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PostPosted: Sun Mar 13, 2011 12:05 am 
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Hello. I have been on suboxone for about 2 weeks now. I am taking 2 8mg's a day. This hasn't been working that well for me. I am still battling intense cravings. I have a bit of a high tolerance, more so then I expected. My last doc visit, he told me to try and not take 16, but maybe 12, and to deal with the cravings, slight withdrawal feelings. I took his advice, but caved in and started taking 3 8mg's a day. One in the morning, one in mid-day, and one at night. I have scheduled a doctors appointment for this coming monday to discuss this as he only wrote me a script for 2 weeks worth anyways, as I guess I am still in the induction thing.

Do you think I am taking to much? Or will he give me any push back? I strongly feel that this is what I need, at this point and time, and my experiment with 3 pills a day has proven to be effective.

Thanks for your input.


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PostPosted: Sun Mar 13, 2011 8:25 am 
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Hi digitalswimmer and welcome,

First of all, congratulations on making the positive step of starting sub and stopping the cycle of active addiction. Now, about your dose. Since you just started suboxone and you are indeed having cravings at 16, but not at 24, then it's my personal, non-medical opinion that you should be taking what is tackling your cravings adequately. Now that said, you should be aware that 24 mg is a rather high dose for someone not taking it for pain. Also, dosing once per day is preferable, but since you just induced, that can come later. The idea behind that is to get out of the habit of taking a pill throughout the day or whenever we "feel" like we "need" something. Think of it as just another medication - take it in the am and forget about it. Anyway, back to your dosing....Many people start out higher to address the cravings and are then able to stabilize at a lower dose. So it's likely that if you go up to 24 mg for now that you could still, at a later date, go back down to 16 and be okay with that dose.

How receptive do you think your doctor will be to taking you up to 24 mg? If it were me, I would focus on it probably being temporary - maybe for a few months, then you'll try to come down. It really sounds to me like he wants you at a lower dose. Let him know that you need him to help you. That with the cravings going on still you feel you are at risk of relapse (which you are). His job is to help you, so help make him see that.

I really hope he is receptive to you. Good luck and I hope some of what I've said is helpful to you. Keep us updated, will you? Take care.

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PostPosted: Sun Mar 13, 2011 8:36 am 
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Thanks for the response. I do suffer from chronic pain. Part of the reason why I started abusing opiates. I have been to detox, which didn't work. I didn't know that suboxone was really effective in treating chronic pain. I have noticed that my injury doesn't bother me so much, perhaps a higher dose would make me forget about it, which would be nice.

Pain management never offered me bupe. Instead we went right to the oxycodone. My psychiatrist is actually prescribing the suboxone and only doing it for me. He simply has no interest in helping other addicts. I guess because of the stigma which surrounds opiate addiction :(

I appreciate the support and will certainly keep you updated. I guess I will just have to put my foot down and explain it's what I need for right now. It's not like I'm even getting a buzz off of this stuff, I'm not. Part of the cycle of addiction was always dosing multiple times a day, so perhaps I Just haven't defeated that process yet.


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PostPosted: Sun Mar 13, 2011 8:51 am 
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Suboxone does help with chronic pain, although it doesn't erase it. It's much, much stronger than "regular" (full agonist) opiates, so most pain mgmt doctors don't offer it unless/until a patient is an addict. With me, I can never go back to full agonists, so sub is my only option left.

When dosing for pain, it is the norm to dose 2-3 times a day. Maybe you should discuss this with your doctor. Do some of reading under the chronic pain section of the forum to learn more about it.

As for not being out of the habit of taking something throughout the day, it's understandable. We cannot expect our ways to change overnight. We spent years learning those habits and it takes time to change them. I know people here will disagree with me, but if you need to dose more often now, you can always go down to once daily later on. Yes, it's ideal to only dose once, however, we must consider this is reality and like I said, change takes time. Oh and by the way, suboxone has a mean half life of 37 hours, so dosing only once daily is sufficient. In some geographical areas, people actually only dose every other day. So there's no worries about having withdrawals later in the day.

You are just beginning this life of remission. You're doing great so far...keep up the good work!

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PostPosted: Sun Mar 13, 2011 11:34 am 
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Digital: What you are going through seems to be pretty common and typical in the early stages of treatment. Many of us have gone through FEELING like we need to have a higher dose - more, more, more. You make the honest statement that you "feel" it is what you need. Hopefully you will come to trust your doctor along with many of the rest of us here when we tell you, that most of this is in your head. Unless you are not doing a good job of taking your bup and are not getting good absorption, taking 24mg is not going to provide any additional discernable physical relief from withdrawal symptoms over 16mg. It just plain is not and cannot. This is because Bup is totally different than a drug like oxycodone, for example. If you take more oxy, you will feel at least some additional result from taking more. With bup, the drug pretty much stops providing any additional effect when it hits what is termed its ceiling. For many people, the ceiling is actually around 4 mg. Taking higher doses may make the effect last a longer amount of time, but it won't produce any additional results.

