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Do you think it's time for me to taper?
Yes 54%  54%  [ 7 ]
No 46%  46%  [ 6 ]
Total votes : 13
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PostPosted: Mon Oct 18, 2010 3:21 pm 
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Hello! I am a twenty-something female Suboxone patient, and I have been since November 2005. Yes, almost five years. I have not used any opiates, cocaine, crack, pills, benzos, or any other illicit substances (besides a little marijuana in the beginning and maybe one drink every year or so for New Years) since November 2005. I have been on 24mg per day since then. I struggled financially with my treatment and to put myself through school. My dad died in 2008. I graduated college shortly after with an AS in Drug & Alcohol Recovery Counseling. I work at a Methadone Maintenance clinic as a counselor, and have been doing so for almost a year and a half. My life is strange in that I'm in recovery, working as a counselor, on Suboxone, and 'advocating' for methadone everyday as my job. There's a lot more than this, but I don't want to bore you on my first day. (LoL) :lol:
[marq=down]

If you feel like reading more:

Anyways, I've been on 24mg of methadone for five years. I want to taper so bad, I can't stop thinking about it. My Sub provider, who is also my PCP at this time, says, "NO NO NO" whenever I discuss tapering. I feel like I've been clean for a long time and I'm ready! He tell me, each and every month, that I need to stay on and that I probably will be on it for life. He's even gone so far as to tell me that if I taper, I have over a 90% chance of relapse. It freakin' pisses me off! I help others everyday who are on Methadone Maintenance to slowly self-taper, at their own pace, off of the program, once they reach stability in their recovery and in their lives. I want to be done. So, I take three 8mg pills per day. This month, they decided to switch me to the "FILM" The film is like a bitter Listerine-strip-type thinggy that comes individually wrapped. They told me it would taste better! HA! It tastes 100 times worse - Only perk is that it disolves a little faster. The first one I took made me almost gag! Anyways, my initial idea was to totally switch back to the pills if they let me. However, I decided that I can use this to my advantage. Since I cringe to take the film strips, I believe that it helps me to taper in that I put it off as long as possible. So, here's the catch. I work 6am-2pm and I'm up until around 10pm each night, during the week. On the weekends I can sleep until noon or even later, but usually someone wakes me up around 11 or noon with a phone call. When I sleep more, on the weekends, I need less Suboxone. The most I've ever gotten down to is about 2.5 pills a day. Yesterday, I only took 2. Now, during the week I'm usually craving them by about 9am (since I've been up for 4 hours already) and today I didn't take it until 2:15pm. I felt a little hot, but nothing too bad. I may take another tonight, but I till try not to. Now, I also tend to nap during the week, which allows me to skip an afternoon pill every now and then, but that's only sometimes. It's so weird how I don't feel "sick" until I am awake for a while. Anyways, I know I don't need to be on this much Suboxone and I know I want to taper off as safely and comfortably as possible - if possible. I can't take time off from work and I cannot and will not be in withdrawals at work either. My patients will call me on it in a second, not to mention my co-workers. Here's another catch: my PCP/ Sub. Dr. works where I work. This is the worst part of all of it. I just want to be done with it. It's gone on long enough and I am looking for some guidance I guess, since my Dr. isn't on board with it. Oh, also, I do weekly individual counseling with a therapist as well - and some 12-Step Meetings, but not as many as I used to go to. Thanks for reading all of this! Hope to hear from someone soon!
~C.i.R.


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PostPosted: Mon Oct 18, 2010 3:50 pm 
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Hello, CIR,

There are many different schools of thought regarding the dosages of Suboxone. Some doctors feel that anything over 16mg/day is overkill. It is my understanding that at 4 mg/day or thereabouts, the opiate receptors become fully saturated, and that it is not until people get down below that dose that they begin to experience some w/d symptoms. Read through the posts on this forum especially those under stopping Suboxone.

I take 24 mg/day as well, but I take it for chronic pain, too. I recently had surgery and I tried to wean my dose down beforehand. I can say that I got it down to 4 mg/day for three days and I felt no symptoms at all except for an increase in pain.

It is hard to know what to do when your doctor does not agree. Maybe you could try talking to him again to see if he would let you try tapering to 16 mg/day for awhile and then go from there, or maybe you could look into getting another doctor? For me, it is important for me to follow my doctor's advice as best I can as it is really easy for me to think that I know better and I know I have to look at that. Your doctor sounds like he knows you very well. I can understand your wanting to get off of this medication but at the dose you are taking you will most likely be a lot better off doing so quite slowly.

I am sure that you will receive more feedback from the others. I wish you well.

Sincerely,
~Rossma


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PostPosted: Mon Oct 18, 2010 4:25 pm 
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Welcome to our boards here. It's nice, and refreshing to see a well, written, cohesive, post, that has been spell checked and actually has punctuation. Just reading your post alone suggests to me that you are stable in your recovery. Not that misspelling words means you are in active addiction - that would be crazy. It's just nice to have posts that are easy to read and make total sense.

Now, onto your questions, it is always so ironic how things work out. I see so many people that want to stay on Suboxone and they have doctors who are pretty much forcing them off. Then there are those like yourself that want to come off and their doctors are wanting them to stay on. Just can't win, hey? The thing is, I have to agree with part of what your doc is saying and doing with you. He is correct that, especially in those who used at a young age and are still in their 20s, the chance of relapse is huge. Then again, after five years, I think that changes the stats some. Certainly he is on target saying that 90% relapse, but often they are only on Suboxone for a short time. I wonder what the stats are for relapse in those who have been in remission for five years on Suboxone. I doubt it would still be 90%. Thing is, I don't think that we know. Then add to it, can you and do you want to be on this medication for 50 or more years yet? Think of the cost alone? That is a long time. In the end, it certainly would make sense to at least strongly consider trying to stop Suboxone at this point and see how you do. I really do think that should be on the table.

