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PostPosted: Thu May 15, 2014 7:31 am 
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So this isn't the first time I've done this to myself. It's really become a major issue for me. I am currently on 2 8mg strips a day. I've been at that dose for about 6 months. I've been taking Subs for almost 2 years now. In the beginning it was wonderful. I was able to get a job and was doing pretty good for myself. I started with taking 2 and 1/2 strips and worked down to 1 and 1/4 Then everything went downhill. Where I was working went out of business and I lost my job. I ended up going back up to 2 strips a day. I don't feel it's enough. I still feel like I'm having cravings, unless I take an extra half a strip. Then I feel ok. I've been honest with my doc about this. The past couple months I've called a few days before my apt and told them I was going to run out early. He then calls me in a couple extra to get thru. Then at my apt he asks me what happened and I tell him that a few times I took an extra half. He hasn't prescribed me any more than the 2 strips though. He said at one point he doesn't like to prescribe more than 16 mg a day because that should be plenty. Well, maybe for others that is, but for me maybe not. I don't know. All I do know is that I feel like I'm failing. Now, here I am AGAIN about to run out early if I don't cut myself way down. Problem with that is I have so much going on in the days before my apt, the time that I will be feeling crappy if I can't figure something out. My daughter has 2 school trips, one of which I am chaperoning, my son's birthday is this weekend and I have to shop and pack for another trip. This is the worst time for me to have done this to myself... again. I was stupid. I screwed up. And now I don't know what to say when I call my docs office. I know I will get the annoyed tone from the secretary, which makes me feel horrible. And I don't know the doc will do anything this time. I'm expecting them to tell me I am going to have to suffer. I'm really worried about this and need some advice on what I should say when I call? I really don't know what I'm going to say. "I ran out again"....then they will ask why...and I will not have a good response to that. That's what I need help with. Skipping days for me is nearly impossible...I've tried. Hell....reducing myself down to half a strip I start wd. I know there is suppose to be enough in my system it shouldn't be that way....but it is that way for me. I don't know if it's because I have high metabolism or if my mind is just that powerful. Either way....I will suffer. There is no getting my mind off of it.


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PostPosted: Thu May 15, 2014 9:17 am 
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Let me say a few things you can think about or not.

First, plainly, anything above 16mg is going to be mostly a psychological placebo effect as at 16mg you should be well above the ceiling effect of buprenorphine, the only other variable here would be the rate at which the buprenorphine is absorbing in the mucous membranes within your mouth. There's a number of posts here regarding this phenomenon here, essentially you want to use all the surface area in your mouth not just under the tongue, avoiding drinking or eating or smoking at all before dosing if at all possible as well as for a half hour after, keeping the solution in your mouth for a longer period, less saliva=higher absorption of buprenorphine. Even under perfect conditions, less than half the dose is absorbed, so try to maximize it. Some people use mouthwash with alcohol and state that it aids the absorption. I do not personally as I cannot use alcohol and it is a potential issue for many opioid addicts from a cross-addiction/craving standpoint.

You also describe what sounds like anxiety to me, is it possible that a concurrent mental health condition such as anxiety, depression or panic, diagnosed or undiagnosed, treated/undertreated or not treated at all, could be potentially causing you to mistake issues related to any of the above for cravings? Because , again, at 16mg cravings should be eliminated to a large degree.

Next, buprenorphine will not completely eliminate ALL cravings for opioids ALL the time but should make them manageable to a huge degree. Cravings are not life-threatening and only last up to twenty minutes. What you are doing by taking extra buprenorphine is avoiding rather than dealing with by keeping active, re-focusing your attention elsewhere.

Unless you've actually been actively using other opioids, it might be worth your time to try to develop some alternate coping skills so you don't feel the need to overuse your medication.

You could also have a talk with your Dr about increasing to 2.5 daily if that is what you really want to do, at least then you would not find yourself in this predicament every month. My worry with that would be, though, that if you were taking 20mg prescribed every day and you still had issues you hadn't dealt with such as the aforementioned, what is going to stop you from taking 24mg or 28mg and still be in he same situation?

Just things to think about; hope all goes well!

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PostPosted: Thu May 15, 2014 10:01 am 
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I was reading a past thread from 2013 and there where a lot of posts on this. We have all been there. Anyway for me the only time I have had these issues is during a dose reduction. I would struggle for about a month maybe two, but once I got the physical and psychological part under control I would be good until I would get hit with, Another dose reduction. I think someone absolutely could benefit from 24Mg. That is a high dose but for some, it may take that. Point is that taking more then prescribed shouldn't be an issue if you are at the right dose. That's what sub does is to take away the obsession. So with that said, is everyone under dosed? Maybe taking it wrong? I don't know.

