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PostPosted: Mon Jul 11, 2011 9:30 am 
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Please allow me to introduce myself"... no wait... that's a well known song lyric :oops:
I came to this site to learn more about suboxone taper to stop 3 years use of long acting morphine like Kadian and then was briefly on Methadone. Had a injury 4 years ago as an athlete that resulted in significant pain and changes in my life. I was always on a very low dose of Kadian, the highest being 20 twice a day,and then Methadone 5 5 5 . I'm here because I want to get off the pain meds and see what my baseline is like as i think my pain is better and I think I have some new options for management that don't involve opiates. I could not tolerate the clonidine and the baclofen to help with WD, so my dr. suggested suboxone. I guess I would say I don't have the behaviors of what people describe as "user".. I hate taking the pills and they just sit in my closet. They don't make me feel good. I actually discovered that I was probably in a low grade withdrawal for about 2 years cuz although my body was telling me to increase my dose i,e, lots of bone pain, sweating at night... i suffered through it. I kind of had this pact that if my underlying pain was managed then I would not increase the Kadian or Methadone. I also simply don't feel good on it so here I am really wanting to taper off and would appreciate the support of this group and the intellect and humor too. I have a few questions 1) Is it possible that I did just kind of hover at this chronic but low level of WD and that might be what the bone pain is about ? Since I started subox 4 days ago I have no more bone pain. My dr. gave me a choice of starting around 8 mg (strips) a day but I started a little lower and use 1/4 strip 3 x a day for the past 4 days. I was uncomfortable but it was tolerable and this morning those symptoms are way better. So my thinking is this ,, I just got rid of a few opiate receptors maybe ? Is my understanding correct that way. He wants me to stay at this dose 2 weeks and then just keep slowly decreasing. From the board, it seems slow is better , and given that I was a bit of an adrenaline athlete, I have to do something counter to my nature. And my next question is this: Some people talk about "zaps" and when i have had too little opiate in my body I would experience something I would call a "jack hammer" sensation. Just this tapping/vibration in my legs, arms, face, even I could feel it in my eyeballs when I lay still. It's a nuisance, but not more than that. I'm thrilled that the bone pain is gone for sure as they (dr) were starting to think either hyperalgesia from the opiates of fibromylagia which I don't have either. My last comment is I understand that I am definitely physically dependent but I don't have a history of recreational using, or using drugs to settle emotional issues for me. I ask that just because I am fortunate to have a healthy support system and things to do to cope- but does that have any bearing on how I will go through the taper ? I mean...would my motivation help me go faster or no matter what, my body is addicted and slow slow slow. I cannot tolerate clonidine, baclofen, so at the end... I have to truly do cold turkey at that last stage and that concerns me as with Methadone I had all the sx you talk about. Any guidance, suggestions, so appreciated. I can tell this is a great and entertaining and supportive bunch. I'm on day 4 taking 2mg (1/4 strip) 3x a day. Also, can someone explain why pain patients are dose different than non pain patients.
I'm Motivated!
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PostPosted: Mon Jul 11, 2011 10:20 am 
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Hello and welcome. I'll start with your last question, why dosing for pain with suboxone is different than dosing for addiction treatment only. BTW, I also have fibromyalgia and I take suboxone for both pain and addiction. Anyway, when it comes to using sub for pain purposes, it only lasts between 4-6 hours, so instead of dosing only once per day, pain patients usually dose 2 or more times a day. I personally take my sub either 2 or 3 times a day, depending on how bad my pain is.

Am I to understand that you plan on using sub as a short term detox tool only? Or do you plan on using it longer term to treat your pain? Sorry if I'm not clear on that. Based on what you said, you have a physical dependency only and aren't addicted to opiates.

If you could clarify how you intend to use suboxone (short term or long for pain), then I can comment further, but I'll wait until I understand for sure what your plans are.

I'm glad you joined the forum. I'm sure you'll find it a very informative and supportive place. Again, welcome! I'll wait to hear back from you with additional info.

