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PostPosted: Sat Mar 10, 2018 8:34 am 
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OK. New here,
I've been up all night worrying AGAIN about detoxing again from Suboxone. I have countless nights, just like these where, I cannot stop worrying about it!! It's getting to the point where I'm making poor judgment calls because of it.

So, I'll try to make this as short as possible. I am currently on Suboxone 12 milligrams a day, which i think is too high for me. My anxiety has has gotten worse on on suboxone. It got worse the first time too I was on it too, but this time, it feels worse than before! I think its too high of a dose for me. However, my doctor wants me to be on 16 milligrams, so for the past 6 months, I find myself going up on my dose, instead of down. I should have listened to my gut and kept the dose way lower. The anxiety is one of the things that is making me want to quit suboxone treatment this time around. There are quite a few reasons I have to quit, but also, some reasons that may be worth staying on it a bit longer? Anyhow, before I get into my own little pro's and cons list, is I was on Suboxone from 2008 to to to 2012. At that point in my life, I have no other choice, other than die. I'll never forget how happy and grateful I was to have found Suboxone! Just the sheer joy that I didn't have to use again, and I also didn't have to die. My opiate addiction was so bad that if there is no possible way I could stay clean without it. So I suppose the side effects of the Sub, paled in comparison to the benefit. This time, I've actually managed to stay clean off everything for the last 3 years, with not touching opiates since my suboxone detox, which was over 5 years ago. That suboxone detox scared the living daylights outta me! In fact, i will say it one of the the best and worst experience in life that I am glad I went through it. It was esseintial to me growing as a person. I realized so much during that detox, however, it is is one of those experiences that you only need to go through once, and I am petrified of going through it again. If it weren't for the depression and anxiety, I wouldn't be afraid at all. I have always suffered bouts of depression, that totally went away throughout the four year period when I was on it. When it came back, I was shocked.I don't know why, as I had been deallng with it for so long.I should have known it was coming. Any how, I know that the fear of withdrawal is no reason to stay on a a medication, but I'm afraid that I will end up doing just that. Being too afraid to withdraw, and staying on it for longer than I really need to be.

I'm thinking now, even though I dread my depression coming back, would be a good time to to taper, or possibly just go off of it. I'm thinking now because if I stay on it for say, a year or more, but going to be too afraid to quit, and could get taken off it for reasons beyond my control. I've thought about it a lot, and if it was tough for me to come off it after 4 years, at at 16 milligrams, I should think after 6 months, 12 milligrams, it will hit me hard, but not as bad, right? I'm more concerned with the following months off Suboxone, not the first 3 to 4 weeks, which I know will be misrable. Maybe someone can can shed some light? Also, I have been thinking of just stopping all together when at least I have some preparation time. i'm terrified of coming off and not having anything for the anxiety.


If this were years ago when I first started Sub, I wouldn't care so much I had a great doctor, who also took my insurance. I recieved excellent care, which s a a lot more than what I have now with my new Suboxone doctor. I moved to another state about 7 years ago now, the first 2, of which I was on Sub. I called Suboxone doctors shortly after moving here, only to to find that there was no way I could afford them at that time. The lowest cost was 375. (Which happens to be my doctor now.) and that's only the doctor's visit, not including the cost of the prescription..
I was shocked to see doctors being able to do this, and well, surprised that many are so shameless to actually do it! The average cost of a suboxone doctor around here is 450, and you have to to jump through hoops to get it. I get it to a point, I really do. Bupe is strictly controlled around here, which while i understand, it's really making me want to go off it, for fear that one day I won't be able to jump through one of these hoops, and I will get taken off it.


