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PostPosted: Tue Sep 24, 2013 9:46 am 
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Hello all,

I need to switch to Subutex from Methadone. I have been on an 80mg daily dose for the last 6 months and prior to that I was on 45mg for 7 months. I have been on Methadone for 13 months in total and I really need to make the switch to Subutex this week as I have to move out of my property. I also struggled to perform my job well as a Creative Director and I actually had my contract terminated. I put this down to the fact that Methadone has really blunted my creative edge.

Anyways, I last dosed 80mg at 6:30am yesterday (32 hours ago) and I intend to take my first dose of Subutex on the 72+ hour mark depending on my COWS score. I have tried to do this once before and took my first dose of Subutex on the 48 hour mark and went into PW's with a trip to A&E necessary and a very shocked housemate who kindly called an ambulance.

Suffice to say I really don't want to repeat that episode but I am prepared for feeling weak and under the weather for the fist few days (week?) after my induction.

So, to my question. On the basis that I am not following the recognised schedule for induction, could anyone please give me any advice to limiting the chance of causing precipitated withdrawal, e.g. minimum COWS score, dosing regime etc.

Many thanks in advance from a very anxious guy in London UK...

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PostPosted: Tue Sep 24, 2013 10:09 am 
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Hi Mozza,

Welcome to our forum! I'm glad you have found us, and I hope we can help you.

First off, the main thing that worries me with the info you gave is the dose you are trying to switch over from. I have read that it is best to switch to suboxone from doses of 30mg or less. I'm afraid that it is going to be pretty tricky to keep you out of PW's with that dose.

If you have no other option, then I would absolutely wait as long as you can to take the first dose of subutex. You need to work on that COWS score, getting it to at least an 18 or 19 at the very minimum. But I would highly recommend putting some more time between your last methadone dose and the suboxone.

We just had a poster here the last few days who was in a similar circumstance. I'm going to link his thread for you here because he received ALOT of good advice.

Go read it, and come back here if you still have any questions OK?

topic9171.html

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PostPosted: Tue Sep 24, 2013 11:10 am 
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Hello Mozza!

QHorsegal's advice was very good, but there are a few other suggestions to make this go smoother for you in my opinion.

If you want the best chance to avoid those PW's then you should continue to taper from the Methadone down to a dose of at LEAST 30mg as QHorse mentioned. Tapering even LOWER than that would be ideal and give you a much better, and easier switch to the subs.

Once you get down to 30mg or below on the Methadone you MUST be in SEVERE withdrawals and have a score no less than a 26 on the Cows sheet. You have to wait as long as possible before taking any subs.

You are going to be feeling horrible that's for sure as you go into those withdrawals before inducting on subs. But you only have to do this one time so may as well do it in a way that gives you the best chance at success.

I've done this switch myself Mozza, and witnessed others doing the same. The lower you can taper that Methadone the better I promise. If you can get it to about 10-20mg of Methadone that would be great! Don't get in any hurry to switch to subs, do this right ok. Once you get to 30mg, and preferably below as I said, then you completely STOP the Methadone and let withdrawals begin.

And don't take ANYTHING that makes you feel better while waiting on those withdrawals either. If you take any kind of comfort meds it only delays the withdrawal process and that's not what you want to happen.

Again those withdrawals have to be SEVERE when Methadone is being switched from. Use that Cows sheet and get to at least a 26 score or higher and then begin by taking 2mg doses of sub until you are stable. It might take 8mg or more to get you stable.

The entire point of making your withdrawals as severe as possible is so the least amount of sub will get you stable. If you make the switch to subs just being in moderate withdrawals it will take massive doses of sub to stabilize you, if that is even possible. I speak from experience here Mozza. Just take your time and you will be ok.

Switching from the 80mg you last took is a nightmare. You have to get that Methadone dose lower Mozza! I did it the way I suggested here and had a near painless switch at the time. The worst part is waiting for the withdrawals to get high enough on the Cows sheet, but it's an absolute must!

Good luck to you! I know you can do this. If you have additional questions just ask. Many knowledgeable members here to help you along.

