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PostPosted: Thu Dec 03, 2015 2:00 am 
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Hi All!

Long time reader, first time poster.

I'll kinda cut to the chase instead of filling you in on my whole story. I have been on suboxone for about 6 months. I started off on 2 mg of suboxone and have been on 2 mg consistently for the 6 months. I have passed all my urine tests with my doctor and have not slipped up once. I had been doing fairly well with that dose until about 2-3 weeks ago.

At the end of August 2015, I got arrested for something that happened in February 2014. I went to court in October and luckily got my charges reduced . I am on probation and have a restricted license, 48 hrs of community service, have to abide by the recommendations of my substance abuse evaluation, and urine tests. If I am a good girl everything will be dismissed after a year (with my original charges being 2 felonies). My probation officer was very adamant from day 1 about me getting off suboxone (that's a whole other post), even after explaining how I am on a low dose and I have been doing much better in my personal life since starting suboxone. When I started my probation, I was looking for a new therapist that specializes in substance abuse and had to get my substance abuse evaluation done anyways. My probation officer recommended my current therapist and I have had one session with her. Unlike the other therapists I dreaded, I am looking forward to going back to her because she was very nice and understanding on how I ended up at the point I am at.

My suboxone doctor does not know I got arrested and about me being on probation. 1. I didnt want to tell her anything until I knew the final outcome and 2. I basically wussed out last time I saw her. I intend on telling her next time I see her. With the stress and anxiety of getting arrested, being "good", doing all the things I need to do to get my charges dismissed, school, and life in general-- I have noticed that the 2 mg of suboxone is not cutting it for me anymore. The urges to use my DOC (which I NEVER have had on 2 mg) and withdrawals at night have gotten pretty bad the last 2-3 weeks. I have always had some minor WDs at night, but it has gotten worse. I have tried taking 1 mg in the AM and 1 mg in the PM and felt like it made it worse as the 1mg in the AM wasnt enough to keep me out of WDs during the day.

Lately, I started taking an extra 2 mg strip (total of 4 mg per day) and felt like 4 mg works much better for me as I dont have the symptoms described above. Obviously, that leaves me in a bind because I will run out early. I am scared to tell her I increased my dose on my own because she is very hit-or-miss with her moods and I dont want/need her to discharge me for being "non compliant." When I had brought up increasing my dose back in August due to WD feelings at night, she gave me clonidine to help me sleep at night- which hasnt/doesnt do anything.

I am not scheduled to see her until the 16 and I cannot handle these symptoms until then. I intend on calling her office first thing tomorrow morning to try to get an emergency appointment for tomorrow or Friday.

So with all of this being said, what would you say to your doctor if you were in my situation? Any idea of what she may say if I am honest? What do I do if she does discharge me as a patient? I was going to suggest at least increasing to 4mg until I have had a few sessions with this new therapist because I know the therapist will help me somewhat with controlling the cravings. I was also going to tell her I do not want to go above 4 mg because I would like to try to start tapering off suboxone once my probation is over.


ANY
input is much appreciated. Thank you in advance!

-B

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PostPosted: Thu Dec 03, 2015 4:28 am 
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Welcome Doxie

I really feel for your situation.

I don't suggest you lie at all. I personally wouldn't tell the doc that you have decided to be your own GP and pharmacist, as she prob wouldn't like that and trust will go downhill. Simply tell her you would like to try a higher dose and see what she says. When/if she suggests something else just advocate for yourself, be assertive and tell her you feel this is the best direction to go right now and that your cravings are nowhere near covered by 2mg. If she is uneducated about this treatment and says no, maybe try and find a new GP.

Very soon someone with experience will come along with good advice but just hang in there.
Good Luck!!


Last edited by mel78 on Sat Dec 05, 2015 10:55 pm, edited 2 times in total.

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PostPosted: Thu Dec 03, 2015 9:56 am 
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Doxie

Were you on sub in 2014 with the same doctor or were you in active addiction?

Sounds to me like the stress of the arrest etc has caused the need for more bupe. You are well below the ceiling level. Perhaps tell her now you are getting cravings and tell her about your situation.

Hopefully she realizes you do need an increase. Let us know what happens.


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PostPosted: Thu Dec 03, 2015 10:41 am 
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@mel & @tiki: Thanks for the replies.