For instance, I failed a drug screen, a few months back. It was horrible. I told my doctor the truth, and I really hadn't taken anything, and it was a a false positive. He sent it back to the lab, but only gave me a weeks worth of meds, and told me the results should be back in a week, and if I was telling the truth, I could get the other 3 weeks worth of meds if I hadn't been in fact, using benzos. However, if I had been using, I was not going to be be getting my Suboxone from him any longer, without first going to an inpatient rehab.That whole week, I was out of my mind with worry!!! I thought about every scenario there is, and then some, to think of how there are benzos in my system, and I was telling the truth! Says every addict, right? Turns out, it was a a false positive and the lab showed there was Bupe only in my system. I was so relieved I cried! But that week , I was such a wreck, and it made me think. It's a horrible feeling that someone has access to your greatest recovery tool, the one thing in life that without out it either certainly be dead, or wish I were dead.. It's just too much power. Too much power in something that could mean the difference if I can go to work the next day, something that could actually make or break me.. That's just too much power to give to a pill or, a strip. Especially, when it is so expensive, not knowing how I'm gonna get my next scripts or not, not knowing if my insurance will cover it for very much longer...
So here I am well over 5 years ago, to the place of hell that is opiate dependence. I've done it to myself. But I can't seem to crawl out of this one alone. I need some help, and my doctor is not helping me, I'm 100 percent sure of this. I am also growing resentful of him so adament to up my dose, when it's killing my anxiety ! Somehow, I need to to work this out. But staying up all night, worrying about all of this is not making things better. I am destroyed by worry these days, and I'm afraid to let it out, because my fear is that I'm going crazy, literally. For once my depression is gone, and I'm thankful for that, however, this constant worrying has to stop somehow..


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PostPosted: Sun Mar 11, 2018 12:47 am 
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First. Welcome to our forum!

Please try to read as many tapering posts in this section to see how to properly do it w/o too much discomfort. A great many members tapered down very slowly and had very little withdrawal issues when they finally stopped. There is no reason you can't be one of them

The addicts mind is our own worst enemy. You say you are terrified of withdrawal but our heads tend to over emphasize just how bad it is. It isn't all that hard to do. IMO, 90% of your fear is in your addict thinking. Once you face that you should be able to successfully get off it. But then, you may function better on a very low dose and not have those side effects you mention. I went from 24 mgs down to 1 mg per day today. All within a year. Now even my low dose feels too strong sometimes. Give it a try before quitting cold turkey. You do that and you WILL have some bad withdrawals. But still not as bad as full agonist opiates.

Again, read through some of our past posts and you'll see for yourself. Those who had trouble didn't taper correctly. Be the other one and taper nice and easy.

Sorry you can't find a better more reasonable doctor. We on the west coast seem to not have too much of that problem. A lot of ours take insurance. And even if I didn't have insurance, my doctor would only charge me $120 for the office visit. No therapy meetings. This forum counts as my recovery. Do some more searching and maybe you can find a better one.

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PostPosted: Sun Mar 11, 2018 10:31 am 
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I totally get the worry. If u look at it like this medicine can be ripped from u at any time...... that is terrifying to someone who worries a lot (I worry too). I try to not go into all the things that can go wrong because if I do that then I'll become a basket case. I'd worry about my head falling off it wasn't attached! But I have to try to avoid the negative thoughts or the what ifs, I know that's hard to do but it can be done if u just try to train urself to immediately switch ur thoughts to something else. I'm sure that's not what a doctor would tell ya to do lol but it's what I do, because I can really worry my butt off sometimes over things I can't control.

I know it's still scary to have such a huge tool like buprenorphine in someone else's hands but that's just how it has to be. There's things we can't control but I try to just not think about it unless it happens. Of course things can happen but if it's going to happen then it's going to happen. I always try to think that if this or that happens I'll do A B or C. I find it easier to let go of negative thoughts if I have a plan. That sounds silly right? It works for me though.

If ur doctor insists on upping ur dose then just find a dose that u feel comfortable on and stockpile the rest. Lower doses seem to work better for ppl sometimes anyway. If u want to taper then just take it slow and steady. I've learned (as far as myself) that having some type of plan will help ease the worry and anxiety.

