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PostPosted: Wed May 18, 2011 12:23 am 
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Wow, I just got done signing in here and checking over the site while reading a bit here and there and am soooooo happy I found this site! I have some questions about suboxone and other things but also want to put my story out there so to speak to find out I am not the only one suffering with some aspect of the treatment. (hopefully?)

I work, or should say worked I will go into that later, in the medical field also and when I admitted my addiction to Vicodin my first thought was the humiliation if anyone found out! So, my primary doc referred me to the only full-time psychiatrist in my town that could treat with suboxone and I was so relieved because I could just take this med and I would be fine. Ha Ha...famous last words. I have suffered from depression and chronic anxiety w/panic attacks since 1988. When I started taking suboxone at 24 mg dosage many different things happened to me, some right away and some down the road and some a few years down the road. First off I have been on suboxone for almost 6 years!!!!!!!!!!!!!! Has anyone been on it this long? Do you know anyone who has been on it this long? Besides being on it, the first side effect I experienced was sweating! I felt like I was going to sweat myself to death (still do sometimes) and my doctor could not tell me if this was from the drug or not? Come on, she is certified to treat with this stuff, she should know the more common side effects like the back of her hand. Then my depression went from being controlled under treatment and doing okay to on the edge and going to jump! Psych raised my antidepressant, took away a dose of my anxiety meds and added Geodon. I took off work one week while taking the Geodon and that was the beginning of my own private hell at work for the rest of the last 5 years. I was not getting better in regards to my depression and was missing work a lot. I have never been that down before and thought the suboxone was suppose to help a little, then I was on the 8/2 at 3 pills a day. So as my life continued in a downward spiral and more drugs added, then taken away then another added then more depression, missed more work , then more anxiety and more panic attacks, which ended me in the ER which is where I work!!! I wish I had known exactly what was going to happen to me after informing my supervisor of my psych/addiction problems, I had talked with my psych about disclosure to my employer or I was going to lose my job and she said "Think long and hard about it because you can't take it away once you tell them" huh???? Now I get it. So last Fall I am in another one of my chronic anxiety stages and one thing I forgot to say which is paramount here is that I would have to call my psych/RN to call in or fax over my prescriptions when I needed them and they are only in the office M, T and TH. That's it, so if they don't take care of something for me by Thursday afternoon, I am screwed till Monday am and let me tell you I had been left hanging on a Thur or Fri afternoon many times! I have gone from Fri (after last dose) till Monday am without suboxone 1 time and thank God I had the clonazepam! And that I didn't have to work the weekend. After that, it still happened but the pharmacist would give me enough subs to get through the weekend and then I had to call and yell about it on a Monday again! Plus I would had another bill from the walkin for having to get my clonazepam. By this time, which was last summer now, I truly did not know who the hell I was anymore. My panic attacks were over the top, especially if I called the pharmacy and again there was no rx on the date stated, and they would end me in the walkin or ER in tears and a nervous wreck! I was back to 1988 again when just the thought of having a panic attack would put me in one. Only, much worse this time around!

So..... some side effects I had developed since being on the suboxone is the sweating, sometimes shaking especially my hands, or a body part will jerk like a big spasm, sometimes a couple times in a row, forgetfulness to the point I am scared and it seems to me my depression and anxiety were getting worse! Oh, before I go on, last Summer I decided on my own to start reducing the suboxone since my psych wasn't trying nor was she answering my questions about side effects, anyway.....wait before I can tell you this I have to go back even further......my insurance company decided they would not pay for suboxone anymore but WOULD pay for subutex and so I was on the smaller white pills (2 mg ea)and had worked down from 24 mg to 6 mg a day ...yay me! Okay now, I can tell you about last Fall...on a typical Thursday afternoon I am on my way to pick up my prescription of suboxone and clonazepam and ....the suboxone was called in but not filled because the insurance company was refusing to pay for it!!! Now? since they had paid for it all year?? Ok, ...so the pharmacist could not help me until someone spoke with my dr and got the rx changed which it was late Thur afternoon now, good luck! We ended up filling I believe it was 9 pills but I had to pay cash and even those few was 40 some dollars I believe it was. So, I had to wait till Monday morning to take care of the suboxone/subutex deal but I had some pills so no withdrawal thank God, but my anxiety was not coming down and that medication had NOT been called in by my dr. ...Wow, was my anxiety out of control again! I awoke that night at 2 am in a full blown panic attack and drove myself to the ER (where I work remind you) to hopefully be helped. Well....long story short...my supervisor called me in to her office the next morning after a meeting I had to be at at 8 am. only to accuse me of having a drug problem?? This is where things went so very wrong, apparently though, co-workers had been going to my supervisor for some time with all these complaints about me. Many things were said in her office that day that were wrong and quite frankly illegal. She had no right to have my privacy violated by being a patient the night before no matter what the ER doctor thinks he knows!!!! I can't say anymore about this part right now because we would be here all night reading it. So I will post more I am sure as things come along.

