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PostPosted: Tue Feb 01, 2011 8:18 am 
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Hi everybody!

The first thing I want to say is how happy I am to have found this forum. I joined about a week ago and have been reading a bit every day. This is an awesome online community and I have learned so much already in the short time I have been here. The knowledge, feelings, opinions and support of one another that I see expressed here are nothing short of amazing. I began my sub induction on Friday, January 14th and although I have taken sub in the past as a detox med, this is my first venture into maintenance. I have a wonderful doctor, nurse and counselor but was feeling very alone and a bit scared as I began treatment. I don't feel comfortable sharing my decision to take suboxone with my friends in 12 step recovery at this time, so this forum truly is a godsend for me.

I'll give a bit of my back-story first and I apologize in advance for the length. I first started using opiates in 1984. From 84-90 I used heroin. The first two years I managed to use without picking up a physical habit, but from 1987-1991 I was strung out more often than not. I cleaned up intermittently usually by doing a 21 day methadone detox and temporarily moving away from the people, places and things that were part of my using. In 1990 I underwent a lot of change in my life; I graduated from college, got my first apartment and first full-time "real job" and broke up with my boyfriend of 5 years who had been my partner in using. I stopped using opiates but I made no attempt at any sort of recovery, in fact I don't think I even had any clue what recovery was at that point. I do know that I wasn't the same person emotionally as I was before heroin came into my life. I became severely depressed and since 1992 have been on anti-depressants. For many years after stopping heroin I self-medicated with alcohol and various other substances when I could get them. I was desperately unhappy. In 2006 some really sad things happened in my life and I started using the vicodin that I was prescribed for my back more and more frequently. My use increased and about 14 months later I had a hefty oxy/norco/methadone habit and had burned through a modest sum of money I had inherited. I eventually decided that enough was enough (and I was out of cash) and entered a year long intensive outpatient program through my medical insurance (Kaiser). Before entering the program I was detoxed off the pills via a 21 day suboxone taper. I remember that experience with sub being so fricking great. I felt "normal" for the first time in years! When the taper ended I didn't have any lingering withdrawals except some trouble sleeping. I became very involved in NA and my outpatient program. I had 15 months clean when I received a devastating medical diagnosis. I lost faith that I deserved anything good in life and I started drinking heavily and using vicodin when I could get it. It took me two months to burn out, hit bottom and end up in a 28 day residential rehab. Once again rejuvenated I re-entered NA, got a sponsor, worked the steps, took service positions, and worked really hard on developing a relationship with my higher power. This past summer my chronic low-level back pain became acute and I found out that I have two herniated discs. I was prescribed vicodin and took it as prescribed for a few months. And then I started taking more. And more. And every time I tried to stop I got sicker than I even believed possible for a 50-70 mg a day hydro habit. With each successive relapse it takes me less time to pull my head out and get into treatment, so two weeks ago I was back at Kaiser. They started me on a Tramadol detox and after three days I met with the doctor who treated me in 2007 and we discussed the pros and cons of an open-ended sub maintenance program. Based on my history and current feelings I decided to go for it and started on January 21st.

I feel a tremendous sense of relief, freedom and certainty that I have made the right decision. My panic and anxiety attacks are gone and I can get more than a few hours of sleep each night. My physical adjustment to the sub has been kind of rocky this time though. I talked to the sub program nurse last Wednesday about it and she said to give it two weeks and that things should get better, but I am not sure they are, so I am going to call again tomorrow. The doctor decided to start me at 8 mgs of sub (split dose) per day even though I didn't have a huge habit this time around (10-14 5/500 vicodin per day). I expected to feel more or less normal like I did the first time I took sub. Instead I felt really *high* physically and mentally for the first three days. No euphoria, but everything else: excess energy for about two hours after dosing followed by nodding out, lethargy, bizarre dreams, difficulty reading or focusing on the computer screen, appetite suppression etc. I definitely did not trust myself to drive in this state! About 8-10 hours after my morning dose the symptoms would start to abate. When I took the second 4 mg dose each day it was the same cycle again. Beginning with Day 4 these side effects started to lessen and I have been able to work and conduct my regular life stuff. BUT, I still spend a few hours following each dose feeling energized and then i'm extremely lethargic and "noddy" for a few more hours. The nurse and doctor told me last week that as I stabilized on the medication these effects would go away and I would feel "normal". Has anyone else reading this experienced these types of reactions when starting sub? I'm sure I am not supposed to feel this way. I don't like feeling slow and drugged. I think it must be a dosing issue, either too high or too low. It doesn't seem possible to me that it could be too low, but then when I read about the "ceiling effect" of sub I get confused and think that maybe I am going through these cycles with each dose because my receptors aren't getting enough sub to even everything out and maintain a steady state of saturation. Like I said, I am going to talk to my doctor about it since today was Day 11, but if anyone in this forum has any knowledge or insight to share I would greatly appreciate it.