Where I do disagree with your doc, and I have current best practices and all sorts of other docs on my side with this, is the dose he has you on. About a year ago or so the best practice was placed at no more than 16 mg for most people. As stated by others, when used for pain, you may need more than 16 mg a day. However, it is very clear and very proven that for the majority of people, anything over 16 mg is wasted. For many people anything over 12mg or even 8 mg is wasted. If you are getting good absorption, you likely will not feel any difference between 24 mg and 16 mg.

So if you are looking for opinions and input, mine would be that you certainly should look at lowering your dose. I could see you coming down, slowly and see how things go. Perhaps once you get in the 1 or 2 mg range, you'll start to have cravings, etc. and decide you are not ready to come off. Or, you may find out that you are doing fine and want to try a life free of Suboxone. The important thing will be to have a backup plan in place. You'll want to "relapse" back to Suboxone and not actual opiates or other drugs, should you run into trouble. Given your success, the time on Suboxone, and where you seem to be in life, I really do think it is realistic to give stopping Suboxone a shot. Without a doubt, I think you should get your dose reduced so you don't continue to "waste" excess medication.

I hope you'll continue to hang around here and post. It's always nice to have new "faces" show up. Hopefully you'll get some additional input and opinions and together you can perhaps take away some information with which to form your own decision about all of this. Good luck to you.


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PostPosted: Mon Oct 18, 2010 4:31 pm 
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First let me say congrats im going to school for the same thing am im cllose to finishing.

But now to you i know how you fell my dr also told me ill be on suboxone the rest of my life which made me upset as wel. anyways you def are in a hard spot cause you see your dr every day. so if u disagree with him it will make things weird at your work which is never good. But at the same time this is your life an he has to understand that. if you think you are ready to tapper then he should support that not tell you how bad it could be for you an you might relapse. im not gonna lie when i read that part i was a lil upset. cause what dr in his right mind would ever tell someone who has been on sub for 5 years they will have a 90% chance at relapse if you lower your dose. I would find another dr if thats how he looks at your case of recovery. thats just me but a comment like that would put me over the edge in the sense you have been seeing me for 5 years no slip ups nothing but if i lower my dose ill relapse most likely seriously that still makes me mad he said that to you. cause ive been on sub for 4 years same as you no slip up just sum weed when i first started sub but have been 100% clean besides sub for a year now. one thing mayb you can try is have your 1 on 1 couns. talk to him about were you are at in your program an you both think its time to lower your dose.


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PostPosted: Mon Oct 18, 2010 4:51 pm 
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Welkum too da phorum :lol: (sorry, Donh, I couldn't resist) :wink:

Regarding dosing, I am in total agreement with Donh, and in fact, I can tell you that when I tapered from 16mg per day down to 12mg per day in one jump I didn't notice ANY difference at all.

Just something to think about.

It's interesting how many people are coming on here and talking about being prescribed the film now. My doctor has yet to even mention it to me.


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PostPosted: Mon Oct 18, 2010 8:06 pm 
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Very good Junkie. I actually did Laugh Out Loud (LOL) when I read that! Good one.

Now, Bboy, hmmmmm... I'm not laughing. In fact, are you serious? Here is your statement:

"if you think you are ready to taper then he [the Sub doctor] should support that not tell you how bad it could be for you an you might relapse."

You can't be serious? And you are in training to do drug counseling? In no way shape or form is it ever the job of a doctor to ignore the facts and support what a patient may want blindly to do. I could give you a million examples of where a patient may "feel" that taking a medication, not taking a medication, having a treatment, not having a treatment, may be best for them - when it really is not. It is not the job of a physician to simply support what a patient wants to do or "thinks" may be best for them. It is the job of a physician to provide the care that is in the patient's best interest based on current research, understanding, protocols, best practices, etc.. Supporting or giving into what a patient wants is what got Michael Jackson killed. He wanted to use Diprovan to sleep and his physician supported that - even though it was clearly the wrong thing. Many patients wanted Oxycontin and got their physicians to support that and you see where it left them. Imagine if a patient didn't want to take their insulin, or high blood pressure meds, or blood thinners, or fill in the blank, medication? It is not the job of the doc to just support them regardless of reality. It is the job of the doc to explain all of the facts so the patient can make an informed decision. And you are mad at her doc? I think you still have a lot to learn before you graduate. Also, it does not sound like her doc is also her boss. In fact she states that her doc is her PCP - primary care physician/provider. I doubt that her primary doctor runs a methadone clinic.

Sorry if that was too harsh, but that statement really surprised the hell out of me, (can you tell) coming from someone that one day may be counseling drug addicts. I will agree with you that this doc, after providing what he sees as the current information and his professional recommendation, may chose to "support" the patient's desire to try to stop her Suboxone. If not, he may then chose to stop the doctor - patient relationship. But the day our doctors start doing what we want, regardless of what we need, is the day we are all in deep do do.


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PostPosted: Mon Oct 18, 2010 10:05 pm 
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C.i.R.

Welcome to the forum! This is an awesome board and there is definitely a wealth of information here as well as some long time posters and suboxone users which generally results in pretty well rounded and experienced advice and information. I am glad you found us and that you felt comfortable posting.

