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PostPosted: Fri Jan 24, 2014 12:48 am 
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Hi all, this is my first time posting and I am in dire need of some advice. I have been on and off Suboxone for the past 3 years, and have been doing really well with it the past 12 months. I started a year ago at 8mg and just started tapering last month. I did one full month at 6mg and didn't really have any problems, so my doctor said let's do another month at 6mg and see how it goes. Well, the day after my doctors visit I lost my job, and I became very stressed and depressed. The 6mg was doing fine during the day, but when I tried to sleep I started craving more, and for the past 2 weeks I've been almost double dosing. I understand the problem here, I'm just a little nervous and not sure how to ask my doctor for help. I've been thinking of seeing a counselor lately, and this incident really makes me think it is necessary, so I definitely plan to start immediately. But in the meantime how should I talk to my doctor about this? I know I need to tell him the truth...does anybody have any idea of what I might expect him to say? I'm worried of being kicked from the program. I don't think he is a very strict doctor, but this does seem like a pretty big deal. This is my first time having something like this ever happen, and I'm hoping that if I am honest with him, and agree to take steps necessary to prevent it from happening again that he will work with me...

Thanks for any input :)


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PostPosted: Fri Jan 24, 2014 1:03 am 
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I agree with you. Be honest and just say what you said here. He sounds compassionate so you probably will just have a discussion and agree on a dose that will stop those cravings again.

6 mg's should have done that though. You could be one of those who have a fast metabolism where it wears off sooner than it does for other patients. We have several members here with that.

Welcome to our forum and I hope it all turns out okay.

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PostPosted: Sat Jan 25, 2014 1:26 am 
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I agree-- if a patient simply told me what you wrote, it would not be an issue-- as your experience is pretty typical. From the doc standpoint, I would rather get a call early, that the person was in trouble, rather than a call after everything was used up. Sometimes it is hard to fill a script early, even if the doc wants to; in WI Medicaid, for example, they will not fill scripts early, and will not allow patients to fill scripts using cash, even if the doc writes the script. Most insurers won't cover early refills either, but they don't have the power to keep a patient from filling a script and paying cash for it.

Does your experience mean that you aren't ready to taper? Not necessarily.. the cravings are stronger during the taper than they will be when the taper is completely over, and the withdrawal has ended (which is TYPICALLY two months after being off opioids completely). BUT... your experience shows how opioid dependence usually works. I have had a number of patients who got through a taper, and did well for months, even years.... and then a girlfriend broke up, or a job was lost, and they found themselves using again. Everyone in the addiction field loves the idea of 'counseling', but I don't think any amount of counseling protects a person from THAT type of relapse, unless the relapse moment happens to occur during an appointment with the counselor! Instead, I think that the nature of relapse shows the value of a recovery 'program', that goes on week after week, indefinitely. There is truth to the adage that 'people who keep attending meetings tend to stay sober, and people who stop are at greater risk of relapse.' It isn't absolute, of course-- but I'm sure there is a trend.

If you still have Suboxone or buprenorphine left, consider searching my blog for 'optimizing absorption' and using 4 mg per day with those instructions. You can search at http://www.suboxsearch.com... search the blog using those words. People typically absorb a third of a dose-- and you can easily absorb more by taking a few steps.

Good luck!


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PostPosted: Tue Jan 28, 2014 2:09 pm 
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As recommend by suboxone makers reckitt and be listed and all others involved in the treatment with suboxone long term maintenance, when a patient is on suboxone you stabilize them and give them the opportunity to build a recovery background to treat the mental part of their disease while taking suboxone. Then when the patient is ready they should start stepping down their down with increased counseling on top of taking suboxone. And if in the middle of a taper a patient has any sort of life stressors then that patient should immediately be re stabilized back to their original dose and possibly even higher and once they are stable again (however long it takes) then they can try to start the weening process again.
So if you are seeing the right kind of sub doctor who is doing the right thing and knows what he is doing then you need to be honest with him so he can adjust your dose so you'll be takin as much is not more of what you've been doubling it to. Your doctor is supposed to stabilize you back. That's just how suboxone works when your on it and have life issues- if you're in a wean down during major stressors such as losing a job then it's critical your doctor stabilizes you immediately back to a higher dose. Everything real sub docs knows this and will encourage this! If not, then you need to look for a new sub doc immediately.

