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PostPosted: Wed Mar 21, 2012 4:59 pm 
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Hello all,

I started on my path to sobriety today...yay me! Well, we all know it's not all peaches and cream. I went through 36 hours of hell and then went to my dr. appt this morning. Throughout the course of the morning I was given 12 mgs. of suboxone. (Dr. said it was not abnormal to need a higher dose on first day) When I left the office I felt good. However during the rest of the afternoon and evening I have experienced some cravings. Now I knew this was not going to be completely pain free...I just wonder if this is normal for the first day. My dr. wants to start me off with 8mg per day, dosed once in the morning. I have not got my script yet...have to go back in the am for my next evaluation and script. I will then receive enough for one week and then monthly after...drug testing at EVERY appt. I got a very strict dr. which I am grateful for...I would never be able to do this if I had any wiggle room. I want to get clean.

So any advice...is it normal to still have some cravings on the first day? I don't think my doc will want to go any higher than 8 mgs a day. And I think that is best, I would just like some reassurance that the cravings will be gone after a few days.

Thanks for the help!


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PostPosted: Wed Mar 21, 2012 5:08 pm 
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Hey there, welcome to the forum and congrats on making it thru that many hrs of wd.. I am sure you are going to get some great advise and encouragement. I do not remember if I craved my first day on sub or not, but my guess would be that since it IS your first day your brain is still in habit mode. I mean you are used to using. So because you have not used in a day or more it is normal for your brain to want to use. I hope this makes sence. I have craved here and there during my 9 month suboxone treatment. FOr the most part suboxone has kept me out of craving..(its the worst for me...)Give yourself some time to get OUT of the habit of feeding your addiction. Good luck on your recovery.


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PostPosted: Wed Mar 21, 2012 5:50 pm 
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Sweet 16 makes an excellent point. Right now you're brand spanking new to remission and all you can probably think about still is using...THAT'S TO BE EXPECTED. Give yourself time. Right now, no one can predict if 8 mg will hold you and your cravings or not. It really depends on what your tolerance and addiction history were like. When it comes to extinguishing cravings, the dose one takes is very individualized. If I were you and if in a few days you're still having pretty strong cravings, I'd contact the new doctor to discuss it with him. With any luck, he isn't as rigid as he sounds and will be flexible to meeting your needs.

Ideally, suboxone will occupy your opiate receptors and physiologically, your cravings will be extinguished. You might be left with what I call "psychological" cravings. Those may come and go with or without suboxone, in my opinion. Usually if you distract yourself they will pass. At this point in your treatment, it's too soon to tell if the cravings you're experiencing right now are psychological or physiological (by my definition only).

I will say that 8 mg, in MY opinion only, is a rather low dose to start treatment at. But again, your doctor knows your history and I DO NOT, nor am I a doctor. But that dose coupled with the fact that you're saying you're having cravings, would indicate to me that you MIGHT need a dose increase in the next few days. But again, I'm no doctor. Play it by ear and like I said, if it keeps up, consider talking to your doctor honestly about the cravings. Cravings need to be taken seriously because they can lead to relapse.

Keep posting and venting if you need to. You're so new to this that you might even feel a bit raw right now. Take it easy, yet try to stay occupied, if that makes sense.

Let us know how you're doing, OK?

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PostPosted: Thu Mar 22, 2012 7:18 am 
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Thank you to you both for the encouragement. I will post later more of my history if you want. I just needed to share some of my excitement this morning before my appointment. Today is the first day in as long as I remember I woke up and didn't need to go get a pill or was worried because I didn't have anything for the day. I'm still a little achy...didn't sleep last night, but I feel so much better than I have been. Funny huh? I am on my way to my next appt. now. I'll post later and let everyone know how I'm doing. Thanks again for the forum to vent last night!


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PostPosted: Thu Mar 22, 2012 3:00 pm 
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Okay, Just a warning...this is most likely going to be a long post. :) I said earlier that I would write more about my history for everyone, so here goes.

