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PostPosted: Sat Jul 14, 2012 2:25 pm 
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Isn't it standard practice that when patients get induced they're given a prescription for a weeks worth of meds and then set up right there for another appointment a week later? Then in the follow up appointment the Dr goes over everything with them- when they're not feeling like absolute death- and then gives them their script for the next 30 days.. That's how my DR did it.. I was under the impression this was the SOP for suboxone treatment..

My Dr told me when I was feeling better to do a little research on subs- he did warn me that there was a ton of misinformation about suboxone on the internet- and figure out any questions I had for him and we'd go over them at my appointment after the first week.. In fact, now that I think about it, I never even actually paid (other than my typical dr visit $20 co pay) for my initial induction visit.. I got started with the payments and signed all the paperwork week 2.. This worked out GREAT for me because I was clear headed again.. My first visit was in & out and my 2nd visit was pretty extensive.. I always thought this was how we all did it?? I couldn't ask for a better way to be honest


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PostPosted: Sat Jul 14, 2012 3:22 pm 
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nogroovin', those sound like really good practices to me.

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PostPosted: Sat Jul 14, 2012 3:59 pm 
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That's not how it's usually done? I've only gone to one sub Dr and that's my regular, family Dr.. I guess I just assumed everyone did it this way.. I actually felt very informed, and in control of my sub treatment.. It's a shame if others didn't have the same experience


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PostPosted: Sat Jul 14, 2012 4:26 pm 
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A problem is that doctors are one of the few professions where and individual can 'hang out a shingle' and practice
with a great deal of independence. This may be good.

But the 8 hour training course and regulations involved with being certified to prescribe Buprinorphine stress record keeping and preventing abuse. It the one drug a family doctor can prescribe that normally would be highly regulated.

The existing regulations stress avoiding "diversion" and abuse. Fine, but this tends to limit the number of patients who can get Bupe without naloxone. The official number of people reacting badly to the naloxone in Suboxone is 15 percent. It may be higher, possible entering the blood stream through bleeding gums etc. Thus many doctors play it safe and will not prescribe pure Bupe, even for pregnant women!

The other lacking part of certification is that there is no requirement that the patient be assigned a diagnosis, that is, the
specific type of drug problem being addressed. The elderly person returning to a retirement home with problems with a drug given after surgery need not be distinguished from a drug user shooting H every day. The person wanting only detox with no problems involved with returning to a drug culture are not distinguished from a user who will no doubt be returning to the old neighborhood and old friends.

That is why I posted the ABC idea. At the very least patients should be given a diagnostic status, told what it is, and given all the options. Although it obviously could be structured so starting at A did not prevent easily going to B or C if the treatment started indicated that it should. As it is good doctors do good things. But as in everything, we do not want to
rely on this for life and death situations.


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PostPosted: Sun Jul 15, 2012 6:02 am 
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Quote:
The official number of people reacting badly to the naloxone in Suboxone is 15 percent. It may be higher, possible entering the blood stream through bleeding gums etc. Thus many doctors play it safe and will not prescribe pure Bupe, even for pregnant women!


Do you have something to back this up? A link for a study or something? We like to make sure our information is accurate and a statistic like this we need to have some source to back that up. Where did you get this figure?

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PostPosted: Sun Jul 15, 2012 12:45 pm 
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I had very bad headaches trying Suboxone for the first time. My doctor switched it to generic Buprinorphine right away and he is the source of the statistic 15% of people have this reaction. I will ask him for documentation next time I am there, but I must say I have seen it in the literature as a number, sometimes it is just stated as "a minority" --- and I actually doubt there has been a randomized peer review trial to determine this. It probably comes from clinical experience. If I were to just say
"some people" that would surly be true, and not an opinion.


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 Post subject: Naloxone problems
PostPosted: Sun Jul 15, 2012 5:26 pm 
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In response to a call for documentation I had a look at what I had saved and found one ref. titled
A RETROSPECTIVE EVALUATION OF PATIENTS SWITCHED FROM SUBUTEX TO SUBOXONE
Published in the journal: Substance Abuse Treatment, Prevention, and Policy 2008 3:16

This is from Finland where policy was introduced to switch all patients to Suboxone to prevent abuse. Following up patients newly introduced to Naloxone the basic findings were at 4 weeks 50 percent reported adverse effects,
At the 4 month point 26.6 reported the same. These are high figures probably because some would report that in an attempt to regain the pure Bupriinorphine.

It does give some idea about what Naloxone can do. It is after all the substance that is injected in animal studies to
produce "punishment" or "pain" in studies, where negative reinforcement is necessary. Naloxone will wipe out any stray endorphins in the brain(the feel good chemicals we produce, an opiates wipe out).

Ihope it does not come to that in this country, where people complaining of headaches or nausea and dizzyness, can try Subutex free from Naloxone to see if this clears it up. I have seen posts where doctors refuse to even try this
because they are more comfortable using Suboxone, but I consider this poor patient care.