So, the bottom line questions I have are (I need to stop getting off track here..lol.): Is my sweating probably due to the suboxone? Is there anyone out there still on a highish dose at almost 6 years? (note that above I said I was down to 6 mg on my own, but here I say highish dose? Well when the insurance company refused to pay and my doc had to change my meds last Fall, she prescribed 3 per day as I was taking, but they were 8 mg tablets so I was now back on 24 mg!!!!( She did say she was sorry after all) :? Yes, I called and questioned it many times and yes I played with the dosage but then didn't know where the hell I was suppose to be...lol..Is there anyone out there who also suffers from other psychiatric disorders along with taking suboxone and tell me I am not alone going through periods of so severe of depression I can barely remember my name? I also had to go down to part-time from full-time because of my problems and that caused a severe money problem that escalated last year. But, I just have never felt like myself since I have been taking this stuff and sometimes I have just wanted to say the hell with it ya know?? But I wouldn't. I also should tell you that in 2005 when I started the suboxone, I was taking up to 24 pills in a 24 - 36 hr period, I had just left my husband and filed for divorce because he was addicted to crack!, I started menopause!!!, I lost everything in the divorce because of my ex, stupid me only asked for child support and I sure could use that maintenance payment now...my daughter is 21 so really the financial problem started when she moved out but I held it together until last summer. Well I thought I did ...I couldn't pay rent for 3 months and got evicted July 31st with a 20 day notice. Man, I could write a book I think...lol....phew! I really put a lot on here and I apologize I was not going to do this, only wanted to ask my questions and wait for some answers but after reading all the posts I guess you all just made me feel it was okay to talk about it all.

So, I am stopping here and hopefully some brave person will have read all this junk and picked out the important questions I wanted answered and post the answers for me...lol.. :oops:


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PostPosted: Wed May 18, 2011 8:21 am 
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Hello and welcome! First of all, yes, the suboxone can definitely be causing the sweating. And it's likely going to be worse at high doses. 24 mg is a pretty high dose to be on after so long, especially for someone not taking it for pain (although it's not totally unheard of). When you were down to 6 mg did the sweating subside or lessen at all?

I'm glad you described some of the hell you've been through lately, because it gave me some ideas. Personally, I'm thinking that your depression and anxiety could very well be completely independent of the suboxone and caused by everything that's going on in your life. Everything you've been through and are going through is enough to cause such anxiety and depression.
That said, some people have said that suboxone causes or contributes to some anxiety, although I've never found that to be the case, but everyone is different. I've never heard of suboxone causing depression though - but again, everyone is different.

Do you see a therapist or counselor? Or does your psychiatrist also do counseling for you? If not, I would highly recommend you find a therapist to help you deal with this stuff. When I started sub I also stopped taking a shitload of xanax and was terrified of my anxiety. It turned out that once I learned meditation as well as learned to live life on life's terms and to accept the normal ups and downs that each day brings, my anxiety is now non-existent.

I truly think your depression and anxiety is more likely related to what's going on in your life and perhaps suboxone is affecting it in some way, too. I also think the worse it gets the more upset you get and the more it snowballs and keeps getting worse. It also sounds like your shrink has been really messing with your antidepressant meds alot. Sometimes we have to give such meds time to work before switching them around so much. Were you given time to stabilize on these meds at all?

I've struggled with major depression for the past 25 years. When I went off opiates I didn't just stop the xanax and pain pills, they also stopped ALL of my meds (sort of to clean out my system and start over). They put me on Celexa and later added Abilify. I'm more stable now than I've ever been in my life. And for what little anxiety I have left I actually take a beta blocker. For me this works better than any benzo ever could.

