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PostPosted: Sat Feb 08, 2014 10:38 pm 
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Hello everyone. I am new to the forum. I guess I will start from the beginning. My addiction began when I had to have an emergency c section with my daughter 10-1-12. I had complications with the surgery that kept me on prescribed meds until I had corrective surgery 4 months later. Needless to say I didn't want to give them up when I became pain free. I started a downward spiral that ended me in the ICU with an infection in my heart from iV ing.

I was 14 days clean when I heard about suboxone. At that point I did my research and decided to try it. I was still experiencing w/d and sick off all my thoughts of using being in control. I have been on 16mg for 3 months and it has really helped me. No cravings, no addiction running my life. I could do normal things without needing drugs or even wanting to. My insurance changed in January and after fighting it all month, they are no longer going to pay for
What I am seeking is opinions, experiences, any input to help me taper off with the least amount of w/d. I have already tapered my 16mg dose to 8mg over the last 2 weeks with little side effects. Today I started 4mg. I have a 30 day supply of the 8mg films. Please let me know the best way to use them. I have read on here for months and have really enjoyed the knowledge and compassion people have for each other. Now it's time for me to tell my story and hope to get the same.

Thank you,
Hopeful, Jen


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PostPosted: Sun Feb 09, 2014 10:43 am 
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Hi Jen,

Welcome to the forum, I'm glad you finally decided to join us in our discussions! :wink:

I'm not surprised that you were able to drop your dose so quickly. We usually don't see people having a hard time until they get under the ceiling levels, which is different for everyone, but generally said to be around 6mg. After that you will start to feel some ups and downs and maybe a bit of physical symptoms. Where it really starts to get tough for most people is around 2mg.

If you only have 30, 8mg strips left, it will be a bit hard for you to complete a slow taper the way we would normally recommend. How are you feeling on the 4mg? If you feel ok there, I would stay at that dose for a few days and then think about trying 2mg. More than likely you will need to stay at 2mg for a bit longer, maybe a couple weeks, and then go down from there. It really depends on your body, and how you react to the drops. Remember that once you get below the ceiling dose it will take a few days for your body to notice it. The bupe stays in your system for a very long time, and it will take a few days to get the extra you have built up off of your receptors.

Just keep in mind that at some point you are going to "hit the wall" so to speak, and each drop after that will be more of a challenge. The key is to drop in small amounts and stay at each new dose until you feel stable and then drop again. It's usually a very long, tedious process. I would recommend that you do alot of reading in the "stopping suboxone" section. Just about everything has been covered there at one time or another.

If you have any more questions feel free to post. Try to remember that your taper journey is highly personal, and you have to do whatever feels right for you. Especially considering that you have a limited supply of subs to work with.

Good luck!

Q

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PostPosted: Sun Feb 09, 2014 2:55 pm 
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Thanks for the reply. I feel ok at the 4mg and will give it a couple more days then drop to 2. Feel kinda emotional (could just be girl hormones) lol. And some muscle twitching but nothing to really complain about. I can get more strips if needed its just gonna really cost me. The place I go to has a program you have to enter. So to get treated I have to see a doctor, counselor, and go to a group meeting with other sub users every month. Then my RX of course isn't covered either. I actually love the program. It's helped me very much and the on site counseling has been beneficial as well. I hate that my new plan doesn't cover it.

My main concern is psychological. I can handle the physical symptoms even though they suck. Can anyone tell me when the cravings start, how to prepare, and anything else I need to watch out for? Just a little nervous.....thanks.


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PostPosted: Sun Feb 09, 2014 3:22 pm 
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Hi Jen,

Just make sure that your READY to reduce each time. It's very easy to get in a rush wanting it to be over. That's usually when problems begin. Shouldn't be a race to the finish line, all you have to do is get there!

You might want to consider a reduction from 4mg to 3mg instead of going right to 2mg. Going from 4mg to 2mg is a 50% reduction, and because bupe is so strong you may feel the sysmtoms a bit more than if you made a smaller reduction at this point. Once you are good and stable at 3mg then you could reduce to 2mg. I personally would do it that way myself. You can usually get away with large reductions at the higher doses, but it gets a little trickier at the smaller ones. Only my opinion here.

I would just say that if your worried about having cravings, then is this the best possible time to stop taking the bupe? I'm not judging and only asking. I know your nervous, and probably even a bit scared, I know I was for sure. But I also can tell you that I was 100% completely positive without a single doubt it was time for me to be finished with subs after a little over 3 years on it. I did have a few days of horrible cravings about 3 months after getting off, but they did pass and I have not had any since.

