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PostPosted: Sat Apr 24, 2010 11:33 pm 
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Congratulations!

I am already down to 1.2 mg. I sneeze a little each morning (I have never been a "multiple sneezer" but now I sneeze like 10 times in a row each morning) and if I forget to take my dose by nighttime I feel pretty bad but, so far so good.

I think that even if I had to stop right now I might be able to do it. If coming off ~1 mg is half as bad as 2 mg then it would definitely be doable but I still don't know if I could resist "just getting a couple of percocets to sleep".


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 Post subject: Two weeks!
PostPosted: Tue Apr 27, 2010 1:57 am 
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An update - it's been two weeks since my last dose of Suboxone and I feel super.

I had the expectation prior to jumping that I would experience a very low degree of PAWS for 2 1/2 to 3 weeks beginning on day 4. What actually happened was quite different - I felt fine for the first 3 days, then a little under the weather (a bit tired, but no depression, GI issues, sweating, nausea, restless legs, etc.) on days 4 & 5, bouncing right back on day 6 and feeling great since then.

A big thanks to Dr. Junig for creating and maintaining this site. And thanks again to everyone who offered their support... particularly annmarie for being patient enough to listen to me while I relentlessly bent her ear, and DiaryofaQuiter for having been the first to show that the liquid taper method was a viable option. You guys rock!

I'll check back in a few weeks, and try to stop by at least once a month thereafter. If anyone has any questions about my taper, please feel free to send a PM anytime.

Take care, and best of luck to all of you.

Bill


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PostPosted: Thu Apr 29, 2010 10:04 pm 
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It's great to hear that you are doing so well! Obviously it's one hell of an inspiration to many of us out here. Although I am nowhere near ready to stop Bup at this point, I certainly hope that day will arrive at some point. Unfortunately, there are not a lot of people on here that stop Bup and then continue to post and let us know how things are going. I really hope that you will continue to post for us. In fact, if you are able, more than once a month would be greatly appreciated - perhaps once a week? I am very certain that there are many readers that would love to hear how things honestly go for you over the next months and perhaps year or two. The more you can let us know - the better off we all will be for it. Please don't think that coming back to post that "everything is going well" is boring or somehow not useful. It is extremely useful! On the other hand, if things should not go as well as you hope, that will be just as important. In fact, whatever the honest truth is will be greatly appreciated!

I wish you the best of luck as you continue addiction-free. Please don't become a stranger.


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PostPosted: Fri Apr 30, 2010 6:13 pm 
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Thanks DonH!

I am a little amazed myself that it wasn't a hassle to finally jump! Here's an update:

Days 7-10: I felt tired, sneezed a few times during the day, had some chills in my upper arms (but only in the mornings), and did feel a little depression. Nothing like the typical "Impending Doom, Where is my life going?" depression, though. Commercials weren't making me cry like during a regular opiate detox.

Days 11 and 12:
The slight malaise has lifted, and I am not as tired anymore. I sleep through the night without any weird sweating. My appetite has been back for over a week, I am able to eat anything I want, and drink coffee without feeling wired. Every now and then I suddenly think, "Oh, did I take my Sub?" And then I smile...and think about how nice it is to not have that worry anymore. Those thoughts are not cravings, but merely a conditioned response since taking it was such a habit for so long. In fact, I forgot how many days it had been since jumping, and I had to get out the calendar.

So I guess I am moving forward in my life now, and will probably look into some type of after care. Not because I feel like I may relapse, but because I know from past experience that it will greatly increase my chances of staying sober. So I am going to do it anyway. I'll keep posting, too.

Thanks again everyone! For all your support!!
AM


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 Post subject: thank you
PostPosted: Sat May 01, 2010 1:12 am 
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Wow Annemarie your posts are so great thank you so much i feel so much more capable and strong after reading your taper. I have just recently started my taper, have a ways to go at 4mg a day now, but i have been scared to death. i have wanted to taper for a long time and have been so petrified by the horrible withdraws stories that i had convinced myself i should just keep on trucking at 8mg a day. Reading your posts has given me the courage and strength to continue moving forward with my recovery and i know that i can and will be able to successfully taper off suboxone soon. Thank you, thank you, and thank you. Best wishes to you in your continued journey of recovery.