I was in active addiction in 2014 when this event that occurred caused me to get arrested in September of this year (yeah it took them a year and a half to realize). What I got arrested for had to do with my addiction spiraling. Thankfully when I got arrested I could say I came to the realization on my own that I needed help and was already getting said help.

Since going through the court proceedings, I have definitely felt a need for an increase of my dose (even though my PO wants the opposite). Im hoping she will see a need for it as well, especially after I explain everything. I dont think ill be 100% forthcoming about adjusting my own dose--but just really stressing the need for an increase. I have made an appointment with my friends doctor (who seems to be a lot more knowledgeable with suboxone) and if my current doctor doesnt help me at this next visit, then I will go see this new doctor.

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PostPosted: Thu Dec 03, 2015 10:43 am 
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Doxie I would be honest about the arrest, that was before u started sub treatment right? Many many addicts have legal issues that they haven't taken care of prior to treatment....I definitely did. That part should not be an issue. I'd also tell the Dr that because of all the stress with the arrest and probation and ur past coming bk that ur cravings have kicked in a lot worse and u have felt the need to take a little extra. Regardless if u mention the taking extra, I wouldn't see anything wrong with telling her about the arrest and major cravings.

Ur taking 2mg, which is under the ceiling level, so I see nothing wrong with upping ur dose to 4mg. That's still a good dose so I don't see why ur Dr would have any problems with it. Being honest in a situation like this would be best imo. Addicts have lots of stuff they have to take care of that they couldn't during actively using and that's very normal, I'd assume that ur Dr wouldn't hold that against u. Good luck!!!

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PostPosted: Thu Dec 03, 2015 9:44 pm 
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Wow, where to start with so much here. I'll try to break it down.

1. As the others have said, be honest with your doc and tell her everything. If you are the first patient with an arrest due to addiction, this has to be your doctors first month. Honestly, she's heard it before. You didn't do anything new. The wheels of justice just finally churned. Explain the outcome to her.

2. If 2 mg were holding you before, they likely still are. Therefore, it's more mental than physical. That only makes sense with what you are going through. I would suggest to you that you suggest to her to increase your dose until you get through this or for at least a few months. After that tell her you'd like to taper back down.

3. Running out early is a problem. It's even worse at low doses as you have no wiggle room. Some docs, the good ones, will totally understand what went on. Some won't. If she discharges you for honesty she's truly a crappy doc. Only you can weigh the risks on this.

4. I know it's scary for people to deal with POs I also know they can ONLY follow what the judge says and what the laws are. Could this PO tell you that you can't wear a blue shirt! Of course not. Many probation orders state you cannot possess any drugs without a perscription. You have one, correct? So your PO can suggest but not force you. If he does call your attorney or your POs supervisor and that will stop. Of course he may then try to go after you on something else. The problem is if we let anyone overstep the law with us, we are teaching them they can get away with it. You don't have to be mean or get emotional or anything like that. Simply state, "I'm doing better than ever on this prescribed, legal medication. Why would you force me into potential relapse? It's not against court order for me to be on sub is it?" Make him answer. He may try to dodge it and say "I just think that blah blah blah." If so, tell him. You really need to follow what your doctor says. If need be remind him he is not a doctor he is a PO officer. Bottom line tell him you will follow everythin g The court order says. Most will just drop it. Understand he can ask you to do anything. He can only require you to follow the law and probation order he can't make other things up. Some POs are on a power trip. They can only do what's allowed

5. Finally, Mel 78. Your example is why it's a really bad idea to let patients set their own dose. By your own admission you "feel" as though you need more than 16 mg a day. I can assure you that you do not and its all in your head. 32 mg is off the charts high, unless taken for pain - although even then... If I could replace the 32 mg you are taking with 10 mg without you knowing, you'd feel no different. You have to do what you will along with your doc. I just don't want to foster this high dose stuff to the masses. It's become very clear that rarely if ever is more Than 8 mg needed. Most do great on 8 mg or less.

Hope this all helps. Please keep us updated.


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PostPosted: Sat Dec 05, 2015 5:56 am 
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Hey Doxi

See, I told you people with great advice would be long soon :)
How long until your appointment, and can you please let us know how it goes? Ta
Just hang in there and keep posting as it does usually make people feel better and supported.