As far as what to tell your dr. You have to call. You can't go through your field trip, help your kids and all of those things you said you have got to do, while feeling bad. I know I wouldn't enjoy it. I know I don't want to do things when I'm not all there. Past history along with poly substance abuse, these all play a factor. Forget the stigma and just be honest with your dr. Some dr's I'd imagine have clauses about this kind of thing. All he can say is no and help perpetuate the cycle. Or is it his fault? We will save that one for another day.. :shock:

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PostPosted: Thu May 15, 2014 3:29 pm 
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Thank you for the responses. They are appreciated. I do understand that according to many, 16mg should be plenty. I've been on doses both higher and lower than that. So I know when this medication is working for me properly or not. Right now, it is not. As far as anxiety goes, I'm sure there is something underlying....but I think we all, as addicts, have something like that to one degree or another. It's a matter of coping with it in a healthy way. What else can I do? Take some other medication that is most likely addictive to treat it? Or try to develop the strength to deal with it? It's a tough road to walk. I'm dosing to eliminate cravings ...that is what this medication is for, right? Otherwise, why does anyone take anything above say, 4mg a day? At one point wasn't that suppose to be the ceiling? To act like life issues and mental state, whether it be anxiety or panic, shouldn't be a factor in this is just lying to ourselves. So does anxiety play a part? I'm sure! Shouldn't that be expected though? Now, that being said, I do realize I've been making a mistake. That mistake is dosing myself instead of communicating with my doctor more efficiently. Honestly though, I don't know what more I could say to him. Maybe it is time to find a doctor that talks to me for more than 2 minutes and asks the same 3 questions every month. I've been at this particular clinic the entire duration of my sobriety and it is very scary facing the prospect of leaving that for something new, even if it may be necessary. I did find another doctor who is willing to see me and is an actual psychiatrist. He wants to see me for 30-60 minute sessions. That sounds good to me, but it is scary. What if I leave my "home" and find this doctor to be completely the wrong fit? What if he decides I don't need to be on this medication? I have a lot to figure out here as you can see. As far as making sure I'm getting the most from my dose....I've done it all. I do use mouthwash prior and I do hold it for as long as possible. Trying to "paint" my mouth with it however is a little tricky lol. I end up swallowing it on accident because of the saliva build up. So, I do think I am getting the most from the medication that I am going to get. I do appreciate the advice though :) I did call my doctors office and am waiting to see what the doctor says.


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PostPosted: Thu May 15, 2014 3:51 pm 
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Do you take your dose all at once or do you split your dose? Several of us who seem to metabolize Suboxone quicker dose twice a day.

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PostPosted: Thu May 15, 2014 4:04 pm 
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I split my dose in 2. One strip in the morning and the second after dinner. Then if I'm up at 2 am still because I can't sleep, I take an extra half. That's where the problem lies.


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PostPosted: Thu May 15, 2014 4:39 pm 
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Don't feel bad, I do the same thing. Isn't it the worst having to call in early? Then while you're waiting for the call, everyone and their brother calls. I feel I need a high dose as well, only weigh a hundred pounds and split my dose. Don't be afraid of the new doctor, there's no reason why he would think you don't need the med, mine prescribed three eight milligram tabs for a long time. Now I'm antsy to hear what comes of your call for early fill

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PostPosted: Thu May 15, 2014 4:59 pm 
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The docs office called me back and the doc allowed them to call me in the extra strips. So thank God for that! I will be get a talking to at my next appointment she said. So be it. I figured that would be the case. I missed something earlier from the first response that I wouldn't like to address.... The question on whetheror I am taking other opiates..... HELL NO. Why would I do that? And how would that even work? Suboxone blocks the effects of opiates. Not to mention I wouldn't corrupt my sobriety and life making that choice. I've been thinking about the whole issue on what dosage is enough. I have to say..... It's not ok nor fair to assume that a dose of 16mg is plenty and attribute the cravings to anxiety. That just doesn't sit well with me. I don't like when others think that just because they've read something or because something worked a specific way for them.... That means that's how it is for everyone. Especially when things like metabolism are factored in. Also the duration of time one is on this medication. I am tall and skinny.... I've always had extremely high metabolism. I eat like a bird... Small frequent meals. It's just the way I'm made. Maybe metabolism has nothing to do with it? I really don't know..... But I'm not willing to assume that everyone is the same and this medication works exactly the same for everyone. Nor do I believe that cravings go away after 20 minutes. Isn't that a bit specific? I'm sure this will come of pissy.... I don't mean for it to though. I just don't want others to read this thread and be mislead into a cookie cutter thought process.


