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PostPosted: Mon Nov 21, 2016 7:03 pm 
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I keep reading posts that refer to the dosing method given by the SuboxDoc, but I can't actually find the original post by the Dr. anywhere. Can someone link me to the post that discusses his method of dosing? Thanks!


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PostPosted: Mon Nov 21, 2016 9:53 pm 
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Hey Subnoob,
Go over to the Suboxone Talkzone and either use the search box or look over on the left side of the page for Dr J s greatest "hits" for the post titled "Maximizing Obsorbtion " .

This is the best and I believe the first post he wrote on the subject. Ive been painting" my sub ever since...

Razor


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PostPosted: Mon Nov 21, 2016 11:36 pm 
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razor55 wrote:
Hey Subnoob,
Go over to the Suboxone Talkzone and either use the search box or look over on the left side of the page for Dr J s greatest "hits" for the post titled "Maximizing Obsorbtion " .

This is the best and I believe the first post he wrote on the subject. Ive been painting" my sub ever since...

Razor



Thanks! I was able to find it. I take the film, is using the teeth method still appropriate, or is there another method that you recommend for turning the film into a saliva solution to "paint' the mouth?


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PostPosted: Mon Nov 21, 2016 11:57 pm 
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I believe that you let it dissolve a little under your tongue and then paint your mouth with the undissolved strip. They will come along and correct me if I'm wrong but I believe I have read that on many posts here


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PostPosted: Tue Nov 22, 2016 12:05 am 
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HTown is correct. Let the film "soften a tad and then with the tip of the tougue scoop out some med and begin the painting process.
No Teeth needed.ha..
I hit the roof of my mouth then side of cheeks, inside the lip, top and bottem. I do this often and over again with my chin down into my chest to keep any salva from beening swollowed. Begin this with the driest mouth possable for as loug as you can. 20 mins or so..


Razor


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PostPosted: Tue Nov 22, 2016 10:54 am 
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Thanks everyone!

I tried it this morning and I don't think I'm doing it right. The strip dissolved almost immediately (within 10-15 seconds) and there is just a bunch of liquid and saliva in my mouth that is unbearable to hold in without swallowing. I made sure my mouth was very dry before I started this process. When I use the "box" instructions and keep the strip under my tongue I am able to hold it there for a good 10-15 minutes without the urge to swallow from over-salvation.

Also, when using the painting method, it feels like it's not properly soaking into my membranes (lol, as if I can feel things going into my membranes, but you know what I mean).

Any and all tips are appreciated!


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PostPosted: Tue Nov 22, 2016 11:08 am 
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I just wake up in the morning, when my mouth is pretty dry, and put my strip under my tongue until I can tell it has dissolved. I try to not swallow but I must admit sometimes I do because I can't help it lol. It usually takes me about 10-15 min until it's totally dissolved. I've tried the painting method too but I obviously wasn't doing something right because it dissolves in a second, like u describe, it happens that way with me too lol. I've just done it the same way for 5 yrs, I do wish I could go longer without swallowing but it's a reflex that just happens.

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PostPosted: Tue Nov 22, 2016 11:31 am 
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Haha, always nice to have company!

Let me back up a little and explain why I am asking this question in the first place, and maybe someone here can help me. (please!)

I have switched Suboxone doctors because I have moved to a different state for work. Before I moved I thought it would be a good time to get off of suboxone, so I went cold turkey from about 4mg a day (I was on subs for about 4 months). I was off of Suboxone for about 3.5 weeks before I decided to go back on the Suboxone from lack of sleep and overall interference with my job performance and mental stability. I must admit, the first time I was on suboxone I wasn't giving it my best shot. I was using intermittently and was excited to lower my dose so I could potentially "get high" sooner, and all of these feelings counter what the whole goal of suboxone is, which is training wheels for living a sober and healthy life.

Anyway, I have decided to give Suboxone an actual fighting chance, so I decided to go see a Suboxone doctor in my new state. He asked me what dose I was previously on and I said 4mg. Now that I am on 4mg, I am wondering if I did myself a disservice by not saying 8mg. And we all know how Subs work, so by wanting 8mg doesn't mean i want to get "high" but quite the opposite, I don't want to feel anything and don't want to think about re-dosing. I am not sure if I am currently wanting to re-dose because of a psychological factor, or if I physically need to re-dose, hence my new obsession of getting the most out of my 4mg.