Personally, I voted "yes" that it is time for you to taper, but that doesn't mean I think it is time for you to taper "off" suboxone. It does sound like you have a pretty solid recovery program and are doing very well. For that reason and the length of time you have been on suboxone as well as the higher dose you are on, it would seem reasonable to try tapering that a little bit. As a note, I can go 2 days without suboxone before I start to feel any kind of real withdrawal symptoms so getting to a lower dose shouldn't be too difficult for you. I don't know what the "right" dose might be for you to land on permanently but I would suspect it to be anywhere between 4 and 12 miligrams per day and you would probably still be just fine. That would of course be between you and your doctor depending on how things go.

When I say permanently I don't necessarily mean permanently. I do think your doctor has a point in terms of the statistics on relapse in your age group and drug of choice. To him it probably seems like you are healthy, alive, living a good life, and why rock the boat if you don't have to just yet. He would probably like to buy some time and get you to your 30's where your chances improve.

I am sure you are very helpful to many people tapering. The sad fact remains that long term, most of those people don't stay drug free long term. I can understand the desire to be "done with it", or to move past this part of your life, to be normal like everyone else, to not depend on medication, to be "free" of all of it. I felt that way so strongly at one point that I just quit taking suboxone. Why not? I am a stable person with a stable life and stable career, great husband, good family, excellent coping skills generally speaking, etc. etc. Both of my suboxone doctors have said numerous times to me that I am not the "typical" suboxone patient and that certain things "just don't apply" to me like they do with others. But when it comes to getting off and staying off opiates, I am no different than anyone else on this forum and it ALL applies to me. All of it. Suboxone made me feel great. The key is that it IS the suboxone that makes me feel that way. But take the suboxone away and my coping skills weaken considerably, I get confused, have difficulty making decisions, feel tired, etc. I jumped off 12mg which is stupid. Had I properly tapered I probably wouldn't have felt so bad. It was nothing like oxycontin withdrawal, but I felt more vulnerable than I have since I tried getting off oxycontin cold turkey. I stayed off suboxone for 3 months. I also have pain issues which was the ultimately tipping point for me going back on. But I can also say that getting off suboxone sounds easy when you are on suboxone and becomes a whole different world when you taper or are off of it.

I am by no means saying you can't do it or that you shouldn't do it or give it a try and like I said, I do think you could decrease the dose quite a bit without jeopardizing your recovery or risking relapse. So if you decide to give it a shot, just read up on the different experiences and techniques. Give your reasoning why you want to go off of it a lot of thought. Are you doing it for the right reasons? I suggest talking to several people about it. Know what the statistical risk is. I definitely suggest getting WAY deeper into the 12-step meetings if you intend to quit suboxone because you will likely want and need that support system in place already at the point you go off entirely.

Right now things are easy for you on suboxone. Why do you want to do it the hard way? I would just give that a whole lot of thought. This is all based on my own experience and there are others here with equally as valuable opinions and advice that may be contrary to mine.

I do wish you the best. I apologize for going on. I think this is a very serious topic that I have grappled with in so many ways and come through to my own conclusions for me.....for now anyways. I hope to see you post again soon.

Take care!
Cherie

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 Post subject: Continued...
PostPosted: Mon Oct 18, 2010 10:14 pm 
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First of all, I hope I didn't start a war here! LoL! Some things I'd like to comment on:

1. My PCP, or primary care physician, has his own practice (with two other physicians there as well) from which he prescribes the Suboxone. He "assisted" me by "putting in a good word" at the methadone clinic where I now work, so that I could obtain a job once I graduated with my D.A.R.C. Degree. He totally helped me out, and once I began working there, quickly discovered that he is the Medical Director of our facility. (Hopefully this doesn't indicate where in the US I am or who the doctor is, as I don't want to put that out there.) So, basically, I feel that in some way I owe him for helping me to get the job, and subsequently I would feel totally guilty to change doctors. Also, some fears of retaliation at work from him are present in my mind, but most likely unrealistic to think.

2. My counselor is awesome! I like him a lot and he's an alcoholic in recovery for MANY years who has helped me a ton! He knows the Dr. and has his own opinions about how the Dr. operates. Mostly regarding his distaste for "addicts" and how no matter how long you've been in recovery (5 years, let's say, lol) and what you're doing now (counseling other addicts for the past 1.5+ years - hypothetically lol) he continues to treat you as though you are a lunatic, drug-seeking, dope monster who has nothing better to do than try to scheme. Unfortunately I'm not exaggerating. It even came to the point where I was going through some panic attacks, and the other doctor in his office prescribed me .5mg of Ativan on a temporary basis when the Dr. was on vacation, which led to both the other doctor and myself getting "yelled at" because "we should know better" that benzos (benzodiazepines) can be addictive and can potentially have contraindications with the Suboxone. I was taking maybe one of those Ativans a month for about a year. 10 pills lasted me a year. But, I don't take them anymore and I conceeded to the fact that I don't need them. I honestly don't like the feeling they give me; unless I'm in mid-panic attack, they make me feel high-ish. I can go on and on but the whole thing is ridiculous...