Karen xoxo


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PostPosted: Tue Sep 24, 2013 5:28 pm 
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what is the COW's Scale


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PostPosted: Wed Sep 25, 2013 7:56 am 
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Hello again,

Thanks very much for the sound advice Brown Eyed Girl and qhorsegal2. You both make absolute sense and I am now thinking I should delay my switch by a few weeks to get stable on a sub 30ml dose of Methadone. Equally, I am now 54 hours in and I am barely scoring more than 3 on the COWS! I was expecting to feel a lot worse by now; it really illustrates how 'sticky' Methadone really is.

I think I will give myself another 24 hours and if there is no significant change with my COWS then I will go back to a lower dose of Methadone. Probably try 40ml for a week then repeat till I'm down to 20ml and then give it another go. It does mean I will have to do this whilst moving house and starting a new job but I'm now thinking, after your valued advice, that this is the most sensible route.

@ qhorsegal2, I've just got back online so I'll check out the link to the thread you sent me.

Anyway, thanks again and I'll update you tomorrow.

Steven :-)

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PostPosted: Wed Sep 25, 2013 7:57 am 
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rungsat69 wrote:
what is the COW's Scale


Check this link for more info on COWS http://www.naabt.org/documents/cows_ind ... _sheet.pdf

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PostPosted: Wed Sep 25, 2013 8:25 am 
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Good job Mozza!

We never know when someone will actually heed our advice. I'm so happy you chose to give yourself more time. If you looked at the other thread, you will see how awful PW's are, and judging by the cows score you reported, you can now see how super long lasting that done really is!

Keep us updated! Switching to sub from methadone is really tough, but it is soooo worth it from what I hear. Our member Tinydancer is wonderful at giving advice on this issue. She's been through it all, and is a strong advocate for subs over methadone. Good luck, and welcome!

Q

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PostPosted: Wed Sep 25, 2013 8:48 am 
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Hey Steven,

It's also a very good example of why using a certain "time" to wait for induction is not always the best way to go. You have waited 54 hours and still only a 3 on the Cows as you said. Many would have assumed (incorrectly) that 54 hours of waiting was plenty of time, took the sub, and been in possible trouble. And you said BARELY scoring a 3!!! I'm so happy you waited and have faith in the Cows scoring. There is no way I personally would ever induct without it.

Great job and keep going. You understand things and know what you have to do. Waiting another 24 hours is a good idea, but even that may not be enough. I would positively get that methadone dose down to 30mg or below and that would make a big difference. That stuff really hangs on as your finding out. The methadone and sub have about the same half life so it takes time to get free of it.

Keep us informed please. We're here for you!

Karen xoxo


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PostPosted: Thu Sep 26, 2013 7:17 am 
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Hello again,

Well unbelievably I am at 78 hours since my last dose of Methadone and I am scoring no more than a 2 on my COWS! And that is being generous!!

I am almost thinking I can just try and carry on without any more Methadone or Subutex and just try and stop everything completely?!

Does anyone know why I wouldn't be showing any symptoms of withdrawal by now? I have not consumed any form of comfort drug since stopping and the only thing I've had is Paracetamol for a headache.

I am due to collect my weekly collection of Methadone and the pharmacy has already called asking of my whereabouts.

I really don't know what to do now, go back on a much lower dose of Methadone or stick at my planned switch, or indeed just not take anything again? Your continued advice would be really appreciated now as I am really confused.

A big thanks to everyone that has helped me so far and to whomever wants to chip in with their thoughts.

Steven

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PostPosted: Thu Sep 26, 2013 7:52 am 
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Hi Steven,

I have to admit I'm not surprised your where your at right now. That's why that methadone is such a bear to get free of. It just hangs around what seems like forever! People get tired of waiting, get in a hurry and take the subs without being ready, and the real problems then begin. I personally believe the half life of methadone could actually be longer than that of the subs. I have no proof of that, but it sure seems like it most of the time.

The way I see it you have 2 choices you could make at this time....

You could stop taking everything, get into withdrawals, and then see if you can continue in that manner dealing with the symptoms that are surely headed your way at some point when the methadone dissapates from your system. That could take days longer? And then try the subs.

Or you could get your methadone, begin to taper that down to 30mg, and preferrably lower, stop that completely once getting the dose down, go into withdrawals, and then switch to subs. If you think about it like this it might make more sense to you....