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PostPosted: Sat May 01, 2010 12:10 pm 
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Went from 1.2 to 1 mg last week. I felt pretty bad 2 of the days and had to take an extra 0.1 mg. Instead of going to .08 next week I might go to .09. I might stay at 1 mg, though, because finals are next week. It all depends. So far so good though.


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 Post subject: checking in
PostPosted: Tue May 04, 2010 5:30 pm 
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A couple of people asked if I would post more frequently about my situation, so I'm checking in a little earlier than I had originally planned.

It's been 3 weeks since I took my last dose of Suboxone and everything is going great. My nose has been running these past few days, but I do have allergies and the pollen count in my area is very high. My right shoulder was bothering me a little bit one day last week too, but again, that's to be expected due to all the soft tissue damage that I've sustained throughout the years, as well as the surgeries to correct some of those problems. What I'm really getting at is... these minor issues have nothing at all to do with my jump, and everything to do with living life the way I did prior to abusing opiates. I actually feel much better than I've felt in many years, including the period of time when I 'was' taking the oxycontin as prescibed - probably because of the diet and daily exercise - so, no complaints there. Mentally I seem to be operating at 100% - I haven't experienced any depression or confusion. I've been getting a lot of things done that I had been meaning to do for a long time, but never seemed to find the time or have the energy to tackle. On the rare occasion that I do think back to when I was in active addiction, I always make it a point to remember just how bad things were and how far I've come. No thoughts of using whatsoever - it's obviously not an option, and at the risk of repeating myself, no amount of mental gymnastics will allow me to rationalize that I could somehow be in control of the situation if I 'was' using again.

So that's about it. I'll be sure to check back as frequently as I possibly can.

Take care everyone!


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PostPosted: Tue May 04, 2010 5:58 pm 
Thanks for the update and I'm glad you're doing so well! That's fantastic! I want to put up a big bold post sometimes on the other sites I hear about that are so anti-Sub.......Look here people......it can and has been done.....people can get off bupe without some big crazy horror story! You just have to be committed and patient!


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PostPosted: Wed May 05, 2010 12:38 am 
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I try to stay away from those sites because all they do is get me fired up. It's the same old story over and over - "Suboxone is horrible... the doctor got me hooked... I should have just tapered off my doc... the withdrawals are the worst, blah, blah, blah, blah, blah"! Yeah right, they should have kept on shooting up, stealing for a fix, risking their lives, their relationships and their freedom rather than take a daily maintenance dose of sub. Reading that drivel makes me want to bang my head against a wall until I knock myself out.

Anyway, thank you very much for the kind words. It means a lot to me.


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 Post subject: ??? liquid taper
PostPosted: Sat May 08, 2010 3:00 pm 
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Hi everyone- I am going to try a taper soon. This is the only taper plan I have come across.
If I understand you correctly you started by taking an 8mg tab to get 800mcg. or as you said.8mg.
Why did you no just get the 2mg taps, and cut them in half, then do liquid taper on the 2 mgs when you go down low?
The other thing that really strikes me as bizarre. Why is there no formal dosage schedule provided by the pharmaceutical industry? Has Dr. Junig (who has commented positively on this liquid method) ever asked the company why they do not provide a taper series of tabs? If he has what is their answer? Even with methadone, there is encouragement to taper down and the availablitly to taper to micro doses. Since suboxone is in the same maintenance category why is there no small dose available? I wish Dr. Junig could provide an answer.

Something I recently found out. There are doctors that have access to generic buprenorpine in low doses.
It is not likely that any doctors are gong to prescribe the new generic buprenorphine 2 mgs that are now available because of the problem of IV use. Some doctors though are detoxing using smaller doses of the bup that is available now.
From what I understand the doses are in the mcg range. ie below 1 mg. I am going to a doctor that is one of the first to concentrate on pulling people off of Suboxone.
Needless to say- he is being scared by the company because he is forced to use generic, since Suboxone (but+nor) is only available as low as 2mg.

It may be a ray of hope for those that want off.

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PostPosted: Sat May 08, 2010 3:42 pm 
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Gaulois: I recently addressed this topic on another post. I'm guessing that you didn't happen to run across it. Here is part of what I posted as it may help you to understand more about what goes on "behind the scenes" with offering a medication for sale in the United States.

