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PostPosted: Fri Jan 29, 2010 2:45 pm 
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Hello, Everyone:

I'm new to all of this but will share my story sometime soon. At present, I need some expert advice.

I've become physically and psychologically dependent on oxycodone IR, taken orally only. As happens with many people, I initially was prescribed oxycodone for some pain issues, and it's morphed from there. Last week, after zooming up to 270 mg, I went to see my family physician about tapering off. After humiliating me and slapping my hand for picking at my cuticles out of nervousness (not a good thing to do to someone who's old enough to be your mother) put me on a long taper, and I am currently on 180 mg per day; the taper will end sometime in early April. I know I have a lot more work to do than just taper, and I would like to go with suboxone as part of that work. I also know that due to some unique health problems, I am at much greater risk for relapse, and that is a scary thought.

I have searched for a long time for physicians who work with suboxone (my current doc doesn't know of anyone, and as it turns out there are a few in my area, but they have serious, uncorrected ethical and behavioral problems). But I finally found an excellent family doc in the nearest large city who specializes in addiction medicine and has worked extensively with suboxone. She has also struggled with addiction herself, so that's a plus. I very much want to work with her. Unfortunately, the earliest appointment I could get with her is March 29. I will be at 15 mg once per day at that time.

My questions, then: is it effective to start on suboxone at the very end of a taper? Or for that matter, after having ended the taper and having been opiate free (for awhile, anyway, but not very long in my case, I'm sure)? Or is it better to start suboxone when one is at a higher tolerance for their drug of choice, as I am now?

It also doesn't help that I'm up for a job I'd really love, and they do drug testing. Argh.

Thank you so much for any help/advice you can provide!

Morningglory


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PostPosted: Fri Jan 29, 2010 4:59 pm 
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for the purpose you describe, which sounds like 1. you expect to have problems with relapse/addiction and 2. (I am guessing a bit here) you have chronic pain problems, there is no reason why starting at the end of the taper or even after you have stopped completely would be a problem. In those cases you will need a whole lot less than 16mg of Sub to maintain you. Propbably 2mg or less. I'm not an expert, or even highly knowledgeble, though. I've just done a lot of reading up on it, and am currently on it to get off of oxy, because unlike you, I found it impossible to be disciplined enough to taper off of that. Good luck, surely someone else will give additional information to either validate or correct what I've said.


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PostPosted: Fri Jan 29, 2010 6:22 pm 
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As far as i understand it and i could be wrong im not a doctor you should wait til your complety off the oxycodone before you start using suboxone. I would think they dont want you on it for 24 hours prior to using suboxone this way they know how many mg to start you off on. Usually you start off anywhere from 8 mg to 24 mg. I was taking 60 to 90 mg of oxy for a few months and when i went to the doctor i started on 8mg of suboxone a day. As far as the drug test goes suboxone doesnt come up on standard urine drug test. I work for a city agency and get random drug tested and never had a problem with it.


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PostPosted: Fri Jan 29, 2010 6:39 pm 
Hi Morningglory! Welcome to the forum. You have found a place here that can give you tremendous support and a lot of information regarding opiate addiction and treatment.
I'm sorry you have found yourself in this predicament. You are certainly not alone. Admitting that you have become addicted to prescription medication is a real hard thing to do. It took a lot of courage to go to your doctor and tell the truth. It was wrong of him/her to treat you the way you were treated. It seems like a lot of doctors don't have much trouble writing script after script for opiate pain meds knowing full well that we are going to run into tolerance, dependence and the possibility of addiction. But then when the latter happens, they act shocked, disgusted and unwilling to help. It's wrong. I guess it was somewhat kind of your doctor to offer a tapering plan for you.....if only that would actually work! For most of us, it won't. Once addiction has its stronghold, we're just simply not able to wean ourselves off the opiates. I don't want to sound like a total pessimist here so I will say....maybe the tapering plan will work for you and you'll be able to stick to it and get off your pain meds. I certainly hope so. However, in your post you said you don't feel that's likely. (Perhaps you can post more of your history and story for us in the intro or addiction story section of the forum.)
The truth is that most of us opiate addicts are not able to wean off our drug of choice. We try, we get close, then cave. Or sometimes we're successful and get off the meds for a short while, only to relapse and start all over again. A lot of us have really messed up our lives because of this. I think as you begin and go through this taper, you will know pretty quick how you're going to do. I know for myself and others, we've gotten off the drugs for a period of time only to go back to them because of intense cravings, low moods and low motivation that kept coming even after weeks or months off the meds. Unfortunately that phenomenon (know as PAWS or Post Acute Withdrawal Syndrome) has led many an addict to relapse over and over again.
Having said all that, the answer to your question about whether it's okay to start Suboxone after a taper is YES. That's not to say that you HAVE to or will with certainty NEED to go on Sub. But there's absolutely no reason you can't. There is a moderator on this forum (Matt2) who had been drug free for several months and started Sub because he was in such a struggle with PAWS. I started Sub after several months of trying abstinence-based recovery. I wasn't taking a whole lot of opiates and wasn't even using every single day again before starting Suboxone. I think you will know after taking the next several weeks trying to cut back your dose. I'm glad you went ahead and made an appt with the Suboxone doctor. By the time March 29th gets here, you may be real glad you did! On the other hand, if you're doing well with the taper and feel you can get off the oxycodone without Sub, then great....you can cancel the appointment.
Your other question was about the need for a higher tolerance for Sub to work. To my knowledge, it shouldn't matter that much. It may make a difference in your starting dose of Sub. But hey, if you require less Sub, that shouldn't be a problem. You do need to know that before your first dose of Suboxone can be given, you will need to be in mild to moderate withdrawals. That usually just means approximately 24 hours off the standard short-acting opiates such as oxycodone. I'm sure your doctor will explain all that when the time draws closer.
Sorry for the long post.....I tend to do that a lot! I'm not a doctor or an expert, but hopefully that helps you some. Take care and please come back!