Sorry, didn't mean to go off on that tangent....Anyway, I hope this helps a little bit. If you have more questions, just ask away. It's what we're here for. Again, welcome!

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 Post subject: Thank you!
PostPosted: Thu May 19, 2011 3:32 pm 
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Thank you for all the information you have given me and I think you have some very good points! Yes, the sweating was decreased when I was down to 6 mg. so I think I can check that one off. I do have a counselor besides my psych doc and I love her but just found out today she is going to be gone from the office for an unlimited time and I have to start seeing someone else now. Guess what happened?? Yup, up went the anxiety at just thinking I have to have a whole new rapport made with another counselor. Have not seen my counselor since quitting my job and all they can offer is a couple weeks away unless I want to go through mobile crisis. No, I don't want to do that either. I hate having to start all over with a new counselor!

Yes, I think my psych doc did make too many changes to soon. I have been having less anxiousness since starting on it so that decreases my use of clonazepam which is good. I am now taking 16 mg of Suboxone which is 2 pills a day and am going to try very hard to really get down and off this stuff. All I know is since I have started taking it and seeing the psych doc I am seeing, I have never got back to good. If you know what I mean? I found it interesting you mentioned a beta blocker. I was running the same thoughts through my head when I was working on the cardiovascular system for school awhile back. It makes sense since the rapid heart rate is what seems to start the anxiety and then the circle begins.

I don't know if I mentioned this part and that is that for the last couple years my body has been having uncontrollable body jerking. It started with my right hand, middle finger while using my mouse at work ...the finger kept "jerking" and hitting the R click of the mouse constantly opening that little window. Well it progressed to every area of my body and there is no rhyme or reason to the jerking. I did notice less of it with the clonazepam which again makes sense. This last week though the jerking is so intense sometimes it hurts. Especially if its my whole arm or leg. I have kind of kept this under my hat because I was afraid it would prevent me from pursuing my schooling and work. Well, now I guess it is so bad it needs to be dealt with.

Again, thank you for answering some of my questions I really appreciate any input on here. I see my psych doc next week to evaluate how the doxepin , which as long as it doesn't start packing on the weight for me and it is helping the anxiety at the lower dose of 10mg 3 x daily I might just stay on it. My family doc I also see next week and one of the things is my elevated BP which is giving me bad headaches when it runs high that I am seeing him for but I would like to talk to him about the beta blocker route. Thanks again!


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PostPosted: Fri May 20, 2011 7:00 am 
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I've heard of some people talking about that body "jerking", although I can't recall the specific circumstances. I believe they were happening during sleep for a small number of people. I also know that such things happen when discontinuing other types of medication, like some antidepressants or it can be a side effect of other types of psychotropic meds. Are you taking or going off anything like that?

Believe me, I know firsthand how much it sucks having to get started with a new therapist. It's a pain in the ass having to start over from the very beginning and it takes a long time to reach a point where you're actually getting some real work done. But I'm sure you know this - it can really be worth it. I'd encourage you to push through and keep searching for a new therapist.

Good luck to you - hang in there. And keep us posted on how you're doing.

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 Post subject: suboxone: just a warning
PostPosted: Mon Jun 06, 2011 6:32 am 
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i had a boyfriend who took about 4 8mg pills a day. originally a heroin addict who took it to detox then kept taking it for the longer high and so he wouldn't use heroin again. i met him when he was taking suboxone and he seemed normal and stable. he started giving them to me recreationally then i started taking them daily. just 1/16 or so of a pill. i never really increased my dose because suboxone seems to be just about as effective no matter how long you take it, which is a miracle in the opiate world (and i'm sure why it has helped many addicts live more stable lives). i'm in college and when he would run out of pills between appointments life just isn't possible: too much pain. eventually started smoking heroin just to deal with withdrawals when didn't have subs: how ridiculous is that? eventually realized couldn't go to school with an opiate addiction, so detoxed myself and got rid of druggie bf. all i have to say is: THESE PILLS ARE STRONG AND ADDICTIVE. if you are an opiate addict, take them to withdrawal but don't start taking them as a replacement. first off, they are $9 a pill, so it seems like a med scam to begin with. secondly, the withdrawal from heroin was easier than suboxone. the half life of subs is impossibly long. withdrawal doesn't even officially start till 2 days after last does and goes on forever. if you're taking subs, know that you're in for a long road to recovery to sobriety, longer and more painful than your heroin wds. JUST A WARNING NOT TO SCARE ANYONE FROM MAKING LEGIT PROGRESS WITH THIS DRUG. good luck to all of you. i got over opiate addiction and you all can too. get off while you're still young and resilient and have enough self worth to be able to!


