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PostPosted: Wed Jan 05, 2011 1:01 am 
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For a long time I took just one 8 mg Sub a day. However, I was having some cravings so I increased it to 16 mgs a day. Now, I'm having real cravings again (and I don't believe it's psychological). I have started taking 24 mgs now, which was my induction dose. I know it's not "bad" to need more, but I haven't heard of anyone needing an increasing maintenance dose. I've been on Subs for 1 and 1/2 years. I wonder why this is happening? :?:

J


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PostPosted: Wed Jan 05, 2011 1:12 am 
I couldnt say because of the ceiling effect as to why 24mgs would have any difference over 16mgs but I can understand needing a dosage increase to some extent. I will have my dose increased once I get on the patient assistance program because I have been on a fraction of the dose I need to be on in order to be stable because I cant afford it. Its not unheard of for people to need to increase their dose so I wouldnt be to worried about it. Even with the ceiling its probably just you getting used to your dose over time and its just not doing it for you anymore. But in reality I think there will always be some mental cravings regardless of the dose with suboxone, for me anyway it just doesnt seem to stop all my cravings which is why Ive been debating going on methadone. Sub has its good days and bad days for me, sometimes it seems to work great and others not so much. I think alot of it has to do with the abosrbtion variable, its hard to get the same amount of absorbtion every single time so some days we get less medication than others. Although at 24mgs or even 16mgs that shouldnt realy come into play since even with poor absorbtion you should still be above the ceiling.


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PostPosted: Wed Jan 05, 2011 1:17 am 
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Hello creel and welcome. Because of suboxone's unique ceiling effect, we don't need increasing doses over time to get the same effect. The dose a person takes to address cravings varies among individuals. If your cravings were taken care of at 8 mg, then based on the mechanism of suboxone, dosages higher should have also addressed those cravings.

Recognize that we all have cravings that aren't addressed by suboxone. I see them as "psychological" cravings (unrelated to the saturation level of the opiate receptors) that are based to triggers and coping skills, or lack thereof. These things we can re-learn. I would also look at your life and environment for unusual stress that could be causing the increased cravings.

Regardless of the cause, I hope they abate soon.

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PostPosted: Wed Jan 05, 2011 1:55 am 
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Thank you Owned and Hat! I have to say that although I'm a new member, I have been a long-time reader of posts on this forum. To me, there has to be more to it than a ceiling effect of 4 mg's for all individuals. Perhaps some people need higher doses for full saturation, do to the individul's unique chemisty. Also, if the ceiling effect is maxed out at 4 mgs, then people should need no more than that dose for induction. Please tell me what I'm missing in this logic? If I'm wrong, then I'll accept that. :wink:

Ever yours,
J :)


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PostPosted: Wed Jan 05, 2011 7:12 am 
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It took me a while to really understand the ceiling concept for suboxone. Hopefully this will help:

The ceiling is generally accepted to be at or around 4 mg. At this dose, it saturates the receptors. BUT - and this is key when it comes to cravings - the opiate receptors/blood level doesn't stay saturated. To keep them saturated, the dose needs to be solidly above the ceiling and it should address all physiological cravings. This accounts for people stabilizing at different and/or higher doses. Some people can be stable at 4 mg (some even less), while others may need 16 (or maybe even more).

When it comes down to it, it's just a number. Try not to compare yourself to other people's doses. As long as you're stable and without cravings, well, that's the most important thing, I think.

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PostPosted: Wed Jan 05, 2011 4:57 pm 
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Hi creel,

You mention that you don't think the cravings are psychological and that may be true, but addiction is an insidious disease. Addiction causes phenomena in the brain that are still poorly understood. What may seem to be a physiological craving could very well have been triggered by a psychological craving.

I can't recall anyone having to increase their dose like you have, not saying that it hasn't happened before...I just don't remember seeing it.

Do you work with a counselor? Your question would be a good one for a counselor.


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PostPosted: Wed Jan 05, 2011 10:47 pm 
Also dont forget that just because the ceiling is around 4mgs doesnt mean that taking 4mgs will put you over the ceiling since subs only have a 35% bioavailability under the tongue so you are only realy taking like 1.5mgs when you dose 4mgs so you would need like 8-10mgs to be solidly above the ceiling.


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PostPosted: Wed Jan 05, 2011 11:56 pm 
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I'm not so sure that is accurate Suboxowned. You have the 35% bioavailability correctly. However, the 4mg ceiling dose already takes that into account. In other words, taking 4mg of Bup, sublingually is thought to put you at the ceiling level. The reduced amount that actually hits the bloodstream has already been taken into account. This is typical of drug dose/route information. The route is already factored into the dose.

Now, don't forget a couple additional items - including the fact that if you don't do a good job of taking the Bup, you may not get as much into your system as the average person does. So making sure you don't swallow, keeping the medication in your mouth 15 minutes, etc. all plays into it. Secondly, while 4 mg is thought to put most people at the ceiling level, that does not mean you will stay at that level for 24 hours. In fact, you very well may not. It just means that 90 to about 120 minutes after dosing, you should be at the ceiling dose level after taking 4mg sub-ling.

Just don't re-factor in the fact that you won't actually absorb 4mg into the bloodstream as that has already been taken into account.


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PostPosted: Thu Jan 06, 2011 12:11 am 
Oh realy? Thats good to hear because I was not aware that it was already taken into account I thougt that it meant you actualy had to get at least 4mgs into your system to be at the ceiling, thats good to hear if only for the fact that it will help me pyschologicaly that I know Im getting close to the ceiling. I always got realy frustrated thinking I was so far under the ceiling.


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PostPosted: Thu Jan 06, 2011 9:19 am 
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Thanks all for the explainations. I kind of get it now....and I'm thinking maybe twice-a-day dosing would help.

J

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 Post subject: methadone
PostPosted: Tue Jan 11, 2011 10:36 pm 
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Suboxowned: I have looked at Methadone as well. I don't see the big stigma attched to it, it doesn't bother me. I do feel it would address some cravings a little better. The thing about it is having to go to a damn clinic every day. I don't have the gas money to do that!

J

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