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 Post subject: Intro Clarification
PostPosted: Mon Jul 11, 2011 10:27 am 
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Thanks so much for your response and here is my clarification. I am wanting to use Suboxone to get off all the opiates and then see what my baseline pain is. ( I have a neuropathy, I don't have fibromyalgia though at one time my dr. thought it was developing) That was related to my question that I had chronic bone pain that I think was actually chronic WD symptoms. So yes, I would like off to see if there are better meds for me that don't involve tolerance, withdrawal etc. I stopped the Methadone last week . That was when I was on 5 mg 3 x a day and then I started Suboxone cuz my WD was so bad and I couldn't tolerate the clonidine or baclofen. I hope this gives you the info you needed to answer.
Thanks in advance,
Anita

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PostPosted: Mon Jul 11, 2011 10:41 am 
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OK, thanks, now I'm clear. You are probably right about that bone pain being related to protracted withdrawals. That kind of pain isn't usually related to neuropathy. So the goal is to taper off all opiates, including suboxone, and see how your pain is without them and go from there. That's a pretty good plan, I think.

If you taper down slowly enough and low enough, you'll have less intense withdrawals. If I were in your shoes that would be my goal. Taper down slowly, with enough time in between dosage drops for your body to get accustomed to the new dose before dropping again. And make those dosage drops as small as possible - the less you feel the drops, the easier the taper and it's related withdrawals should be.

I'd like to add that my husband has had peripheral neuropathy for many, many years (in his feet) and he, too, has a great deal of trouble finding anything that helps his constant pain. I have, however, heard from a couple of people that suboxone actually does a pretty good job of treating that kind of pain though. He hasn't found anything non-narcotic to treat his pain. Have you tried Lyrica or Neurontin yet? Those are sometimes used for neuropathic pain. Anyway, that's something that you can address once you're off the suboxone and can see what your pain level is left untreated.

Has your doctor given you a taper schedule yet? Do you know how long he wants you to be on it? In the "Stopping Suboxone" category, a new "sticky" thread was just posted which has a taper table that you can insert the dose you're on and it can calculate the amount of sub in your system all the way down to zero...Something like that. Check it out - It might help you with your taper.

If you need our help with your taper, we'll do our best to assist you in any way we can. That's what we're here for. And if you have more specific questions about suboxone or anything related to it, just ask. :)

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PostPosted: Mon Jul 11, 2011 10:57 am 
Hello Anita! I'm glad you're posting here....You'll find lots of support and information!
I'm a little bit short on time this morning, so I probably won't cover all of your questions and I apologize for that. What I don't get to, I'm sure someone else will come along with more for you.
I mostly wanted to say that I'm sorry for what you've been through with the ongoing pain and the vicious cycle of opiate pain medications. It's a tough spot that I'm certain that scores of others have found themselves facing. It really sucks to try to sort out where you're at in terms of pain after having your brain (essentially) 'damaged' by being on opiates for a long time. Science tells us that that damage is reversible and that is great news! It just can take a while to revert back to normal functioning when coming off the opiates.
I think, for you, it is more optimistic that you've not been a pain med abuser and it sounds like you have little to no emotional or psychological 'attachment' to your meds. That should help a great deal with your long-term success in getting off of everything.
I think you touched on something in your post that in my opinion, is key......your understanding that long-term opiate use often sort of clouds or skews your pain perception. I know when I have been off opiates before, every little ache or pain was magnified by 100! So don't be too afraid if at first, you feel like your pain is worse on the Suboxone. I agree with you, also, that it kind of sounds like you have been in a little bit of low-level withdrawal at times during your treatment with pain meds. Usually, it would seem impossible for a person to be on a long-acting opiate for pain and still experience low enough 'dips' in their blood levels of opiates to put them into w/d. But I've heard of it before and there's just no getting around the fact that we can all metabolize this stuff in different ways.
I think it's great that 6mg of Sub each day here at first is enough to hold you in terms of keeping you out of severe w/d. A lot of us need more than that mostly because our cravings can't be extinguished without a higher dose of Sub. But apparently cravings won't be an issue for you and that, in my opinion, should be considered a huge blessing indeed!! So, I'd say to just continue on with as low a dose of the Sub that keeps you from having bad w/d symptoms.
With your goal being to get off Sub and reassess your true pain levels, I would advise you to work closely with your doctor in getting your dose down slowly and steadily over a matter of maybe, several months even, in order to avoid getting into that "Is this 'real' pain or w/d pain?" issue. Sub is in fact, a very strong opiate medication, although it's a partial agonsist. That being the case, it usually takes getting down to doses well beneath 1mg/day to avoid a lot of w/d symptoms (ie pain.) So take your time and try to be patient, remembering how long it took you to get this place and it's only reasonable to take a while to get out.
I'll end now. As I said someone else will probably come along and answer some of your other questions for you.
Anita, I'm not a doctor or an expert, just someone else struggling with ending an addiction to opiates, and wants to help others who are here with me. I hope you'll find as much help here as I have!!
Best regards to you and it sounds like you're doing great thus far!


