're thinking.


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PostPosted: Sun Jan 03, 2010 11:48 am 
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Throwing my non-expert two cents in on this one. I agree with the others that something is not adding up here. 4 to 5 months doesn't seem like enough time on a pain medication to require Suboxone therapy. Again, I'm not a doctor or pharmacist. I'm a full blown opiate addict that can not take opiates in any form of moderation because I'm only chasing the high. My wife on the other hand has been taking between 30-40 ml of oxycodone for three years and can walk away from it at any time with seemly no side effects. If it weren't for the pain, she would forget to take the medication (imagine that). I guess everyone is different and each case unique. I would agree with others that a second opinion is in order. I know some people and opiates don't mix. I had a step father that wound up on the psych ward after taking hydrocodone for pain. The stuff made him crazy and after it was out of his system, he was fine. Sounds like some parallels here. Good luck with your situation.


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PostPosted: Sun Jan 03, 2010 12:50 pm 
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Hi All -

My bad on the 1000 versus 100 and not thinking that there may be more in play here than a person in pain being given a patch.

Boxingofficial- please reply if you can. Semefree asked all the questions I thought of as well. If by some strange reason, you went to a doctor - with substantial pain - and the first and only thought was - hey here's a fentanyl patch - I'd be in 2nd opinion mode. If there's more to the story - please share.

My apologies again for not staying speicfic - I'll be more careful in the future. Good Luck boxingofficial whatever you choose - sounds complex.


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 Post subject: More info
PostPosted: Sun Jan 03, 2010 10:53 pm 
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Thanks for all the many replies. This site has been very helpful to me and my wife. I have read many of the stories and replies and see similarities in what is happening to me and in what I should expect.

Out of pure frustration and fear I put up my first post. Many apologies for the mistakes I made, I am still trying to figure this site out.

I don't want you to think that the Doctor I was seeing just gave me the patch and that was the start of my problems. My issues go back over 20 years. I had a misdiagnosed during my military career that resulted in the Doctors retracting my 1st rib so that blood could flow properly to my arm. After that major surgery the Doctors found that my pain was not easily able to be put under control. I was allergic to many of the traditional pain meds.
From that point to now I have had 8 more surgeries, all to try to help with pain in my upper back, neck, shoulder and sternum. The most resent was 2 years ago when I had a stimulator box inserted in me. This was supposed to help me get off the vicodin and improve the quality of my day to day life. Note: I was taking 2 vicodins a day and sometimes a total of 10 pills for the whole week. It didn't. After the wires were attached to my neck and ran down my back into a box implanted in my rear, I was in worse pain than I had been in before. I think my body simply started rejecting the foreign object in me and instead of improving my quality of life it ruined it.
The pain management team began me on morphine 60mg twice a day. The pain stayed, I was depressed, and unable to function. All I wanted was to be normal again. When the morphine didn't work I was then a candidate for the patch. After more than a year I was put on the fentanyl patch starting at 25mg every 3 days. I thought the patch was great. I was able to do things that I hadn't in years. This didn't last long. Shortly after the patch started working, in less than 48 hrs. I was back to the same bad shape I started in. The solution , the Doctor upped the dose. Again it worked, and then again not to long after it stopped working. I kept going in on my regular appointments. I explained the problems I was having, mood swings, depression, heat flashes, chills, unable to eat, insomnia. The solution the Doctor put me in 50mg every 48 hrs. Again it worked life seemed better for a bit. And again it would stop helping. I was simply going crazy trying to get comfortable going from hot bath to hot bath, pacing back and forth, crying inconsolably. I was at the point I wanted to DIE. I couldn't go on any more. I had shut down completely form the outside world. Lost 30lbs & I even shut my wife out. At this point I didn't know I was experiencing WD. I just couldn’t pin down what was going on with me. I thought possibly my body was rejecting the stimulator and it made all these symptoms. I just wasn’t sure what was going on. That’s when I decided I need help from my wife because I was confused.
My wife went to the final appointment with me to help me explain what I had been going through. After I refused to go up to 75mg every 2 days. That is when she referred me to another doctor; the reason was to be put on suboxone. She told me I had to try suboxone. I have seen the suboxone Doctor twice. 2 weeks ago I was suppose to start the treatments. But my insurance wouldn’t cover it. Since then I found one that would, and will begin on suboxone tomorrow. In the mean time he had me go from 50mg to 37.5 mg every 48 hrs. After the first 18 hours I would start having withdrawal. This time I knew what was going on due to the literature my new Doctor gave me. I was looking for any type of information on the web, when I found this site. I have been scared and anxious, but now I am feeling more at ease knowing there is people who have or are going through what I am. I know longer feel alone.
Now that my life is completely out there, Does Suboxone sound like it would work for me? My goal is to be off everything and allow my body to start producing natural pain chemicals and endorphins.
I also want an opinion on if I should just keep tapering down the fentanyl and how long would I have to do that. Can a doctor give me things that help on the second day as that’s when I feel weird and keep going down on the patch? Or is it easier to jump to suboxone, then taper from that. Thanks everyone


