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 Post subject: Need advice
PostPosted: Sun Jan 19, 2014 9:34 pm 
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Hi Im new to the forum, but I am not new to suboxone and opiate drug abuse.
To make a long story short, I was heavily addicted to oxycontin, morphine, methadone for 3 years.
At the peak of my drug abuse I was injecting 320 to 400mg of oxycontin a day.
My grandmother put me in a treatment center that provided suboxone. I entered the treatment center fresh off of a 7 day stent in jail because of a probation vilotaion, failing a u.a.
So I was able to start suboxone right away, after I left the treatment center they reffered me to the clinic I have been seeing for the last 5 years.
Within my first 2 years of suboxone treatment I went thru a lot of different dosages trying to find what worked best for me. I first started suboxone summer of 2008, by winter of 2010 I felt I was doing the best I have ever done on suboxone and settled on 24 mgs a day. 8 mg three times a day and that has honestly worked the best for me.
In in the beginning of 2012 I lost my inshurance provider and I could not afford the suboxone any more, thankfully my provider switched me to generic subutex, which is so much cheaper then suboxone and is even so much cheaper then the generic suboxone.
I had been doing well on 24 mgs of generic subutex from January or 2012 until December 27th 2013, I went to my doctors appointment for a re-fill and was informed by the pa that my doctor of 4 years has retired. This Pa begins to tell me that this new doctor I will be seeing does not like subutex, he does not think suboxone is a long term treatment option ether, and that he is extremely strict about providing proof of drug counseling. Well providing proof of drug counseling is no problem for me, I have been seeing a drug counsler one a month for aftercare for years.
So I have an appointment to meet with my new doctor in the afternoon tomorrow. I vistited my drug counsler yesterday and explained the situation to her and she didn't understand why a new doctor would want to step inn and wreck everything I have been doing, especially since I have been doing extremely well for years, no relapses, no failed ua's. Been consistent with my counseling. She said I don't understand why this new doctor would want to put your sobriety at risk.
So I have my drug counsler backing me up, I have my family backing me up, My family knows how bad of an addict I was and knows I am doing the best I ever have since become drug dependant.
My father died from this opiate addiction we share, and I was sitting right next to him doing just as much as he was. So it is very frightening to know this new doctor may decide to wreck what I have built and what I have been greatly maintaining and doing well on just because he doesn't like subutex and doesn't think suboxone is a life long answer.
The way I look at it is addiction is a life long disease, so why wouldn't suboxone be a life long treatment plan?
Anyways i', just looking for some advice on how to go about this appointment I have tomorrow afternoon, any suggestions would be greatly appreciated. I have no inshurance, there is no way could afford 90 name brand suboxone, that is 1100.00 at my local pharmacy. 90 of the generic suboxone is 700.00 dollars and 90 of the generic subutex is 250.00 which is way more affordable for me, since I pay out of pocket.


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 Post subject: Re: Need advice
PostPosted: Sun Jan 19, 2014 10:11 pm 
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Welcome to the forum!

Very poor indeed of your "former" doctor not to inform you he would be retiring before your next visit. That's just not right, and I think that should be reported to the appropriate people.

I would try not to worry one bit what that PA said because he/she is not the doctor. The actual doctor may listen to your reasoning, completely agree with you, and continue as you were. Go into the appointment same as usual. With your good record at appointments it would be very unfair of any doctor to want to change things up in my opinion.

Now if it's really as that PA said then perhaps it's time to search for a different doctor. That would be a suggestion and something to consider. They are everywhere these days it seems.

Maybe you could even have your counselor give that new doctor a call if they mess with you. Have the counselor tell that doctor you really should remain as you were because your doing great!

Let us know how it goes and I wish you the very best. I can imagine how stressful that can be. I would do your best to relax tonight and not worry about it right now. Get some sleep and see what happens is my best advice!

Karen


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 Post subject: Re: Need advice
PostPosted: Sun Jan 19, 2014 10:43 pm 
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pjc87 wrote:
I first started suboxone summer of 2008, by winter of 2010 I felt I was doing the best I have ever done on suboxone and settled on 24 mgs a day. 8 mg three times a day and that has honestly worked the best for me.
I see you have been on Suboxone for quite some time.....
Starting in 2008 at varied doses, and ending up at 24mg per day in late 2010. So that's around 3 years at a 24mg dose each day to date.