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PostPosted: Mon Jun 06, 2011 1:10 pm 
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So you were using Sub recreationally and only using heroin when you couldn't get any? Have you ever had a full blown heroin addiction? I think it's irresponsible to say that the withdrawal from Sub is worse than from heroin. Full agonist withdrawal is very intense but short lived. Sub withdrawal is relatively mild, but lasts longer. I have detoxed from Sub myself and didn't even rate it in the same ballpark as full agonist withdrawal.

There are a lot of folks here using Sub as a recovery tool. Let's not scare them off.

dpackup - sorry I didn't see your original post. How are things going now? I'm interested to hear what happened with your job after the ER doc discussed your addiction with your supervisor. That sounds so unethical! Hope you're still here.
Lilly


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 Post subject: Irresponsible????
PostPosted: Mon Jun 06, 2011 8:45 pm 
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How is saying sub withdrawl is worse than herion withdrawl irresponsible.......???? Once again this is a posters personal experience not yours. I will tell you that I went through w/d of sub for 4 days and it was the worst w/d of my life from any opiate I have ever taken. I actually had thoughts of suicide which scared the shit out of me.

What would be irresponisble Lilly is to lie and say that for me it was not that bad.......It was horrid and hope I never experience it again. I hate when people are not allowed to share their personal not yours but their personal experience without being told they are irresponsible.

Just so you know we are not that powerful. If someone is researching suboxone they should not take the word of one suboxone or former suboxone user and take what they have to say as gospel. They have to do their research and then make a decision. To not list that for me w/d was the worst ever would be dishonest.......You shared your experience and you said it was short lived......several have disputed that.

Jim


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PostPosted: Tue Jun 07, 2011 2:26 am 
In my humble opinion, what I found "irresponsible" about "opidroid's" comments about how much worse Sub w/d is when compared to Heroin w/d, is that nowhere in the post did "opidroid" mention ever being addicted to Heroin. The OP implied that Suboxone was his/her drug of choice and that he/she only used Heroin on occassion when he/she had no access to Sub. That makes me wonder how could the OP even know what full-blown cold-turkey w/d from Heroin is like? I didn't read anywhere in that post where the OP had in fact ever detoxed straight off Heroin.
I would never argue with anothe person's experience in withdrawal from this that or the other.....It's way to subjective. But I do need to have a good idea of what the whole story behind the experience was, in order to forumulate an opinion regarding whether or not something sounds reasonable or not.
I don't recall reading many stories of anyone coming off a steady dose of buprenorphine over around 2mg/day and not having had a pretty rough go of the w/d for many weeks even. I don't think anyone who has much experience with the drug would argue that it tends to be rough and long and drawn out when w/d from bupe.
On the other hand, I think we'd be pretty hard-pressed to find someone who cold-turkey detoxed off hefty doses of full-agonist opiates (including Heroin) who didn't swear that that detox was as brutal as Hell either. I can personally testify to my own cold-turkey detox with zero comfort meds off large amounts of oxycodone, hydrocone, IV Fentanyl, IV Demerol, Soma, IV Dilaudid and IV Morphine (the latter two being used only minimally as not my faves.) It was the toughest thing I've ever endured in my life and the acute phase was rather lengthy and was followed by six months of severe PAWS, depression, amotivation, etc. I cannot phathom anything being any worse than that was at this point. That's not to say that detoxing from Sub won't be.....I haven't completely done it, so I don't know yet.
I just have to wonder if the detox from Heroin which the OP refers to which was so much easier than the Sub detox, might have been a bit skewed because perhaps buprenorphine played a role in that detox. Perhaps that Heroin detox wasn't so bad because Sub was taken at some point during it. I'm just speculating, but if the OP knew that the Heroin was so much easier.....why did he/she not just detox from the Herion rather than the Sub? Just a thought.
Opidroid, If you're still around, would you mind coming back and clarifying a little bit? That would be great.


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PostPosted: Tue Jun 07, 2011 8:59 am 
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Lilly and SetMeFree made some excellent points and I won't add anything to those points specifically.