3. I would like to say that I didn't spell-check or read over my post prior to posting, I just can type wicked fast and I have an education. I have a little OCD when it comes to people writing like they're reliving their pre-hooked-on-phonics days. I too appreciate a well-written post, and yes, I cringe to see things like, "ur dr rlly pisses me of becuz i dont agree wit dat". Yuk.
:x
4. So I discussed the whole thing with my new BF, of only a couple of weeks, and he has been a great support. He was up around 115mg of methadone not even two years ago and tapered all the way off completely. I am extremely proud of him and it gives me the motivation to do it. He's dead-set on the fact that I'm overmedicated and he thinks that my Dr. is ridiculous for keeping me at 24mg daily, or even starting me right off on 24mg daily. So, to recap: Yesterday I only took 16mg - No biggie! Today, I waited until after 2pm (which is LATE for me to take it) to take my first 8mg film strip. I took another half of a strip (4mg) this evening around 8 or 8:30pm. The only side effects I had are: when I took the first one, I went and took a hour nap, followed by a nice piece of Apple Crumb Pie with Cool Whip, followed by another hour nap. (I had to throw in the whole pie thing- I love food!) So that's only 12mg today. I was taking 24mg three days ago. The only difference I felt was feeling hot - temperature-wise. But I guess it was sort of in my head, as my boyfriend felt my forehead, hands, and leg and said I actually felt sort of cold. So, I guess this would be the start of the hot/cold sweats/chills thing. However, I think I need to stick to the 1.5 film strips for a couple days, and then I plan on going to taking only 8mg per day and I want to split dose: half of one (4mg) in the mid-morning or early afternoon and then the other half in the evening. We'll see and I will keep you all posted! I feel better already: just getting this stuff out of my head.

I appreciate the warm welcome and all of your positive feedback and support!
Thank you all!


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PostPosted: Mon Oct 18, 2010 11:13 pm 
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"I would like to say that I didn't spell-check or read over my post prior to posting"

-Show off -

I'm just kidding (and a little jealous since I'd come off as a 6th grader without spell-check)

Anyone who is on 24 mg of Bup (unless it's for pain) and thinks that they can't go lower or will have problems at a lower dose needs to read this latest post from CIR (Counselor in Recovery). It proves, yet again, that anything over 16 mg, and often over 8-12 mg, is just wasted. I have every confidence that, like many who have gone before her, she will do fine at her target dose of 8mg and won't feel much in the way of withdrawal. The 3rd day will be the toughest but even that will very likely be a breeze.

I think that Jack gave you an awesome post with some really great information. Best of all, she has been through it and has first-hand experience - and we here all got to expierence her when she was off the Suboxone (but I won't go into that) :). Your life seems to be in high gear at this point and going extremely well. Just please don't let coming off of Suboxone screw that up - and it can. That doesn't mean that it will, but it certainly can and has for a whole lot of people. Don't become one of them.

I am a bit confused about your doc. On the one had it sounds like he went through extra work, effort and energy to help get you a job - putting himself on the line, at least a little bit. But then are you saying that he also doesn't trust you and still thinks you are "a lunatic, drug-seeking, dope monster who has nothing better to do than try to scheme."? Unless I'm misunderstanding this all, how can this be the same guy? If he really did think you were a "lunatic, drug-seeking, dope monster who has nothing better to do than try to scheme," why would he help you get the job that he did? That doesn't make sense. Something still tells me this guy is looking out for your best interest and knows the reality of drug addiction and of stopping Suboxone. The thing that I don't get is the high dose he has you on. He loses points with me on that one.

Anyhow, it sounds like you are on the right track. Get yourself down to a reasonable dose and take it from there. Re-read what Jack wrote and think if perhaps you are not better cashing in your chips (staying on Suboxone) rather than rolling the dice and trying to get off of it for the big win.

Then there is the matter of getting into a relationship with another addict. I'm not going to go any farther on that one, but I'm just sayin.


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PostPosted: Tue Oct 19, 2010 1:59 am 
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The only reason that I'm posting this is because I can't sleep. Otherwise, I think that you've gotten a LOT of replies and I'm not so sure that I can add a whole lot.

It's late (so I may have missed something), but I don't think that anyone really has addressed a comment that I found very intriguing:
CounselorinRecovery wrote:
Now, during the week I'm usually craving them by about 9am (since I've been up for 4 hours already) and today I didn't take it until 2:15pm.


When I read that comment, I could understand your PCP saying, "NO NO NO" to a tapering plan.

Of course, I'm writing only from my own experience, but the first red flag for me when tapering is that my cravings are returning and, when I'm ready, THAT doesn't happen until DAYS after a reduction, if at all. Although I haven't been on Sub anywhere near 5 years, I have been at 20mg and 16mg doses. Unlike what I had been told on other forums, I did experience mild withdrawal symptoms when tapering from high doses. However, when I was ready to taper, I never experienced cravings, not until I was below 8mg, the hardest cravings hitting once I went below 6mg.

Quote:
He tell me, each and every month, that I need to stay on and that I probably will be on it for life. He's even gone so far as to tell me that if I taper, I have over a 90% chance of relapse.

I know that this kind of stuff is hard to hear. But, I urge you (if you believe that your PCP/Sub doctor has your best interest at heart) to put more weight on his opinion of your readiness to taper than on the opinions of some very well-intentioned people knowing you only from a post you've made on a forum (I do not mean to offend anyone here. Many people here have helped me and I appreciate it. I DON'T believe that my doctor always has my best interest at heart. I'm not so sure that's the case with the OP).

From reading through this thread, I realize that you have decided to taper. But, you're just at the very beginning of the process and, my experience says, it gets much, MUCH harder the lower you go.