Nothing at all wrong with that, and I'm certainly not saying there is. But that is quite a large dose of subs to be taking for so long. I'm only asking now, but have you given any consideration to possibly lowering the dose at any point? Only curious mainly, but I did want to mention I was also on 24mg for about 2 years (about 3 years total) and decided to stop the sub completely. I began a taper and I can honestly tell you as my dose got lower I felt no difference, and no symptoms. A dose of 2-4mg felt exactly the same as my high dose of 24mg did. I swear it's the absolute truth! I then felt I had been wasting lots of subs, and lots of money!

That may or may not mean a thing to you, or help in any way, but I just wanted to mention that to you in case you were considering a dose reduction at some point in the future. I was able to stock-pile quite a few extra subs that way.

Just something to think about and not suggesting you do anything. I really wish you well at the doctor tomorrow.

Karen


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 Post subject: Re: Need advice
PostPosted: Sun Jan 19, 2014 11:48 pm 
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Well when I first started suboxone, I was very skeptical of it. And I didn't want to be on a big dose. So I started out at 8mg's a day on suboxone. and I stayed that way for about 5 or 6 months, then I talked to my drug counsler which whom I was seeing 3 days a week for 3 hours a day. I was telling him that my cravings weren't exactly all the way gone. So I discussed this with my doctor and she said 8mg's was pretty low and that we could easily try 16 mg. So I began 16mgs and that worked a lot better for me and I was doing pretty good on 16 mgs for about 2 years, then the winter from hell hit me in 2010. In November of 2010 my father passed away at age 48 to a methadone overdose. I was a complete wreck over his death, and I am still to this day having trouble dealing with the fact that he is gone.
After my father died I started to feel cravings real bad, I was dreaming of using in my sleep for about 2 straight months after his death. I was named the executer of his estate, which added stress to my already stressed out life, I found myself thinking about using daily. So I discussed this with my doctor and told her I was afraid cause of the cravings I was having and the dreams I was having, so she decided to jump me up to 24mg's. Once ii started the 24mg's my cravings decreased significantly, and about a month of taking 24 mgs I was having an easier time working thru some of my mental issues regarding my fathers death. I have been steadily seeing the same drug counsler for 3 years and have bee doing very well. I have a baby boy that's going to be born this coming march or april. This will be my first child, so I am a little nervous about that, my mother just got released from a pre-release center and she had no where to go, so I welcomed her to my home. I got fired from my job and money is extremely tight right now. I just don't feel that right here and now is the time to attempt tapering, I feel that my enviorment is too stressfull to even try, I feel I would be setting my self up for failure. Plus I feel that I have been doing extremely well on 24mgs given the circumstances regarding what I have going on in my life. My counsler ddid say she would talk to my doctor if he had any questions or concerns for her, and she does agree that there is no need to try adjusting my dose or swapping medications especially since I have no inshurance and pay out of pocket. She too said she feels that would be too drastic of a change at this point and time in my life.


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 Post subject: Re: Need advice
PostPosted: Mon Jan 20, 2014 12:07 am 
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Very sorry to hear of the passing of your father, especially at such a very young age. This disease is such a monster. My heart goes out to you.

Congratulations on the upcoming birth of the baby boy. I know how nervous it can make you, but also how exciting it can be, and that is because I'm also expecting my first child, a little girl at the end of March. I hope all goes well for mom and baby.

And I'm very happy to hear that you recognize the fact your NOT ready to taper at this time. I fully support your decision to remain right where you are for now, and as long as you feel it's right. It's times like your having now that it's definitely to your advantage to stay put.

I wish you well and please update us after your appointment tomorrow. I'm sure others will be here at some point with offers of suggestions and support. Take care.

Karen


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 Post subject: Re: Need advice
PostPosted: Mon Jan 20, 2014 12:27 am 
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Quote:
My father died from this opiate addiction we share, and I was sitting right next to him doing just as much as he was



Quote:
So I began 16mgs and that worked a lot better for me and I was doing pretty good on 16 mgs for about 2 years, then the winter from hell hit me in 2010. In November of 2010 my father passed away at age 48 to a methadone overdose.