I have been using hydrocodone off and on for several years. With a family history of addiction and a personal history of really "liking" substances I knew I should NOT be taking them...but I did it anyway. Of course I rationalized it thinking I would only take it for a few days. I'll quit tomorrow, next week. Next thing you know I have a regular prescription for 90 Lortab per month and I'm going through them in less than a week. Then I have to go out and buy them off the street to keep me from being sick. To make things even worse I added ambien and xanex to the mix when I started having anxiety issues. I never developed a real habit with the xanax but I have taken 1 or 2 ambien every night for about a six months now too. As I said above, I have a family history with abuse of drugs. There is too much to talk about in this post but I feel it is relevant to mention that my Mom is on suboxone also and has struggled with sobriety even since being on the subs. This makes it harder for me to get clean because I don't feel like she is really ready to take her sobriety seriously and I can't rely on her for support...she wants to help me but it's hard to help someone else when you are struggling yourself.

I finally got honest with my husband last week and told him what was going on with my opiate use. Telling him has been the hardest thing I have ever done, and yet the best. I knew I had a problem and wanted to quit before telling him, but I could not do it on my own. Something in the way I saw my addiction changed when I had to say it out loud to my husband. Seeing the pain and concern on his face and the caring way in which he reacted really made me see what I have done. He was understandably upset and hurt, but at the same time very supportive and kind. Even though he has been great, I still don't feel perfectly comfortable talking with him about how hard it is to quit. He has no idea what I'm going through because he has never had an addiction to anything. So now my Mom and husband are the only ones who know about my addiction...I have several close friends but they are all blissfully unaware of my situation. And I don't feel comfortable opening up to them yet.

I know that compared to some my 12-16 (or however many pills a day I could get). The way I understand it I was lucky I never got my hands on anything stronger like oxycontin because I know I would have loved it. But, I did succeed in making myself physically and mentally addicted to the hydrocodone. The withdrawals are hell. There is no other way to say it, and I know all of you know what I am talking about. The doctor has set me up at 8mg per day, dosed once a day. And I think I am going to be fine with that. My physical withdrawal symptoms pretty much gone. There is enough of the mental craving left that I can use it to work on my coping skills without being to much of a danger to relapse. My only question is according to my history and starting dose are there any suggestions for how long my suboxone use should last? My doctor is pretty strict and he told me today treatment should last no more than one year. I am fine with that in theory...but what does that look like in practice? Is it a reasonable time frame? I want to kick this so badly...I have got to make this work. I am so thankful for suboxone...getting clean without it would be almost impossible. I know people have done it but I don't think I could...the withdrawals are just too awful.

Okay, I'm going to end this rambling now. I am so glad I have this place to write, even if no one responds.


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PostPosted: Thu Mar 22, 2012 4:49 pm 
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With what you just explained (BTW, thanks for sharing that with us), I now say 8 mg is probably appropriate for your tolerance, in my limited opinion. (Also one sentence you typed was left hanging.) It sounds like your tolerance was relatively low "for an addict" and that's why I think your doctor is saying 8 mg is the right dose for you. It's a bit clearer to me now.

As for how long your treatment should be, I would remember to take your prior history as well as family history into account. Your active addiction may not have lasted very long, but you might be at increased risk of relapse. That's not the kind of thing that's written in stone though. You have control over your life progressing forward. That's all I think recovery is about. Improving one's life and oneself. I usually advise people new to suboxone to not even think about when they should go off it/how long to stay on it. Just work on things for now and get used to living life without being high.

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PostPosted: Thu Mar 22, 2012 5:06 pm 
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qhorsegal wrote:
There is enough of the mental craving left that I can use it to work on my coping skills without being to much of a danger to relapse.


You pretty much nailed it there IMO. Especially if one day you want to be off Suboxone, you will have to learn how to deal with cravings to some degree on your own. I've also found that even if I was on a dose of buprenorphine that extinguished my cravings completely, eventually I would become tolerant to that dose and the cravings would eventually start creeping back in.

However if you DO feel that you're struggling staying on top of your cravings, and relapse becomes a real risk, then IMO it'd be wise to increase your dose.

Re your doctor giving you a fixed timeframe for treatment. I'd have an issue with my doctor if he was of that view, as recovery is not one-size-fits-all. There are some people with incredibly complicated issues, like dual-diagnosis, homelessness, longer histories of addiction, greater degrees of social dysfunction, criminality, unemployment etc etc. Some people NEED longer on drug-replacement in order to live without it. Some people simply CAN'T live without it.