When it comes to stating one's personal experience, of course that is and has always been welcome here. The issue is when those opinions are presented as blanket, factual statements, such as "suboxone is addictive" or "the withdrawal from heroin is easier". Dr. Junig and moderators have stated and explained this on numerous occasions. It's just a matter of how that personal experience is presented. For example, "in my experience, heroin withdrawals are more severe than suboxone withdrawals". That's much different than saying, "The withdrawal from heroin is much easier than from suboxone." One is very clearly personal opinion/experience and one is presented as a fact.

As for the statement of "suboxone is addictive", we've discussed the difference between dependency and addiction here before. Addiction is a set of self-destructive behaviors that has the propensity to destroy our lives as well as those around us. There are more criteria involved, but that's the general idea. Dependency is merely a physical dependency on the medication and the need to taper or wean themselves off of it - that can include meds like benzos or even antidepressants; and it doesn't include the same self-destructive behaviors that addiction normally does.

I hope this helps to clear things up, especially with regard to members expressing their personal opinions.

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PostPosted: Tue Jun 07, 2011 9:45 am 
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Lillyval wrote:
So you were using Sub recreationally and only using heroin when you couldn't get any? Have you ever had a full blown heroin addiction? I think it's irresponsible to say that the withdrawal from Sub is worse than from heroin. Full agonist withdrawal is very intense but short lived. Sub withdrawal is relatively mild, but lasts longer. I have detoxed from Sub myself and didn't even rate it in the same ballpark as full agonist withdrawal.


Have you jumped off a dose over 6mg?

Let's be fair here. When people go off suboxone, they generally (well at least the smart ones) taper down to a low dose. The people that say suboxone is a rougher detox than heroin have usually jumped off high doses of both.

When people get off heroin, they rarely taper down. Occasionally I met people who could "cut down" on their habit. But they were few and far between. I've had pretty bad heroin habits, but jumping off the same dose of suboxone that would "held" those habits always hurt more than the, both in duration and intensity.

But people are different, and I understand your experience may have been otherwise. However, the number of people who claim suboxone is harder to get off definitely outweigh the others.


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PostPosted: Tue Jun 07, 2011 10:46 am 
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I'm sorry to have caused offense. I used the word irresponsible because I believe that the person who stated that Sub withdrawal is worse than heroin withdrawal never, in fact, withdrew from heroin.

Jim, I also experienced severe depression when I went off Sub, so I don't mean to minimize the experience. (I had been on 4mg and went to 2mg for a day or two when I jumped).
What made me object was that the statement was neither fact nor the sharing of personal experience, just a conjecture.

Opidroid, I mean no personal offense. I hope you will continue to share in this discussion.
Lilly


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PostPosted: Tue Jun 07, 2011 11:49 am 
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Hi, dpackup. I haven't had the exact same experience as you, as no two experiences on Sub seem to be alike, but I have also been on it since 2005. I don't remember the exact day I started, but in three to four months, it will be six years for me, too. I've absolutely experienced much of what you've talked about. I was on a high dose for a long time, since I was taking it for pain. For about 1.5 years, I was taking either three or four 8-mg tabs per day.

I'm not exactly sure what your plans are as far as whether you truly want to stop taking Sub or just want to taper down to a lower dose or if you are up in the air with what you want to do. In my experience, it has gotten harder to taper over the years, which isn't supposed to happen, but it has. I've done what you've done and gone up and down on my dose, so I've tapered from the same doses to the same doses several times, which is why I say it has gotten harder. That's okay and it is what it is, but up until recently, I didn't fully comprehend how dedicated you have to be to religiously and carefully taking the correct dose and tapering slowly and steadily. Truthfully, it's hard to grasp how tough it gets as you get very low. You absolutely cannot play around with your dose. It's very hard to stick to this, which is why I encourage you to thoroughly consider what you want to achieve before you get going. I started tapering in the end of Oct. 2010 from 8 mg and am down below 1 mg now but I still have quite a ways to go, which I would never have believed when I was taking 8+ mg. I would have thought less than 1 mg was basically there, KWIM? I personally did not respect how strong this med was until I got very low. I would never have believed it would be easier to get from 32 mg to 2 mg than from 2 mg to 0 mg.