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PostPosted: Mon Jan 04, 2010 12:44 am 
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boxingofficial,

well that is brave of you to put your life out here for us, but it is improtant to get the most accurate advice that we can give.....

I might have said already that I am NOT a doctor, or expert......but just an addict with severe chronic pain recovering from active addiction with the great suboxone. I have nothing but good to say about sub treatment. The main thing is though, you have to want to get help or it won't really work that well. From the sounds of it, you will benefit greatly from sub!!

As far as starting your suboxone directly from the fent patch, well I don't have direct experience with that. I have had experience with the fent patch for a pain med tho.

The main thing with switching to suboxone/subutex from the fent patch is the fact of fent in your skin/fat seeping into your body over time after the last patch was taken off, plus the long duration in between fent doses (upto 72 hours). A decent rule of thumb you could go by would be the longer the half life of the pain med and the longer the duration in between doses (i.e. your case, 37.5mcg/h every 48 hours......some Immediate Release meds are every 4 hours) the harder and/or longer the tansition to suboxone will prob be, in theory....If you are on short acting meds, it should be rather easy and a quicker transition time to the buprenorphine (sub).
I don't know what you can and cannot take, but if you switched to for instance, 30mg of Oxycodone Immediate Release (or something similiar.....hydromorphone and oxymorphone Immediate Release are potent meds if oxycodone is out of the question), thats 30mg say every 6 hours is 120mg oxycodone total for the day, if taken every 4 hours that would be up to 180mg oxycodone....etc etc etc.

This way, if you are off of the fent patch for a couple weeks and taking Immediate Release drugs instead, it would be a smoother and easier transition to suboxone. You should be able to wait 24-48 hours and simply take the sub and feel better and it will work wonders. Even if on a 'contin' type med (oxycontin, ms contin, opana extended release, etc) with a longer half life to deal with you should be able to wait 48-72 hours and be able to take the sub with no probs. As long as you are in a moderate w/d the sub will work great. IF NOT....you will be in for a ride for 1-3 days with the horrible and dreaded precipitated w/d's. With the fent patch systems, I don't know if even 72 hours with out any med before your first sub dose is even long enough.....you might have to wait up to 96 hours or more.... You still may feel 'shitty' after 48 hours, but may still need to wait even longer. Fent transdermal system is a tricky subject with suboxone transition because of half life and duration issues.

I hope someone can correct me if I am wrong, and if anyone has first hand experience with this it would be great if you could add to this. Don't be ashamed or embarresed that you have to consider suboxone to help you....it is a noble decision to consider it for your own help. I know you said that your pain dr said to go on the suboxone, but if you really wanted I am sure you could just go a different route, even with a different dr if you wanted, but have choose to give suboxone a try.... We are glad that you have found support here in the forum, I and many others have also had much support from the forum (and much success with suboxone). If I missed anything let me know. If you have any other questions, comments, or concerns please just give me a shout, or ask the forum.....we are here to help!! I truely hope I have been of some help to you at least, and I hope you have lots of luck with everything from switching to suboxone with no problems. Good luck and take care, stay strong!!!! Keep us updated please!!

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"The past is finished. There is nothing to be gained by going over it. Whatever it gave us in the experiences it brought us was something we had to know."----Rebecca Beard

"Have no fear of perfection - you'll never reach it." ---Salvador Dali


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 Post subject: Starting Suboxone
PostPosted: Mon Jan 04, 2010 10:36 am 
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Well it's 1/04/10 amd I have my appointment at 3 pm today with my new pain doctor and will be getting my first prescription of suboxone to start. I think 8 mg a day from what he had told me. I guess im ready to go ahead and do this. I barely made it the last 2 weeks going down to 37.5 mg every 48 hours. I was on a rollercoaster ride every other day and I pray the suboxone stops that. Im hoping to just be on the suboxone for 3 months and start my ween from there. My goal was to completely get off the patch and use the suboxone to make it easier if thats what I understand the doctor wanted me to do. Im really scared but I hate the roller coaster rides.