Again I want to say how glad I am that this forum is here and that I found it! I apologize for being so long-winded with my very first post, but I do feel better having written things down. I look forward to getting to know everyone better.

Thank you!!


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PostPosted: Tue Feb 01, 2011 9:07 am 
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Hello annabella and welcome to the forum. I'm so glad it's been helpful to you. And thanks for sharing your story. You most definitely have been through hell. I believe, based on your history of addiction, that sub maintenance might very well be the best thing for you. I hope it works out.

Dosing...Your response is not unusual at all, although I'll admit it seems to be lasting a bit longer than it does for others. At 8 mg, I would say it's extremely likely that your opiate receptors ARE indeed saturated and probably staying saturated. It's my opinion that your dose may be too high for you. I'm referring to your overall dose. BUT - since you are taking it in 4 mg doses - right around the ceiling - you might need to tweak the way you take your dose. At low doses - around 4 mg or below, the receptors are not saturated and sub acts more like a full agonist than a partial agonist. You could try taking more in the morning and less in the afternoon - if at all in the afternoon. I'm thinking it's possible that if you take more in the morning your receptors will stabilize ABOVE the ceiling and you won't feel those ups and downs and drugged feeling.

Obviously either situation is possible and I'm probably not helping by telling you it could be either way. I think speaking to your doctor is a good idea. Hopefully s/he is well educated about the ceiling (you'd be surprised how many are not). To be honest, I'm just not sure if that dose is too high or too low (see, I'm not much help here, am I?). You might just have to try different ways before you find the dose that's right for you.

I really do wish I could give you more concrete answers. Again, welcome and I hope you can get stabilized very soon and get to feeling much better. Keep us posted.

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PostPosted: Tue Feb 01, 2011 11:59 am 
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annabella,

I'm so glad you found you're way to this forum, it is the best on the internet, by far!

As far as your not being stabilized on sub yet, I have read several stories now, very similar to yours, where an individual had multiple relapses and got on sub and off sub and back again. It seems like people who have had this happen to them have a much harder time adjusting to suboxone with each subsequent relapse. I don't why this happens? But, I seem to remember reading about this phenomenon with other members whose stories were similar to yours and I wanted to throw that out there for you.

To the best of my recollection, these people do eventually stabilize, it just takes a while longer than it used to.

I hope you're able to give suboxone a good long try before you considered tapering or stopping. Many of us stay on suboxone for years, many of us will be on it for life. Please, give Suboxone a good chance so that you can get your brain to start thinking right again.

Thanks for sharing your story and welcome to the forum.


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PostPosted: Wed Feb 02, 2011 3:54 am 
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Thank you Hat and Romeo for the welcome and your helpful information. I feel so relieved to know that I'm not the only person who has had the experience I am having while transitioning onto suboxone! That alone makes me feel tons better! Of course I also really appreciate all the other information, encouragement and suggestions too.

Hat, I also can't figure out the too high/too low dose thing, or whether it is the administration of the dose 4 mg at a time. I know that my doctor does have at least a working knowledge of the ceiling because when I was discussing a starting dose with him I wanted to start with a daily total of 6 or 4 and he said no, that was too low to effectively suppress the cravings in my case. He actually seemed to want to start me at 12 mg. I asked to start at 8 and agreed to go up to 12 if I was having cravings. I actually did have a few cravings around Day 6 and 7. The sub was having full agonist type effects and I had cravings for either some alcohol or more opiates to kick me into a euphoric headspace. Fortunately I want to stay clean (I absolutely consider taking suboxone as prescribed to be staying clean) more than I wanted the euphoria; the cravings passed and I haven't had them again. Anyway, after reading your response, I decided to divide my dose differently today. I took 6 mg this morning and then 2 mg a few hours ago. I had already been wondering if it was the 4 mg dose that was causing the effects of the sub to be more like those of a full agonist, so when you mentioned it as a possibility I decided the first thing to try was a 6/2 split. I know it is too early to say with any certainty, but I did notice a difference today. I got way less of the "low" feeling that I had been having, i.e. the lethargic semi-borderline nodding type feeling that was occurring 5-6 hours after my first 4 mg dose. So, I'm going to stick with the 6/2 split for now and see how I feel. I have group on Thursday and I will have the opportunity to talk to my doctor face-to-face then. My ultimate goal is to take my full dose once a day, which the doctor agreed with, so I'm sure he will be fine with my switching to a 6/2 split.

