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 Post subject: Induction
PostPosted: Mon Jan 17, 2011 8:45 pm 
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Finally got in to see a doc today for suboxone. Seemed nice, asked me some questions, and scripted me 28 8/2 subs. I was surprised there were no tests or anything, but I am grateful it was pretty simple to get help.

I am concerned about when to start taking them. He mentioned I should try to go as long as I can until i had to, but I am really wanting to stop even the mild withdrawals now =(.

I have been taking between 180-240mg of the immeadiate release oxycodone (6-8 of the 30's) daily for the last few months (that was the max, it started at 60-90mg and escalated from there...). I think I have a pretty high tolerance, as I barely noticed the 15mg pill I took this morning at 10am.

It's now 530pm, and I am in the light sweats, cold feet stage... I haven't taken anything since the 15 at 10am.

Are my odds good of not having the dreaded precipitated wd? Or should I try to tough it out longer?

Please help =). Glad to join up and looking forward to being off the stuff for good!

TJW


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PostPosted: Mon Jan 17, 2011 9:14 pm 
Woo man i hate to hear you didnt get any more detailed instructions than that!! I would be very careful as to when you take it. Make sure you are in mild to moderate withdrawal or else you will go through pure hell from PW's. Theirs some thing called COWS worksheet or something that you can score yourself on. Google COWS worksheet i think. Hopefully someone else who knows more about it will come along an tell you about it. I would definitely caution you on taking it too soon. If you took the last dose at 10 this morning, its honestly not about the amount of time but i highly doubt that would be enough withdrawal but im not 100% sure. I would try to wait until you just cant wait any longer. But, the fact that you even have to ask yourself if you are in enough withdrawal is probably a sign that your not. Wait to get others responses because im not very familiar with PW's. Hope things go well!!


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PostPosted: Mon Jan 17, 2011 9:26 pm 
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I'm really getting upset with hearing that docs are having people induce at home, with no clear instructions!

But to answer your question, I agree with lifesaver...google that COWS scale, and wait as long as you can. From what I hear PW's are a living hell, and you don't want to go through that. I would definately wait until you get to the upset stomach, skin crawling phase.
I wish you all the best, and let us know how it goes.
Lilly


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PostPosted: Mon Jan 17, 2011 9:40 pm 
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He seemed to think I'd be ok by bedtime... I dunno.

I was definitely less than impressed with the "treatment" but luckily I have been doing enough research online (otherwise I likely would have just put a whole right under at noon). The problem is FINDING someone that can prescribe. Had I not, I would be blowing another $540 on a run of 30 30's to get me until next week (the nearest other appointment I could find).

My wife scored me a 10 on the COWS scale (mainly because of the sweating, and the inability to keep my legs still voluntarily).

I went ahead and took a half (4mg). Wish me luck!

I have been through withdrawal in full before, and this was probably a 6 or 7 on the 1-10 scale. I think it was that fear that prevented me from wanting it to get to a 8 or 9, even if that would have been safer.

Now I'm hoping I didn't rush it too much, but I have read that Oxy typically only lasts 3-5 hours in non-users, and if that is even remotely accurate, 8 hours to start moderate withdrawals after months of using seems reasonable.

Heading into minute 20 and no acute pain... no relief either, but it seems pwd happens almost instantly so maybe I got lucky.

Thanks,

TJW


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PostPosted: Mon Jan 17, 2011 10:10 pm 
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Seem to be ok. A little cold but I think it'd be worse if I was having pwd.

When should I take the other 4? He said to start with 8 but I wanted to be careful because of the timescale.

Thanks!

TJW


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PostPosted: Mon Jan 17, 2011 10:11 pm 
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I mean mg btw not pills haha :-). When should I take the other half?

Thanks,

TJW


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PostPosted: Mon Jan 17, 2011 11:11 pm 
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All things considered, if you are "only" taking 15mg of oxycodone at a time, that's really not a very huge tolerance. Even 30mg is not that bad. There are people who take 80 to 120 mg of oxydocone AT ONE TIME and don't feel all that much. Those are high tolerance folks. If you've been taking 30mg at a time - perhaps 60mg at a time, you are still at a "reasonable" level on the scale.