My only concern is that was I really going through withdrawal and it wasn't just in my head. I feel that my withdrawals are differant than normal people for some reason.

On my second day after putting on the 37.5 patch I guess around 30 hours after I can't be still, my feet feel cold then warm, I get restless feet, I feel tingly all over and I feel like my body is unconfortable. My mind stars racing and I have to get in a hot tub every 30 minutes and can't sleep. Once I get my new 37.5 patch on it takes about 1 hour and I start feeling better. I sure hope that really is withdraw. I also want to make a clarification. on how long I was on fentanyl. I called my pharmacist and got exact details. I started at 25 mg evry 72 hrs on Dec 21, 2009.
Went to 25 mg every 60 hrs on Feb 2009. Went to 25 mg every 48 hrs Mar 2009. Went to 50 mg evry 72 hrs on Aug 2009. Went to 50 mg every 48 hrs on Oct 2009. So essentially ive been on 50 every 48 hrs for about 4 months only.

Thanks for all info from everyone and I hope all had a wonderful hollidays and will start a new year and be blessed with better health and happiness.

Hope the suboxone gets me off this crazy medicine!!!


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PostPosted: Mon Jan 04, 2010 10:50 am 
BoxingOfficial, Thanks for sharing more of your story. You have been through A LOT!! Having that info sure helps us to give you more specific guidance/advice. I do now think a lot of your pain and problems are related to withdrawals and opiate tolerance/dependence issues. Withdrawals from any type of opiate medication is complete misery, in my opinion. You have suffered long enough. Get all this crap out of your system and give Suboxone a chance, then you can gauge where you really are pain-wise. Don't let anyone make you feel foolish or like you've done something wrong by 'letting yourself get addicted' either. Hopefully, that won't happen....just sayin...if it does-don't buy into it! It sounds to me like you've done everything by the book; done what you're doctors have told you to do; taken your meds as prescribed, etc and found yourself in an unholy mess in spite of it all! By the way, you're not the first person I've heard of that thinks their 'miracle' spinal cord stimulator sucks! (I think that's what you've got implanted in you, correct me if I'm wrong).
I hope you read BigRed's reply....seriously good information and very important. DO NOT let the Suboxone doctor start you on Sub if you've just removed a Fentanyl patch within the last few days. To my knowledge, BigRed is right on the money...that stuff stays in your system, is continuing to be absorbed into your bloodstream even after the patch is taken off! In my opinion (non expert, not a doctor.....) you should be treated just as BigRed says -- switched over to a shorter acting opiate like oxycodone or hydrocodone or whatever immediate release type pain med to control your pain for a week or two. THEN go through 24 hours or so of withdrawal and begin your Suboxone. That should give you the best chance for success. If your Suboxone doctor is suggesting anything other than this type of plan....please ask about "precipitated withdrawal" and question him/her thoroughly on your plan of care. You have every right to know EXACTLY what the plan is and why the plan is the way it is.
Please come back and tell us how everything is going. I'm afraid I posted too late for you to get this before your appointment, but I hope you got BigRed's reply before you left.
I wish I could tell you that all is going to be well soon. But just like the rest of us here...you've just got to let things play out. You're situation is a little unique what with patches. You may have to suffer a little bit longer, but I really believe once you're able to transition over to Sub, you're gonna be able to think straighter than you have in a long time. You might still have some pain, but at least you'll be able to know up from down so to speak!!
Those are just my thoughts ...your doctor should know all of the above and is much more educated than me. Rely on your doctor's directions above anything 'we' have to say. But "knowledge is power" right?!
Again...let us know what happens. Hang in there!


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PostPosted: Mon Jan 04, 2010 10:53 am 
looks like your latest post went up while I was typing mine! I'll PM you real quick.


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PostPosted: Mon Jan 04, 2010 12:31 pm 
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Hey boxingofficial -

I hope you had a chance to read everything! If you catch this note, in short terms, fentanyl is a wild card was for your absorption, left in your body fat (slow leaking into your system), etc. Makes sense right?

It's always good to remove 'wild cards' when dealing with suboxone and expectations. If you can ensure that all fentanyl is out of your system - you will have a more predictable experience. BigRed gave great advice as did setmefree!