Romeo, thank you so much for the support and encouragement. I really appreciate it. I am absolutely planning on continuing to work with my doctor until we get my sub dosage and dosing regimine dialed in to the place where I feel "normal." Stopping or tapering off are not options under consideration right now at all. My history scares me and I know that I need a good long time on sub to "get my brain to start thinking right again" to work on my life and my recovery. I know that it is possible that I may be on sub for life and I am okay with that. I have been on anti-depressants for almost 25 years and know from experience that stopping those is not an option. Addiction is a chronic, life-threatening disease and suboxone is a necessary medication for some of us if we want to keep our disease in remission. I feel truly blessed that it is an option for me.

Wow, another long-ass post from me! I promise that I am not always so long-winded. I am just so happy to be on this forum. Thank you again!!

~Anna


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PostPosted: Wed Feb 02, 2011 7:41 am 
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Hi There Anna,
Just wanted to Get my "Welcome" in and also reiterate what the others have said. That there are a lot of very GOOD people out here willing to help one another out! Congrats of your Starting Recovery. Its sounds like you have really put in the Effort to do this the right way. ie. Counselor, Good Dr. meetings etc., etc... I have been on Suboxone for 2 yrs. (Now that I think of it... Yesterday was my 2 yr. Anniversary :) ] My DOC was Oxycodone and for years & years I was in a self induced Opiate Haze. At the End I was taking 300 - 350 mgs. of Oxycodone a Day. Ran the Gamut of losses, Money, Self Respect, more Money, Family, Health, the Rest of my Money Etc.. I'm sure you know the Drill! I also Keep my Suboxone Medication to myself as far as my support meetings go. I just find it easier to keep that part of my Recovery to myself and my Dr.!! I have the Good Fortune of being an Alcoholic as well so my meetings are AA and I find them MOST Helpful for me. I've rambled enough.... Welcome to the Forum and please keep posting your progress. That's' how we help each other by sharing our ups & Downs with each other so we are NEVER Alone during Recovery!!!! Best of Luck!

God Bless
TW

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PostPosted: Wed Feb 02, 2011 7:55 am 
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Thanks for update. I really hope the change in how you're dosing helps. It's terrific - and somewhat rare - to have a doctor that really, REALLY understands how suboxone works. I'm glad you have that kind of doctor to turn to.

Hang in there - I'll be thinking about you and hoping you continue to feel better. I'll also be looking for your next post.

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


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PostPosted: Tue Feb 08, 2011 3:39 am 
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Hi All,

I'm checking in with an update about my stabilization on sub. I've been reading more of this forum every day, checking out various forum categories and topics and I am amazed by all of the information and knowledge that is shared here! As always, if anyone has any opinions, suggestions, experience and/or commiseration to offer me I would truly appreciate it. The feedback and support I have received so far has been really helpful and honestly just having a place where I can share about sub when I feel the need is a priceless gift.

First off I have to share that this is the third time I have composed this post. Argh! The previous two times I lost the post when I was previewing it before submission. Clearly I was not scrolling correctly or I hit the wrong keys and my post evaporated into nothingness. I think I am kind of a spaz because the very first topic post I made posted twice for some reason. Anyway, I am NOT going to preview the post this time since that seems to be a danger zone for me, so please excuse any misspellings or horrible grammar, lol.

