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PostPosted: Tue Apr 17, 2012 9:33 pm 
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I propose that enough is now known about Suboxone that a formal typology (treatment protocol)
might be introduced as Best Practice, or law.
INDUCTION METHODS:

Type A- Short term/low dose - One month of detox and on to Rehab, or cured.

Type B- Maintained on Subs for over a month -- later decision how to taper, or stay.

Type C- Maintained for life on Subs as best option.

If there is no good reason to not begin at A--then all should be given that option. Having to decide when in pain, or when not enough knowledge has been gained, is never a good thing. INDUCTION SHOULD ALWAYS START WITH A. Moving on to B or C are later decisions.

Finally, going the other direction -- from late into B, back to A is difficult if not impossible. I have talked to a number of people who regret being in B headed toward C ---when A was never offered.

Is there any reason all programs should not proceed: A------B------C. ?

One thing I know for certain - I am over a year into B with no clear plan of taper, and was never offered A, at the beginning when in W/D.

There might be a good reason to start in phase B-- and then all that would be required would be a good reason, written.


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PostPosted: Tue Apr 17, 2012 10:58 pm 
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What an interesting idea you have; it made me think when I applied your theory to myself. I did not go on suboxone voluntarily, as some of you may recall. I was in a psychotic episode when I was put on suboxone without my permission and with no informed consent (by anyone on my behalf). I'm not saying that I regret having done it, because I don't. I know it was the best thing. But you've made me consider something I've never considered before: What would have happened if I were given or treated with your option A? Would I have had a chance of moving forward without suboxone? I'm a pain patient, so maybe not, but maybe so, too.

I'm not one to look backward and regret things, so I won't think lose any sleep over this or anything, but it is a bit disconcerting when, like I said, I apply it to my rather unique situation. It already bothered me that I was put on suboxone with no end in sight, and no one bothered to tell us what it was (not even my husband). Forget about telling us that it was just another opiate that I'd still be dependent on, etc etc etc. But hey, I am where I am right now, right? I can't go backwards - all I can do is go forward from here.

I thank you though. You've definitely given me a new perspective, perhaps just due to the way you presented it, and that's always a good thing.

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PostPosted: Wed Apr 18, 2012 3:37 am 
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ah". but they think a druggy is a druggy,and will continue to think so and treat it that way :roll:

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PostPosted: Wed Apr 18, 2012 3:40 am 
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hat'. they treated me the same way, starting out with pain then addiction.

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PostPosted: Wed Apr 18, 2012 10:17 am 
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Hat, I understand that there are people in your situation that are put on suboxone in hospitals or when their consent is otherwise not available. However, is this really the norm? I don't think so. I believe that under normal circumstances the patient goes into a clinic fully aware that they are going to receive suboxone treatment. In that situation, where is the patient's responsibility to educate themselves about what they are getting into and making their own decision about the course of treatment. I for one was not offered "option A" but I did know that there were people who have had success that way and knew it was an option. My treatment is progressing just as I knew it would because I researched it beforehand. Doesn't everyone have a certain responsibility to do so when going into a new treatment that has unknown elements. (understand I am not speaking about your situation, only those who sought out treatment knowingly.) I guess I can't speak for everyone, but if I had been offered that option I would have declined. If I had been presented with the model that scruffy described having "option A" as the first line of treatment before "b and c" could be considered, I don't know if I would have given up my DOC. I would have felt overwhelmed knowing the drug that is helping me to get clean was only going to be given to me for one month. Knowing I would have to be completely abstinent after thirty days would have scared me away. Think back to your mindset when you were completely involved with your drug. Deciding to get help is a tenuous decision...one made easier with suboxone as an option. I know that there are those out there who get to the point where they are ready to face the withdrawals and cravings and such right away and want "option A" , but I don't agree that it should be the only option for the first time patient.

Just a friendly dissenting opinion. 8)


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PostPosted: Wed Apr 18, 2012 10:31 am 
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Oh, no, don't misunderstand, my situation is completely unique, I recognize that. Most people do have full informed consent and every opportunity to research the medication beforehand. For some reason, it never occurred to me until now that "what if" they at least waited a day and a half until I was lucid, THEN at least had a conversation with me and offered me Option A. I have been on suboxone for almost 3.5 years and have had zero relapses or slips. My husband has a couple of bottles of his old percocets in the house still and I only realized a couple months ago when it occurred to me that it never even bothered me when I saw or even had to handle them. It would take a lot of back-story for me to explain further, but suffice to say that yes, my situation is pretty unusual. I'm definitely not generalizing it to everyone.

