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 Post subject: Induction Disaster!
PostPosted: Wed May 27, 2009 4:26 am 
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I've been using Heroin for about five months and was up to $100-120 a day IV. Was last addicted to Heroin in Thailand in 1975 during Vietnam War.. You'd think I'd have learned! Anyway, saw commercial on Subutex last week and got in touch with a doc the next day. Went in Thursday and we scheduled me for induction on Sat. May 23. That way I could work Friday, withdraw fri. from noon on and be good and sick by Sat. morning. I was guaranteed I would leave his office feeling great! Did not work out!!
I scored 20 to 25 on the scale of withdrawl symptoms (I was hurting! Barely could drive to appointment. Last used noon the previous day.) Started induction with 8mg. Subutex sublingually. No effect after 30 mins. Same dose was repeated every 30 minutes.
After about the fourth dose, my symptoms were markedly worse! After the sixth dose I was in incredible withdrawls! Thank God I had gotten him to come in on Saturday when the office was empty of other patients! I was literally delirious and stumbling about the office in the worst withdrawl agony I've ever experienced! (and I cold turkey'd off Huge doses of pure China White back in 1975, so I know whereof I speak) He was even worried, at one point he asked me if I had hospitalization insurance! NO! I don't!
I suggested we get me on some Percocet and re-think this thing. He informed me that all my receptor sites were now tied up with Bupe and no narcotic would have any effect! So it was in for a dime, in for a dollar at this point. No choice but to push on with the Subutex.
He assured me he had inducted at least fifty patients and all had had a sudden relief at the magic dosage! One guy (a long term Heroin addict) had required nine pills, but the doc noted that he had not been in very much withdrawls upon arrival for induction, So I shouldn't take that much.
So, seven, eight, nine, ten pills. At this point, some five hours into this thing, my agony had subsided to the point that I was not in fear of iminent death, but was still twice as sick as I had been upon arrival at 8 that morning. I suggested that we give up at eleven 8 mg. pills. He said "No, lets go to thirteen." I relented. So it was eleven, twelve, thirteen, and I think even fourteen of those foul tasting pills.
He offered to drive me home, considering I was now in full blown withdrawl syndrome. I declined, he gave me some Valium, collected his induction fee and sent me on my way!

Like a fool I followed his advice and took one Bupe that evening and another Sunday morning. Both times seemed to aggrivate my withdrawl symptoms. I resolved to stop and let the stuff get out of my body so at least some opiate of any kind would allow me to resume running my business at some point!!!
Thank God Monday was Memorial Day! By This morning (Tuesday) a bunch of Percocet got me well enough to get through the day! For better or worse, I'm resolved to tapering off my habit the old fashioned way and arranging a four day "vacation" (locked in my bedroom with my dogs). No more experimental Man-Made wonder drugs for this addict!!
Every word is the Gospel! What went wrong? Am I the first to have this happen to?? I honestly feel I was thrown into "Rapid Detox" and should have been unconscious in a hospital and had life support handy.


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PostPosted: Wed May 27, 2009 5:25 am 
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That is the craziest induction method I've ever heard of. Another pill every 30 minutes? :shock: Doesn't your doc know that it takes about 90 minutes for the buprenorphine to peak in your blood? You should start feeling it within 20 minutes or so but the full dose doesn't kick in for much longer.

88mgs (or more?) of Sub on your first day is NUTS. 32mgs is the top dose and even that is considered much to high by most doctors.

At very high doses Suboxone actually mimics withdrawal symptoms. I don't think the sub put you into precipitated withdrawals. I think your doctor just gave you way too much Suboxone and it made you sick.

For comparison, at my induction I took a half of an 8mg pill, waited about 45minutes to see if I had any adverse reaction and then took the other half. That was it for the day - and I was fine. I was coming off dilaudid and oxy - not i.v., just snorting, but probably about 70-80 mgs of dilaudid & another 20-40 oxy per day. I didn't use for around 36 hrs before my induction because I was out of drugs, but I was still only in mild withdrawals when I took my first Sub. The second day of my induction I went to 12 mgs and was fine. Better than fine actually, I felt great.

With the amount of Sub you took your first day, you still had an incredible amount in your bloodstream the next two days, so it makes sense that taking more would make you feel worse.

I'm sorry your induction was mismanaged and you got so ill. I have heard other stories about people getting sick from high doses of Sub, I don't think it's uncommon. Your doctor should have known better.

I hope you're able to get off opiates and find a way to recover. Best of luck.