For me, the phenomenon of craving is the key to addiction. It's what will drive me to use two weeks after the physical withdrawal symptoms are ended, when the obsession remains or returns and my stomach muscles spasm upon reading the word "euphoria" or I want to rip my skin off when a co-worker on Percs talks to me, her pinned pupils taunting me.

How you describe your current experience with your Suboxone dose concerns me. You work in a high-risk environment and are dating an addict. IMHO, it would be in your best interest to work with your doctor on any tapering plan.


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PostPosted: Tue Oct 19, 2010 8:18 am 
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I will agree with the others who have said that your doctor likely does have your best interest at heart. I think the ativan concern is realistic. He is trying to help addicts, not get them addicted to new substances and the nature of the addict suggests they shouldn't be taking addictive substances. He probably would have preferred sending you to a therapist to teach you meditation techniques than to prescribe ativan. Also, there are huge contraindications to starting a benzodiazapine while on suboxone. You could have died. For that reason, I do think he has your best interest at heart. I agree with Don that the high dose is interesting, however, he is the one who knows you.

I also have to agree with the concerns about your withdrawal or cravings sensation taking a lower dose on day one. If you are going to taper, I think it should be done with the assistance of your doctor.

One of the aspects of recovery which I am sure you are aware of is that addicts like to be their own doctors. When you start doing that, you are behaving like an addict. Most normal people who believed their doctor didn't have their best interest at heart and who had a concern of retaliation if they changed doctors, would probably find another doctor with a good reputation to get a second opinion from. I also suggest that you be honest with your current doctor. I suggest that you tell him how you feel and how what he says makes you feel. Ask him WHY he is making the recommendations he is making. Ask him WHY he thinks 24mg is the correct dose for you. Ask. It is your recovery and you have a right to be an active participant in this process.

Cherie

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 Post subject: Tuesday morning.
PostPosted: Tue Oct 19, 2010 9:26 am 
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Goodmorning everyone! Again, I truly appreciate your feedback and support. I have a couple of things to address since reading the most recent posts.

1. I didn't mean to offend anyone when discussing the use of proper grammar and punctuation. I'm a bit cynical at times.

2. I think I used the wrong words when I wrote, "Now, during the week I'm usually craving them by about 9am (since I've been up for 4 hours already) and today I didn't take it until 2:15pm." I did not mean craving as much as I meant that my body is telling me, "Hello, goodmorning, take your meds!" I don't crave my Suboxone, but rather I can physically feel when I need to take it because I am starting to think about taking it. I know that may sound strange, but once I'm dosed, I feel like I have no thoughts of it at all. Before I dose, I am thinking about dosing. It's weird, I know, but it probably coincides with the whole 24mg thing.

3. I agree with many things that have been said here about my doctor. I *hope* that he does have my best interest at heart, and I can't say I am 100% on board with that, but I will try to believe it. The Ativan thing I agree with as well, and I know I mentioned the contraindications and the addictive potential. That's over with anyways. I plan on telling him what I've been up to, as you're right about me at times wanting to "play doctor". It's in my nature. I just discussed this tapering thing with a coworker who knows my entire story. We discussed how our methadone patients have the ability to self-taper and control their own dose freely, as long as they are drug-free and stable in their recovery and in all other aspects of their lives. We cannot tell them that we refuse to taper them. We can make recommendations and explain the process and potential hazards or consequences, but it is ultimately the patient's decision when they want a dose decrease. I feel that if I can continue to feel ok, I can get on a low enough dose to where everyone's happy. I am not saying I want to be off in a year, 5 years, or even 10 years. I just know that I don't want to be where I am at this time. And eventually, I'm assuming I will need the 2mg pills or film as opposed to the 8mg ones. So, I will eventually speak to my doctor. Next appointment is on 11/1/10. I will speak about it in my group with my counselor tomorrow as well. I feel like they will be on my side and perhaps my counselor can help me figure out a way to advocate for this, so that the doctor will be responsive to my decision. I think by not setting a timeline, but instead just setting a goal, I have a better chance of succeeding in this whole process. I am torn most days, between feeling cursed and blessed. I am truly blessed though.

4. I have dated addicts, non-addicts, and when I was using I was dating guys who were using too. I just got out of a 1.5 year relationship with a guy who was clueless about addiction, recovery, drugs in general, my work, etc. I became aware that he was beginning to act condescending towards me and almost looked at it like he was better than me. He didn't know anything about it and didn't want to know anything about it. This led to resentment and ultimately to the breakup. Since then, I have been "dating" or "seeing" this other guy, who I have known for about a year or more as well. Nothing serious yet, just being friends and supporting one another. We have our own opinions and they differ greatly at times, but I think he is on the right track and I am aware of red flags or danger signs when they happen. I never recommend that addicts stick together or find each other - especially when both are patients at the clinic I work at (lol). Anyways, I think in some ways everyone has a little "addict mentality" at times about various things and that if two people are stable on their own, and can handle life on life's terms, so to speak, that it can work out well. I believe that so far, we have done nothing but support each other and motivate each other to move forward and reach our individual goals. However, I do recognize your concerns and I have clearly contemplated over this a lot lately.

5. After posting last night, to ended up taking the other half - 4mg more. So yesterday and the day before, I totalled 16mg per day. No biggie! I plan to try the 12mg and decrease again at some point this week. I already feel more awake and motivated at work. The only trouble now is this laryngitis I have had for about 6 days so far. I don't feel sick but I can barely speak; and running groups today is already a struggle. I will keep you all posted on my developments throughout the day.

And again, thank you all for the warm welcome and your insights!