At this point, what's done is done. If you've already taken your first 4mg, my suggestion would be to wait 90 minutes and see how you feel. If you do not have withdrawal symptoms, if you do not have cravings, if you feel pretty "good", I would not take any more tonight. However, if you still feel "sick" but better than you did prior to taking the Sub, then go ahead and take the remaining 4mg. Based on what little you have provided, you might do fine at 4mg and then just take another 4mg when you wake up on Tuesday.

As for the level of instruction you received, wow!!! But then again, that is unfortunately what healthcare has come to these days. I sort of wish it were confined only to opiate addiction and Suboxone, but sadly it often is not. Patients really need to take it upon themselves to be a large partner in their care. Doctors spend mere minutes with patients and have to come to a diagnosis and treatment decision in that short time. Sometimes it really takes the patient doing their homework and research in order for it to work out well - whether the treatment is for hypertension or addiction. Again, knowing how much you were taking daily and that it was all short acting, your doc made a pretty good educated guess in telling you that by evening you would likely be safe to take the Sub. Still, it can be a gamble doing it that way. The COWS scale really is a better method - and in office induction is better yet. It just seems like less and less patients receive in office induction these days.

Please continue to let us know how you are doing but it sounds like you are well on your way. What daily dose did the doc put you on?


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PostPosted: Tue Jan 18, 2011 10:57 am 
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Managed to sleep a little last night. It wasn't awful like the last time I went cold turkey, but not nearly as "normal" as I had hoped (probably because I didn't wait the full 24 hours so the perceived effect wasn't as good).

My hunch is (and it's just a hunch), that they want you in full withdrawal because at that point hitting yourself with a hammer would feel good, so the effect of subs is truly awesome instead of just "meh" as I have found it. It's great, don't get me wrong... and FAR better than withdrawals.

Not to say that precipitated withdrawal isn't real either (obviously it is), but the more pain you are in and the further away from the euphoria of pills you are, the perceived effect of the suboxone is probably far greater (making it easier to stay on the treatment perhaps?).

The difference is definitely there. My feet aren't freezing, I can sit still, and as of about 3am, I haven't had any fever flashes. I feel a little nauseous, and had a couple trips to the bathroom, but other than the dull headache I feel, well, like I have a mild flu, but I'll take it because it's MILD =).

The taste (to me at least) is atrocious. Should I call the doctor and see if I can get the strips instead, or just deal with it?

He has me taking 4mg 3 times a day, which seems like a lot (granted I took the 8 last night, then another at 3AM just to be sure it was 100% in my system). From what I understand, suboxone has a VERY long half-life compared to oxycodone, and you shouldn't have to take it more than once a day.

Anyone have thoughts on that? One dose should last at LEAST 12 hours right? Or should I follow the doctors orders and break them up over the day thrice?

Other than that, it's interesting feeling this way knowing it's been 24 hrs. It might not seem like a lot when I say I was only taking 6-8 30mg oxy's a day, but i remember when a quarter (7.5mg) used to get me high as a kite as recently as summer, and being up to needing a 30 just feel good (not euphoric, but better than normal I guess), was scary to me.

Last time I went cold turkey, I was only on 30-60mg a day and it was HELL.

I guess I'm a lightweight haha...


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PostPosted: Tue Jan 18, 2011 11:21 am 
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On the taste - some people prefer the taste of the tablets over the film (like me), but many others prefer the medicinal taste of the strips. (The strips don't have that artificial fruity flavor that the tablets do.)

You're right in that once you are stabilized, once per day dosing is best. However it's not unusual to dose more than that while you're still getting adjusted. 4 mg is right at or around the ceiling and should saturate all the receptors. However, it's often not sufficient to KEEP the receptors saturated, which leaves you kind of up and down. And with cravings. You might be fine at 6 or 8 mg. And once stabilized you can likely switch to once a day dosing. But give yourself time to get stable.

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PostPosted: Tue Jan 18, 2011 11:58 am 
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Speaking personally, I don't think that 12mg is too high of a dose while you are getting stable on Suboxone. You may want to look at dropping down to 8mg after about a month or so and from personal experience, you may find (like I have) that 8mg really is no different than 12 mg was - other than I may not have quite as much of a desire to sleep 10 hours a day. I'm a bit more concerned about the three times a day dosing - unless you have pain. That is outside of any of the guidelines that I have seen. Often during the early stages, as Hat stated, twice a day dosing is more common. It is not as common to dose three times a day - again, unless you take Suboxone for pain as well. If taken for pain, then three times a day is very common.