Still, it is possible that you will be fine AS LONG AS you are at a opiate withdrawal COWS score of mild to moderate withdrawal. We, here, just know of some that had a hard time going straight from the patch to suboxone without surprises. You may not be one, but if you have a choice to avoid the chance, why risk 'precipitated withdrawal?'

Please, please reply back with your game plan after the visit! Plenty of us care here, and WOW you have been through a LOT! I'm trying to wrap my mind around what you have been through, and that you are thinking of bagging all standard pain meds and dealing with your pain. Amazing. Look forward to your updates!


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PostPosted: Mon Jan 04, 2010 12:33 pm 
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Dear boxingofficial,
I won't bore you with the details of my addiction / recovery, But let me under-score what setmefree said. You need some time between your pain meds. and the start of Suboxone treatment (induction). If you start it to early you will go into W/D's and the Suboxone will not do its job! I am not a Dr. or Expert either just a grateful recovering addict on suboxone! You will find a lot of good info / advice on this site. But I would get your dr. situation straightened out first and then use this site and his/her's advice to get the relief you are looking for! I can tell you first hand Suboxone will work if used correctly. I have been on it for almost a year and I live a normal / productive life. before Suboxone treatment I was on 300 - 350mgs of oxy's / day and headed for disaster! Thank God I found Suboxone in time.
I hope everything works out for you. Please keep us posted on your progress and best of luck!

God Bless!
TW


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PostPosted: Mon Jan 04, 2010 1:23 pm 
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I am very glad that you came back to provide us with more information. Yours still remains a very unique situation - one that I really hope you are able to get to the bottom of and find relief for. I am still as confused as to what is honestly going on here as I was following your first post. Obviously, all I can do is make a somewhat educated guess (I do have a 25 year para medical background in addition to being addicted to opiates). My largest concern is for managing your pain. As you may now know, Suboxone will not do a good job of that at all. You may soon find that your underlying pain returns as you stop the pain opiates and only take Suboxone. This is a factor that many of us here do not have to deal with. You may still have to find something to take care of your pain and if that "something" is an opiate pain medication, you will not be able to take Suboxone along with it. I also continue to wonder if you are addicted or not. Telling a doctor that you do not want to increase your pain medication dose or that you want to stop is simply not addictive behavior. You would be hard pressed to find any of the addicts here that have or ever would say that to a doctor. Our goal would be to get more and more. Of course you are going to be dependant to opiates - there is little question there. What you were having happen with the Fentanyl could very well have been withdrawals. Increasing your dose may have helped with that - if withdrawals were the issue. Suboxone should also be able to help with that. The thing is, you could end up getting rid of all of these very bad symptoms (i.e. withdrawal symptoms) but still end up with the pain. Should that happen, Suboxone is not going to be the answer. Now, if you don't have pain return - that will be awesome and then you can use the Suboxone to taper off everything. Again, if you are not addicted, your brain will not push you to start taking opiates again. If you are addicted and you find that you are craving opiates, then Suboxone might be the long term ticket for you and in fact you may be just like the many of others on this site. Still, from all that you have said, I'm not so sure that is the case.

At the end of it all, I still think you have a more unique situation going on here - one that may well baffle many typical pain management doctors and/or addiction doctors. You may still need to find that one in one thousand, rare, physician that can get a handle on both the pain issues and the possible addiction issues or at least deal with the dependence situation. You have been through so much already that I can just sense that you want it all to end. Hopefully, together with your doctors you will be able to get both the pain relief and the mental & physical relief that you very well deserve.

Please let us know how it goes!


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PostPosted: Tue Jan 05, 2010 12:24 am 
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Welcome boxing official. Sure sounds like you've been struggling for a long time. I hope this allows you some change and healing.
I, too, am no doctor or expert...just an opiate addict who's grateful for Suboxone and this support group. Am I reading correctly that you've never abused your meds? Someone (setmefree?) I think mentioned that you could be dependent but not an addict. There is a difference. My addiction started with meds for pain control, too, but I did abuse them.

I also do have experience with increasing tolerance and having withdrawals while still taking the meds. It is possible.

There is also a school of thought/theory (and forgive me I don't recall the technical name) that says the more pain meds and the longer, the worse the pain gets. (Does anyone know what that's called?) That's how it was for me. I went on Suboxone just over a year ago, and my pain has been more manageable now than when I was on the opiates. But we're all different, I just wanted to throw that out there.