Sorry if this post is all over the place, I have 2 bunnies running around me right now chewing on my shoelaces! It's very annoying and they are wanting kale :)

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PostPosted: Sun Mar 11, 2018 1:44 pm 
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Wow, Riley! There is a lot to your story and I really feel for you. I've read both of your posts and very much want you to feel welcome here and like you have a support system at this site. Obviously that's not going to happen right away, but I hope it's possible.

I don't know what to respond to first, because I want to ease your anxiety for sure. First off, I don't know how you detoxed the first time, but there are definitely ways to minimize withdrawal symptoms and even withdrawal. When it comes to tapering, we are just about experts because of how often it is discussed around here. We advocate a slow and steady taper to at least .5mg to .01625, stabilizing at each new lowered dose. There are people who have reported that they experience very little in the way of withdrawal by tapering with patience. I also don't know if you were given any medications to help you with the detox, but we have some that we definitely recommend.

From what I've heard, Tennessee is a difficult place to be an opioid addict. The suboxone doctors are super expensive and only take cash, apparently. You don't feel that you can trust your doctor or the counselor of your group therapy, both of whom seem against stockpiling your medication. We actually recommend doing just that and my suboxone doctor thinks it's a good idea to have a cushion. It just makes sense. I'm not a doomsday prepper by any means, but I think it's a good idea to keep stock of certain things.

I hate the fact that your doctor is insisting that you are on a certain amount of suboxone. And that he is such a hardass that he had you so worked up when he sent your UA results to the lab. It sounds like you've done some exhaustive searches for a new doctor. All I can say is, keep trying! Maybe see if you can find a psychiatrist who prescribes suboxone. Psychiatrists tend to be more understanding, I think.

Right now you're dealing with anxiety, exacerbated by your crappy doctor. What I would like you to do is slow it down. I would like you to think about where you are in your recovery. Because suboxone doesn't "cure" addiction. It puts your addiction in remission so you can work on turning your life around. How is your recovery? Are you seeing an addiction therapist who can help you understand why you are vulnerable to addiction in the first place? Have you been working on your triggers? Have you left all the people in your life who you used with? Are you strengthening your relationships with the people who matter and who you may have hurt during active addiction?

I always suggest SMART Recovery as a support group. They have no opinion on using a medication to combat addiction, and they use cognitive behavioral techniques to help addicts maintain some control on their behavior. There are online groups if you can't find one that meets locally. Here is their address:

https://www.smartrecovery.org/local/

Just put in your zipcode to find a meeting, hopefully close by.

The point is, that you shouldn't just look at the difficulties you are having with suboxone because of your doctor. You need to be honest about where you are in your recovery. It has to take priority over thinking about tapering because you don't want to be back where you started. Since you've already been through one stint on suboxone and was off of it for a while, you know better than most where you stand.

About your dosage of suboxone. I would also be very upset at my doctor insisting that he knows better than I do about the right dosage for me. My doctor has always let me lead the process, with some guidance from him. He respects the expertise I've gained from talking to so many other users of suboxone. I wish yours from the same. While I don't think it's responsible for me to suggest that you go against your doctor's wishes I can speak about it in hypotheticals. Hypothetically, if I were in your situation, I might consider tapering down to 8mg and seeing how that works for me. If it lowered my anxiety, I might stay at that level. If I was to have to give a UA when I went in for my appointment, I would take 16mg the day before, just to ensure that I have plenty in my bloodstream. I would also consider asking for an anti-anxiety med like prozac to be prescribed to me. Hypothetically.

If you are determined to go forward with tapering off suboxone, please go very very slowly. Also consider asking for an anti-depression medication to combat the depression you tend to feel during detox.

We will support you in whatever you decide to do. I hate that you're feeling so upset and anxious.

Amy

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PostPosted: Sun Mar 11, 2018 2:00 pm 
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https://janaburson.wordpress.com/2018/0 ... escribing/

Dr. Burson's follow-up blog details the response of one of the guidelines contributors. Apparently it was going to be much worse!
The way my office is currently configured I would close under these guidelines. I think Tennessee is going to be hit hard with a some closings of Buprenorphine doctors. Anyone in Tennessee should be seriously planning for the contingency of being forced off their medication or into a federal clinic.