I do think if sub patients are at least offered that Option A, and by that all I mean is just discussing it with the person, is what I consider to be a good theory. That's all I mean, just having a conversation about the different lengths of treatment possibilities. That alone I don't think is even done enough with people starting suboxone. Too many doctors have their own ways of treating their sub patients in a cookie cutter fashion. I do think this method would help people to be treated more individually.

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PostPosted: Wed Apr 18, 2012 12:34 pm 
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qhorsegal wrote:
I believe that under normal circumstances the patient goes into a clinic fully aware that they are going to receive suboxone treatment. In that situation, where is the patient's responsibility to educate themselves about what they are getting into and making their own decision about the course of treatment. I for one was not offered "option A" but I did know that there were people who have had success that way and knew it was an option. My treatment is progressing just as I knew it would because I researched it beforehand. Doesn't everyone have a certain responsibility to do so when going into a new treatment that has unknown elements.


Thank you! Option A IS available for everyone (with very few exceptions, like hatmaker). Just because the doctor doesn't lay it out for you in detail, doesn't mean that the information is not out there and available to anyone who puts the time and energy into finding it. I don't understand how people can just go home from the doctor's office and not at least do a google search, in this day and age, before they ingest whatever med their doctor gave them, much less, stay on it long term. I knew exactly what I was getting into, including the side effects and the fact that I would now be dependent on another opiate, because I researched it for weeks and weeks beforehand. Especially with Suboxone, since this is a drug in which treatment is premeditated by the patient in most cases.

My doctor prescribed me 24mg/day of sub and I took it upon myself to only took 8mg, because I educated myself prior to my appointment, and knew that I did not need that much. I quickly tapered myself down to 4mg (the lowest dose that controls my withdrawal and cravings) without his consent or approval. How can anyone blame the doctor or medical field for not giving them more information or choices? It is each person's responsibility to research and decide whether "Type A, B, or C" is best for them. I don't believe anyone doesn't have Type A as a choice. The doctor does not come home with you and force you to take a certain amount of sub each day.

Actually, I just remembered that a few people have said that they do have to take their dose in front of a pharmacist or someone, so obviously, these people are not who I am talking about.

qhorsegal wrote:
I guess I can't speak for everyone, but if I had been offered that option I would have declined. If I had been presented with the model that scruffy described having "option A" as the first line of treatment before "b and c" could be considered, I don't know if I would have given up my DOC. I would have felt overwhelmed knowing the drug that is helping me to get clean was only going to be given to me for one month. Knowing I would have to be completely abstinent after thirty days would have scared me away.


I have never thought about this, but I totally agree with you. I would not have started sub if I knew that I absolutely had to quit in a month.


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PostPosted: Wed Apr 18, 2012 8:56 pm 
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There may be some misunderstanding about and A-B-C protocol used as a practice. It just means that all providers are ready for all possible outcomes - or make the proper referral, if they should.

Now, about one-third of all patients are trying to use Suboxone as a short-term detox method.

Some doctors now only offer this, turning others away. Most doctors have come up with a preferred method and it is unclear how much patients can modify this. It is good when it matches, but unknown how often this happens.

Under A-B-C no patient would be limited or have to make a choice when starting. Induction would be careful, allowing for those who know (or find out) they want short-term treatment. Those finding they want longer term treatment (or are sure they do) are simply allowed to go that route --- as they do now. They would notice no difference and would not be forced to choose in any way.

So, yes, some people are well prepared and know just what they want at induction-- and they would not be influenced in any way under A-B-C. Mostly it is that one-third who think they want to try a short-term treatment - who would be helped and allowed to try that in most facilities. If they determined they wanted to be longer term sub users during that first month--
they would just proceed to do so as their (informed) choice. Choice is increased. And there simply is no corresponding down-side for anyone.

Guidelines for best practice are just that - and what actually happens is mainly controlled by the doctor-patient relationship so, no persons treatment would be altered by this -- unless they wanted it to be. Patient empowerment.


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PostPosted: Wed Apr 18, 2012 9:13 pm 
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the way the treatment team wants it is". treat the patient with meds as well as the treatment as the same thing
and get a treatment done not all ways on the patients be half, and they kill 2 birds with 1 stone. that seams the way its going to me.

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PostPosted: Wed Apr 18, 2012 9:27 pm 
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unique'. i am unique too'. and most of us people in pain. we learn and over look things in live that others would not.
but there is just not enough of space in life for us unique ones.

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PostPosted: Thu Apr 19, 2012 12:18 pm 
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I agree that B and C should always be a choice, but aren't. I just wanted to point out that Type A is always a choice once you get your first sub Rx. It seems that a lot of people who want off of subs blame the doctor for keeping them on it for so long, or for not informing them of the addiction possibilities or possible side effects. Again, it is the individual's responsibility to research any med that they put into their body. And it is not the doctor's fault that anyone stays on it long term.

