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PostPosted: Fri Apr 21, 2017 11:05 am 
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Hello everyone , I have recently started suboxone and now subutex approximately 3 weeks ago . I started with suboxone but I was getting bad anxiety and severe panic attacks lasting 3 to 4 hours about an hour or so after my dose . I was switched to subutex. I had a 3 year pain pill addiction . Started on oxycodone 10/325 for an accident I was in taking 1 pill 3 times a day, fast forward 3 years I was taking 40 to 50 mg of hydromorphone per day and was afraid of death as it was no longer working and my dose kept getting higher. Tired of the vicious cycle and hiding my habit from everyone I went to the doctor for help and was told suboxone would be my best option. I was also told it would be fine to just stay on suboxone for life. I was givin 8mg on the first day and felt great leaving the doctors office , I was told that I could take as much as I needed at 2mg increments every 2 hours to get desired craving reduction and good feeling . I was also told I could take up to 32mg a day which seems like an awful lot . The first day I ended up at 16mg. Seemed fine for a day or so then out of know where I would get these terrifying panic attacks and end up at the ER because I didn't know what was going on , I would loose my breath and almost black out, it was very frightening. I immediately reduced my dose down to 4mg and the same thing kept happening . I stopped taking the suboxone completely out of fear for 3 days , I didn't feel that bad but I started to get real depressed . So after talking to my doctor I told her I would like to try subutex . She put me on it and day one I felt fine . I have been taking it for 3 days now at 4mg a day . My issue is that 4mg works ok but I still feel kind of depressed . Yesterday I took 6mg spaced out in 2 doses and it helped but I started getting the breathing problems and slight anxiety . Will this eventually level out ? Or should I taper off only being on it 3 weeks with 7 days of that 3 weeks not taking it ? My doc really wants me on a dose of 12mg or higher , getting bad side effects on 6mg. I don't know what to do .


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PostPosted: Fri Apr 21, 2017 12:39 pm 
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Jdk, welcome here! Sorry you're not feeling well. I've got to rush off but know that more will come along and can help you out. I'm chiming in here quick bc hawthorne's the longer you take comment is just not true. And especially when you're trying to get on and stabilize and get your life back, reading advice to stop is also not good. That advice would have been very harmful to me had I received it early on. Bup is different than your prior hydromorphone which likely masked underlying issues that are now fully exposed. I too had severe anxiety and depression stopping my doc and in the early days on bup. But that was from it being unmasked once off my doc as well as my grief and sadness for life losses that also became exposed once off my doc and on bup. I got on it and got my life back. the anxiety and depression were treated and resolved and May will be 6 yrs off bup. Wishing you my best bc this is all so hard, P

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Fri Apr 21, 2017 7:07 pm 
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Hawthorn it's not true that the longer ur on buprenorphine, the harder it is to get off of it...... not true. Bupe has a slightly longer half life than regular opiates but that's it. If u taper slowly and reduce ur dose slowly then some have reported not having many symptoms at all. And yes this is a pro suboxone forum but we respect everyone and ask that everyone respect us.

I agree with pelican and everything he said. Many times ppl think buprenorphine is causing all these side effects and symptoms when in actuality these symptoms have been there but being masked by their doc.

It also sounds like ur having a lot of anxiety issues. I've not seen any information that bupe causes panic attacks or depression. I've read many times that it has actually helped depression somewhat. Maybe ask ur doctor about treating the anxiety issues and panic attacks too while ur still doing ur suboxone treatment. Hopefully one of our doctors will chime in.

Good luck whatever u choose to do :)

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PostPosted: Sat Apr 22, 2017 10:48 am 
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Jenn and peli, excellent replies...

idk,

It's so easy to attribute side effects to a particular medication because they seem connected in time. Not to get too fancy, but it's a logical fallacy which is called "after this therefore because of this."

But correlation in time is not in itself causation. . Say I'm feeling tired and I decide to take a bunch of vitamins. The next day I feel great! You can easily see that there are other possible explanations.

In the case of buprenorphine, it's important to keep this in mind while doing a little objective
research into common side effects. As pelican and jenn have pointed out, anxiety and panic attacks
are not among these. It's not to say it's impossible, but just that it's very unlikely they're caused by your
subs...

It's likely that your symptoms are psychosomatic. Your anxiety is real of course, but it's
very likely coming from you, not the medication. I'm prone to the same kinds of responses to medications.
But I'm an old guy now with lots of experience, so I usually figure out what's really going on.

Hope this helps a little. I can understand how distressing the situation is for you. We're all here to help
you and support you. Please keep posting !!