In a related way I do not think drug abusers have trouble abusing Suboxone, or that Buprinorphine would be a very good
drug of choice for abuse. Once again people with only good intentions wanting a benefit, suffer because of the fear
that decision makers have of "abuse". It is unfortunate.


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PostPosted: Mon Jul 16, 2012 8:15 am 
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Can you provide the link, please?

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 Post subject: link
PostPosted: Mon Jul 16, 2012 1:50 pm 
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Type "finland switch from subutex to suboxone" in google, it is the second listing.


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PostPosted: Tue Jul 17, 2012 1:33 pm 
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There are various types of induction. The low dose/short term method is the best for some patients. This is best described in a post by Robert-325 at the following link:

http://www.drugs.com/forum/featured-dru ... 50887.html


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PostPosted: Tue Jul 17, 2012 7:20 pm 
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LOL ... We've heard all about what Robert325 has had to say before this. I'll leave it at that.

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PostPosted: Tue Jul 17, 2012 8:32 pm 
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Not laughing here. I read this balanced and well thought out post about six months too late - and am sorry about that.
He does not claim to have the right answer for everyone and says so. He advocates the importance of group support and counseling. As far as I can tell, a great number of people have benefitted from this well thought out post -- those who choose to control induction to meet their needs. It is not for everyone and that is clear. But it is line with the original legislation
and regulations concerning how Suboxone therapy was to be used. Everyone who has not read it should, there is no way it can harm anyone, and for many is more like missing information when they face induction in a hurry or with the only
doctor they can find, rather than a considered choice. If any doctor has said that this is just "nonsense from the internet" I have not heard about it. It is not funny that people do not know things that they should - especially in medicine.


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PostPosted: Tue Jul 17, 2012 10:15 pm 
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scruffy wrote:
Everyone who has not read it should, there is no way it can harm anyone


Actually, it did harm me. He is the one who told me there is no way that I should go on subs for vicodin addiction when I was first researching it. He scared me away from the treatment that finally saved me, once I did more research and got the nerve to make another induction appt after cancelling my first one after reading his response to me. I lost months of my life, when I could've gotten on sub earlier, and gotten my life together a lot sooner. I understand that he has a lot of knowledge on sub treatment and tapering, but if I wouldn't have listened to him tell me I'd be so much better just tapering off of my Vicodin (like I hadn't tried that dozens of times before...duh), then I wouldn't have wasted so much more money buying pills on the street, increasing my tolerance with every month that went by.

Of course, ultimately, my choices are my responsibility, but I wish I had never asked anyone on that forum for advice, because it seemed like they all used scare tactics to scare me away, telling me that I didn't need sub for a Vicodin habit...nevermind that I'd been popping up to 20 pills a day for that last 700+ days, destroying my liver, obsessing on pills and putting them before anything else in my life, stressing out myself and loved ones, etc...just my little insignificant Vicodin problem.


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PostPosted: Tue Jul 17, 2012 11:44 pm 
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There is no way around it -- everything is not for everyone. What is a great thing for one, maybe wrong for another.
The cure however cannot be censorship or ridicule of viable methods of dealing with drug issues.

Patently false ideas should be labeled and shown for what they are. What Robert_325 and others say may have been wrong for you-- but that does not make it wrong for many others.

But the only real solution here is to have all methods well discussed, with as much information available as possible. And then in the end, we all are responsible for making our own choice. But I do not see the real danger in making a wrong decision based on what someone says or writes. I think the real danger is not enough information -- so that some people make bad
decisions because the choice was not there.

Nothing is perfect ---but the best is full and open articulation, experience, discussion, and even research when available---which is most likely to lead to the best outcome -- most of the time.


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PostPosted: Tue Jul 17, 2012 11:45 pm 
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By the way, I know the guy voluntarily spends hundreds of hours online, helping people taper off of sub, and has a very well thought out plan, so I am not disrespecting him at all. I know I couldn't help as many people as he has...but I just wish he and the others who follow him wouldn't be so quick to dismiss people who have legitimate problems with opiates, telling them that subs are too strong for them. It is not so much what drug or the amount of drugs a person does...as long as it's an opiate. Obviously I believe that taking Vidcodin warrants sub use. It's about how much the person obsesses over the drug and how much of their life has been destroyed over taking the drug.


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PostPosted: Wed Jul 18, 2012 4:19 am 
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The point isn't how much time someone spends giving out advice. That alone doesn't mean shit about whether or not their advice is any good or not. THAT is my point.

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PostPosted: Wed Jul 18, 2012 5:39 pm 
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Why is he banned from drugs.com?


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PostPosted: Wed Jul 18, 2012 7:05 pm 
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They call it a penalty box over there- meaning not permanent. A lot of people do not seem to like it very much, and apparently this ban can be done by one person. I doubt it will last. I do wonder why after all this time-- it is not very radical to advocate low dose therapy for patients wanting it, and be specific about how that works. Has always been an option.


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