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PostPosted: Thu May 15, 2014 5:03 pm 
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Hey mizzme,
You can cix this. Like others have said, most people over take at sometime for many reasons.

I did it becuz I wanted to "feel" something.
what fixed it for me was, Just tired of that scared feeling of runing out . My dr?,no way in hell would hecever up my dose. Never. He says 16 is enough, or12, at the highest.
Turely at 12 or even 8 the ceiling is met for most people I know.

I did this, I switched my doseing times. Morning at 10 am, then afternoon at 4 or so. Never after 6 or 7 pm. It keeps me awake as it may be doing to you, then your up thinking about it! So next comes that extra dose at latenight that you really shouldnt need. Imo.
maybe you work nights atva job, idk, but in the middle of the night sleeping is a good idea! Lol..

No4 making lite of your problem here, but 4 mgs at 2:30 am seems unnecessary to me ...

You have bn give some great advice on this thread, most of all, as Twins has said, be honest with your Dr...best thing you could do...best of luck, and it ll be ok Mizz.........razor


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PostPosted: Thu May 15, 2014 5:04 pm 
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Jeez...I typed that on my phone and made about 264,349 spelling mistakes lol. I hope it still is understandable lol.


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PostPosted: Thu May 15, 2014 5:12 pm 
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Thanks for the response, razor. Maybe the 4mg is unnecessary. IDK at this point. Who's to say what dose is sufficient for everyone? Why does it have to be that because someone....at some point....said 16 should be good enough, that it's written in stone? I've been successful on subs. I've never relapsed. I'm not claiming to be perfect....I'm not doing what I should be doing...which is trusting my doctor. The question is however, do I have reason to? If I feel like a number to him, how can I trust him? Nobody is walking in my shoes but me. Nobody can say for certain that 4mg is pointless for me. It certainly doesn't feel pointless....else I wouldn't be taking it. How nice it would be to stabilize on subs, like I was before. To not constantly be worried about my dose and whether it's enough. How nice it would be to get to a point where I felt comfortable enough to start reducing my dose again.


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PostPosted: Thu May 15, 2014 5:54 pm 
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I hear ya mizz. I do. Ive done the same this winter. I was cruzin aloug in 2013an in january boom got hit with the fearfactor. So what did i do? Went from 4 mgs back to 6... for the last month ive bn try to get back to 4mgs.. this is after 3 1/2 years!...

Idk...like you said we are all differnt.

Thing is i KNOW how potent this med is. This is why many believe 16 mgs is enough...

Well keep workin on it and do read more on this forum and dr junigs Talkzone..great info there mizz..


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PostPosted: Thu May 15, 2014 9:38 pm 
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I think maybe you should cut yourself some slack there razor....6mg vs 4mg really isn't bad at all. It's 2mg. You will get back where you want to be....just be easy on yourself. Everything happens for a reason. Our addictions didn't get us overnight...it took time. For me it was over 10 years in the making. I've been on subs for 2 years and I'm not going to get upset about that. There will come a time when I will be off of this. I don't want to rush it though. If I have to go up, I have to go up. I will work my way back down again. Good luck to you! :)


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PostPosted: Thu May 15, 2014 10:45 pm 
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razor55 wrote:
I hear ya mizz. I do. Ive done the same this winter. I was cruzin aloug in 2013an in january boom got hit with the fearfactor. So what did i do? Went from 4 mgs back to 6... for the last month ive bn try to get back to 4mgs.. this is after 3 1/2 years!...

Idk...like you said we are all differnt.

Thing is i KNOW how potent this med is. This is why many believe 16 mgs is enough...

Well keep workin on it and do read more on this forum and dr junigs Talkzone..great info there mizz..

Its funny how addicts are so similar in how they think, I've been struggling with the same issue (also on it funny enough 3 1/2 years just like you) and I just cannot get below 3mgs and I'll be going along good on that and then something will cause me to think I need more out of nowhere and then before you know it I'm stuck on 4mgs again. I was down to 2mgs for about 2 months straight but then screwed it all up doing the aforementioned.


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PostPosted: Fri May 16, 2014 7:45 am 
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Hi Mizzme

I just wanted to post to tell you in NY the doctors are being told by sub reps NOT to write for more than 16 mgs anymore. I find that odd since the more sub they sell the more money they get. My doctor showed me the letter from them also saying there is no benefit other than psychological. I personally don't believe this is true for all since i am not one of those "one size fits all". Something must be up for the makers to say that. I also know there is a difference of absorption in generic pills vs films, for me.