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 Post subject: Re: Need advice
PostPosted: Mon Jan 20, 2014 12:29 am 
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very sorry to hear that man...very tragic, especially being with him. very very sad

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 Post subject: Re: Need advice
PostPosted: Mon Jan 20, 2014 12:49 am 
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hello there,

I'm going to start by saying that my heart goes out to you for the loss of your father, and the manner in which you l ost him should serve as a somber reminder to us all of why we are here and that this miserable disease kills. I lost my father at seventeen, not directly to addiction, but he was an alcoholic nearly all his life, and died of liver cancer, and that was so painful it's still difficult to think about. I truly feel for you. like you I take 24mgs a day and am quite comfortable with no side effects, wds, or cravings to speak of. I think as long as your not having issues with your dose and it's working for you,I wouldn't concentrate on the number. later on, if your circumstances change and you feel ready, perhaps you could taper back a bit then. imo, you shouldn't right now though. if stress triggers you, than going down on your dose could only put you at risk Imo.


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 Post subject: Re: Need advice
PostPosted: Mon Jan 20, 2014 1:34 am 
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Hey pj87, let me say sorry alao for your losses. I read here that you are expecting a baby in the coming months. Congrats.! With this in mind, the new Dr shouldnt be moving you to suboxone. Subutex is givin to women who are having babies, right? So it seems you will at least have some time to work with this new Dr on this part of your concerneds.. I do hope i have this right. .anyway sounds like your doing well these days and best of luck with this new doc. . . Razor.


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 Post subject: Re: Need advice
PostPosted: Mon Jan 20, 2014 2:27 am 
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Sorry to confuse anyone, I am a male, My fiancé is pregnant and we are expecting at the end of march. My fiancé is a great supporter, but she's never had any addiction problems, so sometimes it's hard for her to understand why. That pa telling us all this news, that my doctor retired and that I'm getting a new guy who doesn't like subutex and doesn't think of suboxone as a long term plan. All this news has greatly stressed me out, and as a result has stressed her out as well.
I'm just preying I can talk to this new doctor and hopefully he will listen and understand that I do have a lot going on in my life right now, new born baby coming soon, loss of my job, no inshurance, still grieving a death. Hopefully he will realize that I know when I'm at risk, and yes stress is my number 1 trigger. Always has been, stress and feelings. Sadness, depression. And anger. them feelings along with stress has always been my main trigger.
So I'm really riding on the hope that I can level with this new doctor and get him to understand that number 1 I have no inshurance, so swithing to suboxone would be a huge change in my recovery because I wouldn't be able to afford to get them, and 2 I have a lot going on in my life at this particular moment, and 3 that I am doing very well on the subutex and the 24 mg's given my circumstances, still seeing my drug counsler monthly, and she has my back and agrees 100 percent with me that a drastic change is not very smart at the moment. I will let everyone know how the appointment goes tomorrow when I get back.


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 Post subject: Re: Need advice
PostPosted: Tue Jan 21, 2014 8:10 pm 
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Well I made my appointment yesterday. I can hear this new doctor talking shit about what I have been doing from inside the exam room. He was talking to the Pa who walked me into the room and asked the usual questions. He said this kid has been on suboxone or subutex for 5 years. That's way too long. And he said he's been on 24mg's which is way too much.
o he says I'm going to offer him 16 mg's of suboxone not subutex a day and if he doesn't accept that he's going to have to go find a different doctor.
So he enters the room and I have heard everything he says, but I wait for him to start talking first. He says you have been on 24mg's and have been in this program for 5 years, and I said yes sir, I have. And he says don't you want to be drug free? He said suboxone isn't meant to be a long term treatment option. And I said well addiction is a life long disease, so why wouldn't a treatment that works for addiction be life long? He didn't agree with me there. We discussed why I ended up on subutex and 24mg's and I explained to him that this is the best I have done on subutex and on 24 mg's. He said well I will not prescribe you 24mgs of subutex. He said you have 2 options. I will write you one more months worth of subutex at 24mgs and then this is going to be our last visit. option 2, since you are struggling financially and since you have a flawless record here at this clinic I will work with you on the subutex and will prescribe it to you, but we are going to start tapering. He said I am willing to give you a months worth of 2 a day then next month I will give you a months worth of 1 1/2 a day and so on until I am tapered off.
He begins to tell me that he has tapered hard core opiate addicts completely off of suboxone with minor side affects. He said that you have a few days of being shakey and feeling like you have a mild cold then you are better. I don't believe him when it comes to that. He made it sound like getting off completely is a piece of cake and that anyone can do it with miminal side affects.
So I decided to keep him as a doctor for the moment and take the 16 mgs a day for the month then set another appointment a month out to see him. I figured this was better then just taking a months worth of 24 mgs a day and then being out of a doctor completely. So I am going to being looking for a different doctor. I don't agree with him that suboxone is not a long term treatment option. Another thing he said that I don't agree with is that financial issues is not a good enough reason to put people on the way more affordable subutex. He said that the guidelines are to use suboxone only, but I have read everywhere that subutex can be used and that it is approved by the fda to be used for opioid treatment. So I am going to take the 16 mgs a day and see this doctor for now, but my search for a new doctor begins today. I want a doctor who isn't going to give me shit for wanting to be on subutex, and a doctor who isn't going to give me shit for wanting to be on a steady dose.