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PostPosted: Mon Jul 11, 2011 11:02 am 
How funny....I see that while I was replying, you and Hat were replying back and forth also! Even funnier is that we all seem to be on the same page!! Hatmaker is exactly who I was thinking would reply to you about your questions about the pain treatment aspects of Sub....so this has worked out perfectly!! Too funny!


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PostPosted: Mon Jul 11, 2011 11:40 am 
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Please allow me to introduce myself
Im a man of wealth and taste
Ive been around for a long, long year
Stole many a mans soul and faith.....

That's the Rolling Stones singing "Sympathy for the Devil".....awesome tune!!!

Hi Anita, welcome to the forum!!

You've already got some great responses and its sounds like you've already got a pretty good handle on what you need to do as far as how to use Suboxone for your specific case.

I wanted to add that your 3 years on Kadian has left you with a dependency, but it sounds like you're not addicted and that difference is HUGE!! The 3 year dependency is going to take some time to break, Suboxone is an excellent tool for this. I see you're at 6mg per day, that's very encouraging to hear. While it's not a super low dose, it sure ain't 16mg like most of us were started at. By the sounds of it, you have a pretty good Suboxone doctor.

OK, here are some general numbers for ya. Morphine ACUTE wd would normally last around 3 or 4 days, it's followed by Post Acute Withdrawal Syndrome (PAWS). PAWS varies greatly from one individual to the next.....it's extremely hard to put a number on how many days of PAWS you would experience......some of us feel it for only a month or two, some of us feel it for much, much longer. If I had to guess, I'd say your PAWS from Morphine would be on the shorter side.

So, you're using Suboxone to get through the acute wd from morphine and to hopefully skip the PAWS of morphine too, what you have to be careful of is that Suboxone is an opiate too....you can become dependent on it as well.....in your case, you don't want to be on Suboxone any longer than you have to.

OK, now that I have confused the hell out of you :D , I'll give you the easy answer. Here's what I would do if I were you, knowing what I know......today is day 4 on Suboxone and you mentioned that the bone pain has dimished greatly.....your acute wd phase is most likely over. By the way, PAWS is a weak version of acute wd. So you should be able to start decreasing your dose until you feel some PAWS symptoms, you might be able to get to 4mg, it might be 2mg, it might be 5mg??? You just have to listen to your body. I would continue trying to decrease my dose every few days until I felt some wd symptoms, stabilize there for a day or two, then move on.

Another important thing to know about Suboxone is that it has a LONG half-life. Suboxone has a half life of 37 hours. As you continue to get your dose lower and lower, you may consider trying to skip a day of dosing. Most of us would start skipping days around the .5mg mark or thereabouts.

You MUST discuss all of our suggestions with your doctor though. He's your doctor, we're not. We're just offering up ideas and hopefully some more information that you can talk to your doctor about.

Good luck and I hope you keep us posted.

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PostPosted: Mon Jul 11, 2011 11:40 am 
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hatmaker and setmefree- immense thanks. Having this info takes away so much of he anxiety and uncertainty. I do have one more question. That chart you suggestetd Hatmaker, does it not work with Mac computers ? I have a feeling it is a PC program.

