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 Post subject: High dose, why?
PostPosted: Mon Sep 14, 2015 6:59 am 
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Hi

I have/had a big problem with opiates and benzos.
My GP, who comes highly recommended, and AOD nurse are both telling me I will be put on over 20 mg of suboxone soon. I started on 8mg 4 days ago and after 2 days I was put up to 12mg, as I was not satisfied with the 8 - still feeling shit, aching joints etc.
I feel fine at 12mg but the professionals are saying I will go up again soon. Does anyone know why?
Is it because the street bought meds will be coming out of my system and will need to up the sub or what? I hear its harder to taper, the higher level you start, is that true and if so why would they want me at least 20mg soon?
I know I have the last say when it comes to making that decision but I jut don't quite get it. I trust my GP and AOD nurse and they explain why the higher dose is to follow but just wanted to know what others think. Im in Australia so I know it has nothing to do with making money for them. I don't pay for GP at all and sub is cheap as.
Thanks in advance


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 Post subject: Re: High dose, why?
PostPosted: Mon Sep 14, 2015 11:36 am 
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Hi Mel, Welcome! I am not sure why, especially if 12mgs is working well for you, they would want you to go to twenty. Are you using the suboxone for pain too? Then I would understand them suggesting you split up the dose. I started at 24mgs last August and have dropped to 8mgs over the course of the year. I do take 4mgs in the am and 4mgs in the pm. I have osteoarthritis in my knees and find that suboxone helps so much with that pain. I was also experiencing some depression as a result of menopause. The suboxone has helped with that too! I say, if you are happy with the result of 12mgs, stay there! Let them know that you are doing well and they will have to respect your decision. Please, keep us informed and let us know how your "suboxone" journey is going.


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 Post subject: Re: High dose, why?
PostPosted: Mon Sep 14, 2015 6:30 pm 
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Yes I will keep you updated. Im seeing the GP on Sunday and find out what the go is then.
Maybe things will have changed by then, who knows. Like you said I wil take it one day at a time.
Thanks


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 Post subject: Re: High dose, why?
PostPosted: Mon Sep 14, 2015 10:48 pm 
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I agree with Michelle. But the good news for you is that because of the ceiling effect, it isn't significantly harder to get off 20 mg than it is off 4 mg. Your tolerance hits a certain level at about 4 mg-- and further dose increases change tolerance very little, if at all.

Pain is a different animal, as there may be effects of buprenorphine on pain that are not yet clearly identified... but for cravings, the vast majority of my patients do fine on 16 mg-- and most of them do fine on 8 mg. I think that early in treatment, people think that 'more is better', and they have a placebo effect with higher doses.... but eventually they tend to move the dose down. I let them choose the pace.. and usually their ability to go down to 8 or 4 mg is a sign that they may be ready to taper off.

The one reason I can think of to give a higher dose would be to use the blocking actions of buprenorphine to prevent effects of agonists (like heroin or oxycodone) and to prevent overdose. The downside of such a high dose though is that if you need emergency surgery, it is very difficult to overcome the block in order to provide pain meds for surgery. A high-enough dose of an agonist will eventually work... but the more buprenorphine, the more agonist required.


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 Post subject: Re: High dose, why?
PostPosted: Tue Sep 15, 2015 5:12 am 
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Thanks for the replies guys.
I spoke to my nurse today and we have established that I may not be covered by 12mg as I am still having heavy cravings throughout the day, especially the evening when I used to use most.
With the cocktail of opiates and benzos I was taking, she says that the priority is for me to stay satisfied with sub and not take the risk of stopping and going back to my old ways. I really understand that point. I would rather go up in dose than throw in the towel and go back to being my own dr./pharmacist.
Im going to focus on getting myself stable and covered well with the subs and not worry too much about dosages. As suboxdoc says, the dose does not effect the tapering so im just goint to go with the professionals.
It took a psychiatrist, 2 psychologists, addiction specialist, AOD nurse and AOD counsellor to convince me that my drug mixture was crazy dangerous and asking for an OD. I was not wanting to die but to be honest I wasn't bothered if it happened. That's why I think they want to just make sure I am totally ok on sub as they know my risky using habits can be triggered fast as im a very impulsive thinker - bipolar.
I am seeing a counsellor once a week, psych fortnightly and at least 4 AA/NA meetings a week.
Today is day 6. The honeymoon period has worn off and I realise I need to do a lot of work to learn new ways of thinking. Today something happened and my mind immediately reverted straight to my default setting of self destruction via drugs. That's why I love the ceiling effect of sub. I didn't go and score to fix my feelings and that's a good step I think. Slowly my habits will change and I will learn how to regulate my emotions and actions.
That's the plan anyway.
I love having this forum and your support. Thanks guys


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 Post subject: Re: High dose, why?
PostPosted: Tue Sep 15, 2015 9:50 am 
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Hi Mel, So happy to hear that you are on the right path. Now I understand why they wanted to raise your dose. You were still having cravings and stated that you didn't really care if you died. It pains me to think you feel that way. You have so much to give and need to be here for your Sisters children! AND, this is the first anniversary of her death that you are clean! That is a major milestone and one you should be very proud of!


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 Post subject: Re: High dose, why?
PostPosted: Wed Sep 16, 2015 4:56 am 
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Thanks Michelle

I appreciate your understanding and kind words.
I had some pretty intense cravings last night and felt I was heading towards my self destructive behaviour again but got through it without using. I though how nice it would be but didn't think about any plans of buying, if you know what I mean. Its crap because I can score 24/7 with just one phone call.
Every time I deny myself that negative behaviour, I think im building a new pathway in my brain.
I can only talk for today but am quite confident will stay clean for the weekend.
Im in my final year at uni and have 2 massive essays due by sunday so will try and preoccupy myself with that. There are no meetings to go to tonight but will be busy studying.
Think im definitely happy I don have to chase money to score and sneak around to buy and use it.

I am so fortunate to have the ability to get on ORT and have this forum for support.
Thanks everyone x


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