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 Post subject: "Maintenance" Dose
PostPosted: Tue Jan 04, 2011 9:25 pm 
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What is a "maintenance" dose in your opinion?

2mg?
4mg?
8mg?

More?

If so (more), then why?

What is a good maintenance dose?

Can someone taking 2mg of suboxone *really* expect to be able to avoid cravings and/or drug seeking behavior? Is this realistic?

What would you suggest for someone who is on 2mg of suboxone and is possibly abusing an SSRI (or trying to abuse it) ?

Should their dose be higher?

Personally, I think, If you're going to be on "maintenance" then take a dose that is adequate to squelch all of the symptoms of addiction. Does that seem reasonable to everyone? I think it does, but I just want some perspective here.


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PostPosted: Tue Jan 04, 2011 9:32 pm 
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Junkie said, "Personally, I think, If you're going to be on "maintenance" then take a dose that is adequate to squelch all of the symptoms of addiction. Does that seem reasonable to everyone? I think it does, but I just want some perspective here."

That sentence about sums it up as far as my opinion goes. I think it's very reasonable. Possibly, with time and working with a counselor or AA or NA or Smart Recovery, etc. the dose would be able to be lowered?


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PostPosted: Tue Jan 04, 2011 9:33 pm 
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It's my opinion that a maintenance dose should be solidly above the ceiling. Even though the opiate receptors should be saturated at or around 4 mg, according to Dr. J, you need to be comfortably above the ceiling to address cravings. I wouldn't expect someone on 2 mg (for maintenance, not if they're tapering) to get very good stifling of their cravings at that low dose. Plus there's the theory that at doses below the ceiling, sub acts more like a full agonist. So I guess what I'm saying is that I agree with you.

Oh - and what's up with the abusing of an SSRI? I've never heard of someone abusing that...could you clarify?

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PostPosted: Tue Jan 04, 2011 11:35 pm 
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I would say that the appropriate maintenance dose is whatever the lowest amount of Bup gets the job done 24-hours a day, 7-days a week. You should not have cravings, nor withdrawal symptoms, nor perceptible peaks and valleys from your medication. For many people this seems to be a dose somewhere between 4mg/day on the low end to 10 or perhaps 12mg/day on the high end. It would appear that most people start to experience problems at or below the 4mg level and fail to experience any perceivable benefit above 10-12mg. With the ends being 4 and 12, I would say that many if not most people seem to find 6-8mg to be a very good long-term maintenance dose. Now, I'm talking strictly addiction treatment here, not pain management.

Hope that helps. As to the SSRI abuse, I've never heard of that. Are you just speaking about having cravings and trying to use an SSRI to see if it gets them high? Otherwise I've never heard of this.


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PostPosted: Fri Jan 07, 2011 6:01 pm 
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Hi, sorry for the delayed response, work is still terribly busy. A good problem to have, I guess.

The person I am referring to took 4 times the prescribed does of Lexapro over the period of a week, and is currently taking 2mg of Sub for "maintenance" but I really thought that taking 4x the prescribed amount of Lexapro was a HUGE sign that this person is very likely not on an adequate dose of suboxone, since this person seems to be continuing with drug seeking/abusing behavior.

I mean, that's pretty much addict mentality right? "Oh, look, the doctor said 'take these for anxiety/depression' and I guess if one is good, then 4 must be GREAT!"

It's stinking thinking and I believe it would probably be less likely to occur on a higher dose of sub, you guys seem to be confirming what I thought.

Thanks for the feedback.


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PostPosted: Fri Jan 07, 2011 6:31 pm 
Definitely get what you saying about a proper dose stopping addictive behaviour but their isnt anything you can get out of taking more of an SSRI. They may have thought such a thing but an SSRI does nothing for you buzz wise. I have never in my life heard of that but i guess now i have. It would probably only make them feel weird or strange but definitely not a buzz. Its not even a narcotic. I guess that does say that their thinking isnt quite appropriate. Maybe more sub could help this. I just have to wander what gave them the idea that an SSRI would give them any type of effect from taking more. Maybe they didnt know much about SSRI's. Who knows. I think a persons maintnance dose should be at or above the ceiling. Wether thats 4 or 16mg's. Whatever keeps that person stable and off the drugs is what i believe is necessary.