What I've learned from this is that you should not do large drops, especially at the higher doses, meaning above 2 mg. Until you get down to the lower doses, you can easily do small drops that shouldn't be that tough at all. If you are on 16, don't drop more than 2 mg from there. Try to keep it around 10%. So, if you dropped from 16 to 14, that's over 10%. The next drop, I'd encourage you to only drop by 1 mg, which is less than 10%. Wait at least one week after each drop or at least wait until you have four days without any discomfort. The bottom line is that you really don't want to burn yourself out at the higher doses. Once you get to around 2 mg, you have to slow way down. Whatever you do, don't just take a bunch of extra here and there. If you do that, you will yo-yo up and down and never really get anywhere. Sub's half life means it stays in you for sooooo long. If you take extra on one day, that extra will last for days. You won't really know how much you are taking. It's imperative to be super, super strict while tapering. To get off of 16 mg without too much discomfort, as being on since 2005, could take you 1.5 years, if you are anything like me. Once you make progress, don't throw it away by taking a bunch of extra from time to time. I suggest recording how much you take each day, so you are accountable to yourself.

The good news is that many of the symptoms people get from Sub start to dissipate as your dose decreases. I've noticed many of my symptoms, some of which are similar to yours, have either gone away completely or greatly lessened as my dose decreased. So, if you are having symptoms on Sub, I doubt you'd need to go completely off it to have them substantially improve.

Following each drop, especially at the lower doses, it's common to experience some depression. Once again, a lot of that can be avoided if you just go slowly. I don't know how Sub detox compares with full agonist detox. I have only been through Sub. The hardest and scariest part of Sub detox, for me, is the emotional part. ReRaise's experience reminds me of a few times I'd like to forget about. It's sooooo important to go slowly and not run out and not drop in huge doses. The world has gone very black for me when I've quit taking it or dropped too fast. It can be quite scary, and if you struggle with depression, you need to be very careful in this regard.

I hope I didn't scare you or discourage you. I'm just going based on my own experience and what I've read from other people. You can taper if you want to taper, whether to a lower dose or off. It takes effort and commitment, but you can absolutely do it. If you do it right, it can be relatively smooth, too. At the low doses, it may get tougher, but we are here to help you, whatever you decide.

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 Post subject: Dependence
PostPosted: Tue Jun 07, 2011 11:27 pm 
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Yes Hat......you have stated your position on addiction vs dependence while taking suboxone. I will tell you that it doesn't mean that I agree with you or Dr J.

I have said several times that if I went 10 days or you went 10 days without suboxone what would you do and no one will answer that. I will tell you that I will go back to addictive behavior to either get suboxone or my drug of choice. That means ER visits, Dr shopping or buying on the street. Yes suboxone keeps my craving and desire for opiates at bay.......but without it I have to start all over with w/d and we know from reading several post it could last up to 30 days. Again this is not my personal experience or yours but knowing how I felt after just 4 days......if my doctor had not come through with getting my suboxone I cannot tell you what I would have done to feel better........because I wanted to die and could not control my own thoughts.

Most of us addicts will say that the worse w/d we went through was our last one......this is so true. Whether it is herion, opiates or suboxone. I have said all along that I worry that I would have to go to treatment to get off suboxone. The reason is because I am weak......there it is. I don't want w/d......and everything that goes with it. So I keep taking suboxone.

Every month I panic right before my appointment because I know my doctor is not on the up and up. I have to be buzzed into his office........spend 3 minutes....pay $175 and walk out with my script. I worry every month that this is the month he gets shut down. I know he is not the right doctor but I fear dropping him for another because despite the negatives I get the script. If that isn't addictive behavior I am not sure what is.

We all have different opinons about addiction......some believe it is a disease......a choice....my family just doesn't understand why I just can't stop as they continue to drink and take opiates.

Some say suboxone has saved their lives......I used to believe that and if you said something negative about suboxone we might be rolling on the ground. After 2 years I am scared about what I have done and think that I could have dealt with the w/d from loratabs and moved on......but I didn't I went on suboxone. Did I save my life........did I trade one addiction for another.....is my brain totally screwed up. I don't know. Addicts hate change........I especially with a passion. Everyday I wonder if I made the right decision.....the side effects are there even though some dispute them. I have a decision to make but for now I am too afraid to stop because I know if I stopped without anyway to get suboxone I am not sure what I am capable of and the one experience I had where I could not stop thoughts of suicide makes me wonder what did I do.