I'll refrain from passing judgement on your doctor though as I have no idea what kind of thought he's put into your time-frame, the reasons behind it etc. He know doubt knows you better than anyone on a forum like this does. IMO there are more effective ways to keep a person moving forward and growing in their recovery than saying "I expect you to be at THIS stage in 12 months" because that's when I'm cutting your treatment. 12 months is also not a very long treatment time-frame. Would he adjust it if one of his patients relapsed at 9 months? Curious.

Unfortunately you're not the only person whos doctor has these kinda paternalistic practices. People come here all the time saying getting off Sub is one of THEIR OWN treatment goals. But they are concerned that rushing their treatment, or stopping it when they're not comfortable, could just end up with them relapsing and back on Suboxone.


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PostPosted: Thu Mar 22, 2012 6:39 pm 
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Sorry about the weird sentence there. I don't even really remember what I meant to say on that one.

In reference to how my doctor would deal with a relapse, he told me that one dirty urine test would result in being kicked out of the program. I know it sounds harsh and I agree not everyone can work within these constraints...but he is the only doctor close to me and I am driving about 35 miles to get to him. Also, I think I can work with it. Of course the test will be when I have to start the taper. I guess I just planned to deal with it when the time comes if I run into problems. But you do raise a good point. Maybe I should try to find out who is going to have to be my contingency plan if he tries to taper me to quickly or cut me off before I am ready. I really think I can do this with him though. He is not a bad guy, I think he is just one of those doctors that wants you to get off the meds as soon as possible. He is a general practice doctor so I didn't expect him to behave the same as some doctors who specialize in addiction treatment as their main practice. After I got the tough guy act from him he actually warmed up quite a bit and made me feel very comfortable with the treatment process.

Thanks again for the input. I need all of the encouragement I can get right now.


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PostPosted: Fri Mar 23, 2012 6:57 am 
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As usual, Tearjerker brings up excellent points. It's what I love about this forum. We all pick up on different parts of posts and respond with what touches us the most, in whatever way that may be, so everyone gets many different perspectives.

Hang in there. How are you doing today?

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PostPosted: Fri Mar 23, 2012 7:41 am 
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I am doing pretty good today. I have been up for about an hour and still have not taken my dose for the day. That is a little victory because I was craving pretty much all night last night and didn't sleep much again. My short term goal is just to stick with the once a day dosing. I think if I can do this it will help my confidence alot because splitting that dose in half and taking it twice a day sounds good to my addicted brain! I think for ME it will be a victory to keep it to once daily.

I really think not having that stupid Ambien is what is giving me the sleeping issues. Thanks for the reply Hatmaker! I really feel like this forum helps.


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PostPosted: Fri Mar 23, 2012 7:52 am 
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After you shared more of your history with us, I noticed that our histories are similar. I also got dependent on Ambien as well as addicted to xanax (I was abusing more than 6 mg a day!). I had rebound sleep issues when I was taken off it at the time I was put on suboxone. Shortly thereafter, my psychiatrist put me on Trazodone for sleep. It's an older, atypical antidepressant that's frequently used these days for sleep. I've been taking that for 3 years now and don't even use it regularly anymore.

I'd say rebound sleep issues from stopping Ambien could definitely be an issue for you. In fact you could be experiencing rebound anxiety from stopping the xanax, too. That is very common with benzos.

Getting to once daily dosing is smart and will serve you well in breaking bad coping skills and habits we created during our addiction. It's a good place to start.

Keep on keeping us posted. :)

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PostPosted: Fri Mar 23, 2012 10:01 pm 
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Hat, thanks for the suggestions for my sleep issues. I wonder how long the rebound from ambien lasts if I do it without any other meds to take its place? Fortunately, I don't think I was on the xanax long enough to become addicted. I only had them for two months and I was only taking maybe three or four per week. They were only the .5 mg. I didn't mention that I am also taking Pristiq for my anxiety/depression which my sub doctor told me would be fine to continue taking.