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PostPosted: Sat Jan 08, 2011 10:12 am 
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Thanks for the reply, lifesaver. Yeah, I think in the case of the person I am referring to it was just an act of desperation. Not knowing any better, and thinking that the meds might have some euphoric effects, the person I am talking about took way more than prescribed. To me, it seemed like a pretty clear sign that they are still in danger, and being on only 2mg of sub, it would not take too long to get that out of your system enough to start getting high on heroin again, which is what this person's drug of choice is.

Thanks again for the feedback everyone


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PostPosted: Sat Jan 08, 2011 2:00 pm 
Junkie, You ask a pertinent question....one that if I recall your history correctly, you have learned the answer to by being on a very low dose yourself at one point. And one that I have now learned the answer to as well. Unlike you, I took the lesson a step further and stayed low long enough that I fooled around and had a brief relapse. Point being, I now have a pretty solid theory based on my own experience and my knowledge of the drug. I just talked about it in a reply on another thread, so I pulled part of that post to share here:

"it seems that you are hanging onto your recovery by your fingernails. Believe me, I know how that feels. I think that's where I was for all those months I spent at or under 1-2mg/day of Suboxone. I was a relapse just waiting to happen. Why? In large part, in my opinion, because I was not using my Suboxone properly. Taking that low of a dose was nearly pointless to me. It wasn't enough to provide the blockade effect to other opiates. To me, the only time to be that low is if you have a well-planned taper in place with a definite end-point and all you're doing is trying to get off the drug with minimal discomfort. These low doses, in my opinion, serve no good purpose in terms of maintenence. There will be some who disagree and that's fine. I'm just sharing my own experience and what I've learned from it. So, in a nutshell.....If one is NOT truly and completely ready (not just the want-to) to try life drug-free, one should remain at a therapeutic dose of Sub, period. I can almost promise you, Christin, that if you did as you discussed with your husband and left your sponsor out of it, and went back up to at least 4mg/day of Sub, you will feel such relief. I know I have!"

Now my physical symptoms were minimal in terms of w/d while reducing my dose of Suboxone lower and lower and lower until I was almost completely off. However, what was going on my head as far as cravings and more and more obsessive thoughts of using, wanting to feel 'better' mentally, falling back into the mindset of an addict...you know 'how could I get ahold of something, maybe I'll make a doctor appointment and try to get something'....you all know the drill. Anyway, not good things happening in the mind!
I''m not 100% certain that even high doses completely extinguish ALL of that for EVERYBODY, as we're all a little different in some ways. But I do know that for me, getting my butt back to the doctor and getting myself back up to 4mg/day, then 6 and now all the way back to 8-12mg/day (per doctor orders I may take 16mg/day) I am feeling an extreme amount of relief.
All that to say....for a true maintenance dose to be as effective for the individual as it possibly can be, in my opinion, you've got to be over 4mg/day, probably in most cases, well over 4mg/day. I guess that means I'm in agreement with what everyone else here has shared.
As to the SSRI thing....very strange! I've never heard of that one. I would think taking that much could get this person into a bad spot. I'm pretty sure it's possible to have some untoward symptoms related to too much of those types of meds. I hope this person stops this behavior asap.
As to your question, Junkie, about whether someone can really expect to avoid cravings at 2mg?....personally, I say "no." Not unless they are truly craving-free and not truly relying on the bup to do the work. And how does one ever know that? I guess like we did.....try and see what happens!! For me, I have to rely on the medication for the foreseeable future, because, on my own.....cravings won!
Anyway...great food for thought Junkie!

Sorry, I know this already too long, but I thought of one more thing I wanted to share and ask others who have been at doses at 2mg/day or less. Regarding the theory (or fact) that buprenorphine "acts like a full-agonist when taken at low doses".......has anyone found that to be true for them? I did not. I never felt anything at all different when I dosed even at less than 1mg/day. I assume that by saying it 'acts' like an agonist, that it would give one some sort of a different 'feeling.' I certainly did not experience that. Maybe what that really means is just that the blood level of the drug bounces around more like an agonist. That I would agree with....although I never really felt like I was going into w/d much even 24 hours after such a small dose. I don't know.....just have been curious about that for a while now.