___________________________________________

I wanted to point out is that there actually are formulations of bup made in less than 2 mg tablets. Unfortunately, they are not available in the United States. In other countries you can obtain 0.5 mg tablets as well as patches. So to make the comment that the manufacturer of Suboxone is deliberately not marketing something other than 8mg and 2mg tablets for any reason other than they are not allowed to, is false. It is the FDA that has not authorized anything other than these two strengths. It is as simple as that. No doubt, a 0.5 mg tablet and potentially patches could be extremely useful to patients in the United States. It does suck that we have to become our own chemist to "cook up" smaller dominations of bup in order to taper. This is a problem. However, the blame is not with the drug companies - it's with the FDA. Now, I guess one could argue that the drug company could petition the FDA for a change. I won't argue that could be done. But I'm very willing to bet if the FDA would allow it, we'd see 0.5 mg Bup available in the United States rather quickly.

___________________________________________

I hope that helps. I also understand that you were not blaming the drug company. My references to that were related to the original poster that I responded to, who somehow seemed to think that the drug companies were refusing to provide taper-friendly doses in order to keep patients "hooked" on bup.


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 Post subject: anamaria! great post
PostPosted: Sat May 08, 2010 4:00 pm 
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Anamarie!!!!- that is a great idea! I had all sorts of ideas as to how to get small doses transfered onto something that can still be placed under you tongue and disolve! I had this crazy idea with tooth paste.
Get this- it is totally stupid next to your filter idea.

Take a 2mg tab, crush it completely and get a uniform powder. Divide it into 10 small piles so that you have 1/10 of a 2mg tab, or .2mg or 200 mcg? Now Im getting confused (I agree w/ Joe the Plumber this is BS to have to do this on your own).
Anyway- take the little pile of 1/10 of 2mg.

Now here is the weird idea. Toothpaste has a fair amount of H20 in it. So blend a bit of tooth past w/the .2mg pile.
then let it dry a bit. Once the tooth past dries it can be sort of molded. You can sort of fabricate your own pill.
Sounds crazy.

Tell me what you all think.

Ana Marie and those that have gotten down to the .1 mg level or 100mg level- is there a ray of hope. Man, I have been- I am not going to go into detail, but I have been extremely hopeless and not wanting to go on this way. That is why I came to this site because I was told there were people who had figured out ways of tapering.

I am at around 3mg. I think I can get down to 2 within a couple of weeks. I do not care how long it takes to taper.
From what I understand, it was not too harsh. The PAWS were not too bad?

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 Post subject: Response Donh
PostPosted: Sat May 08, 2010 4:55 pm 
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To Quote the earlier post:

"I wanted to point out is that there actually are formulations of bup made in less than 2 mg tablets. Unfortunately, they are not available in the United States. In other countries you can obtain 0.5 mg tablets as well as patches. So to make the comment that the manufacturer of Suboxone is deliberately not marketing something other than 8mg and 2mg tablets for any reason other than they are not allowed to, is false. It is the FDA that has not authorized anything other than these two strengths. It is as simple as that. No doubt, a 0.5 mg tablet and potentially patches could be extremely useful to patients in the United States. It does suck that we have to become our own chemist to "cook up" smaller dominations of bup in order to taper. This is a problem. However, the blame is not with the drug companies - it's with the FDA. Now, I guess one could argue that the drug company could petition the FDA for a change. I won't argue that could be done. But I'm very willing to bet if the FDA would allow it, we'd see 0.5 mg Bup available in the United States rather quickly. "

Figured out how to respond.

The Government- if you go and read the FDA and DEA requirements- require naloxone to be added to any formulation for Opiate Dependance Treatment Purposes. This is because Buprenorphine is soluble and easily injected.

Having said that- I remember that one doctor was considering prescribing Subutex for a friend that seemed to have headaches from the naloxone in Suboxone....
So the laws regarding the prescribing of Subutex- they are actually vague because there is a lot of marketing invloved.
Bup has been around forever and is even generic from what I understand. How about that being a slap in the face- those of us not having access to insurance having paid the big bucks for "brand" 2mg suboxone instead of generic subutex. But that is hypothetical.
Do you remember being Induced? I was induced on Subutex 2mg tabs. I started at 6mg. Subutex exists in the US so I have no idea where you got the idea that Buprenorphine by itself is not available in the US. ???? Its called Subutex 2mg.
If it is available in 2mg- it is available in the smaller doses. I have never known of a compound ie the active ingredient of a medicine not being available in smaller doses in the US - JUST because they are smaller doses. (counterintuitive- it would be the larger doses if anything) If you know of any examples where FDA does not allow a lower dose of a med to be available in the US, while allowing the higher dose of the same med... please tell me, because you have really piqued my interest. Perhaps Dr. Junig knows.

