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PostPosted: Tue Oct 21, 2014 5:38 am 
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I have a big issue with Subutex (Buprenorphine) dosing.
I will start by introducing myself. I was a Norco addict for around 3 years, during which my dose went up to 12 of the Norco 10 per day so that’s 120mg per day during the last year of addiction. What made it worse is that around 6 or 8 months ago, I started adding Oxy on top of it. I started with around 60 mg of Oxy per day but my tolerance started to build up pretty fast to it so within 4 months I was using an average of 500mg (Five Hundred) of Oxy/day of course plus the Norco 10!! Around 2 months ago I started a treatment on Buprenorphine and since then I have been opiate free. I started with 24mg on the first day. My doctor asked me to taper down to 12mg within the 1st week but I was very enthusiastic and tried to be ahead of myself so I was down to 8mg after 1 week. Then he asked me to stay on the Buprenorphine 8mg for 2 more weeks during which I tried experimenting a bit, so I tried going below the 8mg margin because I was so eager to finish my detox treatment and get over this nightmare. I managed to cut down to 6mg within 4 days, then to 4mg 4 days later, then I tried to go further down but I couldn't so I actually stayed at 4mg level till my follow up visit (14 days later). I can’t claim it was easy. I felt really crappy. My energy level was awful, my mood was bad, and my body aches were terrible so I could tell that my W/D symptoms were not completely relieved with the 4 mg dose and that it wasn't an adequate dose at that time. By all means and for some reason I decided not to tell my doctor thinking that he will eventually cut down my dose, but surprisingly he extended my 8mg dosing for 4 more weeks! To make things worse, my work got a bit more stressful, so more physical and psychological stress, I couldn't take any more body aches or W/D so I decided: Enough with the experimenting I will just follow the doctor’s instructions and take 8mg per day anyway. I used to split them into 4mg in the morning and 4mg at night and eventually I missed the night dose on a few occasions or felt the need to cut it into ½ on a few other days (so I took just 2mg at night) so you could tell I wasn't trying to spoil myself, I was just giving my body what it barely needs so it doesn't work against me.
Now the scary part is that starting 4 or 5 days ago, so let’s say around 6 weeks after my treatment initially started, I started noticing that even with those 2 x 4mg doses per day (8mg total), I wasn't feeling like that before: more and more discomfort, more body aches to the extent that on Sunday 10/19/2014, 2 days ago , I was hanging out with some friends, I had taken my morning 4mg dose, and around 7:00 pm I had the most inconvenient feeling ever with awful body aches, I had to excuse myself, went back home and took 3 x 4mg = 12mg dose!!! I was so desperate to the extent that the idea of taking Norco was coming back to me be just to relieve me from my misery. Following that dose I was completely back to normal, no euphoria or anything just the discomfort and aches are gone and I was able to be myself again. I went back to re-join my friends, spent all night with them, confident, alert, joyful, and I realized that I haven’t felt that good in quite some time, but at the same time I never stopped wondering: What the heck is going on? Why is my body asking for more to function as normal?
How am I supposed to taper down Buprenorphine when I actually need more? What am I supposed to tell my doctor when I see him in 1 week? I don’t want to use any Norcos or Oxys. I had a few of them lying around me since I quit and it never hit me to take even one pill until that night! (Although I doubt they will ever work with the Buprenorphine blocking my receptors). I don’t want to go back to the opiates but I feel desperate like there is no light at the end of the tunnel. I don’t know what to do? Please help!!


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PostPosted: Tue Oct 21, 2014 2:20 pm 
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First off,welcome to the forum. Tell your dr the truth. Tell him what you have been doing Ironemons. Imo your are under dosing yourself most of the time. From what im understanding here you havnt begun to stablize. Stop experimenting .You had a huge habit. 500 mgs of oxy then in 15 days you dropped to 4mgs of bupe. Ya,wd was going to happen. Stablize.. Look what happpened when you dosed up to 12 mgs? Your blood leavels were more than likely all over the place. Now, are you just going to use bupe to detox or is a maintaince plan in place? Also you body is full of all those oxys and narcos. They dont just go away quickly. this just my opinion,but maybe take this slowly. Be honest with your dr, thats your best bet. And having those pills around isnt a great idea either. hope this helps somewhat. i see people make the mistake of not finding a stable dose. I dont know where yours should be right know but higher than 4mgs maybe a start... How are you feeling today Iron?..............Razor...


