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PostPosted: Thu Dec 19, 2013 4:10 pm 
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hi everyone!
yesterday was my appt to start suboxen. my dr is my neurologist, who has been seeing for over 5yrs for my neck injuries and migraines. she has only prescribed 4 patients thus far on suboxen, me being her 4th, she not sure on how much I should start at. she kept me in her ofc for almost 4hrs and was constantly calling the suboxen rep for questions regarding my treatment. I took my last Percocet tues night at 10:30pm and she did not give me my 1st does until almost 3pm on wed b/c she said I wasn't in w/d yet. when I started to show signs of wd, she gave me 4mg. waited another 30mins and gave me another 4mg and said I shouldn't need to take more than another 4-8mg for the rest of the day. I started feeling very sick (w/d sick) by 6pm yesterday, called her and told her I was taking another 4mg. then by 10pm last night, I was going into w/d again, shaking, restless, sweating, stomach ache. I tried to go to sleep, im normally sleeping by 11 but the w/d just got worse. so I took another 4mg by 12am and finally felt comfortable. so in total I had taken 16mg yesterday. when I woke up this morning I took 8mg, my dr called and I told her all the above. she said 16mg should be my daily dose.
I already took the 16mg today and was feeling ok until now. im starting to feel w/d symptoms again. I don't understand how or when the dr determines what dosage I am suppose to be at? I know she has only done 3 patients before me, I feel she does not really know. I have told her all about this site, and how more of you know more than most dr's.
Im sorry for rambling, its so hard for me to putting all of this on here, especially under these conditions. I am going to take another 4mg, b/c the whole point of going on suboxen was to not feel w/d. I am going to s/w my dr but I wanted to get some advise from any of you.

Also most of you say to not swallow when it is dissolving under your tongue, so I spit out any saliva I have after its all dissolved. By doing this, am I losing some of the doseage? my dr also never heard of this or about the headaches/stomaches swallowing the naloxone can give you. And while she was on the phone w/ the suboxen rep, the rep said that's not true. but I read too many people on here say it does. so how do they know, they never took it!

thanks for reading my babbling post. any input would be greatly appreciated :(

I feel like su


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PostPosted: Fri Dec 20, 2013 1:06 am 
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Your doc is welcome to send me an email-- or you can-- drj@fdlpsych.com .

All the worry about dosing... it really doesn't have to be complicated. Every patient is going to be at the 'ceiling level' to be stable, so the only question is whether to just go there directly, or taper to it. I used to look at what people were taking and come to a schedule... now I just do the following--- take 4 mg. after 2 hours, if you are not vomiting, take another 4 mg. that's day one.

Day two, take 8 mg. after 2 hours if not vomiting, take the other 8 mg. from there on take 8 mg twice per day-- or 16 mg once per day.

If you vomit, the dose I higher than you are used to. Take the same dose the next day, and the nausea should be gone... then the next day after that, keep taking that same dose, unless you feel that withdrawal comes at the end of the dosing interval, in which case you increase to 16 mg per day.

A couple important things to remember. Dosing takes longer than people realize; at least 60 minutes for full onset of a dose. Second, dosing efficiency has a DRAMATIC effect on what gets absorbed. If you put two strips under your tongue and leave them there until gone, you will absorb about 30%-- about 5 mg total. If you take one strip, put it on your tongue in a dry mouth, rub it against the inside surface of each cheek, and let it sit there, most and dissolved, for 30 minutes-- then repeat a couple hours later-- you will absorb (I believe) at least twice as much buprenorphine.

Never rinse with water or food after dosing-- wait 15 minutes or more. Remember that buprenorphine in solid form is doing NOTHING. It can't get absorbed until it is in solution, and close to the cells that line the oral cavity. Absorption is ALL about having a high concentration of dissolved buprenorphine, next to the oral mucosa surface. The concentration gradient at that spot drives diffusion into tissue;.