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PostPosted: Wed May 27, 2009 10:23 am 
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Thanks so much for the information!! Gosh, I'm a little nervous now that I may have damaged some organ because thirteen 8mg. pills is 104 milligrams! Within five hours I might add!
I can't believe this doctor is so misinformed... And he's not alone because as I stated, at around six pills and three hours into the process, when things had taken a decidedly bad turn, he contacted another doc on the links by phone and relayed our dilemma. The other doctor (a physician at a local high dollar inpatient facility who apparently had vast experience with induction) assured him that he was on the right track. The other doc said he had once had to push eleven Bupe's sublingually to achieve initial patient comfort. My doc's previous record was nine.

My doc made the call with me in the room so I heard the whole thing. The only reason we stopped at thirteen pills is that I just couldn't handle any more and it was getting late in the day! Both these doc's agreed there was no upper limit to the dose!!!

After such a dosing, how long till I can be assured all the Bupe is off my receptors and out of my system? So I can accurately guage my new opoid minimum maintenance level? I'm curious to see if it's dropped significantly or, God forbid, raised to some new high level.... Thanks again for the help. Confused.


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 Post subject: Bad DR.
PostPosted: Wed May 27, 2009 10:50 am 
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Hi tweedldee,
I have never herd of anything like your induction???
That Dr. has to be NUT'S.... When I was using I was taking 300 - 350 mgs. of ocxy/day.
I like you was off the pills for about 24 hrs. before my induction. I was also barley able to drive and in moderate / severe W/D. They started me off with 2mgs. of suboxone and within an hour I started to feel better. Thay gave me 2mgs every hour or so till I got to 8mgs. By that afternoon I felt pretty good. That was almost 4 months ago and I am clean & taking 16mgs/day. I'm sorry to hear you had such a bad experience. Maybe the good Doc. will chime in on this?
I wish you well in your attempt to get clean!
Best of luck to you....
TW


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PostPosted: Wed May 27, 2009 12:04 pm 
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Thanks for the input Twinply and Diary.

I picked this doctor after calling around from a list of doctors that provide this therapy (on the internet).
The first four or five were either not doing the therapy anymore or were numbers to inpatient treatment facilities. I work six days a week and have no insurance so inpatient is not an option for me. Eventually I got quotes from two doc's who do outpatient therapy. This one was about half the price of the other one. So I went with him.
I must say, he is a very compassionate man.

I have an appointment to see him in a week for follow-up to see how I'm doing and adjust my dose. Obviously, my dose is zero and I'm not going to go see him. I'm in a quandry as to how to handle this with him. Far be it for me to tell an elderly doctor how to conduct his practice.
Still, I feel like I need to do something. I wouldn't want anyone else to go through what I did. I'm still concerned that blast of Bupe may have damaged me.
Does anyone have information on Bupe ovderdose implications? Or any suggestions on how to approach the good doctor regarding his methodology.
Thanks


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PostPosted: Wed May 27, 2009 12:10 pm 
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I wouldn't worry.. Buprenorphine is a pretty safe drug. From what I've read, the doc says that above 32mg, bupe becomes a pure antagonist! Overdose isn't really possible because buprenorphine has a 'ceiling' where there is a plateau of effects.

I'm sorry you went through all of that. Are you going to try it again or have you yet?


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PostPosted: Wed May 27, 2009 12:51 pm 
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The half-life of bupe is around 36 hours, which means that the amount of bupe in your body decreases by half every day and a half. So if you had 105mgs on Saturday morning, you would still have about 52 mgs left in your body by Sunday night. Then that amount decreases by half over the next 36 hours, and so on until it's all out of your system. If you took any other doses they follow the same process. It will probably be a while yet until your system is totally cleared of bupe.

I don't know what to say about how you should handle the situation with your doctor. I understand why you'd want to keep anyone else from having this experience though, it sounds awful.

Hopefully Dr. Junig will have some advice for you. He answers private messages sometimes in the Q&A part of the forum, so maybe you should send him one?

How are you doing now, by the way? I wonder if the amount of bupe still in your system is helping you at all. I know your induction was mishandled, but when done right Suboxone can be a great recovery tool. If you're still having cravings or if you think you might start using again, I hope you'll reconsider it.

If you're really concerened about the effects of that high dose of bupe, you could ask for a blood test to show your liver function.