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PostPosted: Tue Oct 19, 2010 10:37 am 
This has been a great discussion. I just wanted to add something about "saturation". My doc told me at at 16mg/day the opiate receptors are 94% bound by bupe. (Rossma said the receptors are saturated at 4mg, but what I think she meant was that at 4mg you are usually at the ceiling, where your blood level is "steady state" and your daily dose simply maintains that state). So if you have 94% saturation at 16mg, another 8mg can only bind the remaining 6%, which is a high cost for a low benefit. I believe that is why current practice is the maintain at no higher than 16mg/day unless it is for pain or another compelling reason.

It seems a little concerning that if you wait four hours before taking your dose, you're getting that feeling that it's time. After taking 24mg for 5 years you should be able to go 2-3 days without noticing a thing, because you blood level is so high. (Again people, where is that chart that shows this!? It would be so helpful if I could find it!)

As for your doctor - when you said that the methadone patients are allowed to taper at their own pace as they feel ready, is your doctor the one overseeing these patients? Although I do agree that he wants to keep you safe, it seems odd that he would let the methadone patients taper and not you.

I know recovery requires rigorous honesty, but if your doctor is in effect your boss (which sounds like a conflict of interest to me) and he is going to react negatively to your tapering, you might have to go ahead (as it seems like you're already doing) and taper without his knowledge. Like Cherie said, it doesn't mean you have to taper "off", maybe just taper to a dose that feels more reasonable to you.
Thank you so much for postin your story. It brings up many issues that people on this forum have issues with and need to discuss. In fact, the topic you mentionned at the end, being in relationships with other addicts vs. non-addicts could really be a whole other thread that I think people would have a lot to talk about.
Take care and I wish you the best,
Lilly


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PostPosted: Tue Oct 19, 2010 10:47 am 
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I have to agree with Rossma. It's my understanding that at 4 mg (the ceiling) the opiate receptors are saturated. That's what I believe the ceiling means. But I'm no doctor or chemist, so maybe I'm wrong?

Counselor - Welcome to the forum. You've gotten great feedback here and I don't think I can add anything more to what's already been said. The only thing I'll say is I think you should be fine to taper down a bit and stabilize at a lower dose. Save you some money and time. Good luck.

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PostPosted: Tue Oct 19, 2010 2:51 pm 
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This is an excellent thread. A great example of why this is the best forum on the 'net for people taking bupe.


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 Post subject: Tuesday Afternoon...
PostPosted: Tue Oct 19, 2010 3:42 pm 
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It's Tuesday afternoon and so far, I've taken an 8mg film. I worked 6-2. I feel very tired today, even thought I got a decent amount of sleep last night. Anyways, my BF convinced me to go for a walk today before I crash for my afternoon nap. So, I walked around a cemetary near my house for almost an hour. It felt great! I feel out of breath and a little sore, since my energy level is generally comparable to a potato. However, I think this is a great motivation for me. He's definitely pushing me, and in the right direction. (He rides a bike for miles everyday - like a total nut, in my opinion) But then again, I've never been a very athletic person. So, now I'm back and feeling BAD. I got the yawns and watery eyes like CRAZY and my back is killing me.

Anyways, I wanted to comment on Lilly's post when she mentioned,

"It seems a little concerning that if you wait four hours before taking your dose, you're getting that feeling that it's time. After taking 24mg for 5 years you should be able to go 2-3 days without noticing a thing, because you blood level is so high. (Again people, where is that chart that shows this!? It would be so helpful if I could find it!)"

This sounds absolutely insane to me! I could NEVER even skip one day! I can barely go six hours without feeling the need to dose. Maybe it goes right through me!? I know for a fact I don't drink enough fluids and my food intake is erratic at best, so I can SOMEWHAT attribute my energy level to my health, diet, exercise (lack there of in this case). I feel like if I went even one day without a Sub, I would be in total and utter withdrawals. Believe me, I am prolonging my doses lately, but I'm about to take half of one as soon as I finish typing this (4mg). I find it hard to believe that most of you maxed out at 16mg. I mean, I must have an insane opiate tolerance at this point, compared to the rest of you guys! I feel like I've been overmedicated for years, now that I'm looking back at this time. I was using heroin (intranasally, not IV - not that there's too big of a difference there). And I was up to maybe 3-5 bundles (30-50) bags per day. This may seem insane to some of you, but on the East Coast, and I'm up north, this seems to be about the norm. Therefore, I think my tolerance for Suboxone was perhaps, adjusted or guess-timated appropriately. I think that there's a difference based on geographical location, substance of abuse (which particular opiate was the drug of choice), and the potency of the heroin, if that was the primary drug of choice. Anyways, I'm a bit baffled by this whole thing and I feel like I'm in a sticky situation at this time with the doctor, considering all of the other factors.

Also, my doctor is not my "boss". He's the Medical Director of the clinic - next to him (I believe) is a president-type-guy, under him is a Clinic Director, then supervisors, then me. So actually, he's not really someone I have to answer to at work, but more or less I work alongside him. And yes, he does prescribe the methadone to all of the patients. His signature is on all of the documents there and yes, he signs off on every dose change and completes doctor's orders for these changes. I guess it's complicated and I know there's DRASTICALLY different rules, guidelines, and policies for prescribing methadone vs. Suboxone.

Hope you all have a wonderful afternoon, and I agree that this is a serious issue that needs to be discussed. I know I'm not the ONLY person in this boat. I wish I found this forum sooner. Perhaps I could have been further along...Perhaps, Perhaps! Oh well! Talk to you all later! (@ 12mg so far today)...