Again,
very grateful

Anita

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PostPosted: Mon Jul 11, 2011 11:57 am 
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Here's the link to that thread: http://suboxforum.com/viewtopic.php?t=4447

In it there's a link to a website with what seems to be an interactive table. Since it's web-based, I would think it'll work just fine for you too. I haven't tried it myself (as I'm not tapering off), but from what I could tell, it might be very helpful for some people who are stopping. Hopefully it can help you out. Hang in there!

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PostPosted: Mon Jul 11, 2011 6:16 pm 
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Thanks again everybody...and yes.. Romeo good song. Being new and welcomed to this forum is giving me tremendous support. It's great to have a place and ask all these questions, and then try to let life be a little bit normal at home. I know I'll be bugging you all a lot

Anita

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 Post subject: Symptoms ?
PostPosted: Tue Jul 12, 2011 8:50 am 
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Hi again... I started Suboxone last Friday and my dr. suggested 1/4 strip 3-4x a day. I've been getting by with 3x a day but after reading more I think I am probably having some PAWS. Also quite nauseated but it passes and I read that spitting saliva out after 20 minutes so I will try that. I see my dr. this week. I notice most people take it once a day and although I have a chronic pain condition, if I am using the Suboxone to get off the opiates, wouldn't it be ultimately better to take it once a day? Also, I'm not totally turning off ALL the w/d symptoms and trying to just tolerate some so I don't end up on a higher dose. The constipation, despite all the supplements that I take for it is a major problem- plus my thinking is if I can handle the symptoms at 6 right now x 5 days...ultimately that would be better for me ? I'm just learning about ceiling and all and it seems like if I can get to 4 and stay there that would be best? I was never on high doses of Kadian, Methadone as I was so sensitive and also... I have a wicked chronic headache now. My hunch is PAWS as well as plain old side effects ? Would love some help sorting out the symptoms and best way to dose.
Anita

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PostPosted: Tue Jul 12, 2011 8:58 am 
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The constipation is definitely a side effect of opiates, including suboxone. As for dosing multiple times a day or once a day, I'm guessing your doctor recommended multiple times because of your pain. Do you find that after you dose you have less pain? If you're having luck with some reduced pain, you could continue dosing twice or more per day. If you aren't concerned with pain control, you could go down to once per day. It's really your call (and your doc's).

If you've got enough sub in your system to where you're not having any acute withdrawals, then you shouldn't be experiencing any PAWS either. Withdrawals - acute or PAWS - will only happen when there's no opiates in your system at all.

As for your headaches, some people experience those after dosing. What they do instead of swallowing after their sub dissolves is to spit and they say that takes care of those headaches. So give that a try and see if that addresses your headaches.

I'm not sure if I answered all of your questions or not. If not, just let me know and I'll give it another try. :)

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PostPosted: Tue Jul 12, 2011 9:00 am 
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Anita - I saw you posted a second thread with the same reply you posted above. I deleted that second thread so as to avoid having replies to your questions in two different spots. Just so you know.

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PostPosted: Tue Jul 12, 2011 9:08 am 
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Thanks hat maker, and ya, thanks for deleting that post. Ok, so.. I am trying to weigh feeling bad from taking more suboxone versus withdrawal sx. It does help with my pain, but again, I want off all the opiates to see what my baseline pain is now and shoot for a different med for pain management. So I view the subox now as for a true taper, not pain management. I mean.. if I can hang through some of these symptoms now a few more days and stay at 6, is that ok ? Should, in a few more days...some opiate receptors kind of down regulate ? And this morning I did do the spitting out saliva trick you mentioned.
Thanks for the quick response and off to walk and distract myself
Anita

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PostPosted: Tue Jul 12, 2011 11:20 am 
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Because you're still very new to Suboxone, day 5 for you, you're probably still stabilizing on it. Could be some of the reason you're getting nauseated.

As for the headaches, many people attribute that to the Naloxone in Suboxone, spitting seems to help most people with this issue.

Once a day dosing is where you need to be, in my opinion. Suboxone has a very long half life, one dose should be able to get you through the day without any problems.