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PostPosted: Wed May 27, 2009 4:34 pm 
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How am I doing now? Frankly, just fine...
I went to a graduation last night of a friends son and everyone commented how good I looked and I was the life of the after gathering. I was in rare form!
I'd done an IM injection of a relatively small amount of Heroin that morning cause I was still feeling sickly from the disastrous weekend. It seemed to kind of even me out... maybe. I figured the Bupe was still tying up most of my receptors but I wanted to occupy them as they emptied. (Suddenly I'm a chemist/doctor... not!)

By last night, I still felt fine and really somehow didn't even feel like I'm still addicted! After the graduation I came home and thought about another shot of dope, but resisted because subjectively, I didn't need it. Slept fine!

I took a small shot of dope IV this morning and felt it. (I wasn't really sick... shouldn't have, but was scared I'd get sick at work)

So bottom line, I've got 15 8mg. Suboxone left from the initial prescription of 30. I'm scared to death to take any of them! I suspect that maybe after all the mess this weekend, I'm in Suboxone treatment right now. Heck, maybe if I just take one in the AM and one in the PM I can flush the dope down the toilet and be done with it!
But maybe the Bupe will make me sick and no way to get well like happened Saturday! That can't happen!
Before I saw the Suboxone commercial here was my plan:
I listed my company for sale right after I realized I was addicted several months ago. I can't go a week off, I'd lose all my customers! I figured it would sell in a few weeks. Then I'd take a week and cold turkey and remember this lesson forever and be good.
Then I would use the proceeds from the company sale to start another company! (I've started a few of them now and am good at it, so no big deal)

In about ten minutes, I'm meeting with buyers who want my company and have cash.
They just left... company sold!!!! Yippee! I'll have cash in hand and time on my hands by next Wed.
So that settles it. I'm jonesing the second week in June. Till then, I'm doing as little dope as possible!
Thank you all! What a relief!
I know this sounds like Peyton Place, but I swear to God it's all true.


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PostPosted: Wed May 27, 2009 8:51 pm 
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Something isn't right. I'm not saying your story isn't true-- but something was messed up somewhere. First, you said Suboxone, right? Not Subutex? And you were using them correctly-- i.e letting them dissolve in saliva so the bupe could diffuse across mucous membranes in the mouth-- not just swallowing them? I have a couple thoughts... but even with my assumptions and conclusions there are things that don't quite make sense.

OK... first, just getting the agonists out of your system doesn't GUARANTEE that you wont have precipitated withdrawal-- most people know that you ideally get your tolerance down to a level of about 30 mg of methadone before induction, for example. I don't know the conversion doses for heroin, but if your tolerance was very, very high, you would get precipitated withdrawal when starting Suboxone even if the heroin is all gone. When a person has a very high tolerance, I like to wait a few days if possible; that way the person's tolerance will come down a bit during the cold turkey phase. You only waited 24 hours, so I think the first thing to go wrong was that you got precipitated withdrawal. A similar action happens if a person goes through detox of oxycodone, for example, and then after a few weeks, when the person feels almost back to normal, he takes the opiate blocker naltrexone-- and gets violently ill (been there done that!). Even though the person feels better and his receptors are almost back to normal, the blocking effect of naltrexone is enough to cause withdrawal. If the person waits a couple months after detox, that won't happen.

Once a person gets precipitated withdrawal, there is really no way to fix things. You have to just batten down the hatches and wait it out. Increasing Suboxone to any dose won't help, because the problem isn't the level of Suboxone-- the problem is the insensitivity of the receptors! At 8, and certainly at 16 mg, all of the receptors are bound up; adding more buprenorphine won't help, and might hurt as I will mention in a moment. The thing to do is load up on clonidine and wait, and in three days it will be over.

Taking agonists then to try to bail is not going to work; bupe will 'outbind' any little percocet pill and so they will do nothing. But then the doc made things even worse-- the only way to make such a bad situation worse would be to give a complete antagonist-- that would REALLY suck! And that is what you/he did-- there is a study or two that shows buprenorphine becoming a total agonist at super high doses-- say over 40 mg or so! So at that point, you were getting less and less opiate effect for each tablet that you took. More than that, each Suboxone tablet contains 2 mg of naloxone-- which is a lot of naloxone if given IV (about twice the amount needed to wake an overdosing human). Ten tabs of Suboxone is 20 MG!!! WOW! Naloxone DOES get absorbed at the intestine, but the liver is good at breaking it down. But the liver is NOT going to be able to destroy 20 MG of naloxone!! So in essence, you had a bit of withdrawal, and then took a whole lot of opiate antagonists to make sure the withdrawal was as bad as it could possibly could be!