For me 16 is more than enough, as a matter of fact i am trying to get down to 12 mg again. I have chronic pain so i take 8 mg around 9am then 4 mg about 12:30 & the last 4 mg by 4:30. If i take the sub after 5 pm I can't sleep at all. I used to take 4 mg in the morning but somehow i convinced myself i needed "a full dose" of 8 mg :roll: . For me it's addict thinking. More can be better (money, Love, etc) but not with suboxone & ice cream :D

I a just grateful to be alive with the help of sub & good doctors. I look back & am so lucky I survived & made the choice to use sub as a recovery tool.


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PostPosted: Fri May 16, 2014 10:13 am 
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I think there have been studies done that show 16mg of Suboxone fills 99% of your opiate receptors. I think (?) that's part of why doctors are being told 16mg is the limit.

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PostPosted: Fri May 16, 2014 11:57 am 
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Hi mizzme,

I think I can speak for most of us on this site that takes suboxone. I would say that we all have one time or another run out early. What I use to do when that would happen to me was cut my strips in half. or even quarters. I would then just take a quarter in the morning and a quarter aroung lunchtime and then dinner and late night.

I realize that it is not a good habit to get into taking subs several times during the day in order to break addict behavior. But. if you are running out early, it is more than likely a mental game going on. If you just take a little less each time. then you can split your does of 2 strips into 4 - 4 mg. doses. take throughout the day for now , until you can manage the mental cravings.

As time goes on and you level out again, you can take less frequently.


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PostPosted: Fri May 16, 2014 1:01 pm 
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Thanks Mizz,

its just that I had something happen in dec, and I reached, more sub to FEEL better..
I tslk about meeting an shit, but what did do, I reached..I addict right?..

2 years ago , at 16, I jumped to 8mgs. Felt 100 times better. Less sidd effects, more energy, the whole bit.
6 months later dropped to 6. 6 till this pasted nov. Down to 4mgs..and mind you, I was tappering just to see if I could, and how I felt. Not some plan to get off.

So now at 6mgs, and ya , im fine with that..

I just learn so much here a d at doc s talkzone, im a pro sub guy with no exit in place.

I see itvasca medicine, not a drug. A med I may just keep needing. I used for decades, over three of them,

I stopped useing, everything, no beer , nothing I fi d that amazing today..I was ready...



razor


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PostPosted: Fri May 16, 2014 1:43 pm 
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Why do doctors Rx such high doses when its being used for pain? The lower the dose the better it will work for pain once your body adjusts to that tolerance level. When I was dosing 2mgs a day I could actually feel agonist pain killing properties when I dosed. Sometimes Id feel pretty damn good from my 2mg dose and then Id get that trigger to want to "feel even better" and Id take another dose and instead of adding to it it pretty much canceled out the agonist effects. A doctor who knows his stuff should not have a person on it for pain above 2mgs IMO, theres no benefit and it doesn't even work as well.


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PostPosted: Fri May 16, 2014 2:18 pm 
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To the OP, I anticipated that you might take my post in a way I certainly did not intend it. But you might want to reread it; it contains many different things to think about, nothing that is 'written in stone.' Your thread is called 'needing advice - running out early,' and I threw many options and scenario's out there. It sounds like you have your mind made up that you simply do better on X-dose and perhaps that is the answer.

My original post actually ends with the obvious option of advocating for yourself and having your dose increased to what you believe it should be so you do not find yourself in this predicament again as that in itself is extremely stressful. My concern would be, again as said before, not written in stone, but something I have seen quite frequently, is that someone increases and does only that, and finds themselves still over-using in an attempt to medicate real life stressors and the problem of running out of medication early continues. Perhaps you could move forward with a dose increase (assuming your prescriber is on board) and then take it from there looking at other possibilities *if* you still don't find your prescribed dose effective after some time. If you increase and no further issues exist, you were absolutely right, you need a higher dose. To me, the real test would be taking the 20mg for a period of time then assessing.

I mentioned active use because you spoke heavily of cravings, a phenomenon that typically ends in actual using if not in remission or unless the person experiencing cravings is on a stable medication or engaged in some sort of active recovery program. Wasn't trying to be accusatory, it happens.

The other scenario's are not cookie-cutter as the vary widely and they have been the case for many people I have known personally, professionally and read accounts from here.

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