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PostPosted: Wed Oct 22, 2014 5:09 am 
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Thanks for your reply. Let me ask you this. How bad do you think is it going to be if I go cold turkey at this point? 6 weeks off opiates, and average of 6mg of Subutex per day(I know most probably I am under-dosed and that the appropriate dose for me should have been anywhere between 8 - 12 mg per day)? My point of view is this: If I am not getting adequate W/D relief anyway, and my treatment looks like it might drag for so long due to the fact that I am showing very slow progress if any at all. Is it wise at all to even think of that? How severe the W/D will be and how long will they last?


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PostPosted: Wed Oct 22, 2014 9:35 am 
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Hey Iron,
Cold turkey now?, well chances are slim imo at this time. Let me ask you this, why? As i said before you can stablize on a maintenance dose. Why not? Im just asking.
Again i look at your habit and see it as fairly high.
WD, ya it would be a bitch, you could try it. Others have but the chances that you wouldn't be reaching for relief are slim.
Iron, give it a real chance to work. You said it yourself you felt pretty good the other day shen you dosed at 12 mgs. It can work for you..
What concerns me is your tolerance has bn so high to be jumping now.

Also, are and your dr in agreement that you are to be detoxing or on maintenance? ??

Just my 2 cents and like to see you keep posting...oh and by the way i love racing..you must have had a fun time doing that!!!!


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PostPosted: Wed Oct 22, 2014 10:39 am 
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Sorry Iron, the comment about racing was for someone else


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PostPosted: Wed Oct 22, 2014 10:15 pm 
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razor55 wrote:
Hey Iron,
Cold turkey now?, well chances are slim imo at this time. Let me ask you this, why? As i said before you can stablize on a maintenance dose. Why not? Im just asking.
Again i look at your habit and see it as fairly high.
WD, ya it would be a bitch, you could try it. Others have but the chances that you wouldn't be reaching for relief are slim.
Iron, give it a real chance to work. You said it yourself you felt pretty good the other day shen you dosed at 12 mgs. It can work for you..
What concerns me is your tolerance has bn so high to be jumping now.

Also, are and your dr in agreement that you are to be detoxing or on maintenance? ??

Just my 2 cents and like to see you keep posting...oh and by the way i love racing..you must have had a fun time doing that!!!!
razor55 wrote:
Hey Iron,
Cold turkey now?, well chances are slim imo at this time. Let me ask you this, why? As i said before you can stablize on a maintenance dose. Why not? Im just asking.
Again i look at your habit and see it as fairly high.
WD, ya it would be a bitch, you could try it. Others have but the chances that you wouldn't be reaching for relief are slim.
Iron, give it a real chance to work. You said it yourself you felt pretty good the other day shen you dosed at 12 mgs. It can work for you..
What concerns me is your tolerance has bn so high to be jumping now.

Also, are and your dr in agreement that you are to be detoxing or on maintenance? ??

Just my 2 cents and like to see you keep posting...oh and by the way i love racing..you must have had a fun time doing that!!!!