Just take your time with the taper, make absolutely certain your ready to stop taking the subs, and try not to worry about any cravings right now is my best advice. The taper should be your only concern at this point. Your doing very well, just keep moving forward when your ready to do so. Those that follow a slow, steady, and commited taper plan seem to do the best and have the least amount of symptoms. Hope this helps and I wish you the best Jen.

Karen


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PostPosted: Mon Feb 10, 2014 12:39 am 
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Thank u brown eyed girl. I am going to take your advise and stay at 4mg a while. I have been very emotional today for some reason & think I should just stay put a bit. Maybe later on in the week I may decrease to 3mg. I do feel uneasy about it so I am going to go a little slower. My first reaction was to quit when I found out my insurance wouldn't cover it. But now I know it's not all about money. It's about doing what I need to do to stay in recovery.

One more question....are dr's usually willing to switch u over to subutex due to the decrease in cost? I want to ask at my apt next week but also don't want to come across as someone who wants to start abusing the drug. Any suggestions??


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PostPosted: Mon Feb 10, 2014 1:34 am 
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Hey Jen,

Glad you understand I'm just looking out for your best interest. I know when I was tapering myself it was so easy to want to get it over with immediately, want to rush, and not do what was best for me in the end. I had lots of different suggestions and took them all into consideration. In the end you have to do what you feel is best for you to achieve the results you are looking for. If you believe it's best to remain on the bupe a while longer then that's a smart decision for yourself. You will know when your ready to stop, and know when your ready to taper further. When you do decide to taper, try to take small steps instead of bigger ones. It will pay off for you in the long run.

As far as what doctors will do about switching from Suboxone to plain Buprenorphine depends on your doctor. Some will make that switch for their patients if they have legitimate reasons, and some will give you all kinds of excuses for not being able to do it, or wanting to do it, and simply refuse to do so.

You might just ask your doctor if he/she would consider switching you soley because of tight money issues alone and have your reasons ready to explain. If you have excellent office visits, clean UA tests each time, and no problems or concerns for the doctor they may just do it for you. All you can do is give it your best shot.

Karen


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PostPosted: Tue Feb 11, 2014 12:12 am 
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Have had no issues what so ever at the drs office. It won't hurt to ask. Do I tell them I have already tapered my dose? I don't want to make them mad & get kicked out completely. But hey, if I can't afford my entire script then it would be a crappy reason to get released.


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PostPosted: Tue Feb 11, 2014 9:46 am 
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Hey Jen,

BEG is completely right, if you aren't positive you are ready then you need to to whatever you can to be sure you stay in treatment. I can tell you with 100% certainty that if it's just about the money, you aren't ready. I say this from experience!

Also, my suggestion to drop from 4 to 2mg was based on the fact that you said you had not experienced any WD symptoms. But, the emotional stuff you are describing is probably related, and I would take it slower if you can.

This situation is definitely tough. I get your point about the cost. Unfortunately this is a very expensive treatment if you don't have insurance that will cover it. I hate that more than anything! Have you thought about checking into the patient assistance program? Ask your doctor next time you go if he has filled all of his spots for it yet. If not, maybe you would be a good candidate for it. This will allow you to receive all of your medication for a year absolutely free.

Good luck! Let us know how it goes.

Q

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PostPosted: Tue Feb 11, 2014 10:33 am 
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Jwhite0009 wrote:
Have had no issues what so ever at the drs office. It won't hurt to ask. Do I tell them I have already tapered my dose? I don't want to make them mad & get kicked out completely. But hey, if I can't afford my entire script then it would be a crappy reason to get released.
Hello Jen,

Have you tapered your dose from 16mg to 8mg, and then down to 4mg without the doctors knowledge? I'm just asking to be sure I understand correctly. I did that after I was on subs for over 2 years. I was ready to be off and the doctor wanted to keep me on much, much longer. That was ok of course, but I knew I was in position for it to be over and began tapering over the next year without his knowing. I was able to stock away lots of subs too. I was on 24mg per day and as I reduced my dose to 16mg, then 12mg, etc the extra subs really added up!

About informing the doctor you have tapered, it has to be your decision. But let me just say that if your attempting to get pure buprenorphine instead of the suboxone to save you some money, it might be best not to inform him at the same time. He might get upset you tapered without his knowledge (if that's what you did) and refuse to make the switch for you. Just my opinion ok. Might not be a problem at all, but should you chance it is the question I would ask myself. I just don't want to tell you to be dishonest with the doctor. Maybe ask for the suboxone to pure bupe switch at one visit and mentioning tapering at another? Again, just my thoughts.