Hi Dohn,
Thanks for our great advice for doxi and then myself.
I just wanted to clarify my comment that my doc lets me control what dosage Im on.
When I first started sub I was not really wanting to go on it but was highly encouraged by my GP, addiction specialist and AOD nurse. So my drug doctor started me on 8mg. He stated that I would probable require the full amount of sub in time to come due to what I was taking and the dangerously large amounts. I was reluctant to go up but my cravings were not being covered much at all on 8mg or 16mg. That's why he did a slow increase with me. He wasn't surprised when I asked to try larger doses.
I understand where your coming from as your not the first I have heard say that above about 16mg
or so is the most required. On the other hand I have heard of and know plenty of people who are doing well on 20mg but cannot taper just yet as its early days.
It just makes me wonder why do they even make doses of up to 32mg, if it doesn't do much (if anything) over 8mg? Im not a doctor so I certainly cannot answer that question myself but it does make me wonder. Im tapering back down to 20mg within 2 weeks and see how I go from there, as I don't want to even be on it for long; but will if it keeps me clean and safe.
I have been attending NA for nearly 12 months now so I wont hold resentment against you, but for you to say its all in my head is a bit arrogant in my opinion, as you don't know anything about me, my history, my situation or my doctor, whom by the way is the one encouraging the higher dose.

I really do appreciate you giving me the information you did though, as I am now quite interested to do some research on the topic.
Are you a doctor? Whether you are or not do you have any idea of where I could get accurate information on what you claim is correct dosage please. Thanking you in advance.

Just so I don't 'foster this high dosage stuff to the masses', I will try to delete my original post.
Kind regards
Mel


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PostPosted: Sat Dec 05, 2015 8:19 am 
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Hey Mel,
Ive read this thread and a few others .
If you want to learn more ahout Buprenorphine, id suggest highly that you go over to Dr Junigs Talkzone blog, use the seach box, and put in any questions you may have regarding suboxone, dosages, etc..

Also, you can start with The Users Guide of Suboxone, written by Dr J.

Suboxforum.com/users.guide.pdf.

This should get you started. Ther are many people here Mel who do have a wealth of experience. I believe understanding the medicine itself can and will have an overall effect on recovery.

Here iin the states today it seems the standard of care for dosing begins in the 12 mg to 16mgs range. Years ago many drs believed that 32 mgs was the top dose. After watching addicts ,and ive seen this myself many times at clinic, 16mgs seems to be more than enough for physical cravings. Ther are rarities though.
High doses also bring higher and more side effects.

I get what Donh is saying. Ive seen it here at two clinics. Addicts believe they need more because we have ALWAYS thought we needed more of everything. Lol..

Theres a saying in the bupe world: Less is More". I believe this is ture.

After 6 months to a years most people can drop easily to the single digits. Understanding the ceiling effect and tolerance of Buprenorphine after the first year enabled me to drop from 16mg to 8mgs overnight. I didnt feel a thing. Better actually. .

Anyway...the best place to learn is right here!! So, research the Talkzone mel. Your doin great!! Thoses NAers accept you over there taking bupe?"..hope so. I was there almost 4 years...

Peace....razor


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PostPosted: Sun Dec 06, 2015 1:20 am 
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So sorry Doxi for temporarily taking over your thread. How are you going? Please keep us updated as to how your going.

Thank you very much Razor for replying to me in a non judgmental and caring way. Your advice is really helpful and I will certainly be looking at Dr Junig's blogs and information.

I live in Australia and its well known we are a tad behind from the rest of the world lol so that may be why 32mg is not such a big deal over here.
When I find out information matching what Dohn and yourself are saying, I shall be taking it to my doctor next time I see him. Like I said, I am dropping to 20mg in 2 weeks but I may speed that up to one week when I can get a quicker appointment.
My AOD nurse made me wait until my doc returned from holidays because he is known for being extremely careful and experienced with suboxone.
I do think its the Aussie thing compared to America that is causing the major differences in dosages. I really cannot wait to see him to discuss this topic, once he gets back from another small break (work not play).