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 Post subject: suboxone free in sweden
PostPosted: Sun Jan 09, 2011 7:02 am 
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I feel sorry for you in the united states. I live in Sweden and here we get Suboxone free in healthcare.


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PostPosted: Sun Jan 09, 2011 10:54 am 
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You have a strange definition of "free". You pay for it!


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PostPosted: Sun Jan 09, 2011 11:10 am 
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Hi rolly and welcome! I think it's great that suboxone is included in your universal health care system! I would think that means that addiction is more understood over there. I can't tell you how many stories I've heard of people in the US who need suboxone yet cannot afford it, thereby putting their life in danger because they have no access to it. Thanks for sharing - hope you stick around.

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PostPosted: Mon Jan 10, 2011 12:10 am 
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I watched a documentary made a few years ago highlighting clinics dosing addicts with heroin. Alot of people were trying to shut it down. Wonder if its still going on.

*EDIT - this is in sweden.


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PostPosted: Wed Jan 12, 2011 5:15 pm 
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rollyy78 wrote:
I feel sorry for you in the united states. I live in Sweden and here we get Suboxone free in healthcare.


You also only have 9.3 million citizens in total, which makes implementing universal healthcare a cakewalk compared to a place like the US where we have almost 30 times as many citizens.

Still, I have nothing but love and admiration for Sweden :D


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PostPosted: Wed Jan 12, 2011 8:06 pm 
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It's not the number of citizens that is the issue, it's the % of money spent on "defence".


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PostPosted: Wed Jan 12, 2011 9:47 pm 
Jobe wrote:
I watched a documentary made a few years ago highlighting clinics dosing addicts with heroin. Alot of people were trying to shut it down. Wonder if its still going on.

*EDIT - this is in sweden.
I think they still do it in the UK. Its realy hard to get onto a clinic like that Ive read tho, you have to be able to prove you have pretty much tried every other maintenance medication out there bupe/methadone and whatever else and failed before you are allowed such treatment. Maybe Im wrong but thats just what I remember reading.


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PostPosted: Thu Jan 13, 2011 12:40 pm 
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junkie781 wrote:
rollyy78 wrote:
I feel sorry for you in the united states. I live in Sweden and here we get Suboxone free in healthcare.


You also only have 9.3 million citizens in total, which makes implementing universal healthcare a cakewalk compared to a place like the US where we have almost 30 times as many citizens.

Still, I have nothing but love and admiration for Sweden :D


Excuse my poor English. in Sweden, we are only about 9 million inhabitants. but in order to join the Suboxone program, it takes many inquiries and we shall have failed other treatments. But I have read on this forum that many people have low levels, just because you are living in the united states must pay for those expensive Suboxone tablets. It's a little sad when that drug users may not always have so much money. Here in Sweden the care of Suboxone, which makes it a little easier only. But you're right. United States has more inhabitants. once again sorry for my poor English.


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PostPosted: Thu Jan 13, 2011 2:31 pm 
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moman wrote:
You have a strange definition of "free". You pay for it!


no no I'm not lying.The State stands for Suboxone just entering the program. so it's free. :lol:


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 Post subject:
PostPosted: Thu Jan 13, 2011 6:25 pm 
Not that the sidebar on 'free' drugs in other countries isn't interesting, but is anyone other than me still interested in Junkie's original questions/post? Any chance of this thread getting back on track with more discussion on the original topic? It's very interesting to me and I think others could benefit from the information as well.
Just a thought.


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 Post subject:
PostPosted: Fri Jan 14, 2011 5:58 am 
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setmefree wrote:
Not that the sidebar on 'free' drugs in other countries isn't interesting, but is anyone other than me still interested in Junkie's original questions/post? Any chance of this thread getting back on track with more discussion on the original topic? It's very interesting to me and I think others could benefit from the information as well.
Just a thought.


it was my fault. I stop now. sorry


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PostPosted: Fri Jan 14, 2011 7:31 am 
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rollyy - There's no need to apologize. It's pretty normal for these threads to take on a life of their own, so to speak. Sometimes they get off topic from time to time, but no apologies necessary.

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