When your at 80mg of methadone as you were it takes a very loooong time to get it out of your system as it's doing right now. But if you can get your dose down as low as possible, and the LOWER the better, then it will take less time to get in withdrawals because you will have less methadone in your system at that time.

Switching to subs from 80mg of methadone is nearly impossible, or a nightmare at the least.
But switching from 30mg or less is indeed possible as most have done. It's still difficult, but can be done.

Seeing as it's already been 78 hours and you are only a 2 at most on the Cows, I would just completely stop everything right now and wait for withdrawals to begin. Then you would want to switch to subs at that point and remain on them as long as you choose.

If you get more methadone at this point it will begin addiing it into your system and will take much longer to accomplish the ultimate goal you have. You have already waited for 78 hours, might as well continue to wait and sooner or later those withdrawals will show themselves to you! It's just a matter of you waiting for that to happen.

You will know when withdrawals are headed your way. I would not take any more methadone, wait as long as it takes for withdrawals to begin, get to that score of 26 on the Cows, and then begin the sub induction. If it were me in your shoes that's exactly what I would be doing Steven. Others may advise differently, and you will have to make up your own mind how you want to proceed. I have given you my best advice based of knowledge, education, and experience. But it's your life and your decision to make here.

I wish you the absolute best. I will try to be here if you should want to ask me something. You hang in there ok. I'm sure you will figure it out soon and you will be able to make the switch to subs if that's what you want to do. Good luck!

Karen xoxo


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PostPosted: Thu Sep 26, 2013 8:25 am 
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Hey Karen,

Thanks again for your thoughts. It's really good to get another point of view.

I collected my Methadone but so far it remains untouched. I was leaning toward toughing it out and now I'm convinced it's the way forward.

I did naively think that I may get through this without any withdrawal. That for some reason I could jump from 80ml and two years of HEAVY opiate abuse and come out the other end unscathed! LOL, that would be something?!

Anyway, I guess there's no harm in dreaming?

Thanks again and I'll keep you posted of any significant developments.

Steven x

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PostPosted: Thu Sep 26, 2013 1:19 pm 
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Hey Steven,

The decision to go off methadone completely vs. whether to induce onto suboxone, and continue with suboxone maintenance, should be influenced by how you're doing overall in your life. Are you in a good place? Are you working? Do you have a good support system around you? Do you feel vulnerable to relapse? The answers to these questions usually guide someone to decide whether they want or need maintenance. If your goal is simply to be off everything, then yes, it's probably worth it to see how you do off the methadone.

While methadone does have a pretty long half life, I for one, am surprised that you've gone 3 days with little to no consequence. That's pretty amazing. I remember having to skip a day or two throughout the course of my Meth maintenance (due to the bizarre clinic hours) and I'd have trouble. I wouldn't be in dire straights but I'd be pretty uncomfortable and had a hell of a time sleeping after one missed dose. Are you sleeping fine? You must be metabolizing it extremely slow. But that makes me curious about your dose increase.. why was your dose nearly doubled 6 months ago? Was it not holding you through the day?

I agree with BEG, if you are generally feeling ok right now, there should be no harm in waiting it out to see how you do. You could get lucky, it's not impossible, everyone's system works a bit differently and crazier things have happened.

My last bit of advice is that IF you do decide to go back onto methadone, I would not resume the 80mgs. You shouldn't need that now. You could probably start with something considerably less and get by just fine, seeing as how you're doing so well off of everything for 3 days now.

Good luck, let us know how it goes.


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PostPosted: Fri Sep 27, 2013 5:34 am 
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Hello all,

Well I had some bad news last night which has thrown everything up in the air. The job, which came with a place to live, has fallen through. Seems like it's one step forward and two back at the moment.

It actually answers Tinydancer's question yesterday about where I am at in my life right now and whether it lends itself to making a switch etc.

To be honest the last couple of years have been a bit of a mess. My marriage of 11 years ended and I've gone from owning my own business, having the privilege of raising my three beautiful daughters and living very comfortably to now being on the verge of being homeless.

A lot of this has been down to my addiction and also being diagnosed with PTSD from events as a child. I, like most people here have been subjected to certain traumas. The most significant turning point was loosing my business and home to my business partner who stole close to a million pounds form me. I pretty much fell apart after that and took refuge in heavy drug use. During that time I also was in a road traffic accident which got me hooked on pain pills. There's plenty more that's happened and sadly my ex wife and children bore the brunt of it. I'm still racked with guilt. Again, this is a very common emotion amongst addicts.