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PostPosted: Tue Oct 19, 2010 4:41 pm 
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I guess I should have posted right away when I was thinking about it. I just figured I'd made enough comments on this thread. But...

When I read your comments about feeling the need to dose so soon, I had the exact same reaction that Lilly did. In fact, I completely agree with her. The reason I think this, is due to the dozens of people that I have read reports from who have gone several days without any withdrawal. It is due to those who have needed to stop their Bup for a surgery (in order to obtain pain medication and actually have it work) and they stop their Suboxone three days prior, find that they are not in withdrawals and sadly their pain meds don't even work - because they still have so much Bup in their system. It is just simple chemistry that at 24mg everyday, you most certainly should be able to go 24 hours without feeling withdrawal, You are so stacked up with Bup, that this simply is the case.

Now, before we go further, let's examine this more. Let's start with your comments:

"I can barely go six hours without feeling the need to dose."

"I feel like if I went even one day without a Sub, I would be in total and utter withdrawals."


The word that jumps out at me is "feel". I don't at all doubt that you do feel this way. However, I would strongly suggest to you that these are psychological feelings and not at all physiological responses from your body. Your brain and mind makes you FEEL like you NEED to dose, but chemically, you are very likely not in withdrawals and not in need of Bup. Now, I know, that there are those 1 in 1,000 people that don't process the Bup like others, but it is always amazing how many people think that they are that 1 rather than the other 999. As addicts we always want to think that we are different and we are special.

I'm not making up all of this on my own. It comes from my reading and study and frankly right out of Dr. Junig's blogs. He has written multiple times how patients on Bup will often feel like they need more meds or an additional dose or feel like they are going into withdrawals but after he works with them and convinces them to push through it, they do just fine after about 15 or 20 minutes. I have every confidence that if you were prevented from taking additional Bup and someone talked with you and helped you through your craving, you too would get past it and would find that, like Lilly said, you really could go two days without a dose after having been at 24 mg. In fact, if we gave you a sugar pill rather than Bup so you thought you took a dose, you would do just fine. Now at day three and for certain, day four, you would actually have physiological withdrawal symptoms. It would no longer just be in your head. It's just not the case at the 24-hour mark, and clearly not at a 6 or 12 hour mark.

Just give what Lilly and I are saying to you some thought. I'm not at all saying you are crazy or anything of the sort by saying that it's in your head. I totally believe that you are feeling the sensation of cravings. It's just a mental rather than a physical reason. It may also mean (may mean not does mean - just may mean) that your doctor is correct and you are not yet ready to stop Bup. It is often these mental cravings that do addicts in when they stop their maintenance. If even at 24 mg you have the sensation that you just have to have a dose every 24 hours, you still have some level of mental addiction active. Then again, in your line of work, I'm sure you already know this. It's often just harder when we have to apply it to ourselves.

By the way, exercise is often reported to do wonders while tapering - as you found out during your walk. Your boyfriend is giving you good advice in pushing you to get some exercise, as it likely will make you feel better.

And finally, don't rush yourself with your taper. You were on a high dose and not all of it was going un-used. To try to go from 24 mg/day straight to 8 mg/day is a hell of a large drop. You very well may want to try 16 for a couple of weeks then 12 for a couple of weeks and then 8. You are much less likely to feel the drops using this method. You are very likely to feel pretty darn crappy in days 3 through 6 if you cut your dose by 2/3s all at once. After all, you've been at 24 mg for five years. Why go through discomfort rather than spend just another month getting your dose down? After 60 months taking 24 mg, what's another month? You don't get extra points for suffering.


