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 Post subject: A little about Mr Purple
PostPosted: Sat Jul 07, 2012 4:19 am 
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Hi there:

Been reading a bit. Now it's time to reach out.

I'll start by introducing my pain "problem". I started taking pain pills after a terrible car accident 16 years ago. For several years I use Percs, then several years off. Four years ago, my back went and my Dr put me on Vicodan, 2x a day, then Narco (10/325) 2x a day. Then came 3 knee surgeries and a major shoulder surgery. I ended up on Oral Morphine and Diladad. With my Dr's help we weened me back to Oxy 6x 15mg x2 x20 Oxycontin. My Orthopod then sent me to a pain specialist. We're down to 3x 15mg oxy and 3x20 oxycontin. Monday we are going to set up a tapering schedule and i it goes well, great, if not, I go the Suboxone route. The biggest problem I have is that I still have lots of pain. Even so, I feel clear that the pills are 99% due to addiction, hence, I want to go to 0, then figure out other ways to deal with the pain.

On the personal side, I have a family, an amazing 4 year old, am ceo of a small start up and love to ski, bike, run (before he knee surgeries).

I'd love to hear about tapering strategies for Oxy and, separately, experiences switching to Suboxone. How hard is the first day? How hard is it to taper Suboxone once on it? How do they treat me if i have significant, but short term [days, up to a week] pain (say from my upcoming shoulder surgery) and am on Suboxone?

Thanks!

Mr Purple


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 Post subject: Oxy Taper
PostPosted: Sat Jul 07, 2012 1:22 pm 
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Hi Mr. Purple,

A general rule of thumb for an oxy taper is to reduce 25% every 4-5 days. It is important to remember this is a percentage decrease and not a mg decrease. Therefore it will be much slower towards the end, as 25% of 1 mg is a much smaller decrease than 25% of 100 mg. Another general rule is to make sure you are stable before doing another decrease, and try not to go back up. For example, if you need to stay at 15 mg for two weeks, so be it; but it is better than going back up to 25 mg. Your body will tell you if you are reducing too quickly.

I wish I could give you first hand experiences, but my oxy tapers were always unsuccessful. My personal taper theory was always "I can start tomorrow", and "now I don't have enough to taper, might as well have a big going away party". :o

Regarding the switch to suboxone, it is important that you be in at least mild withdrawal before starting it. I would recommend being in moderate - moderate severe withdrawal. You can use the COWS scale (google it) to measure your withdrawal. Taking an 8 mg sub an hour after your last oxy dose is a BIG mistake. The absolute last thing you want is precipitated withdrawal, which for me was normal withdrawal x 100. That first sub on day one should make you feel better, not worse. If it makes you feel worse, you have started it too soon. That's why most doctors will start you at 2 mg, wait a couple hours, and if all is OK will give you another 2 mg, and so on.

Sounds like you have never been on maintenance. My layman advice is only go the sub route as a last resort. If you can taper the oxy and get clean, do it. It won't be easy, but nothing worth doing ever is.

Read as much as you can about suboxone. You owe yourself that much, so you know what you're getting yourself into.

Good luck
J


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PostPosted: Sat Jul 07, 2012 4:13 pm 
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Just reading your whole situation I think methadone would be a better option. You'll get better pain control and for what u mention your life will be much easier say you have a upcoming operation. Suboxone and surgery don't go well together, first you have to taper which equals feeling like shit, than u have the operation and will get very little pain relief. BC the suboxonewill still block the pain meds let alone getting a understanding DR who won't judge you and understand you need much stronger and larger pain meds/doses to try and get even a lil relief.


Your other question getting off suboxone is harder than getting off your DOC in my opinion because of the longer half life. As of getting off oxy its not as bad as u think. I am also a pain management patient I was on 240mg and 600mcg of fentora for years. Just following the planned taper you and your Dr set up works best but def keep your Dr in the loop of what's going on becausehe could give u comfort meds if things get to hard.

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 Post subject:
PostPosted: Sat Jul 07, 2012 5:11 pm 
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The only advice as a newbie i might add is please follow jimmy's instructions to the letter about being in moderate withdrawl when you go to the Dr for the induction. I did not follow that advice and went in fairly high. I didnt want to "waste" the bit of my DOC. wow BIG mistake. If you decide to go the suboxone route, as i did please learn from my mistake. After day one, its been much easier than i had ever imagined. Best Wishes Mr. Purple!


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 Post subject:
PostPosted: Sat Jul 07, 2012 5:27 pm 
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First of all, THANK YOU! I can tell you just getting a few notes today makes me fell quite a bit better. I think the plan is going to be take the rest of July and part of August to get stable, find a good local support group and get a few meetings set up with my old therapist. Then try to taper in Sep-Oct-Nov. If I succeed, excellent, if I fail then go the Suboxone.

I'm going to need lots of support. I will definitely post the plan on Monday.


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 Post subject:
PostPosted: Mon Jul 09, 2012 4:35 pm 
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Hi there:

Just back from the Dr. We're going to start to tapper. We're dropping only 5% to get started. In two weeks, we drop another 10% and see how we are doing. Doc's goal is to taper me off in 4 months.

FYI, for Suboxone, he would want to be take my last dose on a Sat am, then start the Suboxone on Monday am. So a 48 hour cold turkey. That seems long (and miserable and plain hard) compared to what folks here are saying. Can anyone comment on that?

Best,
Mr Purple


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PostPosted: Tue Jul 10, 2012 8:31 am 
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48 hours is an extremely long time to be in withdrawals before a suboxone induction. If one goes from a short-acting full opioid agonist to suboxone (a partial opioid agonist), they need to be in mild-to-moderate withdrawals. Here's the COWS chart to help you figure out when you're in the right amount of withdrawals: http://www.naabt.org/documents/cows_ind ... _sheet.pdf

The best way to ascertain when you're in the right amount of withdrawals is not to go by the AMOUNT of time in w/d, but to go by HOW BAD your w/d are. Usually people can induce after about 12-24 hours (again, if they are going from a short-acting opiate).

48 hours sure seems like a lot of useless suffering to me. If you're inducing on a Monday morning, I'd say (but I'm no doctor!), that you could take your last dose more like Saturday night. But again, I'm no doctor and your doctor knows what you've been taking and how much, etc etc etc. I DON'T. I'm just giving you generalizations.

And believe me, it is better to wait longer than to take a chance and go into precipitated withdrawals. Those are said to be about a thousand times worse than regular withdrawals!

I hope this helps. Oh and welcome!

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 Post subject:
PostPosted: Wed Jul 11, 2012 6:08 am 
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My sub doctor had me do a 48 hour withdrawal from percocet before starting sub as well. With the clonidine, the anti-nausea drug, and xanax as comfort meds, it really wasn't that bad. I didn't even have trouble with intestinal issues. 48 hours may, indeed, be excessively long, as Hat says, but I was pretty satisfied with the results. The misery of that withdrawal is a good reminder for me of what not to let happen. Also, the way I felt the morning of the induction, compared to what I felt after dosing with the sub was night and day. I went from relative misery to feeling completely normal and great. Maybe there was a psychological benefit to doing it that way.

As far as tapering off sub, I am currently tapering and I've had very few problems doing it so far. I've gone from taking 16 mg per day to 6 mg/day. That being said, I recognize that the hardest part of the taper is still ahead of me. If you have the will power to taper oxy then I don't see you having real trouble with tapering off sub.

Good luck!

Amy

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PostPosted: Wed Jul 11, 2012 6:12 am 
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So I double posted and I can't figure out how to just delete this message. If someone wants to let me know how to delete this post, that would be great!

Amy

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