Forgive my ignorance when I say this: my Dr. and did not have a clear agreement. I don’t know if this is a bit unorthodox but I was pretty clear forward from the very beginning when I asked him: “How long will the process take?”(I was talking then about the Sub taper off) and he answered saying that it is pretty subjective, it could take a month and it could take a year. Plus, when he was explaining the whole process in the very beginning and then he started talking about the strategy he uses with his patients and he said: “ It is being done which such finesse that makes the process unpainful and w/d unnoticeable” so I assume from all that he is planning a detox for me.
Now back to the answer to your question:
First, I have been on so many forums and there is somehow a collective agreement between people who used Buprenorphine that the longer you stay on it, the longer the pain, the W/D and the more chance you will get worse and persistent PAWS. As much as painful it is to go cold turkey off full agonist Opiates, as much as you probably know the extent of your misery, we are talking mostly few weeks at most cases (Exceptions exist of course), but statistically speaking and I am not a scholar neither did I conduct a scientific study to examine and investigate Buprenorphine use, taper-off or W/D but there are far more stories that talk about long term, long lasting PAWS and painful W/D for people who stayed on Buprenorphine for a long time.

Second, I had this discussion with my doctor and he doesn't believe in what I do believe, he doesn't mind putting me on Buprenorphine for years, he doesn't see any downside in it, plus from the stories he tells, he always mentions patients who have been on Buprenorphine for years and years so it seems that this is his mindset, that some people who used to abuse Opiates can’t really stop Buprenorphine or maybe they relapse on Oxy or Hydro once they stop the Buprenorphine, so the less evil option – according to him - is to have them somehow indefinitely on Buprenorphine better than them abusing other Opiates. The thing is, I don’t believe that being for years on Buprenorphine is a lesser evil. I believe it is an addiction replacing another addiction. It is a disguised addiction because on paper you are on a “Detox program” but in fact you are getting by with a partial agonist that is taken once or twice daily instead of a full agonist that is taken every 4 or 6 hours. I know this may be considered oversimplifying the facts and it doesn't take in consideration tolerance that it is very specific to full agonist opiates as opposed to the “Buprenorphine’ ceiling effect”, but I am just looking at the bigger picture here and I want a long term solution instead of partial short term solutions. Yes I want relief from my W/D but I also want my life back, a life that is “drug-free” no matter what drug it is.
The problem also is that I am not in a position where I can change doctors at the moment due to many factors.
I was looking for help, for someone who understands my prospective and who can help me achieve my goals (because I believe they are very legit and very doable) with a faster detox even if it involves some discomfort. The good part is that even with the lowest Buprenorphine dose I ever reached and that was 2mg/day, I had zero effect on my energy levels, or on my morale. I am not looking to get high, I am very motivated, I exercise vigorously (weight lifting and cardio), I try to eat healthy, and I try to get involved more often in social activities. I was saying, even with such a low dose, my only complaint was only the physical W/D and some feeling of discomfort.
My only hope is to find a strategy that fits my objectives and my goals because obviously my doctor has a completely different prospective.
Thanks everyone for your help
Wish me good luck


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PostPosted: Wed Oct 22, 2014 10:57 pm 
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Hey Iron,
Thanks for explanation in total.
You sound done with opiates period.
Finding the way out you may need alittle more of a taper, or as you said, you could cold turkey it.
A process that could take a month to three months. It ll take this loug for your receptors to grow anew.

Can you find some comfort meds for the begining or acute wd s?

The fact that you are working out and live healthy will be of great benefit.
I do wish you the best of luck Iron, and please keep posting an check out the Stopping forum for others tapering and jumping experiences. .

Hang in there...razor56


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PostPosted: Thu Oct 23, 2014 9:41 pm 
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Welcome to the forum Iron,

Some of your statements are a bit wrong. For one, I think you found a great doctor who isn't in it for the money. He truly wants his patients to live a happy life w/o abusing. If he was in it for the money he'd taper you off right away so he could fill your spot with another addict. We need more like him.

Second, it is not trading one addiction for another. It is opiate replacement therapy and works quite well. Do you shoot up your Sub? Take more than prescribed? That's being an addict. Taking it as prescribed, or even lower in your case is not addictive behavior. I'm in agreement with Razor that you should give your self a year on a steady dose and see how you feel after that. Please refrain from making statements like that one.