I wish you all the best and am glad you found a place full of really good, supportive people.

Please keep us updated.

Melissa


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 Post subject: Started the suboxone
PostPosted: Thu Jan 07, 2010 7:52 am 
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Scenerio of what happens and times:

See my doctor Monday Jan 4th @ 3 pm he gives me a prescription of suboxone and wants me to take 8mg every 8 hours for starters. He clearly states that it was very important to be in mild withdrawal before I start. Gave me this little chart to help add up my score on wd's.

Jan 5 Tuesday @ 3 pm I tore the 25 mg patch off for the last time. I actually went out to dinner just to keep my mind off of things as I was nervous. About 7 hours later at 10 pm that day I started to feel restless and strange like I was starting wd;s again. It always seem like I started wd's way to early and maybe I truly am a fast metabolizer and go thru it faster than normal. About Midnight Jan 6 I started to really feel restless, clammy, running nose and heartbeat at 100 per min. I felt that the anxiety waiting was just making me feel worse and maybe some of the symtoms were in my head. About 3 am 12 hours after last patch I was pacing the floor, legs were moving uncontrollably, felt like I was going insane. I still had the 100 heartbeat my pupils were slighlty large and I was starting to get shaky. My wife was helping with keeping the score so I wouldnt take the suboxone to early. I needed to be at 25 on a chart they gave me. Adding all symtoms. It was driving me crazy.
At 6 am I was miserable and already throwing up. My wife still kept telling me not now and I was trying to convince her I needed to start. I was rocking, shaking, going from ice cold to hot back and fourth, my pulse was up to 105 per min, my eyes were tearing(probally from crying, and my nose was running. I was moving my legs and felt as my body was on fire. I was going ape. My anxiety was totally making me think about death. At 10 am my score was around 20 and my wife and I agreed that I was enough into the wd's to start. I was throwing up nothing but doing that multiple times and my pulse was 115 per min and my face was pale. I held onto the pill for another 15 minutes scared to take it because I didnt want to mess up and go into precipitated wd's to early and have the severe wd's they talk about if you make a mistake. But in honesty I thought I was in the worst wd's a person could have anyways.
10:15 am I prayed to God and stuck the 8mg pill under my tongue and let it dissolve.

Here we go! About 30 min after I started to calm down a bit slowly and was just still in a panic waiting for everything to just go away. at 11:30 am I really started to feel so much better and couldnt believe this whole thing. But the pill was working.

By noon I was convinced that the suboxone does work. So essentially It took about 19 1/2 hours after my last patch before I took my first pill.

As the time passed I was more convinced that I didnt take it to early. I took my 2nd dose 8 hours later at 6:30 pm and feel better. I ate for the first time a full meal since I havent in 2 days. The only thing thats bothering me is a upset stomach still and im not sure if thats from the prior wd's from throwing up or the suboxone is going to make me uneasy in the stomach all the time. Hopefully my body adjust to it and that goes away. I have my follow up this Monday and I think there going to change my dosage some. Maybe 8mg twice a day. Im not sure but I dont think 8mg every 8 hours is good. Does that mean im on 24 mg a day, or 8 mg since I take it 3 times a day. Every 8 hours.

It confuses me. But I can say I havent got the good sleep I needed yet. This whole ordeal has kept me up since the day I tore the patch off. I seem to really be tired but just havent fell asleep. Im hoping I do during today.

Well thats my story so far, and Im happy that the wd's are gone but not entirely happy im taking another pill to stop it and get me off fentanyl. I pray that I just take this suboxone for 3 months and I can get off without going through what I did just to get on them. My doctor wants me on them for 6 months. And they want to work with other things with pain.

But honestly since going down to the initial 25 mg from 50 mg fentanyl my pain started to go down also. I honestly now think the fentanyl was making me worse in pain.

Thanks for all support and hope this helps someone else in my situation. I will keep everyone posted as I go.