I have a couple thoughts and suggestions for you. The first is, since you are still pretty new to all of this, I would not worry about it a lot. If these things were still happening three months from now I would be much more concerned. But at only a few weeks in, it is very typical. My second suggestion is to try to take half of an 8mg tab - or 4 mg at a time. I think that you might very much find that you don't feel any different. It sounds like you are dosing three times a day. That too is something you may want to get down to one or at least two times a day. But for now, rather than taking 8mg three times a day, try taking 4 mg. Your brain wants you to take SOMETHING and much of the relief you are feeling is likely psychological rather than physical. By taking half a tab, you will satisfy your mental craving and will likely find out that you feel just as good. However, at the end of the day, you'll have taken 12 mg rather than 24. At least give it a try for a day or two and see how it works for you. I really think that it will work.

As for pain, I have to ask HatMaker what she meant by

"It's much, much stronger than "regular" (full agonist) opiates, so most pain mgmt doctors don't offer it unless/until a patient is an addict."

Did you perhaps not write that like you wanted to Hat? I know that you don't think that Bup is stronger than full opiates when it comes to treating pain. Do you? I don’t' think that is the case. In any event, bup will not treat pain as well as a full opiate does. However, some people have reported that they do get some level of pain relief from taking bup. Those who do take it for pain often do need to dose multiple times throughout the day and they too often need to exceed the 16mg daily maximum that is somewhat the standard recommendation for addiction treatment with bup. So if your doctor is trying to treat your pain, then yes, you may want/need more than 16mg a day and more than one or two doses per day. However, for addiction, once a day is preferred and 16mg usually always more than covers it - like 99.9% of the time. The chance that any of us are that remaing 0.1% is well, 0.1% LOL.

I hope that helps and gives you some ideas. Please give the 4mg dose a try. I think you might be amazed to find out it works just as well as the three 8mg doses you have been taking.


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PostPosted: Sun Mar 13, 2011 11:48 am 
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You're right, don, that's not what I meant. I should have been clearer (and I'll probably get jumped on again for "confusing" people - not you, don. Oh well, I'm not perfect, never claimed to be). Anyway, what I meant is that it's stronger in that it will raise one's tolerance to opiates in general CONSIDERABLY. No, it does not treat pain in the same way that full agonists do. But it will help the pain. Most people, including myself, say it lessens it to the point that it makes it manageable or tolerable.

Thanks for picking up on that, don. Again, I apologize for my lack of clarity. Hope this makes sense now.

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-I'm only responsible for what I say, not for what you understand.


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PostPosted: Sun Mar 13, 2011 11:51 am 
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I appreciate the feedback. My psychiatrist isn't in the business of pain management. He simply took the certification just to help treat me, he isn't advertising that he's able to prescribe bupe. The induction is totally new to him, and he doesn't really understand my specific needs, only what he has read in regards to treatment. So, I guess I will be forceful tomorrow and get the extra prescription, however I will try what you mentioned. My supply is running low as we thought 16 mg's was going to be it, however I have found that it wasn't and have been taking the extra pills. I did leave him a voice mail to explain this and scheduled the appointment earlier then we have anticipated. I guess I won't really worry about it and just hope he doles out the extra amount to at least cover my day to day maintenance. As for the pain, it's a lot better then not being on anything at all. Allows me to perform day to day activities that I would normally dread, as I knew that I would be paying for it later on. Anyways, great forum. It's good to talk to people that have some experience. As for eventually getting off of the suboxone, that's not really my goal.