It's ok that you have been doubling doses, this is NOT a relapse! You are just doing what you doctor SHOULD be doing after you lost your job. So go get honest with him so that he can write you a new script cause your gonna run out early if you don't. And if he refuses then take your cash and go to a new doc that knows what he's doing and is trained better in real sub maintenece. Most physchiatrist are actually trained more in sub maintenece. My sub doctor whose a physchiatrist is the one who told me if I had any issues in life (like lose my job, a breakup, etc.) while weening suboxone then I must be immediately restabilized at my original dose and he asked me if I understood that and was ok with that because it's important and I said yes I get it because I knew it was right.

I know it can feel like a set back but this is where you gotta learn to live life on life's terms and move forward no backward. We can't set expectations for ourselves that we can't meet. We can however set realistic goals and it's important to know the difference.

Be well :) and good luck let us know how it goes, have any more question message me.

Sorry you're struggling, or have been struggling. I hope you're well now.


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PostPosted: Tue Jan 28, 2014 2:19 pm 
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If your doctor increases your dose then the pharmacy has to fill it. It's not up to the pharmacy it's up to the doctor. If it's too early to fill a script and your pharmacis refuses to fill it then If your doctor calls the pharmacy and tells them to fill it even though it's too early then the pharmacist under federal law has to fill the script. Your insurance may not pay for it until it's due again, but the pharmacy will allow you to pay cash until your insurance will pay for it again. I'm not sure what laws are being talked about but they are none I've ever heard of. If a patient is say on 8 mg of suboxone and they get 30 strips on the 31st of the month and the dosage is once a day and they come in with a new script say on the 14th of the next month with the same instructions from the same doc then I don't think the pharmacy can legally refill it even if the doctor approves it. But if that patients comes in on the 14th of the month and has a script for 16mg a day and instructions written on the script that it's a dose increase then the pharmacy has to fill and doesn't need a doctors permission or any legal permission. I've frequently went from 8mg to 24 mg to 16mg up and down many times under the care and instruction of my doctor and I've never had a problem getting a script filled early as long as it was a legitimant dosage increase. Most times I called early and my doc told me to up my dose and come back one day before I'm out and he would write a new dosage increase. This is legal. There are certain laws to this medicine but what I've share is the law and it's legal. So yes you can get your script filled even if it's early with a few adjustments made by your doctor and or pharmacist :)


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PostPosted: Tue Jan 28, 2014 2:25 pm 
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And excellent advice from the sub doctor btw he's absolutely right. I've had to go cold turkey off 24 mg of suboxone a day for like 9 days before cause I couldn't afford my meds due to having to pay for other things like bills etc. And in those days of cold turkey I didn't relapse by the grace of god even though I was withdrawing so bad there's no words for it. And the reason is because I work a recovery program, suboxone isn't my sole program, suboxone is only a tool, what actually keeps me clean is NA. And the 12 steps and my willpower to work them.


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PostPosted: Tue Jan 28, 2014 3:31 pm 
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Unfortunately KadyRx while your comments regarding cash, early refills, etc. may have been valid years ago, we are in an ever changing landscape due to all sorts of reasons - top of this list, tightening regulations for controlled substances (state databases, regulations, etc.) and this insurance hell of ObamaCare we've all been forced into. To that end, some insurance companies have now forced contracts with pharmacies stating that the pharmacy agrees NOT to fill an insured's scrip for cash. As crazy as that may sound it is very much true. Then we have the DEA getting involved in all sorts of things way beyond their understanding or control. To that end, and this has not been totally proven but appears very likely, Walgreens entered into a settlement agreement following some dispensing violations in Florida. Walgreens has denied this. What they have not denied is they put a new program into force in 2013 that requires their pharmacists to contact the prescribing doctor for all sorts of extra information on all new controlled scripts. This has met with huge pushback from the medical community claiming it's not the pharmacist's job to find out what the diagnosis is for which the controlled substance has been prescribed, how long the treatment is expected to last, what else may have been tried - yet this has not stopped them. Dr. J has experienced this himself after writing scripts for Bup and having a pharmacist not only call to verify it's a valid script but what the diagnostic code is and on and on. I personally made my tiny little stand and won't fill at Walgreens anymore. Here are several references for what I just stated:

http://behavenet.com/blog/boycott-walgreens

http://paindr.com/is-walgreens-opiate-policy-deceptive/

http://www.ismanet.org/news/Article740. ... ugBf2HnYps

http://ddtheory.blogspot.com/2013/04/th ... rmacy.html

Bottom line is (in my opinion) government totally F's up everything and anything they put their hands on. ObamaCare is a prime example of that. In Seattle Washington doctors can't prescribe more than X milligrams for X period of time. And on and on it goes. I also believe that the larger a corporation gets, ie Walgreems, banking, insurance, etc., the more "government-like" in their operations they get. So at this point, believe it or not, some pharmacies, often the large chains, refuse to fill cash controlled and sometimes just general substance scripts - per not a state or federal law but agreements with insurance and their own policies. If you can still find one, a local, non-chain, pharmacy is your best bet.

It's a new world out there and government more and more is in control. It's not only very scary but very sad what is being done to us by the nanny state. Perhaps this needs to be it's own thread - especially this diagnosis code crap. I did want to correct the outdated info, however.

Don


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PostPosted: Thu Jan 30, 2014 11:10 am 
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Don, thanks for sharing, perhaps it's your state? Or your own personal situation?

The info I provided is recent info. That's currently how all the walgreens in my state operate. We have a walgreens about every 5 miles throughout the whole state. Just a month ago I had an issue like this and I could get my script filled under cash out. And I have one of the worst insurance situations ever.

I've never heard of a pharmacy not allowing a patient to get their meds filled as long as it's completely legal. And running out of meds due to a dosage increase and then needing to refill new script is legal. I find that the problem that dr j and most docs run into is how to write the scripts so that it doesn't cause people's insurances to have a melt down and brain freeze.

If a patient is taking 24mg a day and their insurance only covers for 16 mg a day then it can cause a hassle. Those pharmacies want that money and rarely refuse to let a person give them cash of any kind.. And as with any pharmacy these pharmacies make the most money off of suboxone! So they all smile when u pay for it.

I hate if this is starting to change in other areas of our country, that's very unfortunate, but Walgreens is a huge change and when one changes they all must.
I don't understand why a pharmacy wouldn't allow a person to pay cash for a legal script,

Walmart however won't allow a person to refill just one strip. Incase they can't afford but one. But they do allow Walmart to fill them for cash- out price.

The information I provided I understand may be outdated to you and your area and experience. But in a lot of areas in the United States it's not out dated it's valid.

Lots of love


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PostPosted: Thu Jan 30, 2014 12:50 pm 
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i dont know where you live kadyrx but i have never heard of any of the statements you make to being true...actually for most of the country TODAY. most doctors do not allow for refills on a script even for patients of a few years...and a pharmacist will most certainly NOT fill a script that someone ran out of meds on...in many cases in many parts of the country, the doctor COULD NOT even call in a script for suboxone even if he wanted to...the pharmacist MUST see a physical script with the doctors DEA liscense number on it

thats just the way it really is in today's real world

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PostPosted: Thu Jan 30, 2014 1:05 pm 
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not to mention, kadyrx, you telling the OP that double dosing is OK and there's nothing wrong with that...that is HORRIBLE advice to give somebody and i really hope you never say somwething like that again....that is how people get kicked out of suboxone programs everyday..not to mention how they run out of meds and get SICK...most doctors WILL NOT write for extra meds no matter what

now in the OP's situation, if he would have called the doctor immediately, then the doc could have worked with him...if he hasnt already done so, i would urge him to call the doctor, explain and hope that its not too late for him to fix this mistake.

as far as life problems, and increasing the dose back to higher than the original dose...well, i've never heard of that either...but i guess some people might need that...i would say it would be TOTALLY on an individual basis...these life stresses or problems WILL come up for everybody throughout life...no matter what...doctors know this, people know this....for this reason, this is why a lot of doctors require counseling throughout suboxone treatment...further: this is why,even if its not required, it is WISE to get into counseling anyway.....suboxone is not magic...its not going to make anybody's problems go away...but good counseling will help deal with those problems.