Once someone gets their first Rx of subs to take home, it is possible to just use it short term to detox. No one forces you to keep taking it, or to even go to the 2nd follow up appt. I just don't understand how people blame the doctor for something that the individual continues to do willingly. :?


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PostPosted: Thu Apr 19, 2012 12:42 pm 
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I just wanted to mention that yes, it is up to people to research any med they get put on, but it is up to their doctor, AS WELL, to give them INFORMED CONSENT about EVERY MEDICATION they put them on. And I think it's quite clear from what people post on this site that doctors simply are not providing people with this necessary informed consent. It is the law, after all.

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 Post subject: taper program
PostPosted: Thu Apr 19, 2012 2:01 pm 
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If any one thing has been learned in the field of drug tapering and detox -- a program designed and monitored by the person
taking the drug will not work. It is the control and discipline and structure from the outside that makes success possible -- in all cases.

Well, all may be too extreme a word. But the rare exception cannot be accepted as the rule. For patients, being in W/D is about the worst time to start up a do-it-yourself program.


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PostPosted: Thu Apr 19, 2012 2:53 pm 
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Scruffy said, "If any one thing has been learned in the field of drug tapering and detox -- a program designed and monitored by the person taking the drug will not work."

With regards to Suboxone, I couldn't disagree more. Many folks on this board who have tapered did it using their own schedule. They took their time, reduced their dose slowly and when THEY felt ready, they jumped.

The problem with following their doctors instructions to taper is this, a boat load of doctors who prescribe Suboxone are not really trained in addictionology and they honestly don't have a clue as to how to properly taper their patients.

If I've learned one thing while being a member of this forum, it's that no two tapers are exactly alike.

If I was tapering, the LAST thing I would want is an outside influence trying to dictate to me how to taper off of Suboxone, IMO, that's a recipe for disaster.

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 Post subject: What Romeo said
PostPosted: Thu Apr 19, 2012 3:49 pm 
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My long term Doctor before I moved was an addiction specialist and his taper recommendation was for a very slow taper, maybe too slow (for me anyway). He recommended 1 reduction per week, when patient felt comfortable 2 reductions per week and so on to every other day and then every day. That is for just going for example from 8mg to 7mg or 6mg. then repeat the same thing on down the line.

It took me 2.5 years on 8mg to be ready to taper and now I'm down to 1.5 mg which had taken me 4 months. When I feel ready, I drop the dose. If it don't feel right, I go back up. Sometimes I do the reduction only every other day. It's all up to me and I haven't felt bad at all really.

I think the biggest factor in tapering is that you must be ready- not just fed up with sub. At about one year on sub I was so upset with how much I was sweating at aa meetings and wanted to come off sub. No way was I ready, I would still take extra sub on occasion in an attempt to feel better at the time.


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 Post subject: taper vs quit
PostPosted: Thu Apr 19, 2012 5:12 pm 
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It is important to distinguish a slow taper from an abrupt quit (jump). Romeo is right that many doctors do not know about tapers and quitting, and they should. This leaves many doing their own taper - which is of course possible - and what is usually done. But with this particular drug it is widely reported that tapering is quite easy at high levels.

Dr. J, in his tapes relates that tapering fairly slowly from 16 down to 4 or even 2mg can be done with little difficulty by most.

That leaves the quit, which is reported to be the hard part. Acting more like C/T experienced on other powerful drugs.
This is the point when the best of intentions run into horrible W/D in ways many have never experienced before.

Tapering is one thing. Quitting is another. Tapers can and are done by individuals in all sorts of ways and are often
successful. It is with the quit that brings on W/D - and at this point if the quit is treated just like a taper, and no good plan and help is provided, here is where the quit fails.

When it gets as bad as it can get, one needs all the help and planning they can get. Quits (jumps) thought to be like a
taper are very likely to fail

But another distinction must be made. The taper and quit spelled out in a one month program (Called A)- Takes place all within 30 or 60 days ---- and this is quite unlike the taper and eventual jump of a person who has been taking subs for years. This is precisely why A-B-C is best practice -- It appears that the whole process of quitting DOC, replacing with Sub, tapering Sub-- all done in 30 days -- is by far the best for persons with simple cases of fearing W/D only.

These easier cases should be recognized and kept at phase A at all times. More complex cases might well go into phase B, but the eventual taper (if wanted) and quit, will be a different thing than the one month phase A.