Be that as it may, as I said- as an Opiate Dependance Treatment Med- like Methadone- in order for it to be prescribed for this exact purpose it is supposed to be prescribed as the naloxone combined substance/medication: Suboxone.
But now that you mention it- I am going to check out and see if it is actually illegal for a doctor to prescribe the 2mg Subutex instead of Suboxone. I do not think it is come to think of it- the doctors are just hesitant because of the IV risk. I think pregnant women or people with Liver problems are allowed to be on Bup without naloxone because naloxone has its own properties and side effects (even at low doses)and has been shown to cause liver damage. So, I will get back on what the guidlines are.
Now, if it is available, and not required to be prescribed as the Naloxone combined substance- Suboxone- then that would really raise even more red flags. If that is the case... why has this not been told to patients?
Thanks for the info- now I am motivated to see which formulations are available, what the guidelines are with regard to prescribing. Generic availability of Suboxone.

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PostPosted: Sat May 08, 2010 5:22 pm 
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Physicians can and do prescribe generic subutex (without narcan) everyday in the United States. There is no requirement to prescribe Suboxone. It is up to individual physicians. In fact, there have been posts on this site discussing how some docs are willing to prescribe generic subutex and others are not. This has everything to do with being able to inject bup when narcan is not part of the formulation. Trust me on this. There is no law prohibiting docs from prescribing generic bup without narcan in it - NONE.

Now for this comment:

"If it is available in 2mg- it is available in the smaller doses."

Okay, you go and find it (in the United States). Certainly in liquid form a medical provider can inject whatever amount he or she wishes to. However, in tablet form, it is not available in the United States under 2 mg. You can call any pharmacy anywhere in the USA and you will not find it - nor can they order it. The comment "If it is available in 2mg- it is available in the smaller doses." is 100% false - unless you go outside of the USA.

Good luck with that toothpaste idea. I think I’ll stick with the liquid taper method when the time comes for me to drop below 2 mg.


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PostPosted: Sat May 08, 2010 7:32 pm 
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Hey...don't have a lot of time to respond right now (getting ready to go out with that guy i married 6 years ago today....what was I thinking??? :wink: ..kidding...I love him...most of the time). But, I did want to add to what donh said about the generic subutex in the US.

gaulois stated:
"It is not likely that any doctors are gong to prescribe the new generic buprenorphine 2 mgs that are now available because of the problem of IV use."


and

"The Government- if you go and read the FDA and DEA requirements- require naloxone to be added to any formulation for Opiate Dependance Treatment Purposes. This is because Buprenorphine is soluble and easily injected.

Having said that- I remember that one doctor was considering prescribing Subutex for a friend that seemed to have headaches from the naloxone in Suboxone....
So the laws regarding the prescribing of Subutex- they are actually vague because there is a lot of marketing invloved.
Bup has been around forever and is even generic from what I understand. How about that being a slap in the face- those of us not having access to insurance having paid the big bucks for "brand" 2mg suboxone instead of generic subutex. But that is hypothetical. "


I am prescribed 2mg generic Subutex (buprenorphine) and have been for about 2 months....I switched for cost reasons. It has been available for months in the US, although it is up to the doctor to decide when and if to prescribe it (as donh pointed out). So, rest assured, it is legal (at least I hope so.... :) )

Also, I do know that the patent on suboxone ran out in October (the US patent...not the European patent....I think that continues for several more years), and that Reckitt-Benckiser has stated that they will not be develping a generic.

LONDON (Dow Jones)--Reckitt Benckiser PLC (RB.LN) has no plans to launch its own generic Suboxone product when its exclusive rights to the heroin-dependance treatment expire in October, the group's chief executive said Wednesday.

The household cleaning and personal care products maker has exclusivity for Suboxone in the U.S. until the end of September and in Europe until 2016.

Analysts have speculated that Reckitt could be planning to launch its own generic product in the U.S. to offset the impact of the loss.