I think staying at 6mg is fine for now, but I don't think you need to stay there too long. Remember, Suboxone is a powerful opiate, you will become dependent on it if you stay on it for a long time. You may find that you need to stay on Suboxone for a while and work your taper very slowly......and that's fine too. I'm just trying to help push you along so you don't end up becoming dependent on Suboxone.....even though in the long run it may happen, which certainly is not the end of the world. We're kind of walking a bit of a tightrope here.

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PostPosted: Tue Jul 12, 2011 11:37 am 
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I'm not sure I agree with Romeo's idea of you becoming dependent on Suboxone. Since you were already dependent on other opiates and suboxone is just another opiate (albeit a partial agonist), you're not really going to get dependent in any different way. An opiate is an opiate is an opiate. And you already have a dependency to them.

I think since you just started sub you can probably stay at 6 mg for a few to several more days, until you feel ok. Then you can probably try dropping to 4 mg and see how that feels. If you feel any withdrawals, I'd bump up to 5 mg. Remember, when you drop your dose, you want to do it in a way that causes the least amount of discomfort.

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PostPosted: Tue Jul 12, 2011 11:59 am 
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Romeo and Hat- Ok, thanks, and my instincts make me want be at a lower dose, like you said at 4. And I think since I am so new that is just random, but I hear you mentioning the ceiling and all. I know the taper part is gonna be so hard and my fears are about not being able to take the clonidine and baclofen like others... so.. maybe what I'll try ( and I'm seeing the dr. on Thursday) is once a day dose of 4, and then ask for the "fastest, slow" taper possible :wink: I see how individual this is, and what is a bummer is that for 2 years I kept saying to my dr's I really think I'm in withdrawal and they just didn't buy it. Oh well, gotta think forward now. That's the past.
Anita

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PostPosted: Tue Jul 12, 2011 2:51 pm 
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Hi Anita, I was looking through Dr. J's archives, because I know he has posted info on equivalent methadone/Suboxone dosages. What I ended up finding is a little upsetting, and I'll post the link below. Basically, someone who was down to 8mg of methadone was asking about using Sub to end the taper, and Dr J's answer was DON'T DO IT! He said that Sub is equal to 30-40mg of methadone so the patient would be INCREASING his tolerance. I know you were on 15mg of methadone (and some morphine?) so your tolerance was higher than the poster, but still I would read this reply carefully. You might want to get down to 2mg ASAP and taper off very quickly. I'm sorry to be the bearer of bad news, but ultimately I hope this helps.
Please keep us posted on your progress,
Lilly

here's the link:
http://suboxonetalkzone.com/2009/12/17/ ... r-no-bupe/


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PostPosted: Tue Jul 12, 2011 2:56 pm 
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For those of you following this who don't have time to follow the link:
Here is just a small portion of Dr. J's answer to using Sub to taper off a low dose of methadone:

"OH MY GOD, NO!! If you are at 8 mg[methadone] , you are in the home stretch!! Bupe would be like going back to 30-40 mg of methadone– and bupe is very hard to taper because of the odd ceiling effect and high potency. Some day we will have a neat way to use buprenorphine as a tapering tool; things that would help would be a much lower amount of buprenorphine in a pill that is the same size or even larger, or perhaps an injectable product that slowly dissolves, allowing the blood level of buprenorphine to slowly decrease. But using what is available today, you would need to take a tiny, tiny fraction of a Suboxone tablet in order to take a dose equivalent to only 8– let alone 2– mg of methadone. You would literally need to take about one hundredth of a tablet! Remember that buprenorphine is a ‘microgram’ medication; a dose of 50 micrograms is quite potent, and one tablet contains 8000 micrograms!"

Again, I'm sorry to be the one posting this, but it's better to know the facts.


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PostPosted: Tue Jul 12, 2011 3:18 pm 
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well... now i am freaking out because i was on Methadone 5-5-5 and then i tapered down to zero and now I'm all saturated again. I'm going to call my doctor- I couldn't tolerate the clonidine so that is why they thought this would be better. what should I do. Now I'm scared.

Anita

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