So......I continue to try to learn by reading the forum and listen to eperiences but I have to tell you when a moderator simply expresses that all is sunny and bright and that all the side effects are for some other reason than suboxone makes me laugh that someone in that capacity is so close minded.......I used to be a black or white type of person that the rules are the rules........but sometimes it just is what it is.......and that is ok.

Jim


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PostPosted: Wed Jun 08, 2011 5:47 pm 
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This is an interesting topic so here is my two cents worth. I am one of the ones who got beat up for 30 days and am 60 days clean today. I was only on suboxone for 2 months and wonder if perhaps when quiting a person not only is detoxing from the sub but also the ten years of heavy, daily opiate use as well. It's also kind of odd that I have not craved drugs, not even once since I quit. I believe that each person has their own unique experience with quitting any kind of addiction. I know length of time using, how much per day and age are all factors that contribute as well. I'll be 60 next week, so I'm no spring chicken.


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PostPosted: Thu Jun 09, 2011 11:22 am 
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This is what the DSM-IV states about Substance Dependence and how it is diagnosed. FYI.
There are two categories: Substance Dependence and Substance Abuse.

First let me say that many in the field argue over the semantics of this diagnosis and many misunderstand the way it is written. That is especially important when a client is coming in for treatment who is mandated by the courts for whatever reason...a wrong diagnosis can really fuck someone's life up. Personally, I really hate mental health diagnoses...labels...mental health issues are so judged. And this diagnostic tool, the DSM, is really to help communicate with other medical and mental health providers. Bottom line. It doesn't address treatment strategies at all.

Substance Dependence: A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as minifested by three (or more) of the following, occurring at any time in the SAME 12- month period:

1.) Tolerance, as defined by either of the following
a. a need for markedlly increased amounts of the substance to achieve intoxication or desired effect
b. markedly diminished effect with continued use of the same amount of substance ( this means reverse tolerance a l ot of times at end stage disease)

2.) Withdrawal, as manifested by either of the following:
a. the characteristic withdrawal syndrome for the substance (meaning opiates vs etoh etc)
b. the same or a closely related substancee is taken to relieve or avoid withdrawal symptoms (such as drinking alcohol when you run out of opiates or finding more opiates to minimize w/d.)

3.) the substance is ofoten taken in larger amounts or over a longer period than was intended
4.) There is a persistent desire or unsuccessful efforts to cut down or control substance use
5.) a great deal of time is spent in activities necessary to obtain the substance (such as hitting ER's, driving long distances to obtain said drug), use the substance (such as chain smoking), or recover from its effects.
6.) Important social, occupational, or recreatinal activities are given up or reduced becauase of substance use
7.) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (such as current cocaine use despite recognition of cocaine induced deperssion, or continued drinking despite recognition that an ulcer was made worse by etoh consumption)

Then, we specify if there is 1.) With Physiologic dependence: evidence of tolerance or w/d
or 2.) Without Physiologic Dependence: no evidence of tolerance or w/d.

There is more....there are course specifiers depending on remission times, or if someone is on agonist therapy (methadone) and mention of partial agonist therapy.

So when diagnosing someone with opiate dependence you need to have at least 3 (or more) of the above list of 7 symptoms that occur within the SAME 12 MONTH PERIOD.

The difference between a dependence diagnosis versus an abuse diagnosis is that the first two of the above are not included (tolerance and withdrawal) and you need to only meet one (or more) of the following in order to have an abuse diagnosis:
1.) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (repeated absences at work, poor work performance related to substance use, neglect of children or household etc)
2.) recurrent substance use in situations in which it is physically hazardous (driving while using etc)
3.) recurrent substance related legal problems (arrests, etc)
4. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (arguments with spouse about consequences of intoxication, physical fights)
and,
B. The symptoms have never met the criteria for substance dependence for this class of substance.

The significance of the two diagnoses many times comes down to if a client meets certain ASAM requirements as a way to determine what kind of treatment someone needs. (Residential, outpatient, education only) for instance if someone gets a DUI and they only meet abuse criteria they might be ok with just attending the educational courses and then following whatever their states laws require for DUI versus having a dependence diagnosis and needing full blown treatment.

So, as far as many in the mental health community are concerned someone on methadone or Suboxone is "using". Many medical and mental health professionals cannot be on Suboxone and work in their field of practice depending on which state they live in.