Also, the withdrawals do not get worse the longer you are on it. That is just plain misinformation. We have several members who tapered and quit successfully after 5-8 years on it. All of them said it was easier than they thought. (if you taper right)

Suboxone is a great drug if used correctly. Some may be on it for life. Only you know yourself good enough to know if you'll relapse after stopping it. The relapse stats are not good. The vast majority end up back on their drug of choice. Razor was just looking out for your best interests when he suggested you stay on it and give it a chance. With so many failures, why put yourself at risk. All I'm saying is, do it right. That's all.

I truly hope this site helps and its members can give you the support you need. Keep posting.

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PostPosted: Thu Oct 23, 2014 9:52 pm 
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I understand your position on thinking that buprenorphine is just trading one addiction for another, but the fact is that couldn't be further from the truth iron. The hallmark symptoms of addiction are constant obsession with our drug of choice that takes over all of our higher thinking and reasoning. When taken properly, yes you're dependent on buprenorphine but not addicted. Addiction is a disease of the mind and body characterized by an uncontrollable compulsion to use, despite negative, and at times catastrophic consequences. Buprenorphine maintenance doesn't fit this description in the least. Our medication allows us to live normal and productive lives while taking a daily medication. yes, we're dependent on buprenorphine, just as a diabetic is dependent on insulin to stay healthy and well. Many people who are sick wish they could go back to a time when they didn't have to take medication but addiction is a chronic, relapsing disease that deserves any and all effective treatment modalities. We respect the decisions of others here regarding whatever treatment works for them, and don't debate which is better or worse. It's actually against the rules of the forum. Everyone is different, and different things work for different people. I hope this helps you ti understand maintenance treatment a bit better, and perhaps even convince you to give it a real shot. It has given so many addicts their lives back, and is one of the most evidence based treatments in medicine.


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PostPosted: Fri Oct 24, 2014 4:59 am 
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I think I really understand where you come from. Only today, I was able to realize that I am in need for that treatment and I will be for quite some time. I put myself in that situation where I became dependent on such treatment. Addiction altered lots of chemistry inside my body and my brain and it might take some time to restore it, until then I have to admit that I will be dependent on Buprenorphine. I have to accept the fact that it will be somehow a slow process. Today I realized how fragile I am and how my body's physiology and chemistry was completely ruined by those narcotics so the solution will take some time and will require some patience. This might be contradicting with what I wrote earlier but things happened and I found myself facing new realities.


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PostPosted: Fri Oct 24, 2014 6:55 am 
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It sucks to be an addict, no doubt about it! Especially after we realize what we've done and that it won't be easy to repair much of the damage. I'm so glad you're going to give this treatment a real shot at helping you get your life back together. And remember we're here to support you All the way!


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PostPosted: Fri Oct 24, 2014 8:08 am 
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Iron,
Admitting you and an addict is a hard first step and your doing that today .
You will do fine on this med, once stablized on a dose of your liking the real healing can begin.
The best thing i did for myself was to realize that Sub was a Med and not just a drug . A true lifesaver.

Keep posting Iron...

Razor


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PostPosted: Fri Oct 24, 2014 1:35 pm 
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ironemos wrote:
I think I really understand where you come from. Only today, I was able to realize that I am in need for that treatment and I will be for quite some time. I put myself in that situation where I became dependent on such treatment. Addiction altered lots of chemistry inside my body and my brain and it might take some time to restore it, until then I have to admit that I will be dependent on Buprenorphine. I have to accept the fact that it will be somehow a slow process. Today I realized how fragile I am and how my body's physiology and chemistry was completely ruined by those narcotics so the solution will take some time and will require some patience. This might be contradicting with what I wrote earlier but things happened and I found myself facing new realities.



Excellent! You've seen the light and now know what to do. Be easy on your body, you've abused it for a long time. If you really want off all opiates, including Suboxone, there needs to be a recovery program in place first. Be it a 12 step program, an addiction therapist, Rational Recovery, or whatever floats your boat, it is near impossible to do it on our own.

It sounds like we have the beginnings of a recovering addict here. You made my day!

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