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PostPosted: Sun Mar 13, 2011 4:21 pm 
Hi digital and welcome. How nice that you have a psychiatrist who was willing to go through the certification process just for you! That's amazing! Although he doesn't seem to be interested in taking care of "addicts" in general, you are sort of showing him the 'new face of addiction.' Obviously I don't know you, what you look like, what you do for a living, your level of education, etc. but I'm assuming you might not look or behave like the stereotypical addict that unfortunately a lot of people think of when they picture an 'addict.' This is entirely wrong thinking, in my opinion, as so many of us opiate addicts are highly functioning, otherwise law-abiding, respectable, contributing members of society! This disease is epidemic.....so many people winding up addicted to their prescription pain medication!! It's just devastating.
Anyway, I think it's neat that your psychiatrist is doing this for you, and maybe he will consider doing more of this in the future because of you. In any case, as you've suggested, he isn't all that familiar with the issue of addiction and treatment with buprenorphine. All the more reason that you have got to be well educated yourself....and this is a great place to come for information and support. So I'm glad you're here!
I wanted to mention something to you about your pain, since you said you're using bupe for pain as well as addiction. I can't speak much to the issue of chronic debilitating pain, because I don't have that, but I have been on Sub for a good while and I have tried to learn all about it that I can. Something that I learned here a long time ago was that it is quite common to experience a higher than usual level of pain or to be somewhat hypersensitive to discomfort after coming off full agonist opioids. I know that for quite a while after starting bupe everything seemed more painful to me. This is just something I wanted to throw out there for you to consider.
I also agree with what has been said about this being sort of an adjustment period in your treatment. Many of us start out needing or feeling that we need up to 24mg/day. I believe that I did myself for the first few days of my treatment, although I do not take Sub for pain. I pretty shortly realized that I did not require that much for the long-term. With few exceptions, most of us find that 16mg/day is plenty and often once down to 8mg/day we realize that there is no difference between taking the 8mg as opposed to the 16mg. However, when it is taken for pain, I understand that it often does take a higher dose and more frequent dosing increments than what are usual when taken purely for addiction.
I would suggest that when you see your doctor, you just explain to him what you've learned and how you've been feeling. Hopefully he'll be okay with that and allow you to continue to experiment with your dosing for a little longer. As you probably already have learned, buprenorphine has that "ceiling effect" so you're not going to overdose by taking too much of it. It's simply a matter of standards of practice for the doctors and for many of us, it's an issue of not wanting to take more of a drug than is necessary, for financial reasons or otherwise. I was really lucky in that my Sub doc is also a recovering opiate addict who has taken bupe himself.....so he "gets it." Hopefully you'll be able to work with your doctor so that he will begin to get it too! Let us know how your appointment goes!


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PostPosted: Tue Mar 15, 2011 11:16 am 
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HEH. I saw the doctor. Explained what I told you, and he said, "okay, very well". Just like that. The entire appointment lasted maybe 9 minutes. I am ultra paranoid about everything and spend so much time thinking of the what-ifs. I need to stop that.


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 Post subject: congrats!!
PostPosted: Tue Mar 15, 2011 9:20 pm 
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I'm so glad you have entered into a life with recovery and help. I have been on Subs for about 2 years, and I required 24 mgs at first. It was prossibly in my head...yet I had not had any opiods for some time when I inducted (you'll learn about the cravings that you may have for a long time after stopping opioid use.) You may want to find a counselor to help you deal with the crap that still will show up in everyday life. I found a wonderful counselor who helped me get through the hard times in life besides being addicted to opioids. The beginning cravings will pass eventually, and then you can adjust the dose downward.

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PostPosted: Wed Mar 16, 2011 1:03 am 
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Hey swimmer,

I know I can certainly relate to the paranoid thinking you mentioned AND constantly thinking of the what-if's too. For me, I think it was a 'carry-over' of my abusing days. I would always be wondering if I could score enough Hydro's or Oxy's to get me through the next few days. I had several dealers in place around town and inevitably, on a few days, they would all be out of my 'meds' at the same time......then panic mode set in!!

Actually, it wasn't only my dealers who I would worry about, my orthopaedic surgeon prescribed me Hydro's once per week for nearly ten years.....every once in a while he would go out of town and I would have to rely on one of the other doctors in the practice to call in my meds and it would drive me banana's waiting for him to make the call.

I know with regular opiates (Oxy's, Hydro's, etc), no matter how many I had it was never enough for me to stop playing my game of 'find the opiates' wherever they may be in town. What many of us who have taken Suboxone do is we try to build up a little stash. I believe I had 30 or 40 built up after a while and that goes a LONG way to putting your mind at ease!! With Suboxone, you can actually have a bunch of pills stashed away and they don't call your name 24/7 like the other opiates would do.

I know your 'paranoid' thinking really revolved more around your doctor visit and what he would say about increasing your dose and I am very happy that he was so understanding about it, but you may find yourself in the situation I mentioned above and either way....having a little stash built up should help calm your mind greatly.

BTW, Congratulations on taking that super duper HUGE first step into recovery by choosing Suboxone!!


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 Post subject: yeah...
PostPosted: Wed Mar 16, 2011 11:04 am 
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I also have my "stash" of extra Subs. It is not to sell or get high with (which is pretty impossible when you take Subs regularly), it is for emergencies. An emergency could be as simple as the death of the doctor or the doctor leaving the area and having no Sub docs around for miles, a natural disaster (aka Japan), or my regular pills could be stolen (I keep my pills in various places for that reason). I mean, sorry, but this is a key part of my recovery and I take it very seriously. Call it addictive behavior if you will, but I believe in planning for all the ups and downs of life.

J


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PostPosted: Wed Mar 16, 2011 8:59 pm 
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Thanks again for the support. I am seeing a counselor and working on my recovery. I've been down this road before sadly. But I've learned that before, I was basically keeping the addiction underground, instead of on the surface as I've read. I'm trying to squirrel away some subs too, but right now it's super difficult to do. It is the addict mentality. You know you're dependent on these things and want to ensure your supply remains uninterrupted as to avoid a world of hurting. I guess from my knowledge we have about 36 hours, or so to figure something out --if shit really hit the fan.

Good to see many of you on here. Will talk to you later.


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