"I normally wouldn't comment on this but no we're not," said CEO Bart Becht on a conference call with reporters.

He said the company was looking for other ways to offset the loss of exclusivity in the U.S. Up to 80% of the revenues and profits of the company's pharmaceuticals division might be lost to generic competition in 2010, with the possibility of further erosion thereafter, he said.

He added that the pharmaceutical business was a relatively small part of the business.

Suboxone posted net revenue of GBP219 million in the six months to June 30 and adjusted operating profit of GBP132 million.

Suboxone is a prescription drug used to treat heroin dependence.

-By Michael Carolan, Dow Jones Newswires; 44-20-7842-9278; michael.carolan@dowjones.com


I don't know if this is still true or if another company has bought the rights to develop the generic at this time. I have also heard (and I think it was somewhere on the forum somewhere....can't remember where) that there is a company trying to make the generic formula, but that they are having problems with the combination of nalaxone and bupe...they can't get it close enough to the brand name drug so that the FDA will approve it. Again, that is not a quote, just something I read somewhere.

I do think, in general, that drug companies are lying, cheating, greedy bastards (personal commentary) that are not above f...ing over people to turn a profit. Having said that.....I really think that this is an instance where it is just a matter of time before generic Suboxone and varying doses are approved. Honestly, there is a giant profit for whatever drug company can develop the generic Suboxone first, so I would think they are working hard on it as we speak. It may be a long time though....the FDA is not exactly known for its speed.

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PostPosted: Sat May 08, 2010 7:50 pm 
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Donh- Yes, that is what I thought!!! And you are right- smaller formulations aside from injectable are not available in the US. But sure enought bupe can be prescribed!!

As (I forgot her name) said- there are some docs going out on a limb. Why is it not more common for patients that have shown that they are serious in recovery, get piss tested etc?

Otherwise

Instead of reducing my suspicion, this has radically increased it. Below at the end of the Post- you will find a Bupe prescription from overseas. One of the many pill formulations of .2mg (200mcg) Bupe available in Europe, and ...the rest of the world etc. This is crazy!

So- having gotten involved in a discussion on the matter- As most of you know, my experience w/ Sub has not been all that good. At this point I have almost lost hope. However Anamarie and Schoedinger "Is the cat dead or alive" (what are the matrix mechanic probabilites involved w/bupe abstinance?) They have given me hope with their creative taper methods.
Not to mention- I have never seen someone refer to Schroedinger's Cat paradox- on a drug site no less... but how appropriate when you think of it. That really is great. I should have called myself De Broglie instead of Gaulois.

I also have a lot more hope because in getting in this discussion, and researching on the net... I discovered of the existance of low dose bupe availablitly on the Internet. Not even that expensive. At this point do you think I care about getting busted? Be a bit ludicrous with a bottle of 8s in my hand and being taken down clutching a box of .2s.. by the Postal Police.

The degree of hopelessness- my lack of zest for anything in life, my feeling of absolute hoplessness because I know I cannot deal with another Jump from 1 or 2mg of Sub... just cannot even think about going through that and failing again.
And having to take this med the rest of my life and live in this state of - no feelings.. none really.
That is why I asked about these tapering methods

Low Dose Bupe - there is no excuse as to why the company should not have included a spectrum formulations combined with naloxone, including a tapering schedule series of formulations. Believe me the FDA and DEA would have said- "you want to market 2 other lower doses- no problem". I WORKED WITH THEM! Do you think that they would have said "uh...no lower doses of suboxone are dangerous". No BS- It was not in the interest of the company. Be Logical.


RE: "[i][b]If it is available in 2mg- it is available in smaller doses"[/b]

Don- I did not make myself very clear, I was being a bit facetious. It is a bit Axxxhoxxxish on my behalf.
I know that low dose bupe is not available- I already knew that- what I meant is that there is no other instances that I know of where a company is told that a lower formulation would be prohibited. ie prohibiting a country from marketing smaller doses, while it is ok with higher doses (controlled substances). And that is the whole point of this- Rickettes had no intention of marketing lower doses. Why would they want to pay to send a work force to undertake a huge marketing project for lower doses of a med in order to wean people off of their block buster patent med and reduce the amount of sales? Imagine the company sending out a new wave of reps to the same old Suboxone Docs, informing them that we have the lower doses available for people that want to wean off-because it turns out that coming off of suboxone (long term use) at 2mgs is psychologically hard (cruel) on the patient.. " we need you to petition the Government on behalf of patients rights". Maybe someone might be interested in this simple request- provide patients with a taper schedule of doses.
Is that a lot to ask. Otherwise, I do not think I would have found all of the other questionable practices with the company.



