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 Post subject: How Long Should I Wait?
PostPosted: Thu Feb 14, 2013 5:23 am 
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First I would like to thank Dr. Junig. He has literally saved my life.

I have been on opiates for over four years now. I am in chronic pain for a penetrating SCI resulting from a gunshot to my back. My injury has resulted in three SC surgeries, two were fusions. Last year I started shooting up because I was I could not find relief. Three weeks ago I had my third surgery, which the specialist, neurosurgeons, etc boast should be my last.

I want to switch to Buprenorphine for my pain, because as soon as I can I want off the pain meds! I have lost so much. i have come close to losing my life. I have destroyed my marriage (I am praying Buprenorphine will bring her back) and I have not been involved with my children like I should. I have lost most friends and I live in a deep, dark, lonely hole called despair.

I had everything, I know everyone says this, but I did. I was a fitness enthusiast, decorated vet, I had a beautiful wife and children, custom Harley, custom 4x4, etc. You have all heard the story. I am extremely angry that Uncle Sam has gotten its dirty little bureaucratic hands on this medicine and has in turn made things so hard for the doctors that there are thousands of horror stories of people going through extreme and unnecessary pain because they can't get their Subs for some reason. That is absolute BS!

I see a psychiatrist for PTSD, so I feel strongly that as soon as I get my pain under control, I am ready to move on to a drug free life. I pray Buprenorphine is the bridge that will take me there.

I have done a great deal of research on this, but I did not think I would be saved until I started my correspondence with Dr. Junig.

You see, my PGP at the VA would not give me Suboxone or Subutex but he will prescribe me plenty of opiates. I do not have insurance or an income other than what I receive from my employer for the injury/time loss pay. Now my civilian doctor has agreed to prescribe my Buprenorphine for my chronic pain. I will pick up my script tomorrow. I cannot tell him the truth about shooting up. I will be honest about the amount I take but I realize shooting up changes things.

I currently shoot up 32mgs-40mgs a day. This works out to a shot about every 3 hours. How long should I wait for induction? I have dried drying up several times. When I get to about 8-10 hours I feel like I am dying. I have seen times of 9 hours all the way to 36 hours. How long should I wait? I DO NOT want to encounter precipitated withdrawals.

I hope Dr. Junig reads this or another Dr. because I want to avoid as much of the hellish WDs as possible, but I do not want to go into Precipitated withdrawals either.

So, I promised myself this would be short, and it appears I have written a novel. I'm excited to be here and to have a support system who understands this living hell.


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PostPosted: Thu Feb 14, 2013 11:35 am 
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Hey Kansas. Sorry about everything you've been through and can't thank you enough for your military service!
It sounds like you've given your situation a great deal of thought and have concluded that you must end the cycle you're in with pain meds. Most all of us here have been in the same boat, or very similar. I think you'll be glad you found the forum and you've already acknowledged Dr. Junig's good work, so welcome!
Okay, you've had your last surgery, you said. So I'll take that to mean that the doctors have advised you that whatever pain you remain in after you've recovered from the surgery is yours to deal with probably permanently? Have you recovered fully from the surgery at this point? I think that's important because if your pain level is really high...right now might not be the time to make the change to Sub. Although some chronic pain sufferers get decent relief with Sub, I'd venture to say that, generally speaking, bupe (Sub) is not a super good pain reliever, especially not for acute pain such as post surgical pain.
What particular pain med have you/are you using currently? You said you're injecting it. I'm assuming whatever drug you're on isn't meant to be injected which makes this that much more of a dangerous situation. You said it's the only way you can get relief...is that from withdrawal or from pain? Because if your pain level is so high that you get no relief from oral opioids, I'm deeply concerned about your physical readiness for this change.
However, if the issue is more that you're trying to stay out of withdrawal or that you just can't "feel" what you want from the drugs anymore, you probably are more ready. Shoot, I'm confusing myself now!
You know where you are..it surely sounds like you've crossed the line from dependence to addiction and you're ready for it to stop. Google "cows opiate withdrawal scale" for more information about your question as to when to induce. Your doctor should assess that and induce you in the office, in my opinion, but not all of them do. Generally, if you're on no long acting meds (like fentanyl patch or extended release opioids) you're okay to take your first Sub dose as early as 8-12 hours after your last dose. It should be based more on physical wd symptoms than time, however. You said you feel like you're dying within a few hours....how so? What are your symptoms? Look at the pupils of your eyes...if they're dilated (big) and you've got the chills or goose flesh, bathroom issues, runny nose, leg pain and RLS....you're more than likely ready. To be on the safe side, I'd take only about 2mg to start with then wait an hour. If you feel a little bit better, take another 2 and so on. This usually helps to prevent full blown precipitated withdrawal.
Hope that helps. There's a whole lot to learn about this drug and about recovery from addiction. Nothing I've said is intended as expert advice and your physician should be working closely with you until you get stabilized. Good luck and keep posting.


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 Post subject: Dilaudid
PostPosted: Thu Feb 14, 2013 12:47 pm 
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I'm sorry, I did not say what med. I am slamming dillys.

I guess I'm disappointed now. I thought they offered equal pain relief to diluadid.

Wow. Now what do I do....if I take diluadid orally I have to take more than prescribed to achieve pain relief.

Darn. I feel defeated again. I did not want go any longer on opiates but maybe you are right, maybe it's too soon.
I hope others post and let me know how well Subutex works for pain.

Thank you.