That's my suggestion. I'm no expert. I'm clearly not a doctor. I'm just a 10 plus year addict in remission for 15 months with over 20 years of emergency medical training and experience - including administering some of the same narcotics that the folks here became addicted to - just like myself. I was started on 16mg of Sub daily, taken twice a day and am currently on 8mg once a day.


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PostPosted: Tue Jan 18, 2011 12:20 pm 
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TJW-


How are you today (tuesday)?

I just wanted to let you know how awesome it is to hear your motivation! You are doing great and I bet you are excited! It sounds like you got the whole induction down with some help on here and I think its a wonderful idea to ask for advice, as I did. I had a very tough induction..the same day I was switching to sub, I had a fever and kidney infection and it was pure hell! I didn't sleep for the first few weeks. I am relieved to hear that you got some sleep!

This site has helped me tremendously as I hope you will count on it to help you through any tough times and any questions you have. It is a learning experience to go through what we do and I would say to make the best of it!

Look very forward to hearing how you are doing. Don't expect it to be easy...remember it will take some work but it sounds like you have support and are on the ride track!

Wishing you luck!

Jessica

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PostPosted: Tue Jan 18, 2011 10:22 pm 
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Doing ok I guess =). Called the doc and next script will definitely be for the films though... that orange is yuck haha.

Still feeling a bit achey, but I know from experience it's nowhere NEAR the withdrawal I went through when I went cold turkey. I can't believe I went through a week of hell the last time I stopped when these pills were basically a phone call and cursory office visit away. I don't know what I was thinking... maybe I was trying to prove that I could, and I did... for a few months at least lol.

I'm hoping this can be a permanent solution for something I clearly can't control. I can't say that I hated the euphoric feelings, but it will be nice once I'm fully back to "normal".

Any thoughts on how many days it usually takes to get back to square one as far as feeling good? I don't mean feeling great or anything, just not feeling the light withdrawals? Is it faster than cold turkey because of the subs? Should the subs have done everything by now (I have 5x4mg doses in me)? Dare I ask if the (albeit mild) discomfort I'm feeling just "is" my good now?

Will it get better, or is this as good as it gets? If it is it is certainly bearable, but I'm a baby when it comes to pain (probably why it was so easy to get hooked on the pills lol).

I'm glad I found this place. Thanks for all of the help so far!


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 Post subject: checkin up
PostPosted: Fri Jan 21, 2011 4:53 pm 
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I would think you would be feeling partially better now.....With me being sick at the same time as switching onto sub, I felt pretty good about day 5. I was still adjusting to the normal feeling and struggled with not following my schedule of shooting up in the morning and night and then night again! I still think about that sometimes and it has been 4 months. BUT my thinking process has changed and I get through it with support.

It's been a few days since I replied...hope your feeling better!

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 Post subject: oh yeah
PostPosted: Fri Jan 21, 2011 4:56 pm 
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I guess I should add that sleep didn't get back to normal for me for a few weeks and no sleeping pill would help me. Hope you don't go through that but if you are....remember it will get better!

I also started on 24mg which I found out was way too high for me and made me extra sleepy once I adjusted. Now I feel pretty energetic most days and I am at 12mg today!

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PostPosted: Thu Jan 27, 2011 10:32 am 
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Hey, where are you now? I hope you are feeling so much better that you just haven't thought of updating us.

I am rather surprised to hear some people don't feel dramatically well right after induction. Maybe it depends on what
drug you were taking, and how much you were on, but I was on vicodin ES and it doesn't sound like you were taking
more than I was. I went 21 hours without taking anything, then took 4 mg of suboxone. Within hours of taking that
first dose of sub, I felt well and have been getting the best sleep I have had in years ever since.

If you aren't feeling dramatically better by now, you should have a talk with your doctor.
Honestly, sub does more than keep you out of withdrawal. The bad moments for me are when
I am in a situation that is stressful and my desire to pop a couple pills surfaces. So far a deep breath
and thinking of the crap I escaped by quitting are enough to get me through.

Please let us know how you are doing NOW.
This forum is a life saver.


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PostPosted: Thu Jan 27, 2011 10:44 am 
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You're right, Lena, many people do feel dramatically better ("normal") after their first or second dose - but not everyone. I honestly don't know what determines that, but it could very well be what they were taking and how much, like you said. I know for me I did not feel better immediately either, but then I had so many other things going on at the time and was hospitalized at the time I induced.

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