Anyway razor, thanks again for directing me with your caring nature and without being too forward. Its pretty much a situation that I was just going long with advice of a very highly regarded doctor in the medical industry. Maybe Australia needs to reassess suboxone and the dose they hand out.

Thanks again :)
Time for research


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PostPosted: Mon Dec 07, 2015 7:44 pm 
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Thanks all for the replies! I want to give you all a great reply. Rather than typing this all out on my phone, I'll reply when I get home. I definitely have an interesting update which will blow everyone's mine, just like it did mine.

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PostPosted: Mon Dec 07, 2015 10:21 pm 
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Hey Doxie...

It's not unusual for people on lower doses of sub to experience "dose creep" - that is the dose you're prescribed stops holding you for the full 24 hours, cravings return, and a slightly higher dose of Suboxone is then required to keep your cravings at bay. This is because at lower doses Suboxone acts more like an agonist in its dose/response curve. A good doctor should be aware of this. This problem subsides once the dose increases to where the ceiling effects starts to happen. It's particularly noticeable for those on methadone, which is why some people start out on 30mg and end up on 100mg.

I'd be straight up honest with your doctor. Tell her that you're getting withdrawals in the evening and you're craving other opioids. 2mg is a minoscule dose anyway.

And as for your probation officer. Is it his/her business what medications you're on? I think not. Sounds like he's a nosy 12-stepper or abstinence lobby freak.


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PostPosted: Wed Dec 09, 2015 1:52 am 
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@Mel, LOL! Its perfectly fine.. thats what discussions are for!

Everyone, THANK YOU so much for the replies.

I definitely feel like I have the "dose creep". Even if I went up to 3mg, I think I'd be okay.

Personally, I don't think it is my probation officers decision and know whats best for me. He doesnt have an MD after his name. I looked up the law in VA, and a judge has to order me off the script. However, I do have to abide by the recommended treatment after taking my substance abuse evaluation, which I took today. My lawyer (who happens to be a family friend) said if it becomes an issue, we will be going back to court.

I saw my suboxone dr this morning.. I seriously do not understand this crazy woman. I called her yesterday (on her emergency number) crying saying I needed to be seen ASAP. She asked if this was a life crisis and of course I said yes! I told her about my arrest and about my PO wanting me to get off the suboxone and said I wasnt ready yet. I told her I have been having cravings with all the pressure triggering old behaviors. She said well, I'm the doctor and it is my decision about your care..but we can taper you off over 2 months. I swear I just stared at my phone. So I went in today and no matter what I said, she would NOT budge. I told her I know I will relapse if I am forced off of suboxone. But NOPE! She wrote me for a taper to be off in 8 weeks. HA! So, I'm on probation and having cravings and you think the best idea is to taper me?! I'm really pissed that she would be that careless and today reinforced my decision to change to another doctor. Now I have enough suboxone to get me to my appt with my new doctor.

Now going to the whole PO issue. I went to see my therapist today and like I said before, she's great. After taking the substance abuse evaluation, she said she is not going to refer me to an outpatient program even though I tested in the 90th percentile for addiction. Since I have been clean and on subs for 6 months, she is fine with me just working with her. She does want to know what my "plan" is as far as the subs go and I told her about my doctor not knowing one foot from the other. I told her I would be switching docs Dec 22. I did NOT tell her about her wanting to taper me because it's another headache I dont need right now and want to see what the new doc says.

*bangs head against wall*

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PostPosted: Wed Dec 09, 2015 8:11 am 
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OMFG
I cannot believe your stupid doctor. Im glad your getting a new one. I would actually put a complaint in against her. Not sure where to but I wouldn't let her get way with such bad treatment, or lack thereof.
Do you have enough until the next doc but only being on 2mg or 4mg?

I wish you all the best, you are having real bad luck ATM.

Keep us update please.


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PostPosted: Wed Dec 09, 2015 2:12 pm 
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Doxie that sucks! I totally agree with u switching doctors, I'd do exactly the same thing. She obviously didn't listen to a word u said to her. Sometimes I guess it doesn't matter if u try to be honest. Imo being forced to taper off suboxone after only being in treatment for six months, is not cool and I just don't understand what she's thinking, especially after u told her u felt like u were close to a relapse. Makes zero sense to me. Hopefully ur new Dr will be much better and more understanding. Good luck!

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