Today is day 18 on the sub and with each passing day I am more confident and excited about my decision to start sub rather than do the short detox using tramadol which was the other option offered to me by my addiction doctor. Given my history of repeated relapse over the years sub just makes sense. The sub program provided through my health care/hmo (Kaiser) seems well-organized and everyone has been super knowledgeable and compassionate so far. I have an addiction doctor who I like and who I previously treated with in 2007 when I did a short sub detox followed by a year-long intensive outpatient program. In addition I have a counselor, a program nurse and a group session every Thursday which is a 1.5 hour process group with a counselor and 8-10 other people in the sub program. After reading some of the doctor horror stories in this forum I realize how lucky I am to have the resources my health care provides!

I am happy to report that almost all of the unpleasant side effects I was experiencing when I started the sub have disappeared entirely or subsided greatly. The one problem I continue to have is with an icky nodding-type drowsiness. This was very pronounced the the first four or five days I was taking sub and although it has lessened, it is still an issue when I am at work. I work an 8-5 job and am on a computer (sedentary) for almost my entire workday. When I get drowsy it is very hard to focus and work at my regular pace. Unfortunately my work is not very exciting or intellectually stimulating so I'm trying to find ways of dealing with getting so sleepy every day. (Yes, caffeine helps, but I can only ride that train so far...) I have had some success with changing the way I take my dose but I'd love to hear any ideas anyone has on how to deal with this issue.


My daily dose is 8 mg and so far it has been effective at preventing withdrawals and cravings (more on cravings later in this post). Initially I was splitting my dose 4 mg in the morning in 4 in the late afternoon/early evening per my doctor's recommendation. After reading and getting some feedback I tried a regimen of dosing 6 mg in the a.m and 2 mg in the p.m. which was awesome on the day I didn't have to go to work (except for an occasional afternoon nap I really am not affected by the drowsy side effect on days when I don't work). Unfortunately, when I returned to work the 6/2 split did not improve my overwhelming desire to sleep in my cubicle, lol. Last Friday I switched to dosing 2 mg in the a.m. and 6 mg in the p.m. and it does seem to help so I will continue with that plan for the rest of this week. Ironically I am now having trouble getting to bed on time when I take the 6 mg in the late afternoon/early evening, but I hope that will simply be a matter of forcing myself to go to bed even though I don't feel ready to sleep. Ultimately I really want to get to where I dose only once per day. The twice a day dosing reminds me of when I was taking vicodin and I am trying to eliminate as many triggers as possible from my daily routine.

As far as cravings go, I have experienced what I think of as "ghost cravings" several times in the evenings around 7 p.m. I call them "ghost cravings" because when I think about what it is I actually "want", I can't pin it down. I believe it is simply a conditioned response since 7 p.m. was about the time I would allow myself to take "extra" vicodin every night to feel high. (During the day I just took enough pills to feel well.) Fortunately I read one of Dr. J's blog posts about cravings and simply waiting 15 minutes and the craving would be gone. It really works! To me that is the most amazing thing about sub...it truly does relieve me of the obsession and compulsion to use full agonist opiates. I no longer wake up every morning with feelings of dread and nausea, my first thoughts being of how many pills I have left, how much money I have, what I need to do to get more pills, and how in the hell I am going to make it through the month until my next payday. I know this is the easy part; getting on the sub and off the vicodin. I know sub is just the first step. I know that I have financial damage to repair and a shit load of work to do on my recovery program; figuring out where the weaknesses were in my program that led me to relapse again, and working on daily basis to build a stronger recovery program and a stronger me, and that's just to start with! I don't feel overwhelmed this time though, and I know am so blessed to have another chance at all of this.

Overall I am feeling really good and am so very thankful that sub was available to me and that I have found support and knowledge on this forum and through Kaiser. I believe that given my history, sub is the right choice for me. I have not felt this positive about the future in a very, very long time and I am very grateful. What an amazing gift.

Blessings,

~anna


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PostPosted: Tue Feb 08, 2011 7:31 am 
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Hi annabella and thanks for the update. I'm happy to hear you're doing well. I don't recall your addiction history, but what occurred to me when reading about your drowsiness is that perhaps your dose is too high. But before trying to lower it yet, you could keep trying different dosing times to see if that helps. Have you considered not dosing in the morning at all and taking it all in the evening? That might help with the daytime, at-work sleepiness. Might be worth a try. Just a thought I had.
If after you've tried moving around your dosing schedule and it doesn't help, you could try just 6 mg and see if that helps. It actually might. Again, thanks for the update. Keep up the good work.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

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


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