I want opinions about getting off and what to expect Thanks again


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PostPosted: Thu Jan 07, 2010 10:53 am 
I am so glad you posted! I've been wondering about you....a little afraid that things hadn't gone well, you had dosed your Sub too early, or something bad had happened at your appointment. What a relief that you are okay!
I must say I am a little shocked that you were able to remove that last Fent patch and do okay taking your first Sub dose as soon as you did. Just goes to show us all that it's true what we often say....."Everyone is different!" I'm just glad you were able to hang on through the misery you were in, take your dose and get some relief. That's great. Suboxone really is an amazing drug!!
As far as your questions. If you are dosing 8mg three times a day - you are on 24mg/day. Some people need that much for a long time, but I'd say most people don't stay on that much for very long. Try not to worry about it too much at this point. Just let yourself settle in and feel okay for a bit, then work with your doctor to bring your dose down if that's what you're wanting to do. Personally, my doc started me at "up to 24mg/day". He had me dose kind of "as neeeded". I found that I did not need that 3rd 8mg pill after just a short time (few days maybe) and settled in at 16mg/day for the first month or so. Again everyone is different. Don't worry about taking "too much" - one of the unique things about this medication is its 'ceiling effect' which you can research on the forum or elsewhere and find plenty of information.
Your nausea - maybe just left over from what you've been through, but may be a side effect of your Sub. Some of us here spit out the 'orang goo spit' that's left after we dissolve our Sub and that has alleviated headaches and nausea for us. Just let the pill dissolve completely, hold that goo in your mouth, swish it around, move it around with your tongue or whatever for 10 minutes or so, then spit it out. Maybe try that.
As far as your goal of being on Sub short-term - again lots of discussions about that very thing here on the forum. But most of us are approaching that discussion from the perspective of an 'addict', which I mentioned before, I'm not sure that you fit that category - you're defininely dependent, but not sure about addicted. We'll leave that up to your doctors! In any case, just let yourself get lined out here and worry about how much, how long, ect a little later.
I am just so happy that you're feeling better!


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PostPosted: Thu Jan 07, 2010 3:16 pm 
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It's great to hear that you are doing so well. It's also great to hear that at least through right now, you are not having issues with pain management. In my mind, that is going to be at least half of your battle here. If you are able to control your pain without narcotic medications - that will be awesome. Of course, mild as it is, Suboxone will provide at least a little bit of pain relief (and of course is a narcotic). Your final hurdle will be when you stop the Suboxone. If you again do not have pain issues, you'll be home free with that part of the problem.

The other half of all of this will be to determine if you are addicted to opiates or not. Your doctor will be able to help you to determine this. Beyond that, you will somewhat know yourself as you'll find out whether or not you have cravings for the drug, have any drug seeking behavior, or any of the other hallmarks of addiction. If none of these things present themselves, you will be a great candidate to stay off of Sub. Obviously, most of us here do not have that luxury, because if or when we stop Suboxone we risk relapse. You may not have that risk. That is in the future though. It's not for dealing with today.

About the only thing that I am surprised about is the fact that your doctor told you that you needed a 25 on the COWS score. I have not heard that before. In fact, I'm holding a chart here in my hands produced by the National Alliance of Advocates for Buprenorphine Treatment (NAABT) and they clearly say you should have a COWS score of at least 5 but that some physicians prefer scores of 15 or higher. They don't at all mention 25 or higher!!! In fact, 25 is the starting point for Moderately Severe Withdrawals. A score of 5-12 is mild withdrawal with moderate starting at 13. Most things I have read say this is where you are in the safe zone to take Suboxone. I have no idea why he would have told you 25!

Obviously, there is nothing you can do about that now, but I would completely agree with how you were feeling in that you were very ready for your first dose long before you actually took it. Why even bring all of this up??? Well I certainly don't want you to feel bad, but more importantly it would seem pretty clear that for anyone else reading this, that they would not have to suffer in withdrawals like this for as long as you did. You went into big time withdrawal! Fentanyl can be a very confusing drug. In patch form it is considered a long acting or long-term drug, but Fentanyl in itself has about the shortest half-life of any opiate out there. In fact, many drug tests even have a hard time picking it up after 12-24 hours because of it's short half-life. The way it works and sometimes can be stored in the body sometimes throws a monkey wrench into all of this, and I won't even attempt to try to explain it. In any event, your case is very clear that after taking off the patch, it did not take very long at all for the drug to be out of your system and for you to be in big time withdrawals.

I'm very confident that you will continue to feel better with each passing day. Please come back and let us know how you are doing. I have felt from your very first post that you are not the typical case and would have some very interesting things to share with us. I hope you'll allow us to follow along on your journey as you get to the bottom of what really is going on with you.


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PostPosted: Thu Jan 07, 2010 4:04 pm 
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I'm with donh and setmefree... I'd love to hear an update on how you are doing! Thanks for the update - you have helped many people. THANKS!


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