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PostPosted: Fri Jan 29, 2010 7:41 pm 
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Welcome Morningglory!

I read the terrific responses. I hope you return and read the replies. I only wanted to comment on the upcoming job opportunity.

The big difference between your taper method and moving to suboxone and then tapering would be that your opiate - 'may' pop positive on a standard test. Suboxone requires a special test - and because of the expense and rarity - appears to be seldom tested for. I have read again and again that suboxone testing is not on a standard 5 panel test, etc.

I don't know your location, but if your job is coming up before your potential move to suboxone - you may want to consider looking some more for yet another doctor and perhaps transferring to the March doctor later.

That's all I was thinking - was - wow - you have an opportunity to move to a job you want - and opiates are holding you back - controlling your options. Suboxone is a tool - that helps remove that stress from you, while you continue to taper or come up with a plan with your TEAM of doctors/counselor/NA/whatever works...


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PostPosted: Sat Jan 30, 2010 3:04 pm 
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Thank you, everyone, for your kind words, your welcome and encouragement, and your advice! It's so comforting to know there's a place I can go to discuss these things. They've been weighing heavily on my shoulders for awhile now.

I'm thinking it may be best to wait until the job offer actually materializes, if it does, and then do an induction, making sure that I time things such that opiates won't show on the drug screen (they are very strict--the job is in health care). I think I can get through the taper otherwise, and wait until March to go to suboxone.

It's a HUGE relief to know I can go with suboxone after the taper. I will be needing it, I'm certain. So now I have hope, and I thank you all so very much for that!


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PostPosted: Sat Jan 30, 2010 9:38 pm 
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Morningglory-

Managing your pain issues is a major issue for you, Suboxone will not provide much pain relief for you, so be cautious of that fact. I have talked with many people who were frustrated with not being able to control their pain issues while being on Suboxone.
Also, if you can manage to taper without slips, take some time to decide if Suboxone is really necessary.I just don't want you to do something that you may not need to do. If you need it, fine- but anyone that can taper to a normal amount of the opiate they were originally prescribed should weigh the pros and cons before taking the plunge.

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"It is never too late to be what you might have been!" - George Eliot


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PostPosted: Tue Feb 02, 2010 12:09 pm 
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Thanks, Shelwoy--wise advice, and you are quite right about management of pain issues. In addition to migraine, I have interstitial cystitis, sciatica, and kidney stones, so this will take some serious thought. So far, only one small slip on the taper (but that's enough to make me wary), and I'd like to see if I can stay the course. Hopefully the new doc who works with suboxone can help me with a decision, too.

I wish there were some good pain management facilities where I live, but my part of the country is ground zero for drug abuse, and the pain clinics around here are pretty much pill mills.


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PostPosted: Wed Feb 03, 2010 1:14 am 
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I've read that Suboxone doesn't provide pain relief, and here there is lots of anecdotal evidence. But it seem so supply me some, not nearly as much as Oxy, but I might venture to say about as much as Hydro. It's hard to really evaluate, though. It could just be the withdrawals I experience periodically as I taper. But I'm used to some amount of pain from arthritis, and when I'm fully dosed on Suboxone, like around 2 hours after taking a dose an for the next 6 hours or so, the pain goes away. (That's while I'm tapering and staying very near the minimum Suboxone amount I need to not feel sick. I felt no pain for the first week before I really started tapering.)


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