As far as the suboxone goes...today was my first dose with the film. I took my whole 8mg about 8:00 this morning and I actually felt really good until this afternoon. My withdrawal symptoms seem to be completely gone still at almost 9:00 this evening. The only thing that returns is the slight achy feeling in my legs and low back. The cravings seem to be completely eliminated for several hours after I take the subs and will return if I spend any time at all not being busy doing something else. By this morning I was really looking forward to my dosing. Do you think this is just my old habit of taking a handfull of pills every 2-4 hours messing with my brain? I was thinking about splitting my dose tomorrow and taking 4mg in the morning and then 4mg in the evening to see if it held me over better. I am hoping by doing this I can have a complete day of no pain and no cravings. Then I can switch back to once per day the next day but wait until later in the morning or early afternoon to take it and then maybe it will last longer through the evening routines with the family. Would this be a mistake or does it sound like the right thing to try? I don't want to give in to addictive behavior if that's all it is. My other option would be to tough out the cravings and aches throughout the morning tomorrow and just wait to take my dose till around lunch time. That would be more on point with what the doc wants me to do but the other way sound easier. He wants me to take my dose all at once every day but said it was up to me what time of day worked best.

I am totally fine with ya'll being honest with me. I don't get offended easily, I can take it. :) I have spent hours on here reading the past few days alot of the current and older posts. I know that everyone that posts here regularly seems to really want to help people with their overall goals, whatever they may be.

Thanks!


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PostPosted: Sat Mar 24, 2012 7:55 am 
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That's a really good question and right off the top of my head, I don't believe it's an easy answer. The simplest explanation would be to raise your dose by, say, only 2 mg and put you at 10 and see if that extra bit of sub will hold you better for 24 hours. Your tolerance could be higher than your doc or anyone originally thought, or you might metabolize suboxone faster than usual. Or YOUR ceiling - usually around 4 mg - could be closer to 6 mg.

But in your position, you have a doctor that doesn't want to raise your dose, so you're left with this situation and trying to figure out a way to reduce your suffering.

According to Dr. Junig, you should stabilize within about a week at the longest (I believe he even says shorter than that). Based on that, you COULD try to the twice daily dosing for a week and see if that helps then try going back to once daily and see if you've stabilized by then. After that little experiment, you could reassess.

At least then you'd know if you had enough time to stabilize, because you still could. And I certainly don't blame you for wanting to dose twice, especially if you're feeling that uncomfortable every evening the whole night. Doesn't sound pleasant to me.

Next time the cravings and withdrawals come on, try to distract yourself. If they go away after you've distracted yourself, then you know it wasn't w/d but was related to addict thinking, because with real w/d, they don't go away with distraction methods.

I hope this helps.

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


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PostPosted: Mon Mar 26, 2012 8:55 am 
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Good morning all,

Just thought I would give a quick update. I am doing pretty good. I notice that each day I feel a little better. Mornings are GREAT for me now! I have been sleeping well the past two nights and yesterday I didn't even take my Sub until 11:00. I just didn't feel like I had to have it as soon as I got up...great feeling. I am still having cravings...but I think it is just mental...not real withdrawal. One thing I have noticed is that the hours before I take my dose for the day I have less cravings. It's like when I know I still haven't taken it I know I have that to look forward to for the day...but after I take it I know it will be the next day before I have the next dose and my anxiety starts to rise and my cravings creep back in. I am hoping that this will ease over time as I get into the habit of sobriety.

One of the things that I wanted to do is start exercising regularly. My doctor said it would be helpful with my body aches and back and leg pain. So, Saturday morning while my boys were having regular baseball practice I walked a little over a mile at our local park. Then yesterday we rode our horses for a couple of hours. I am a little sore today from using all those muscles that haven't been used regularly in awhile but I am hoping if I stick to some kind of physical activity every day it will help me in the long run.

Okay, so now I want to mention a couple of side effects I am having. The first one is the soreness under my tongue. I started noticing Saturday that it felt kind of raw under there...then yesterday when I had my dose it felt like it was burning the first few minutes and has been kind of tender ever since. Any suggestions for what to do for this? I noticed other people complaining about this but didn't know if it would get better after awhile or if it was something that I will just have to deal with. The other thing is I am getting those muscle jerks that I have read about. This started yesterday. It's funny because I used to get the same thing when I would take tramadol at high doses and sometimes after a long hydrocodone binge I would get them too. Does this get better after I adjust more to the medicine?

Thanks for all of your responses...I am hanging in there. Today is one week since my last pill!!!! That is so cool!!!!


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