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 Post subject: Re: Need advice
PostPosted: Tue Jan 21, 2014 9:20 pm 
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I'm so sorry for what you are going thru right now. my last sub Dr. had arbitrary time limit on treatment as well. I knew it wasn't a good fit. I went to the naabt website to the Dr. patient treatment match service page. it asks some general info questions and then gives you a place to write what you are seeking from s doctor and treatment. I write that I felt placing time limits on treatment wasnt good for my recovery, and that I felt I would relapse if forced to taper before ready. this info is emailed to participating doctors in your specified willing too travel distance, and a doctor who is willing to accept you will email you. I got a response in a few days, and spoke with this new Dr. on the phone before meeting him to assure we'd be a good fit. he is also of the opinion that bupe should be a long term treatment for a lifelong condition. our first appt went very well and Ifeel much better knowing I won't be forced out of the only treatment that had ever helped me. that's the approach that worked for me, and I recommend it highly because it assures that you'll find a doc who supports long term bupe. just specify in the section where you write that that is what you are looking for. good luck my friend. I'm not sure why, but it seems to me so many of these doctors are on the short term band wagon. It's as if they purposely disregard hard evidence that bupe works best when used long term or indefinitely. I have found that doctors who are addiction specialists are more amenable to the idea of long term bupe. hope this helps. let us know how it goes please.


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 Post subject: Re: Need advice
PostPosted: Tue Jan 21, 2014 9:21 pm 
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Hey Guy,

I'm very sorry this new doctor failed to see the real picture here. I think what says it all are two very important factors.....

1. Your FLAWLESS record at this clinic.
2. You are not READY to stop the bupe.

He should have not have been so insistent about lowering your dose or tapering, and been extremely pleased you are such and ideal patient. Any other doctor would love to have you as their patient I'm sure.

I think you are making the right decisions for the time being. You took his offer of 16mgs of Subutex a day for now, and you can begin the search for the new doctor if you believe that's for the best. Tell you the honest truth, I'm willing to bet you will not even notice the difference in reduction. That 16mg is still a very large dose. You may be pleasantly surprised it will be just fine. And it should save you some money!

I might suggest you give it your best effort and try to make the 16mg work. If you find the 16mg does indeed do the job you may even want to continue with this doctor for a while. Don't burn the bridge too quickly. At the end of the month if you find the 16mg is ok then ask him if you can remain at that dose for a while instead of immediately tapering. I doubt he will as he sounds very firm, but you never know. In the meantime you could have another doctor lined up. I think that's what I would do.

Anyway I'm glad you at least got the Subutex instead of Suboxone so make the best of it. Give that 16mg an honest chance and I think it will do the job for you.