Like I said, I have had my fair share of bad luck but there's no denying I made some bad decisions and I've been very selfish at times. I've paid a heavy price and I know my addiction has been the most costly in every way imaginable.

I'm certain that people have had it far worse than me and whilst I'm not trying to glean sympathy I thought I'd give you some context to my desire to become opiate free and get my life back on track.

So I have basically gone back to taking Methadone :( The only consolation is I have reduced my dose to 50ml. I will be trying to make the switch again as soon as my home/work situation is more stable. Importantly, I need to get off of Methadone as I truly believe it has negatively effected my ability in my profession as a creative.

I am sincerely grateful for the genuine interest and really useful advice I have received. I guess we are here because we realise how beneficial this support network is.

I will return with an update when I attempt this again. In the meantime, I wish everyone well and hope you get what your heart desires and deserves.

Steven xoxoxo

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PostPosted: Fri Sep 27, 2013 7:14 am 
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Hi Steven,

Thank you for that very honest look into your life. Yes many here have similar stories to tell, and my own comes very close to yours in several ways. Drugs have destroyed many lives as we all know, and not only ours. It consumes entire families along with friends and acquaintances.

We will be here when you are ready. I would highly recommend you take this time to slowly taper down your Methadone dose so when you are ready to either stop it completely, or make a switch to subs, you are at the lowest possible dose when that times comes. If you can get your dose down to 30mgs or below the advantage will be with you.

I wish you the very best Steven. I'm sure you can bounce back. I've done it, and I know many here have too. Just have to really want that change to happen in your life and it is indeed possible I assure you. Take care my friend and I hope to hear from you soon!

Karen xoxo


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PostPosted: Fri Sep 27, 2013 12:45 pm 
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I'm very sorry for your setback, Steven. I'm glad, at least, that you are able to keep on your methadone instead of relapsing. Keep working your dose down and that will help when you try to make the switch next time. I hope that your job situation improves soon!

Just keep working toward bettering your life! Every step you take puts distance from your lowest low. I'm not saying that chance will be on your side and that you won't experience anymore setbacks, but working toward a goal has value on its own. I wish you the best in whatever decisions you make.

Amy

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PostPosted: Mon Sep 30, 2013 4:20 am 
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Hello all,

i think i messed up! I stopped my methadone on Friday and by 4am this morning I thought my score was enough to induct. Boy was wrong!! I've had 4mg Subutex and the worst PW have kicked in.

what shall i do? Keep taking more subutex or stop? Please help, I'm in hell!!

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PostPosted: Mon Sep 30, 2013 8:59 am 
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Oh, I'm sorry Mozza!

The only thing to do now is to flood the hell out of your receptors with the suboxone. Take 8mg right away and then wait a bit. Maybe Tiny will see this and have better suggestions for you before too long. I'm hesitant to give you much advice because I haven't been through it first hand.

You will have to push through it and give the subs time to take over your receptors. No going back now!

The only good news is that I've heard the worst of the PW only lasts an hour or two. If you can make it that long you should start slowly feeling better.

Keep us updated!

Q

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PostPosted: Mon Sep 30, 2013 10:34 am 
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Mozza wrote:
Hello all,

i think i messed up! I stopped my methadone on Friday and by 4am this morning I thought my score was enough to induct. Boy was wrong!! I've had 4mg Subutex and the worst PW have kicked in.

what shall i do? Keep taking more subutex or stop? Please help, I'm in hell!!



Hi Steven,

I'm sorry to hear that news! PW's are the worst thing ever as I personally know from experience having had them twice in the past. I'm going to RESPECTFULLY disagree with QHorsegal here, and maybe most others, and suggest you stop taking any more subs, or anything else for that matter. Let the PW's pass on their own, and then re-do the entire induction at the right time.

If this were a weaker class medication such as Vicodin, or perhaps Oxy's then saturating the receptors with lots of subs to hopefully kick those drugs off might be the way to go. But we're dealing with Methadone here, and it has a very long half life just as the subs do. It sticks on those receptors and doesn't want to let go easily!