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PostPosted: Thu Jan 30, 2014 1:10 pm 
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I see my doc every two months, I get one physical paper Rx and then I am told to call the next month when I need my subutex refilled and its gets called in so there is no rule about having to have a written rx. You are correct though in that most of that other nonsense is not true in todays world though. I have one question though to anyone who may have actual experience with this, I want to fill my ativan today because I hate cutting it so close and right down to my last pill and with the weather I never know if something might prevent me from being able to drive to get it the day I run out so my ? is can I fill it today its the 28th day since I filled it and I seem to remember you're allowed to fill it 1-2 days early but I don't wanna go in there and get turned away.


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PostPosted: Thu Jan 30, 2014 1:24 pm 
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buprecision, i understand that what i mentioned isnt true for everyone, i know some doctors will allow for refills, but A LOT of them wont.

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PostPosted: Thu Dec 24, 2015 4:04 pm 
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No I never really thought I was going to have this many problems with the pharmacy that I have had. So this is the first time that I've ever gone over maybe two strips so I ran out a couple of days early. Never ran out before, but the pharmacy treated me like I was a drug addict argued and argued with me. The bad thing is that the doctor wrote on my prescription that I can get it early if I needed to. So I called in a refill a little early and they said Yep we will have it ready in a couple of hours ...three hours later I drive up there . The pharmacist says nope we can't fill it it's not due to be filled yet. I Said well the doctor wrote on the prescription that I can pick it up early if I needed to? At this point it was after 5 PM and the doctors office was closed. He left me no options to call the doctor to get them to OK it or anything. I contacted the doctor the next day and he went ahead and changed the dosage he said that it sounded like I needed the dosage increased a little bit he didn't have a problem with that at all . They said they called in a new prescription to the pharmacy and that I can go pick it up. I get back to the pharmacy and the pharmacist continuously argues with me again. I think what makes me angry is that this is the only time of ever had to get a refill early, and I don't believe it's fair that the pharmacy should try to make a medical decision that's the doctors job. I told the pharmacist fine if the insurance will not pay for it yet I will just get a few until they will. He proceeded to argue with me in front of all the customers why was I taking the amount that I was taking? That I should have enough left over. This was Christmas time, and I honestly was going out of town as well. It embarrassed me! He finally gave me a few strips and I paid cash but he didn't give me the increased dosage amount he gave me the previous prescription of a few strips which didn't make any sense to me . So what he really did is what I asked him to do yesterday... yesterday he continuously said he was unable to? I just hate that they treat everyone like drug addicts that are on this medication. I don't want to ever go through that or feel like a low piece of crap again. I just want off this medicine.


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PostPosted: Fri Dec 25, 2015 8:20 pm 
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suboxdoc wrote:
There is truth to the adage that 'people who keep attending meetings tend to stay sober, and people who stop are at greater risk of relapse.' It isn't absolute, of course-- but I'm sure there is a trend.


I wish that were true for me, then I wouldn't be sitting here back on Suboxone. Twice I relapsed with over a year up while doing 5 or 6 NA meetings a week.


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PostPosted: Fri Dec 25, 2015 11:54 pm 
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Hope, see if it's okay to change pharmacies so you can find one that will treat you with respect. Explain the whole thing to you doctor and maybe he'll call the pharmacist and straighten him out.

Plus, if the pharmacist told other people around you what drug you are taking and insinuated that you are an addict then I believe they have violated HIPPA laws and can get in serious trouble. Your medical information is strictly confidential. Plus, not all patients on Suboxone are addicts. A select few take it to try to get off their high dose of opiate pain medication. They are physically dependent but not addicts. Your pharmacist doesn't know your information so he best be careful what he says in the presence of others.

Just my 2ยข worth. Rule

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