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PostPosted: Sun Mar 11, 2018 2:41 pm 
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Completely disheartening docm2.

Amy

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PostPosted: Sun Mar 11, 2018 3:18 pm 
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Yes it is. Fortunately I live in a more progressive, enlightened state. That kind of discussion isn't happening here, actually the opposite, how can we get more providers on board. Letting NPs and PAs prescribe has helped here as well.


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PostPosted: Sun Mar 11, 2018 7:16 pm 
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This is almost exactly what was done in the methadone clinic (methadone being the most highly regulated drug in the country). But we didn’t require monthly pregnancy tests, which sounds completely over the top. We also did not require weekly office visits for new patients, but the patients did see a nurse every day for dosing. The trauma assessment was just part of the overall mental health assessment.
It all sounds way too stringent. I would neither want to be a patient nor an employee in a clinic like that. Can you imagine being a case manager having dozens of patients? Also, for someone without insurance it would be impossible to pay for all those labs, etc. It sounds like Tennessee is intentionally discouraging people from Suboxone treatment (big surprise *sarcasm*).

Also, just out of curiosity I looked up SMART recovery and there are only 4 meetings in the entire state- 2 of which are in Nashville.

Riley, I, personally, would do what others have implied. We obviously cannot give medical advice, but “I” would continue filling the 16mg prescriptions and then taper down to a dose that was comfortable for me. Many people I have spoken with over the years have done very well on 8mg or even less (myself included). I would safely store the extra medication, which would alleviate the anxiety of suddenly being cut off (which I totally understand). I, too, dread withdrawals after having gone off Suboxone before, even though I am on a low dose. But on the other hand, I know I can do it, and come out ok in the end. So, if the Suboxone is helping you, fear shouldn’t force you off of it.

I hope you feel better and that you can possibly pursue therapy and/or medication to treat your anxiety. Feel free to continue posting here for support.


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PostPosted: Mon Mar 12, 2018 12:02 pm 
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Yes, unfortunately SMART Recovery meetings are few and far between in some states. But they also hold online meetings, which anyone can attend.

There is also a workbook you can order for $10. I have a copy of it as well as information on how to lead a SMART Recovery group. It looks like a very worthwhile workbook. I would view it as a great investment!

Here is a link to purchasing the workbook:

https://www.smartrecovery.org/shop/prod ... d-edition/

If I can help in any way, Riley, please let me know!

Amy

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PostPosted: Tue Mar 13, 2018 11:56 am 
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Amy, thanks for your continued promotion of SMART Recovery. I have been attending for 2 years and it is very helpful. The workbook is well done. I have a half dozen and loan them out to anyone with even a little interest.
I haven't used online meetings but have spoken with a couple of folks who have and they have found them as good as live (better, if you have social anxiety or panic disorder).
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PostPosted: Tue Mar 13, 2018 12:41 pm 
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Thanks, docm2. I have been trying to find and look up scientific data to support SMART Recovery, but so far not many studies have been published and no long term studies. However, I am heartened by the positive results so far.

12 step based meetings are everywhere, but not because they are scientifically supported, but because for a long time there were no alternatives. I've seen the phrase, "If it works for you, it works!" I think that is true, but sometimes the mental gymnastics required to make it work for addicts seem excessive.

What I like about SMART Recovery is that it was created from scientifically proven principles. Cognitive behavioral techniques have been proven as evidence based, and it was upon these techniques that SMART was created. I also appreciate that you don't have to say that you are powerless. The principles of SMART Recovery guide the addict to using their power to affect change.

I'm going to start checking out their online meetings myself.