Can someone help me better understand if 4mg a day is a good dose for "beginning" a proper Suboxone treatment? When I went back on the Suboxone I was not in any real type of withdrawal, I was only having sleep issues and slight anxiety, not actual physical opiod WD symptoms, so the Subs aren't preventing any WD, just cravings.

Sorry for the wall of text, but any help is greatly appreciated.


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PostPosted: Tue Nov 22, 2016 12:53 pm 
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Imo 4mg sounds good for someone who wasn't in withdrawal starting suboxone. But if it doesn't hold ur cravings down, then u may need to go up to 6 or 8mg. Cravings is the entire reason I needed this treatment. It's very possible that u may need a little bit more, not much but a little bit. That's my opinion on it....if 4mg isn't keeping ur cravings away then u may need another 2mg or so more, especially since ur just starting bk up on suboxone again. Others will be along to give u their opinions too.

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PostPosted: Mon Nov 28, 2016 10:56 am 
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A couple thoughts... first, I sometimes worry that I have done a disservice by drawing too much attention on dosing. I focused on it because of patients who felt they needed higher levels in their bloodstream than what their doctor allowed-- people who were forced to stay on 4 mg per day, for example.

I guess my concern would depend on the individual's situation. Someone who wants to stop buprenorphine within a year or two will do best if he/she takes the dose as if it were blood pressure medication, pushing concerns like 'am I getting enough?' out of mind. It is hard to taper off buprenorphine when still focusing on how every dose makes a person 'feel'. On the other hand, if someone is planning on staying on buprenorphine meds for years and year, it doesn't make much difference how he/she takes it (assuming it is being taken safely).

The thing to remember with dosing buprenorphine is that only a third of a dose is typically absorbed. Bunavail increases the absorption to about 50% by holding the drug against the inside of the cheek in an adhesive pouch, away from the flow of saliva. When people taper off buprenorphine they are taking small doses that are hard to take consistently, in part because of daily variations in the amount of saliva... so for that reason I recommend that people find a consistent way to dose during a taper by replicating the action of Bunavail.

In other words, during a taper, considering putting your dose ON your tongue, not under it, and then holding it against the inside of your cheek for 5-10 minutes. I have no studies or blood levels, but I would expect that type of dosing to 1. increase the percent of drug absorbed, and 2. provide more consistency between doses.

Finally, is 4 mg enough? Yes, for some people-- but as already stated, you want to be on enough buprenorphine to avoid 'feeling' anything, which requires that blood levels never drop below a certain threshold. I think many people require more than 4 mg to get to that stable place. I read an article by a pharmacist for a web site earlier this year, claiming that 'receptors are completely bound by 16 mg of buprenorphine'-- but he was using a very superficial approach to the science. As someone here already wrote, there is a difference between cravings and withdrawal symptoms, and we have a limited understanding of how buprenorphine binding translates into reduction of cravings. Binding is not a 'static' process where receptors are simply occupied or not. Predicting the interactions between molecules requires an understanding of quantum physics that frankly is over my head!

If you are having withdrawal symptoms, you may need a higher dose. SOME withdrawal symptoms can be 'all in your head'... but if you have diarrhea, your pupils are large, and you are sweating at the end of the dose interval, you probably need more.


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PostPosted: Mon Nov 28, 2016 6:38 pm 
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suboxdoc wrote:
....Bunavail....


Doc, as usual, thanks for the advice and wealth of information, always a pleasure to read your posts!

Not to hijack my own thread or anything, but I'm having a pretty serious skin reaction to Suboxone film, i.e, itchy raised bumpy rash on upper thigh, arm area near armpit, lower back. Do you recommend I give Bunavail a shot to see if a different formulation lessens my skin reaction? Or should I go straight to requesting to be put on Subutex to see if it is the Naloxone I am having a bad reaction to? Once I stop taking Suboxone, within a week my skin goes back to it's not rashy self, so I am pretty confident that it is something in the Suboxone film that is making me break out in a itchy rash. Thanks


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