So, for some reason people think that the marketing behind Suboxone is anything different from that of other companies and their marketing... .that this company is a philanthropical enterprise, not motivated both by profit.
Ie- coming out with a very good med that will help people, but marketing it in such a way that they are a assured a devoted patient base. Marketing techinique? Not provide and "exit strategy", knowing full well the potency of the substance.

There is no market initiative at this point for petioning for other formulations. It is far more profitable to simply leave things the way they are- increasing the amount of people on sub, not providing those that want to get off with a reasonable taper- and pump it until they loose the Patent. It is the opposite: They have allowed an increase in the number of Sub patients a doctor can have since 2006. There is no push that I know of as to providing a tapering plan for those that want off of this medicine. There is a push to increase clients. Ask me for proof.
Once they loose the Patent on Buprenorphine/Naloxone ie " Suboxone trademark"- you can be sure that the smaller doses will be available. Who knows- maybe they will take advantage of that market, and create some special formulation that requires us, again, to use a "Suboxone" brand name to taper. "Suboxone SR", "Suboxone Patch", Suboxone 100mcg tab"


Just look at the new generic availability- 2,8mg Bupe is available generic. Doctors are being frightened into not prescribing it Does that make sense? You cannot OD on Bupe! Methadone is given to "good behavior" ex addicts in "take homes". That would be like Methadone clinics refusing patients to get "take homes". No difference.

As you said DonH- Drs do prescribe Subutex. I put that out there to prove my point. (I wish Dr. Junig would clairify some of this). Here is a challenge if you think that Drs are not either 1) being intimidated not to prescribe gen bupe or 2) the Marketing is such that...lets say it is in the good Drs best interest to only prescribe brand name Suboxone- even to committed recovering addicts. Why do good behavior ex junkies at Meth clinics get take homes (of a deadly OD substance)- Methadone, and we Suboxone Patients that have shown to be serious are not offered the same as in being able to be prescribed generic Bupe so we can save quite a bit of money.

Its all in the marketing-
Yes the FDA also does its job and causes a lot of pain in the ass for pharm co's as well, but there are many cases where the regulations create a marketable situation for a company- and this appears to be a prime case as you have so well illustrated by DonH providing us with all the info on Bupe being available in harmless micro doses in tab form everywhere in the world .....except the US......- which is where Suboxone sales have skyrocketed.
As I said, I own pharmaceutical stocks. Yes, they help and provide life saving services. Brokerage firms also can help investors make the right choice, but they can also indulge in less than ethical practices...(Goldman Sachs).

There is not doubt that in many circumstances Suboxone is a good medicine. Life Saving. Yes even those that criticize it do not hesitate to say that it is a miracle drug when detoxing Heroin/OC/ SAOpiate addicts. (a 4-5 day Sub Taper) It is, arguably, a better alternative to Methadone Maintenance.
But look carefully at these facts: Do not fool yourself
1. It is an Opiate (even if it is partial agonist)- a powerful opiate
2. It is an Opiate Maintenance Med just like Methadone. Your CNS is flooded with large quantities of agonist and partial antagonist opiate. Your brain only knows the difference in the effect (no high, ceiling effect), otherwise your opiate receptors are being lit up just like you are taking a potent opiate for however long you are on it. In some cases that is a better alternative than dying on the street. In others, the thought of a powerful drug circulating through their system for the rest of their lives is a bit disconcerting to say the least.
3. Your body gets all the undesirable effects that it would from any opiate- Gastrointestinal, Libido, Hormonal Changes, numbing of feelings, in older men difficulties with urination.
4. The marketing has been done in such a way that prescribing has not been properly supervised ex. Getting my Suboxone from a pediatrician that took an 8hr class? A Pediatrician? I smell a fish as far as unethical marketing to any doctor that wants to enter into the "addiction treatment" scene- even though they are a pediatrician.. WTF? Do you know what another dried up burned out 70+ year old Psychiatrist told me as she was strutting around in a leather skirt and fishnet stockings and creepy masquera? "Hey I dont make as much as I used to but it beats working with Crazy People". Yes, she was being straight forward.
5. Lastly- there is not way to taper without reverting to classroom chemistry. Or, if you are lucky like me- being able to spend about 3 months in France and going from .2mg pills cut in halves then quarters to putting on transdermal pathces, whatever seems the best detox method. IT IS CRUEL pure and simple that they have not provided an option other than jumping at 2 MG and telling patients that the withdrawal is a protracted miserable - according to Wikepedia "6-12 months of post acute withdrawal" (look under Buprenorphine- wikepedia has a nice review" CRUEL.
So am I angry. Yes. I am frankly.
I am grateful that angie and schroedinger (despite them thinking that I am an axxxxhxxxl) have provided me with a "how to do it guide" and what to expect.
This SITE HAS GIVEN ME HOPE.. So I am not angry at anyone here.