What is needed is some way to insure that clearly type A patients are given and even encouraged to use Subs in a way that will best help them. Some sort of vague waiting and allowing them to stay on or increase subs for months or years with no good plan is just unacceptable and I believe, harmful. "Do no harm." part of the Oath.


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 Post subject: Re: taper vs quit
PostPosted: Thu Apr 19, 2012 9:42 pm 
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scruffy wrote:
It is important to distinguish a slow taper from an abrupt quit (jump). Romeo is right that many doctors do not know about tapers and quitting, and they should. This leaves many doing their own taper - which is of course possible - and what is usually done. But with this particular drug it is widely reported that tapering is quite easy at high levels.

Dr. J, in his tapes relates that tapering fairly slowly from 16 down to 4 or even 2mg can be done with little difficulty by most.

That leaves the quit, which is reported to be the hard part. Acting more like C/T experienced on other powerful drugs.
This is the point when the best of intentions run into horrible W/D in ways many have never experienced before.

Tapering is one thing. Quitting is another. Tapers can and are done by individuals in all sorts of ways and are often
successful. It is with the quit that brings on W/D - and at this point if the quit is treated just like a taper, and no good plan and help is provided, here is where the quit fails.

When it gets as bad as it can get, one needs all the help and planning they can get. Quits (jumps) thought to be like a
taper are very likely to fail

But another distinction must be made. The taper and quit spelled out in a one month program (Called A)- Takes place all within 30 or 60 days ---- and this is quite unlike the taper and eventual jump of a person who has been taking subs for years. This is precisely why A-B-C is best practice -- It appears that the whole process of quitting DOC, replacing with Sub, tapering Sub-- all done in 30 days -- is by far the best for persons with simple cases of fearing W/D only.

These easier cases should be recognized and kept at phase A at all times. More complex cases might well go into phase B, but the eventual taper (if wanted) and quit, will be a different thing than the one month phase A.

What is needed is some way to insure that clearly type A patients are given and even encouraged to use Subs in a way that will best help them. Some sort of vague waiting and allowing them to stay on or increase subs for months or years with no good plan is just unacceptable and I believe, harmful. "Do no harm." part of the Oath.


I have to agree with you Scruffy in regards to different induction type profiles. My Dr. started me on 2 8mg/2mg tabs a day and I was literally getting loaded off these. Because of my own personal research and the help from various people within this forum, I found that my Dr. probably prescribed me too much so I immediately, on my own, lowered my dose to 4mg a day. I notified my Dr. immediately and he agreed with my self-reduction. I am definitely a "type A" and as of today I am only using 2mg a day for my third week of subs. Because of research and the people within this forum, I am successfully using subs as a tapering tool.

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PostPosted: Fri Apr 20, 2012 1:14 am 
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i think a-b and c are all very good treatment from the start. but every f'n time i say i would need to taper down to mcrogr's
to my dr'. he just sits there very/very silent. i all ways wounder why.
i just think '. oh he thinking' johnboy is just a mental patient hooked on subs and he would'nt no or feel the f'n differ'ts anyway.
he would not help me with my car accident "and feels the same way about that.
and f'n sooo my lawyer won't get any info from him' and shit". this is just not o.k.

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 Post subject: Re: taper program
PostPosted: Fri Apr 20, 2012 11:07 am 
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scruffy wrote:
If any one thing has been learned in the field of drug tapering and detox -- a program designed and monitored by the person
taking the drug will not work. It is the control and discipline and structure from the outside that makes success possible -- in all cases.


I totally agree with this statement since the reason a drug addict usually can't taper is because of the pill (or whatever your doc) = reward (getting high). But I do think Suboxone is the exception since we are not getting high off of it. This should make it easier to taper.

With that being said, I have tapered down to 3mg from 8mg, but I have only been on it for 2 months. True, it might be harder to taper to this amount if you've been on it for more months, or years...I wouldn't know. Plus, I still haven't jumped, or even gone under 2mg, which is the point where it is said to be the hardest. So maybe I should keep quiet on that subject until I have actually have accomplished that. :wink:


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 Post subject: still an issue
PostPosted: Thu Jul 12, 2012 10:39 pm 
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In spite of some fears of being "assigned" a status, the ideal would be starting at A (informed consent) with a smooth move
to B if it is warranted , and to C if necessary. This is not required today --- thus not done.

How does this get done? Any ideas on how to make this induction information a required practice? As of now each must do their own research and take action --- not always working with the doctor. We would not allow cancer treatment to go on in this way!

AS OF NOW - A DEBILITATED PATIEND (IN W/D) NEEDS TO TAKE TOO MUCH UNILATERAL ACTION TO STAY IN GROUP A.

After 90 days it is clearly too late for that option. And that is not (((Informed Consent)))............


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