And really, in my opinion I believe I am clean but when I read what ReRaise wrote above I think he has very valid points. We will go through w/d if we don't have Sub. and we will be likely to revert to drug seeking behavior in order to NOT have w/d. And really the big difference between abuse and dependence is obviously tolerance and w/d symptoms.

I think we all agree we are dependent on Suboxone. Are we clean? What difference does that make really to determine "clean" time? Maybe it is important to some...I know in AA/NA they put a lot of stock in sobriety birthdays. Maybe that is a motivator for some. It definitely makes a difference if you want to work in the mental and medical health field and you've disclosed your past addition and current recovery status...To get licensed you are asked the question if you've ever been in treatment, or are currently abusing a medication and one has to decide if they will disclose this or not. People in AA say rigorous honesty. That rigorous honesty can really inpede your work...Personally, from experience I believe I need to be congruent in my life and my work life so at this point I do disclose it. I once made a decision to not disclose it because I was not required to and eventually it came back to bite me. And becauase of my transparency about my addiction and my recovery I got hurt very badly in court going through a divorce, even though I was the stable one. My history was out there. I get to be the scapegoat much of the time. Still. But, that's just my opinion.

It's complicated. People in this field don't even agree. Some Sub dr say anyone on sub should be on Sub for life. Some Sub dr say be on it for four months and taper off. THEY don't agree.

I'm only posting this as information...I don't think there is an answer. the only answer is what each of us feels about ourselves. I feel I am clean because I don't do behaviors that I did when in active addiction and my life has changed radically. Integrity is very important to me. Living a life being helpful is very important to me. Yet I do sometimes struggle with the idea I am on this medication because I am terrified of w/d. I think about it a lot. The idea of trying to go off of it. But on the other hand I take it each morning and go on my day without another thought....until I get a hotflash, or start yawning a lot, or other symptoms that make me wonder what the heck is going on.

I'm grateful for one thing and that is that I do not have cravings for opiates, for alcohol, for anything mood altering. So I juggle that against my fear of w/d, my history of three relapses,, and what is going on in my life currently, what kind of stressors do I have...and make a decision to remain on Sub for now.


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PostPosted: Thu Jun 09, 2011 12:50 pm 
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Great post, China! It's all so technical and I think it comes down to each one of us making our own honest assessment of ourselves. Sobriety dates and clean time are all supposed to be a way for us to celebrate our progress, not a way for other people to judge us.

Personally, my sobriety date from alcohol is super important to me, because that was MY drug and it was killing me. I'll never forget that date or stop celebrating it. I think I want another date when I get off Sub, because this is so tough to do and I want to recognize it. Obviously, there is a big difference between being loaded and then hungover and being on Suboxone. I'm not falling over and passing out. I'm not calling people and forgetting everything I said. I'm not going to crash my car because I'm so intoxicated. It's totally different.

On the other hand, the amount of time I spend thinking about how much Sub I have, how much I'm taking, whether I can stop; the amount of time I spend feeling kinda crappy because my body wants more Sub, etc. all feels way too much to me like when I use to stress over my alcohol. It feels too much like what everyone would accept as active addiction in some ways. It's discouraging to me to have been sober from alcohol all this time, but I get w/d symptoms and am waiting until I can take my little piece of Sub to get me closer to well. It's like when I'd sit in class and count the minutes until it would be over so I could go home and drink to steady my nerves. I mean, I thought I was done with this nutty crap! It reminds me how attached I still am to a substance and I'd like to cut that chord for me, regardless of what any organization or doctor says. Before my final sobriety date from alcohol, for a couple years, I would go for months at a time sober and then relapse for a couple days, then repeat. I gotta say that the time I spend sober before starting Sub felt a whole lot freer to me than being sober on Sub. That said, do I have a problem with people who are fine with staying on Sub forever? NO! Do I think they are NOT sober? NO! It's not even my place to make that determination anyway. (Someone who is snorting or shooting Sub is another story.)

It really doesn't matter what other people think about your recovery, in the end. Recovery is about being honest with yourself about where your life is at. Anyone can fake recovery, but that's only cheating oneself. Someone can be on no drugs whatsoever and not be in recovery, and that can be very obvious. There's not simple check list that you can take to conclusively determine that you are sober and in recovery.

laddertipper

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First you take a drink, then the drink takes a drink, then the drink takes you. ~F. Scott Fitzgerald


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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