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PostPosted: Thu Feb 14, 2013 1:19 pm 
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I didn't mean to discourage you. But knowledge is power. And I'd be lying if I told you that bupe provides anywhere near the pain relieving properties of dilaudid. It's almost like comparing apples to oranges. Dilaudid is a full agonist opioid. It acts in the brain in a different way than bupe does. Bupe is an agonist/antagonist and as such it doesn't provide the euphoria or pack the punch that you're used to.
In my opinion, it's time to get real honest about how much pain you're really in versus how much of your pain is related to the fact that you're addicted. You're in a vicious cycle...your tolerance is high and you've resorted to mainlining drugs that aren't intended to be used that way. You're flirting with disaster, big time. You're swirling the drain. You've lost a great deal. That tells me that your reason for using drugs is not only about treating your pain. Those who use drugs appropriately don't usually have their lives falling apart....they have pain, they take meds, their pain level comes down and they're able to function better. They become dependent on the meds. Not addicted. Those are two different things. And based on your behaviors and your losses, it's not hard to conclude that you're addicted. There's no shame in that. It's a disease that can be treated. And bupe is a viable option.
The thing is....some pain is inevitable. For one thing, there is a phenomenon in which after one has been on opioids for some time, when one stops they're going to experience an exacerbation of pain at first. It isn't completely real...it's your brain screaming for the drugs it's been used to and it presents as an increase in pain. It will get better, but it will suck for a little while. However, once you've transitioned to bupe, it'll settle down and you'll be able to get a truer baseline of where you really are painwise.
In my opinion, it's worth a try. It may be that you need to wait another 2-3 weeks (the usual accepted post op time period being around 6 weeks depending on the surgery obviously) before trying this. But I think you should try it. What do you have to lose? You have a lot to gain potentially here. You could get your life back.
I didn't mean to imply that bupe is completely ineffective for pain....as I said, a lot of people feel they get adequate pain control with it. So again, I'd try it....give it a month or two. If it doesn't work for you, go back to full agonist opioids. But if that's how it pans out, I'd strongly suggest that you get some counseling, go to some meetings, work on a spiritual program of some kind and dig deep! If you must be on pain management for the rest of your life, you've got to find a drug that is harder to abuse and you've got to break the cycle you're in. If not, I fear for your life. I know the despair you wrote about and it ends nowhere good. So please, don't be discouraged about bupe. I think you're a great candidate for it. I just don't want you start it immediately if you've still got acute pain from surgery.


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 Post subject:
PostPosted: Thu Feb 14, 2013 3:21 pm 
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Hi Kansas,

FYI suboxone and subtex have an identical active ingredient, buprenorphine. Suboxone has a minimal amount of naloxone added (supposedly to prevent diversion and abuse) and subtex does not. They are essentially the same med but subtex has generics available, unfortunately many dr.s will not prescribe it. They are brainwashed by the drug reps who say subtex will be diverted and the dea will shut down their practices or something.

If u are tired of the dilaudid game I highly recommend sub. Dilaudid was my drug of choice too although I was not recovering from surgery. There is not as much pain relief reported with bupe but I do believe there is some. I had a surgery while in suboxone treatment and I believe it helped my pain but also I needed Tylenol and ibuprofen to help out.

Are you waiting to induce today?

Gb


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 Post subject: Thank you
PostPosted: Mon Feb 18, 2013 6:40 am 
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glen bee wrote:
Hi Kansas,

FYI suboxone and subtex have an identical active ingredient, buprenorphine. Suboxone has a minimal amount of naloxone added (supposedly to prevent diversion and abuse) and subtex does not. They are essentially the same med but subtex has generics available, unfortunately many dr.s will not prescribe it. They are brainwashed by the drug reps who say subtex will be diverted and the dea will shut down their practices or something.

If u are tired of the dilaudid game I highly recommend sub. Dilaudid was my drug of choice too although I was not recovering from surgery. There is not as much pain relief reported with bupe but I do believe there is some. I had a surgery while in suboxone treatment and I believe it helped my pain but also I needed Tylenol and ibuprofen to help out.

Are you waiting to induce today?

Gb



Thank both of you for taking the time to respond.

I am not going to induce today. I will wait for two more weeks. In the meantime I will do my best to taper down some so induction won't be so difficult.

They say take small steps but that never seems to work for me. I usually have to go without for about 12 hours then a lower dose works for me.

I am very angry to be in this place. I have tried going back to orals and they not do crap for me.

Is my 32mg railing habit a day too high to try and WD for induction?

I have been on my knees praying for help but I also realize I need to switch to subs.

I thought about the first time I took opiates. It was a rodeo injury. After years of riding my entire body aches. Maybe I will be on subs forever?


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 Post subject: BTW
PostPosted: Mon Feb 18, 2013 6:43 am 
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By the way. Where do you think 32mg railed daily puts me on a chart of tolerance? 1 being the lowest? Have you read of users railing more? I really have no idea how to compare myself to other users. Am I heavy duty? Average?


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 Post subject:
PostPosted: Mon Feb 18, 2013 12:31 pm 
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Hi Kansas, im glad you found dr j and this forum.

I was also a dilaudid user. Im a nurse so I got IV dilaudid from my hospital job. I was using about 12 to 18 mg a day depending on what I could steal. I would say the amount your using is pretty high. When I read you are using dilaudid i literally moaned put loud. Its such a fuckin powerful drug and hard to stop. It can be done though.

I wouldnt worry about how long you may have to be on sub right now. I think you need to get some help now. Shooting pills is so dangerous, all those fillers and shit going into your arm..........

I really hope you can transition to sub with no big issues. I wonder though....have you thought about the methadone clinic? It may work better for pain?

Either way dude I will be thinking about you.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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