The only thing that I don't get is your comment that you took some percocet a day or two later and had relief-- with that much buprenorphine in your system (given the half life you are probably still stuffed with buprenorphine!) I wouldn't expect percocet to touch you for a month or so! Maybe you just got better as your tolerance came down to meet the opiate activity contained in buprenorphine.

At this point, you are probably still 'on' Suboxone. I would just take 8 mg per day-- that is all-- and you should be OK. The agonists you take now are not going to do much of anything, unless you have some super-fast way to metbolize buprenorphine.

Wow.


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PostPosted: Thu May 28, 2009 12:45 am 
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Thanks for the input Suboxdoc.

The medicine used was Subutex, not Suboxone. He said in his experience people had an easier time coming off Subutex. Also, I was aware that the Subutex did NOT have the Naltrexone and I was MUCH more comfortable with that!

I believe you nailed the problem, though. I had a VERY high tolerance for Heroin. I was shooting two $10 bags at a time every four or six hours IV. Mind you, I didn't feel it... Just didn't get sick! I tried to impress on the doc that fact, but he insisted as long as I was good and sick, the Subutex would work. He'd seen plenty of junkies using Heroin and the induction worked on everyone. Well, it didn't work on me!

I agree with you I should have gone 48 hours, not the 20 that I did before induction. Also, the fact that I started to feel some relief about 60 or 70 hours after my last dose of opiate (after taking some oxycodone) may have been more to do with my actually coming out the backside of withdrawl illness and/or the Bupe still in my system finally satisfying my receptors than any effects of the percocets themselves.

However, as I am slowly getting more knowledgeable on the subject, I've been shooting Heroin the last few days and am now finally getting "down" from it. Tiny amounts compared to before. Still, I expect I've undone any good that could have come from the whole untidy (and expensive) affair.

I think I'll go back to the doc and see if he'll prescribe me a maintenance dose of Percocet for the next week or two while I train the new buyer of my business (as I'm contractually bound to do). Then I'd like him to wean me onto Darvon which I've found keeps me from withdrawls from Percocet. They don't get you high, but keep you from getting sick. Then after four to six days on Darvon, I can kick from that stuff standing on my head. I did it before like that and I worked through the whole process (outside in the summer heat). By the way, has anyone ever tried that, or am I the only one? I assume it kind of tricks your brain like when the muscle builders trick their muscles by completely switching routines every little bit before the muscles can get used to one exercise.

I refuse to chance another Subutex disaster.
If he won't agree to that, I'll have to maintain myself on Heroin for the next couple weeks and I'm afraid the withdrawl will be severe as hell! At least I've got some Clonidine!

And in answer to your question, yes, I let the Subutex disolve under my tongue completely each time and even held the vile liquid remnants under my tongue for an extended time (like an extra five minutes) after each one was completely disolved. I truly wanted this to work! I followed his instructions to the letter!

I just thank God he used Subutex and not Suboxone! I shudder to think!

I think I'll figure out how to print out this entire thread and give it to my doctor to read. I know he feels very bad for me. And I know he also helps a lot of people. He's a very good man, just ran into something in me he wasn't prepared for. There is some very good info here that I know would help him build his knowledge base.

Thanks to all contributors! Very good stuff!

P.S. I wonder how it is that that one guy he inducted suddenly got well at nine 8mg. Subutex? According to this thread, he shouldn't have, right?
Tricky business, this Subutex, I believe.


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PostPosted: Thu May 28, 2009 2:16 am 
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I thought it was illegal for doctors to prescribe opiates to treat addiction, except for Sub. Isn't that why MMT patients have to go to a methadone clinic where the drugs can be dispensed directly?

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PostPosted: Thu May 28, 2009 9:16 am 
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You are probably right. So I'm probably out of luck on that count.
"It was a good idea, and it would have worked, if the farmer didn't have a fondness for the sheep"
as the old wolf in sheeps clothing joke punch line goes.

I've been browsing chat sites after googling precipitated withdrawl. That's what happened. The Bupe threw me into precipitated withdrawl. I should have gone longer without dope before induction. I'm guessing 48 hours in my case.
There are many descriptions of precipitated withdrawl. Some very imaginative and all correct. Basically it's withdrawls suddenly turned up to "15" on a scale of 10 with some evil quotient tossed in for good measure! 'worth avoiding at ANY cost!


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