ZONOR- BUPRENORPHINE HYDROCHLORIDE.

Zonor

Brand Names: Zonor, Suboxone, Subutex, Tidigesic
Generic name: Buprenorphine
Manufacturer: Pharmatec
Each Zonor tablet contains: Buprenorphine Hydrochloride USP 0.216 mg, equivalent to Buprenorphine base; 0.200 mg.

How does Zonor/Tidigesic work?
Zonor sublingual tablets contain the active ingredient buprenorphine, which is a type of medicine called an opioid.

Opioids are painkillers such as codeine, morphine and diamorphine (heroin) that work by mimicking the action of naturally occurring pain-reducing chemicals called endorphins. Endorphins are found in the brain and spinal cord and reduce pain by combining with opioid receptors. However, opioids also act in the brain to cause feelings of euphoria and hallucinations. They can be addictive and people taking them long-term can become dependent on them.

Buprenorphine is an opioid that is used to wean people off their addiction to stronger opioids such as morphine, diamorphine (heroin) and methadone. It is prescribed as a substitute for such drugs. By acting on the same opioid receptors as other opioids, buprenorphine prevents the physical withdrawal symptoms that occur when these drugs are stopped. This prevents physical cravings. Over time, the dose of buprenorhpine is gradually reduced until it can be stopped completely.

Buprenorphine is only suitable as an opioid substitute in people who are moderately dependent on other opioids. This is because in addition to stimulating opioid receptors, buprenorphine also blocks them. In people who are dependent on high doses of opioids, this can cause withdrawal symptoms when the buprenorphine is started. For this reason, in people highly addicted to opioids, the daily opioid dose should be reduced gradually before therapy with buprenorphine is started.

For people taking methadone, the methadone dose should be reduced before this medicine is started. However, buprenorphine may still cause symptoms of withdrawal in people dependent upon methadone.

For drug addicts who have not undergone withdrawal, the first dose of this medicine should be taken at least 4 hours after the last use of the opioid, or when the first signs of craving appear. If it is taken earlier than this it can actually cause withdrawal symptoms.

Buprenorphine substitution therapy for opioid addiction must be used in combination with other medical, social and psychological treatment.

The Zonor sublingual tablets should be allowed to dissolve underneath the tongue. This allows the buprenorphine to be absorbed into the bloodstream through the rich supply of blood vessels found in this area. The tablets dissolve in about five to ten minutes. They should not be chewed or swallowed, as this would make them less effective.[b][i]
[/size][/size]

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 Post subject: TAPERING SCHEDULE
PostPosted: Sat May 08, 2010 8:08 pm 
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Having spent a great deal of my day, making a point that we do not seem to have any options, aside from high school chemistry, to create low dose formulatins of bupe, I have a request for the Owner of this Site.

Dr Junig, you seem to be a very genuine person, concerned with the well being of his patients and friends on this site, and I do not say that in any sort of sarcastic way. I understand that your hands are tied.

Since you prescribe Suboxone, and surely have patients that want to get off, can you please share with us the following:

Your Medical Advice as to how to taper beyond the high dose 2 mg tabs. How to prepare low dose suboxone tabs, or doses so that a proper weaning, that would bring the patient (especially older patients such as myself, 51 yrs old) down gradually and comfortably to a reasonable degree (obviously not pain free). Can you propose a Taper based on what the company has provided you with?
I think as a Doctor who has willingly taken the forefront of Suboxone treatment it would be nice to hear what you have to say on the matter.