How are you feeling today Jen?

Karen


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PostPosted: Tue Feb 11, 2014 5:36 pm 
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In my view you should really try to do every and anything you can to stay on a stable dosage of buprenorphine.

Make calls to various pharmacy's and have cash costs of prescriptions (buprenorphine/naloxone (generic Suboxone), Zubsolv, buprenorphine HCL) ready for your next visit. Have the conversation about switching to buprenorphine HCL instead of Suboxone because of the major price difference. Totally depending on the prescribers views, switching to buprenorphine HCL is possible, plausible and a great idea and if you could swing that cost and that is the factor that keeps you in treatment, you should fight for it. Also, it seems that generic Suboxone (buprenorphine/naloxone) is coming down in price to some degree, look into/discuss that also.

I'm assuming you've talked to your DR about the fact that you have switched insurance providers and layed the situation out to him/her and asked for input on that end because there is a likely possibility that your DR could contact your insurance provider directly and obtain a prior-authorization for buprenorphine (Suboxone); ASK ABOUT THIS! it may be a 6 month authorization requirement your physician will need to keep up with.

Ask the pharmacy's you contact about savings programs they offer for uninsured/cash customers; often these programs exist but are not offered up-front or widely known about. I know Walgreens has one that costs $20 or $30 per year and very greatly reduces the cost of both Suboxone and buprenorphine HCL, factor these prices in when you are calling around and budgeting. I utilized this myself for a period of time when I was without insurance and remember the cost of buprenorphine being reduced to about $150/monthly for 16mg and this was at least three years ago at this point.

Ask your physician about the patient assistance program RB (manufacturer of Suboxone) has for one year of free visits/medication, if he/she is aware and could you possibly utilize it?

Worst case scenario, price-check 15-45 tablets per month and think about maintenance on a dosage of 4mg-12mg daily rather than the larger dosages maybe it will work long-term, maybe it's better than nothing until you get things more financially straightened out and your cost of treatment in your monthly budget; look into optimizing how the tablet/film dissolves for more effective absorbtion and, thus, the need for lower dosage at lower financial cost.

Even if treatment for you costs some cash and you are able to budget it into your life (a life so greatly impacted positively by the use of buprenorphine, right?) so much the better!

Good luck,
Travis

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PostPosted: Tue Feb 11, 2014 8:11 pm 
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Travis actually mirrored a lot of the advice that I was going to give. I'd do my homework in terms of calling pharmacies and checking on prices. I had to do that years ago when I was without insurance for a few months....I had to pay cash. It sucked, but I found (at the time) that Target was the cheapest, and I often had to go pick up a few days at a time. The pharmacist looked at me like I was a scumbag but I couldn't care less.

All I can say is this....and this is without me knowing your individual circumstances, finances, etc....your recovery is PRICELESS, and is intertwined with your health, happiness, your LIFE. Its easy for us to forget the role that maintenance medication might be playing in reducing/eliminating our cravings when we're on it. Ideally, you won't come off until you are really and truly ready, and you know that in your heart.

I'm a little sensitive right now because I strung together multiple years and just had a week-long slip.....so I am just speaking from my heart. I wish you well. <3


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PostPosted: Mon Feb 17, 2014 4:30 pm 
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Thanks for all the advice. I have been doing exactly what has been suggested. My dr called in and got the meds pre authorized. That took about 2 weeks. So I go to the pharmacy all excited and its still $386.00 for the script. And that was after a $50 off coupon. Thought it was due to a deductible. So I called my insurance and they said that they could only give me a certain amount off each month because this is a non formulary med. great. Next step back to the dr. Request for patient assist is denied due to my husband making too much money. So I'm kinda stuck again.

I have not seen my dr since last month when I got the script. When I call in they will only let me talk to the medical assistant. So I honestly don't know If my dr knows about my decrease in dose. I only filled half my script at this point and I go back this Thursday. At this point I know I want to stay on some type of bup. My dose has decreased from 16 to 8mg. Then to 4mg. When I tried to go to 3mg I was very anxious and uncomfortable. So I went back to 4mg and feel pretty good here. I know I need to continue my sub use because what everyone has said to me here is true. My husband also agrees and is very supportive (thank goodness).

So I'm back to this.....when I see my dr Thursday to I tell her about the taper? Suggest Subutex so the med is more affordable?? I don't want to mess up. If she switched me to Subutex I could really stock up some extra because my insurance DOES cover this one. Thanks again for all the help!


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