Amy

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PostPosted: Wed Mar 14, 2018 11:54 am 
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Thankfully my clinic is in Kentucky, so if anything happens in TN maybe KY won't follow in their footsteps. I live on the border so it's nothing for me to go grocery shopping in KY. That's how close. I'm actually just as close to VA. I go buy my cigarettes in VA lol (I know bad habits). So if anything happens, I'm thankful I have more choices. I'm fortunate to live on the border of all three states. But I can tell ya, as far as judgements on buprenorphine go, it's not very positive at all, in all 3 areas. Small towns with small town opinions, and that's sad.

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PostPosted: Wed Mar 14, 2018 11:55 am 
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Wow!
Thanks so much for the replies. I'm so comforted in the fact I'm not alone. I remember coming off 16 milligrams 5 years ago, and while it was a long, drawn out detox I remember at some points thinking that it wasn't as bad as I feared. Most of the symptoms were just greatly annoying. However the anxiety was really bad, and that is what is stuck in my head. Also, I suffer from major depression, like a lot of others do, and it was gone for those 4 years while I was on Suboxone. Of course I was depressed during the detox, but my actual depression came back about 6 months after I came off it and I didn't know how to deal with it. I believe that fear is something that will make me never want to go off it again. to live life without that horrible blackness is such a relief, I can't even put it into words.

However, I think it's a very real possibility that a lot of doctors will eventually close around here. It's think it's highly unethical to make treatment so hard to maintain. I've seen 2 doctors here so far. The first one knew nothing about Suboxone and was so blantantly crooked that I switched doctors after 1 appointment. He prescribed 16 milligrams without even asking me how much I was using and for how long. I should have listened to my gut and not taken that much, but I did and got horribly sick for 3 days. He also told me that Bupe doesn't have withdrawal if you get down to 4 milligrams. (My current doctor also says this) One of my best friends still sees him. He was unemployed for a few months, and could not afford his visit. He had to detox from 16 milligrams, and that doctor wouldn't do a damn thing for him, because he didn't have 400 dollars to see him. He wouldn't even prescribe him Clonidine. It's nothing short of discusting.

And I totally agree about my thinking being 100 percent addict!! I go through periods where I tell myself I will do what it takes to be on it for the rest of my life, to other times where I just want to detox from it right away so I don't have to worry about it anymore. I do wonder where I would be without it at this point through. If I'm being honest, I don't think I could stay clean. I don't think I would live through another relapse. More than anything, I worry about my mental state. I honestly don't know if I can live with my depression coming back full force if I stop Suboxone. But as for now, I feel like my life is not in my own hands anymore.
I think I'm going to start tapering very slowly, and build some sort of a stock pile. My first time I was on it, I had 2 years worth of Suboxone saved up, and I believe to this day that stock pile saved my life.
I wish I could be honest with my doctor, but I don't think it's in my best interest to do so.

Thank you so much for all of your replies. It really, really helps to know I'm not alone. I'm going to stick around here for sure. Being able to be totally honest about how I feel helps so much. I feel like a huge burden has been lifted.


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PostPosted: Fri Apr 06, 2018 4:22 pm 
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I think these Tennessee guidelines for prescribing bupe are a step in the right direction. If these were implemented in my State I would never have been put on bupe due to Item #1!

Some may be a bit over the top, but it would prevent someone like me from having to deal with the hell that is a low and slow bupe taper. I should have gone to a short term detox for the small amount of pain pills I was taking for pain.

I was inducted on 16 mg's which was way over the top as far as my tolerance. I was given no information at all about the drug. I trusted my doctor to do the right thing. He did not. He didn't even use the COWS sheet to induct me.

IMHO too many people like me are getting put on way too much of this medication in error. These guidelines would help to stop that.

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PostPosted: Sat Apr 07, 2018 3:10 pm 
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I do agree with u Dee. I’ve heard of ppl being put on 16mg for small tolerance and that’s just ridiculous imo. I think everyone is different and ppl should always be treated individually and what fits their needs instead of saying something like..... oh ur unable to stop taking an opiate, here’s 16mg. I totally agree and one would think that it’s just common sense that ppl be treated individually, but there are a few doctors out there that lump everyone wanting to stop opiates the same as the next. It is sad.

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