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 Post subject: Looking for insight
PostPosted: Mon May 02, 2016 11:08 am 
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Hello all! I'm hoping this is the right place to write this. I'm writing to try and get insight on some things that my long term boyfriend and I are going through with suboxone. He was on percocet for about three years due to a back problem, and went to rehab two years ago. He was put on suboxone, and everything has been pretty good since then! There's of course a lot of questions and mistrust from the years of percocet use. He has been slowly lowering his dose of sub, from 16mg down to 4mg. He was taking 4 mg for quite some time until we broke up over his excessive drinking. Now that I am back in the picture, he has stopped using alcohol to cope, but while I was gone he increased his sub dosage to 8mg. He says he feels like he needs it and can't explain why. Occasionally he will take 1.5 pills (12 mg?) And says it's because he feels like he needs it.

Occasionally, he will only take a half a pill per day (4mg). When he takes the whole pill in a day, he is what I refer to as a "zombie." Not nodding out, but struggling to stay awake and moving very slowly. When he takes 1.5 pills, things are really bad. He shakes very badly all over and nods out and can barely move. He was on subutex foe the first 1.5 years of being on suboxone because when he first took suboxone, he had an allergic reaction: difficulty swallowing, etc. His pain management clinic that was managing his subutex stopped prescribing suboxone, and he's been unable to find another doctor that prescribes the subutex since. However, he hasn't had those allergic reactions since (other than a case of very bad hives which may be unrelated). He was on regular suboxone for a few months and now for the last couple of months he's been on zubsolv because of insurance. He is convinced it is the zubsolv that is making him nod out etc.

So, I'm looking to find out if anyone can help me understand his "need" to take more suboxone than prescribed. My mind is spinning in all sorts of crazy directions. (Is he doing it because he likes feeling like a "zombie"? Is he feeling something out of it?

Also - can anyone weigh in on the zubsolv vs suboxone vs subutex? Is he nodding out/almost nodding out because he's taking too much or could it be the different medication?

Why is it making him shake when he's really out of it when he takes more than 4mg? When he takes 8mg, his hands shake slightly and when he takes 12mg, he pretty much shakes all over.

Any help is greatly appreciated! I want so badly to understand and be there for him through this. Not understanding compounded with the mistrust and questions from the percocet abuse is really hurting our relationship, maybe even ending it.


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 Post subject: Re: Looking for insight
PostPosted: Mon May 02, 2016 2:04 pm 
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The first thing that comes to mind when I hear the words "nod" or "drowsiness" associated with a person taking Buprenorphine, whether it's Suboxone, Zubsolv, or Subutex, is that a central nervous sytem depressant like alchohol or bennzodiazepines is involved. If you're prettty sure it's not alchohol, then there's a good chance it's a benzo, or a benzo-like drug. Doctors office urine screens are only dependable if they are directly observed, and so it is relatively easy to manipulate the results. Plus, benzo-like drugs such as Sonata, Lunesta, Ambien, etc., or even barbiturate-like Soma(Carisoprodol) might not even show up. Your state might have a scheduled medication(controlled substances) database his Dr can check, but of course drugs acquired on the street or from friends aren't covered there. More benign things like Neurontin(Gabapentin) can cause drowsiness too but usually not the nodding behavior reminiscent of the using days I think you're talking about. I've been at 4mg/day Suboxone for 16 months, and sometimes I feel as though I need a higher dose. I've tried a few times taking an additional 1-2mgs, but it never made me feel tired.
Symptoms like jumpiness, anxiety, even headache I associate with higher doses of Buprenorphine- like 8mgs and up. Just after my induction, I was forced to take a minimum of 8mgs so I would have a higher blocking level in case I relapsed. I definitely felt jumpy and a little anxious, and was glad when I could drop it down to 4mgs a week later- felt much better.
To the best of my knowledge, there's little or no difference between the different Buprenorphine products potency levels, regardless of if they're with or without the Naloxone. Other members may have better information about that however. There's just so much complexity to this disease, I hope you are able to figure this out to help your friend, and keep your own recovery and happiness where you need them, good luck! Mike