8 mg, taken carefully, is PLENTY for anyone the first day. Most people have some 'psychological withdrawal' for a few days.... but note that if it were REAL, it would occur only at the end of the dosing interval, and get continually worse. That is not what usually happens--- instead people have sweats and worry that they will get sick... but with a bit of distraction, they do fine.

Please share my comments with your doc. The risks at induction are that the person has too low a tolerance, and will get pukey... or has too high of a tolerance and feel withdrawal. The second risk is prevented by going a bit longer before inducing in people taking ridiculously high does of agonists.


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PostPosted: Sat Dec 21, 2013 8:01 pm 
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suboxdoc wrote:
Your doc is welcome to send me an email-- or you can-- drj@fdlpsych.com .

All the worry about dosing... it really doesn't have to be complicated. Every patient is going to be at the 'ceiling level' to be stable, so the only question is whether to just go there directly, or taper to it. I used to look at what people were taking and come to a schedule... now I just do the following--- take 4 mg. after 2 hours, if you are not vomiting, take another 4 mg. that's day one.

Day two, take 8 mg. after 2 hours if not vomiting, take the other 8 mg. from there on take 8 mg twice per day-- or 16 mg once per day.

If you vomit, the dose I higher than you are used to. Take the same dose the next day, and the nausea should be gone... then the next day after that, keep taking that same dose, unless you feel that withdrawal comes at the end of the dosing interval, in which case you increase to 16 mg per day.

A couple important things to remember. Dosing takes longer than people realize; at least 60 minutes for full onset of a dose. Second, dosing efficiency has a DRAMATIC effect on what gets absorbed. If you put two strips under your tongue and leave them there until gone, you will absorb about 30%-- about 5 mg total. If you take one strip, put it on your tongue in a dry mouth, rub it against the inside surface of each cheek, and let it sit there, most and dissolved, for 30 minutes-- then repeat a couple hours later-- you will absorb (I believe) at least twice as much buprenorphine.

Never rinse with water or food after dosing-- wait 15 minutes or more. Remember that buprenorphine in solid form is doing NOTHING. It can't get absorbed until it is in solution, and close to the cells that line the oral cavity. Absorption is ALL about having a high concentration of dissolved buprenorphine, next to the oral mucosa surface. The concentration gradient at that spot drives diffusion into tissue;.

8 mg, taken carefully, is PLENTY for anyone the first day. Most people have some 'psychological withdrawal' for a few days.... but note that if it were REAL, it would occur only at the end of the dosing interval, and get continually worse. That is not what usually happens--- instead people have sweats and worry that they will get sick... but with a bit of distraction, they do fine.

Please share my comments with your doc. The risks at induction are that the person has too low a tolerance, and will get pukey... or has too high of a tolerance and feel withdrawal. The second risk is prevented by going a bit longer before inducing in people taking ridiculously high does of agonists.


Hi Dr J,
First I want to say thank u for responding to me and also for creating this site. I can see that YOU are in the good dr category. In my experience, that is very hard to find! I would really appreciate some of your advise as to why I am feeling so anxious and confused, even more than I was before I started. Btw- its very hard for me to communicate thru email under normal circumstance so now, its even harder.
Its been 4days and the what I can say is I have NO desire to take a Percocet but why am I still feeling so off? I know u said to only take 16mg a day but 20mg is where I feel comfortable. Am I doing it wrong? I start in the morning, that's when I feel the worst, by taking 12mg and my goal was to only take 4mg more as u suggested but I start feeling w/d symptoms, so I took another 4mg. I keep it under my tongue for a good 20mins and paint the inside of my mouth, as I read to do from ppl on here and then I spit all the saliva out. I am terrified to get bad head or stomach aches. As I also learned from here. By doing this am I losing the some of the dose and that's y I feel I need 20mg?
I don't know when u will be able to answer me, im sure u are very busy.
But thank you again for everything


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