Godfrey


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PostPosted: Mon Apr 24, 2017 3:07 am 
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Thank you all for your responses . I really appreciate all of them. I finally have mellowed out and now that I'm on subutex for a bit the anxiety has gone away. From what I've been through I do think the anxiety did in fact come from me and was being exacerbated by suboxone . Not so much with subutex. I think i had a lot of fear inside from where i ended up in my addiction as I never thought I would be addicted to anything like this, and also a lot of fear taking this medication(suboxone/subutex). I must say I have felt great the last couple of days. I have been taking 12mg a day (2 ,2mg pills 3 times a day) and i have felt somewhat normal all day. When I take 4mg at 7am it seems to wear off and I'm feeling worn out and anxiety by 12pm so I take another 2 and back to normal than again around 5pm feeling bad so another 2. Not sure if this is the best way to do it , my doctor basically is leaving it up to me to find out what makes me comfortable. Thank you guys for your support , this has been one of the hardest things I've been through .


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PostPosted: Tue Apr 25, 2017 8:06 pm 
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A couple comments...

it is difficult to explain the reality of the situation in one paragraph, or even in an entire book that is read only once. Like most people, you have an impression about the power of medications. You've taken things that made you feel miserable, and it seems as if those things have effects on your body that are complex and hard to explain.

In reality, EVERY side effect, caused by EVERY medication, has a reason behind that side effect. Sometimes the side effect is not actually caused by the medication, but rather is manufactured by the patient's mind. But even in those cases, there is a reason for the symptom. Certain brain pathways are triggered, for example, that either drum up memories of symptoms so that they are replayed, or that activate pathways that cause the symptom. For example if a medication increases the excitatory pathways in the brain, blood flow to the GI system would decrease, and intestinal motility would decrease, resulting in constipation (if low in the GI tract) or nausea (if higher in the GI tract).

Buprenorphine and buprenorphine/naloxone combination meds have very specific actions. They are relatively narrow in their effects, having actions only at opioid receptors. In other words, if a side effect cannot be explained through actions at opioid receptors, or perhaps in very rare cases allergic reactions, then those symptoms are created by the mind. That doesn't mean they don't exist, but it does mean that the only 'cure' will be to keep one's mind open, so that the mind will have a different reaction going forward.

The allergic issue is a problem, because people use 'allergy' to explain all sorts of symptoms. Allergies to buprenorphine, naloxone, or excipients are very rare-- much rarer than the complaints online or in doctor offices. The vast majority of people who complain of allergies to Suboxone (or other meds) are incorrect. One of the most common examples is the 'allergy' to morphine that is listed in 5-10% of medical charts. In virtually all those cases, the person experienced histamine from mast cells triggered by morphine, something that happens in every person who is not taking an antihistamine when getting morphine IM or IV. The reactions are experienced and recorded as 'allergies', and in the era of electronic medical records, that label sticks forever-- even though it is completely wrong. And any smart doctor KNOWS it is wrong-- but no doctor takes the time to try to fix the error, because he/she knows that it will take forever to explain, and the patient will probably cling to the idea of having a morphine allergy, no matter what the doctor says. So we ignore it, and let the allergy stay-- and give other narcotics instead.

I digress... With buprenorphine meds, the side effects are almost always caused by 'tolerance mismatch'-- a term that docm2 and I have used, and probably (!) invented in this regard (way to go docm2!!) In the extreme form, tolerance mismatch is 'PW' or precipitated withdrawal-- where the person still has opioid agonists activating the mu receptor, and buprenorphine comes along and slams the receptor shut, causing severe withdrawal symptoms. But in milder cases, the agonist is gone but the receptor is still in a state of tolerance. And when buprenorphine comes along, opioid, i.e. endorphin, pathways are turned off-- and the person feels crappy. Crappy includes depressed, with GI symptoms, aches and pains, fatigue, sweats, mild fever, excitation in brain circuits causing anxiety, etc.

The symptoms you experienced early in the course of buprenorphine treatment were almost certainly caused by buprenorphine hitting receptors for the first time, NOT because of naloxone, and not because of any difference between Suboxone and plain buprenorphine. Likewise, the symptoms at high doses of buprenorphine or Suboxone were not caused by those high doses, but rather by the fact that you took the higher doses FIRST. Now, you are used to the buprenorphine-- and you happen to be on a lower dose. If you increase your dose, you will likely feel exactly the same as how you feel on a low dose. At least that's how it works for everyone else!

Of course, you MIGHT have psychological symptoms at a higher dose. You MIGHT remember feeling lousy at higher doses, and assume you will feel lousy again at higher doses- and then you WILL feel lousy at higher doses. That doesn't mean that the higher doses 'caused' the symptoms; it just means that you are feeling the way that you expect to feel.

I know this all sounds bizarre, but it really is very simple, and very straightforward. If you stick with buprenorphine, one thing you will notice is how consistent it is from one person to the next; MUCH more consistent that the actions of, say, Prozac or Abilify. You will learn, over time, that people starting buprenorphine will feel exactly THIS, at THIS time after starting it, at THIS dose. It is not a complicated or scary drug. That's what drives many of us to try to help people-- because we see all these people needlessly freaking out over something that is actually very simple and logical.

Good luck-- sounds like your doctor is saying the right thing. You need to be on a dose high enough to stay above the ceiling threshold; that is what allows people to feel 'normal' all of the time, in between doses.


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