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 Post subject: Re: Looking for insight
PostPosted: Mon May 02, 2016 10:28 pm 
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My thought after reading your post is that something is not right. People who take 4-16 mg of buprenorphine each day do not 'nod' from the drug, whether it is plain buprenorphine, zubsolv, or Suboxone film. Tolerance removes almost all of the sedation. To answer your question, they are all equivalent; buprenorphine is the active drug in Suboxone, Zubsolv, and generic formulations, and they all work the exact same way. And because of the ceiling effect, the effects of 4 mg are the same as the effects from 16 mg.... unless he is taking it wrong, e.g. swallowing it instead of putting it under his tongue.

I strongly suspect another substance is involved, most likely clonazepam by the sound of it. Clonazepam (brand name Klonopin) doesn't always show up in point-of-care drug tests.... but my strong recommendation is that before you waste any more time, you go to a lab that does hair follicle testing and invest a couple hundred bucks. Understand that it is EASY to buy fake urine and fake a urine test... and you have a write, and maybe an obligation, to make certain you are hearing the truth.

Any person who is in recovery would understand a partner's concern. Many times, I've suggested to patients that we get the test just to rule out any questions... and he should be willing to do that FOR YOU.

Because if you are hearing a bunch of BS, do you really want to waste more time?


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 Post subject: Re: Looking for insight
PostPosted: Tue May 03, 2016 4:18 pm 
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Like suboxdoc, I too think there's some other medication involved. Sub doesn't make u nod out or shake. It doesn't matter if it's zubsolve or subutex or suboxone, doesn't matter. The nodding out could be from another drug he's possibly abusing. Could the shaking be from him stopping the drinking? Every person I went to rehab with that was coming off alcohol, they shook horribly bad and broke out in a red looking rash all over. If he abused alcohol enough, he could definitely experience withdrawal symptoms from that.

That's just my opinion and like suboxdoc, I'd request a drug test. Go buy one from Wal-Mart if u have to and watch him take it. Addicts can fool the one's they love pretty easily sometimes. We know how to manipulate and lie when we're using. Good luck!

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 Post subject: Re: Looking for insight
PostPosted: Tue May 03, 2016 7:52 pm 
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Thank you all for your replies! I've considered that could be going on, but I really don't think it is. I hope I'm not just being naive, however I realize that is a very real possibility. :(

Do you guys have any idea how to describe the feeling of needing to take more subs?


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 Post subject: Re: Looking for insight
PostPosted: Tue May 03, 2016 8:17 pm 
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jsi wrote:
Thank you all for your replies! I've considered that could be going on, but I really don't think it is. I hope I'm not just being naive, however I realize that is a very real possibility. :(

Do you guys have any idea how to describe the feeling of needing to take more subs?


Let me see if I can answer that in a helpful way. But I agree with the doctor and others who suspect that something is hinky. Nobody shakes from sub. So he's either being fake about the shaking, he's having episodes of hypoglycemia or sub withdrawal (which takes several days of no sub to happen), or he's lying to you. Like others have said. Addicts are supremely good liars!

So, if I were feeling the need to take more sub it would be from one of two needs. I would need it physically, or I would need it mentally. If I needed it physically I would be starting to suffer withdrawals, which include body aches, periods of chills, nausea, vomiting, diarrhea, sneezing, runny nose. About a half hour after I take the sub I would feel much better. Also, you should know that if he takes any opiates he's not supposed to and then takes sub he would go into precipitated withdrawals which would look like the symptoms I just described but he would be violently sick and include shaking.

If I need sub mentally I would not be showing any physical symptoms of withdrawal, but I would probably be agitated and maybe anxious.

I hope this helps.

Amy

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