I am sure that all those that are devoted to living free of suboxone would greatly appreciate the advice of an M.D.

Gaulois.

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 Post subject:
PostPosted: Sat May 08, 2010 9:23 pm 
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Just FYI, Dr. Junig already addressed this issue on his blog, which is where I got the idea to mix a liquid solution to taper. He suggested decreasing your dose by 10% each month (once you get below 1-2 mgs).

It honestly is not difficult to make the liquid solution, I would hardly even consider it high-school-chemistry-level hard. It's just a matter of calculating the proportion of medication to water in order to get the dose you want, and then mixing. You don't have to heat anything or have anything other than water to make up the solution.

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PostPosted: Sun May 09, 2010 7:30 am 
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Thanks Don- could you please direct me to where he did post about this? ie where in this whole blog etc ? I looked but could not find where he directly discusses the issue.
It has nothing to do with being hard or complicated. My background is in Biology and I did quite a bit of Chemistry and and research involving biochemistry. Making solutions is probably the easiest thing to do, as long as you begin with a known quantity of a know substance (what they call standards when calibrating detection machines).

I want the opinion of an MD regarding this or any other tapering method. He seems to know a awful lot about Bupe, and its potency and how this affects a taper. Anyway, if he has talked about it, please if you could give me the link to that post it would be greatly appreciated.

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 Post subject: response Donh
PostPosted: Sun May 09, 2010 8:01 am 
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DonH- Why do you think that this company is any different from any other company? THE FDA HAS NOT BEEN approached on the matter. The company has not asked for approval. The FDA only approves applications! So ask yourself why the company did not bother to do this from the very start????

There is solid evidence that the company did not bring up the issue of it being necessary to allow smaller doses to be available. No, I have told you that I work (used to ) along side FDA and DEA.
Because of the substance being the same molecular substance- there is no problem in the FDA approving a medication of this sort. Until Bupe was used in the high dose form for Opiate Dependency- Bupe was unheard of. There is no market for it because it is one of the painkillers used in Europe that is not as dangerous as things like OxyContin. In Europe the pain killer industry does not exist as it does there. There are many many different types of therapies and drugs that are used before someone is put on a powerful opiate. My friend there had breast cancer. She then had reconstructive Surgery. The powerful meds she was only given in small quantities. The medical community does everything in its power not to have powerful opiates used therefore creating another problem.
What happened is a combination of the Gov.[i] not being asked for approval, and then the Gov being easily influence and not even being made aware that it would be - and I paraphrase you:
"of course it would be great for us to have the smaller doses available and the patches"

I explained to you that my ex wife is a pharmacist in France. Again- I am willing to put myself out and expose myself because I have nothing to lose- if you think I am making this up, I will give you the name of her pharmacy.
The reps deal with pharmacies in Europe in a similar way that reps deal with Drs here. Pharmacists do much more than count pills and tell you "where the dog food section is" at CVS. Pharmacies are pharmacies- the idea that pharmacies sell cigarettes, coca cola, alcohol, dog food, instant soup- ...people are stunned when they here this. There are no boundaries.
Everything is fuzzy.
So when the Rickettes company reps come and follow up on Subutex she has asked why (since she and I are on good terms and I have the girls) not the availability of the low dose painkilling doses in the US.
There answer is that there is no market for it. And they are right- there is no market for low dose bupe here FOR PAINKILLING- if you have 80mg OxyContin....80 mgs of a very addictive oppiate bound up in a resin making it XR, or (Contin as in continuous release).

However- had they wanted to take the time to market the low dose to Sub docs they would have gotten approval from the FDA. It is not as you say- the other way around. ie The FDA is not obstructing them from marketing low dose bupe in the US. They simply have never applied for it under the properly stated prescription guidelines and treatment.
So it is not as simple as you think.

Listen- it is not the purpose of this thread to argue the pros and cons. Although I think that this is a bit strange that it would not be - at least a subject on the site somewhere.

If you would like, I will provide you with solid evidence that the company has no interest in getting the FDA to allow low dose bupe to be sold in the US.
You have to ask yourself why though. Why is low dose codeine allowed? Low dose Morphine? etc?

Aside from all this, I appreciate the input from the others about micro dosing

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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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