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 Post subject: Pill Absorbtion - Veins?
PostPosted: Mon Dec 13, 2010 8:32 pm 
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Hi all,

I've been reading a lot about different ways to let suboxone dissolve and various preferences on how long to leave it in, swallow, not swallow, etc. My question is: does it really matter a whole lot? I induced at 8mg TID and now I'm at 8mg 5x/day. My doctor has me at a high dose to start off with because my cravings were really bad and he wants me to have multiple dosings per day to help ensure good pain reilef. I'm prescribed it for opioid dependence of course, but I have chronic back and hip pain that I self-medicated with street opiates and pills, so suboxone helps with my pain quite a bit.

I've noticed that no matter how "perfectly" or "non-perfectly" I take my suboxone, I don't experience any withdrawal symptoms at all, so I'm thinking it doesn't really matter how perfect I try to be when dissolving my tabs. It usually takes me 10-30 minutes to dissolve completely, depending on if I'm doing one tab or two. I'm seeing my doctor in about a week, so I'm gonna ask if he can prescribe me the films instead so that I don't have to worry about this dissolving/absorbtion issue. I hear that those have a much better absorbtion level and dissolve very quickly.

Also, where EXACTLY are these "veins under the tongue" that are constantly mentioned? Are they on the floor of your mouth or on the underside of your tongue? I see veins everywhere but I've read there are specifically two large ones under the tongue. I see two large ones on the UNDERSIDE of my tongue, but I'm not sure if those are the ones. How does it absorb through the skin? And also, the pill for me never gets fully dissolved. No matter what, there is always powder left over. I could understand that the skin is water-permiable, but some of the pill just simply doesn't dissolve all the way I guess.

As long as I have no wds and my pain relief is at a good level and my cravings are held, I am happy. So far, that has been the case, but being an addict I'm always concerned about better absorbtion and not wasting any of the medication, that's why I'm excited to get the films. I remember when I first started them I had lots of energy and I could tell it was working definitely but now that I'm taking it everyday, I don't even notice that I'm taking any medication, but I've heard when people switch to the films, they can tell a big difference, so I'm hoping for the same.



That's all for now, thanks,
Caleb


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PostPosted: Mon Dec 13, 2010 10:13 pm 
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Dr. J has mentioned that there is no need to try to find veins under your tongue. The tablet will dissolve through any/all of the mucous membranes in the inside of your mouth.

I'm not understanding how your tablets don't dissolve all the way. To be honest, that's never happened to me. If it's not dissolving then I would say you are missing some of the medicine. You can always take what hasn't dissolved and chew it in your FRONT teeth and spread it around the membranes on the inside of your mouth. You may not need so many doses during the day if you get the medicine from the whole tablet.

And it's not unusual to feel normal (not feel anything) when taking your dose. I've never "felt" anything and I've never had withdrawals between doses. Some people do feel the strips/film have better bio-availability and are thus "stronger". Some people have reduced their dose after switching to the film, but not everyone. I guess I'm not clear what you think the film will do or how it will make you feel.

Anyway, I hope this helps. Welcome to the forum.

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PostPosted: Mon Dec 13, 2010 10:42 pm 
If i spoke honestly, i would say that your having too take 5 tablets possibly because your not getting the right absorption. I've heard of people taking as high as 4 but 5 i believe is the most i've heard of. I think if you'll read a lot of the stuff on this site you'll see what i mean. Your waisting a lot of money taking 5 tablets a day. Do you know about the ceiling level? Personally i take 16mg's once a day. I can understand you needing to dose a couple times a day for pain but you could probably be perfect with say, 2 maybe 3 times a day on a bad day. Thats only my opinion so dont read it as fact. Does your doctor have you taking 5 tablets or are you doing that because you feel its necessary? As for absorption, you can make up a solution and spread it all around in the inside of your mouth. Really anywhere but your teeth. Your cheeks, your gums, the inner part of your lips, the roof of your mouth and the back of your throat. Under the tongue is nothing special really. Its just the easiest instructions doctors can give you. And for some its the easiest method. Anyways, welcome to the forum and i just know you'll find everything you need here!!


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 Post subject:
PostPosted: Mon Dec 13, 2010 11:12 pm 
Yeah 40mgs a day of suboxone is totaly uneccessary, doses of 24-32mgs are acting more of an antagonist than an agonist. Also with some of the pill not dissolving believe it or not but that happens with the strips as well if you just let it sit and dont move it around with your tongue. I put the strip in my mouth and let it sit for about 2-3 minutes till soft and then use my tongue to push it around into a paste until its like a jelly spread all over getting the most surface area. The faster you make it dissolve the more you are gonna get out of it, when its sitting there still intact you arent gonna get much out of it. I also figured out a way to keep a lot of saliva from pooling up to fast, after you put the strip/pill in keep your tongue elevated some and inhale air through your mouth periodicaly letting it pass under your tongue, the air dries out spit that is starting to form. Before I starting inhaling like that I would have a pool of spit covering my dose in less then 5 minutes and its irritating knowing that expensive med is getting trapped in that spit and getting swallowed. Some people may not like it but I found the best way of all with the tabs was to crush them to a dust and then dump it under my tongue, that dissolved even faster than the strips.


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 Post subject:
PostPosted: Tue Dec 14, 2010 2:05 am 
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Yes, my doctor has instructed me to take 5 per day. The tablet breaks down completely but there is still a moist paste that I have to spread around my mouth. My mouth does indeed produce a lot of saliva during my dosing, causing me to swallow a lot. I know it's expensive but with my insurance they're only $0.67/pill.

I have heard of the 32mg ceiling level but not the 4mg ceiling level. What is that? How do I know that I have reached 4mg?

Also, think of all the suboxone patients that don't think twice about maximum absorbtion and they just let it soak in for a bit and swallow like me? They obviously don't have any issues, so do you think that I am overthinking this whole thing? I'm not trying to feel a high or anything I just think maybe it's not getting absorbed that well, or at least not as well as it should be.

What differences do you guys notice from using the maximum absorbtion methods? With my first dose ever, I had no idea how to dissolve it so I just sloppily did it, and I definitely felt it kick in. So in my eyes, that should be a sufficient method right? Why can't I just keep doing it this way or is your way that much better?

I'll talk to my doc when I see him in a week about lowering to 2-3 pills per day. Being on 5 makes me feel like overkill and like it's not doing much. Do you think I'd benefit from a much lower dose?



Thanks a lot,
Caleb


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PostPosted: Tue Dec 14, 2010 7:46 am 
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It's not that you'd necessarily benefit from a lower dose as much as what you're taking now could be considered overkill. In other words, you're not getting anything out of taking that much.

32 mg is not the ceiling. 4 mg is generally accepted to be at or around the ceiling. At the ceiling (which is not set in stone and can vary from person to person), the opiate receptors are saturated, addressing withdrawals and taking care of cravings. People settle on a stable dose often based on what dose takes care of their cravings. This is why some people are on 8 mg, others at 16. But for opiate addiction only (not pain control) most people are at 16 mg or less.

I also dose for pain control. I take 8 mg up to 3 times a day. Suboxone's pain properties last on average about 4-6 hours, which is why we dose more than once per day. For opiate addiction only, the mean half-life is about 37 hours, so those people only dose once per day.

I hope this helps you understand a bit better. If you have more questions, please let us know. We'll try to explain things to your satisfaction.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

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


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