Karen


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 Post subject: Re: Need advice
PostPosted: Tue Jan 21, 2014 9:34 pm 
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Sorry to hear about this situation. I'm completely on your team. Opioid dependence is a lifelong condition and buprenorphine in the form of Suboxone/Subutex/Zubsolv and all generics are indeed a treatment for that condition, there are no 'guidelines,' only a false-hype and some scare-tactics originally started by the manufacturer of Suboxone/Subutex and kept up by people interested in the marketing of buprenorphine/naloxone that some prescribers bought into hook, line and sinker. That being said, different prescribers have different views of how buprenorphine treatment should work and you now know what this particular prescriber believes.

Like Brown Eyed Girl said, It's very possible that there won't be a noticeable difference between 16mg and 24mg, you should be above the ceiling, so don't get too worried about that as it might work out just fine for you. If you do notice a difference that is physical you might try to maximize the absorbtion of your dosage by utilizing all the surface area in your mouth, there should be some posts by SuboxDoc about this on this site.

If you're not the one initiating a taper, I don't believe that anyone should be forced into that situation after X-amount-of-time. If it were me I would look into finding a new prescriber who has the long-term-treatment mindset I do. Advocate for yourself, it sounds like your Counselor could be a good resource in this respect also, you might want to sign a release of information so he/she can have contact with your prescriber to advocate for you and let them know what you have been doing in terms of progress on that end. Good luck and sorry again!

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 Post subject: Re: Need advice
PostPosted: Wed Jan 22, 2014 7:47 pm 
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Thanks for all the replies, I'm glad to see that I'm not completely crazy for thinking that it is a bad idea to just start tapering right away. Specially since my last doctor of 3 years and the doctor before her of 2 years were both very different and viewed the treatment process very different then this new doctor. My very first doctor of 2 years always told me that if it's working for me and I am staying away from the drugs and staying away from the drug crowd and my cravings are handled then that was all that mattered and that's what she wanted. My second doctor of 3 years was pretty much the same, however she would ask me if I thought I was ready to start tapering, and I would just respond by telling her that I am doing very well right now with what we're doing and that I didn't see any reason to fix something that wasn't broken. And she would respect my answer and leave me alone from there. But this new doctor wasn't having anything I said.
It was almost as if he was treating me as a drug addict. He was basically implying that I have a problem right now and that he will not condone the problem. I think its strange he would view suboxone/subutex treatment as a problem. Because I have been told the exact opposite for years.
I'm going to use the naabt web page and see what happens. My travel distance is some what limited, but hopefully something will come of that. I am doing well on the 16 mg's so far, I don't feel as normal but I'm not miserable ether, and most of that is mental I'm sure. The stress of this whole process is beginning to cause problems in my relationship. My mind has been so wrapped up in trying to fix this issue that it is beginning to drive my partner insane, cause it's stressing her out too.
When I went to inpatient treatment even the suboxone doctor there told all of us there wich was around 12 to 15 people that opioid addiction is a disease, and it is a life long disease that never goes away. I asked him some questions in that session, and one of the questions I had for him was this. I said I cant help but feel that I am not doing what is right here but getting on a medication that I am going to need everyday, and there are going to be a lot of people judging me and saying that I'm just using a crutch instead of truly dealing with the problem, how do I handle feeling this way and what do I say to the nay-sayers. And he said that is a terrific question and he said think of suboxone to an opioid addicted as you would think about insulin for a diabetic. Are you going to tell a diabetic that they are using a crutch by using insulin? He said suboxone is no different to an opioid addicted then insulin is to a diabetic. And that really stuck with me. So it is hard to go from 2 different doctors who supported what I was doing 100 percent to a doctor who is basically saying I am still a drug addict. I am very confused and scared right now. And I just really hope I can get this figured out not only for my self but for my loved ones as well.
And I really do not understand this new doctors theory on subutex, he basically made it sound that anyone on subutex is not serious about recovery and that subutex is no good. And when I told him the only reason I am on it is due to financial reasons he said that's not a good enough excuse. I said well I was on suboxone for 3 years, 2 years of it paying out of pocket and the price has tripled on them since the last time I paid out of pocket for them which was 2010. It used to cost me 425.00 for 90 suboxone, now it would be 1100.00 for the name brand and 700.00 for the generic. I don't know anyone who could afford that every month aying out of pocket. That's more then my house payment is. Anyways I will utilize the naabt site and see what happens there and I will call around and see what I can figure out there too. Thanks for everyones support, and if you have any other suggestions please feel free to share them.


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