In my own opinion, adding more sub just might prolong the PW's and I know you don't want that. If taking more sub to kick the Methadone away from your receptors would work, and I'm not saying it wouldn't, it might take an enormous amount to do that with. Might take 24-32mgs or MORE to make that happen? It becomes somewhat of a guessing game in my opinion. And once that did happen, if it did, you might be sick from too much sub in your system.

I would stop the sub, let withdrawals pass, and then re-do everything. We know for certain if you stop the subs the PW's will stop soon. What is necessarily not certain is how long it will take to make you feel better taking more sub right now?

All this is my own personal opinion based on my own experience Steven. I'm saying if it were ME I would positively stop the subs immediately and get those PW's gone as soon as possible. I would take no chance at prolonging them myself. Then you would have to stop the Methadone, get into normal withdrawals, get to a score of about 26 or higher (because it's methadone) on the Cows, and then re-induct with the subs.

This is exactly what I would do myself Steven and my opinions and suggestions here alone. I'm not trying to argue or go against anyone else's advice here, just saying what has worked for me in the past when I was in PW's and wanted out of them fast! I'm no doctor, and no expert either, just an addict with personal experience with PW's unfortunately.

No matter what you decide I certainly wish you the very best Steven! I hope you feel better real soon and get back on track. Suboxone/Subutex Therapy is a great choice, and it has definitely saved this girls life!

Hugs,
Karen xoxo


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PostPosted: Mon Sep 30, 2013 12:13 pm 
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I agree with Karen in that it is definitely going to take a very large amount of subs to kick that methadone off the receptors at this point. 24 - 36mgs would be a good guess at where you might wind up.

Use your own judgement here Mozza. There are two choices, either lay off subs completely today and let the PW's die down and try again later, as Karen suggested. Or, soak the shit out of the receptors today and suffer a few days of feeling not so hot until the subs take over and get settled in. Either way, you probably won't feel great for a couple days.

Please keep in mind that my recommendation above was only given from secondhand knowledge. I have not been through PW's and haven't had experience with methadone. That is a beast of it's own and I am only repeating advice I have seen given here from others who have been there, done that.

Karen has been through it, and I respect her opinion. You may get others chiming in later on.

How are you feeling right now Mozza? You hanging in there?

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PostPosted: Mon Sep 30, 2013 1:48 pm 
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Hi Mozza,

This might help explain some things. I know we throw around words like partial agonist, full agonist, long acting, short acting, etc.. and it doesn't always paint a clear picture of why the meds work the way they do or how they interact with each other.

Interestingly enough, Buprenorphine has a higher affinity for the opioid receptors and sticks even better than methadone. That's why people go into precipitated withdrawals. Once you take a suboxone dose, if there is any methadone still hanging around filling your receptors, it will be pushed off immediately, thus sending you into severe withdrawals quickly. So that's what happened when you took your 4mgs.

Here's the second part of what's going on.. You might be wondering, why do I feel miserable if the suboxone sticks stronger to my receptors and has replaced the methadone? Now that the sub has wiped out the methadone, it HAS filled it's place.. but only partially. This is where the full & partial agonist comes into play. Methadone is a full (and long acting) agonist and fit to your receptors completely. Think of your receptors as little locks.. Methadone was the perfect key for it and slid in perfectly, filling every crevasse. Suboxone is a partial agonist and is not a perfect fit. It will fit into the receptor hole, but will not cover every crevasse. Simply put, suboxone is not as strong as methadone in the opiate department. Most people who switch over from methadone to suboxone have a higher tolerance to suboxone than the usual oxy/ pain pill addict. More is usually needed to fill the receptors that are now lacking any sort of relief.

You can do it either way you choose to do it.. waiting it out and re-inducing, or taking more until your receptors are better saturated and the withdrawals start to fade. Either way will be uncomfortable. It's just how it is, I'm sorry. This is not an easy process for most people simply because of the nature of these two particular medicines, and everyone reacts a bit differently. I can tell you that you will adjust to suboxone eventually. Your receptors will become accustomed to the partial agonist vs. the full agonist, and you'll feel better. It just takes most of us several days.

Where is Amber411? She usually has good advice during the meth--->sub transitions.


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