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 Post subject: Interesting...
PostPosted: Tue Oct 19, 2010 5:27 pm 
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Very, very interesting. I am not at all surprised by what you have responded with. Actually, I go through this same lecture multiple times per day with my own patients. "Methadone has what's called a half-life. If you miss a day, you will NOT be sick. You may even begin to feel uncomfortable physically, but you will not be in withdrawals, as you still have half of your methadone in your system. Your liver and other organs and tissues store some and release it slowly...wah wah wah wah wah..." My patients here this from my mouth on a daily basis. I know it's true and every now and then, I even get someone telling me, "hey, you were right, I made it through 2 days not using and I was ok" etc. etc.
Here's my problem. I certainly don't believe I am the 1 out of 1,000. I simply don't have that kind of luck - lol. However, I am far enough along here that I can recognize cravings and can implement coping skills, etc. in order to squash them "with the quickness" I must say. However, I am certainly not imagining the yawning, water eyes, and chills that go with all of this. I am in total agreement that at times, I have to tell myself, it's mind over matter. Perhaps, I am just hypothesizing that these symptoms may possibly be attributed to the way in which I have always dosed. I don't pop three 8mg pills at once, that's for sure. As I mentioned, one in the am, the afternoon, and the evening. It's been this way for 5 years. At one time I switched to one in the am, half in the afternoon, and one in the evening. I saw no difference, which for sure can be explained by the previous comments regarding the "ceiling" and the absorbtion, etc. Now, instead of taking that 4mg I was going to before my nap, I didn't do it. I layed down without it and was ALMOST asleep when my evil aunt decided to crawl out of her lair in hell to call me and upset me with the various crap she spews from her soul-less being. Now, I'm awake again. I'm not yawning and my eyes aren't watering. Therefore, I can only imagine that what was happening before to be earlier this afternoon could have been caused by allergies from my stroll through the cemetary, or due to just being exhausted from work. Either way, I am whole-heartedly tell you all that I cannot go 24 hours or 48 hours without my Suboxone. It is simply not possible. How do I know this? Because I have tried it. I have tried it maybe 3 or 4 times over the years. The farthest I could get was dinner time. Now, I had the same skills then and I was implementing the same coping mechanisms at that time as well. I just said "F- it. I quit." and I was fully prepared to be fine for a few days, get sick, and just cold-turkey the hell out of the whole things. However, by dinner time without the Suboxone, I was, to put it politely, physically attached to the toilet for an extended period of time with the whole spectrum of withdrawals that you would seem to expect to see after 2-3 or even 4 days with no Bup. I'm not saying you're right or wrong. I'm just documenting my experience. I now know a hell of a lot better than I did then, however, about slowly tapering being WAYYYY more successful in the long run. So, here's my plan for now: Go sleep for another hour or so, wake up, take a shower, see how I feel and put it off. My fear is: I will not sleep at all. This is an unreasonable fear, as you have all mentioned that I have so much stored up in my system. (Not sure if my skin is crawling because I'm talking about it, or because it's time to take some.) Maybe I will continue the experiment and not dose for as long as possible, but I would rather do the following right now: Go with the 16mg for a couple of more days and then bump down to 12mg somewhere between Friday and Saturday. As I said, I don't want to rush things here, but I don't want to prolong things either or start randomly dosing at random times. I do agree with the fact that I am NOT a doctor and I don't want to mess up my system more than it's already been. I have also discussed this at legnth with my mother, who I share a home with, and have informed her of my plan. She is supportive, agrees that this has gone on long enough, and is prepared for me to become more hostile and bitchy than usual. Well, in all actuality, she basically said, "If you're going to bitch, go outside." And it's pretty cold here so, I will try to also monitor my responses to others and general mood throughout this whole thing too. Perhaps it's time to move this thread over to the STOPPING SUBOXONE section...We shall see...


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PostPosted: Tue Oct 19, 2010 9:27 pm 
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I whole heartedly agree with everything Don said. Right now, you ARE in fact claiming that you are that 1 in 1000 in which case you wouldn't be lucky, rather UNLUCKY. This is possible. Because your physical reaction to discontinuation of suboxone is so outside the norm and statistics, you should probably discuss it with your doctor because for you, if you are that 1 in 1000, it will be much different. The advice on this forum is not likely to help you at that point because the people giving it are NOT the 1 in 1000. If you ARE the 1 in 1000, then it would have nothing to do with your tolerance to narcotics. Believe me, there are people on this forum who have taken enough to kill 4 horses at once and still the 16mg of suboxone works just fine for them dosing once per day. It is a metabolism issue, not a tolerance issue, or at least that is what I believe Dr. Junig once mentioned. I am CLEARLY not a doctor.

I will say that in my personal experience, prior to learning about the properties of bupe, I feared missing a dose and would WATCH for symptoms. I don't agree that I do not notice it at all when I skip 2 days. I can skip a day (do not prefer it) and if I keep busy, it won't bother me at all. In fact I think it is all psychological at that point. Day 2 I actually wake feeling fine and certainly will think about it but am still basically ok the entire day. It is day three where I start feeling it. The yawning will kick in at evening and then insomnia starts in the morning. By day 4 insomnia and withdrawal is full force (NOT as bad as oxycontin withdrawal or even close - I mean full force for sub). The same timeline applies for tapering 4mg or more at a time, except that on days 2-3 I will get sniffly, pupils enlarge just a bit, and I start yawning. The watery eyes start but again, not like oxy. With oxy it was like I had to carry around a tissue to mop up the eyes and with sub I can still just wipe them away with my hand. It just isn't the same withdrawal at all. With tapering, it stops at some yawning and psychological cravings and maybe some sneezing.

The best test for you to tell if you are actually having withdrawal or not is to go look in the mirror at your pupils. Do they respond to light? How large are they? You may in fact want to go look in a mirror in your bathroom after a dose to see what they look like and compare them to something in size. When you check 6 hours later, look in the same mirror with the same lighting. Then look 12 hours after dosing and see what they are. You know you are in withdrawal when your pupils are HUGE and I mean HUGE like non-reactive to light huge. When I jumped off 12mg mine were huge WELL after the physical withdrawal symptoms went away. In fact they were huge for about 2 months at least. People would comment on it they were so huge. It was weird looking. If your pupils aren't huge, then you probably aren't in any kind of REAL withdrawal.

I say this because that is something your doctor would want to know about and likely would want to see so he could in fact make better recommendations for you. That is something you can't control and that does not rely on your self report. Psychological factors cannot change that whereas psychological factors CAN make you yawn, or make your stomach sick, or make you feel pain or insomnia. In my opinion psychological factors also cannot make you sneeze but I could be wrong on that. Sneezing was huge for me when I was in withdrawal.

Cherie

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 Post subject: Agree with others
PostPosted: Tue Oct 19, 2010 11:30 pm 
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Hi, I'm new here too but have been on sub for about 3 years. I went from 32 to 8 in a week with no problems. Now I go back and forth between 4, 6, and 8 but try to only take it once a day. Yes sometimes I "need" that evening dose but I know its just good old fashioned cravings. I encourage you to seek out a couple of Dr. Junigs posts:

Anxiety, are you sure?
Video post about ceiling effect
Maximum absorption.

We're all in this together. I wish you the best, and hello to everyone here.
Jimmy


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