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PostPosted: Sun Jan 15, 2017 1:47 am 
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Happy weekend gang!

So, for anyone whom didn't read my posts right before Christmas....I was really struggling being reduced from 4mg to 3mg. My long time Sub doc forced me to reduce sooner than I was ready and had been pushing me to wean completely off for the past year.

I ended up making an appt with another doc (he's actually a doc I saw many yrs ago). I told him I was having difficulty with the reduction. Instead of prescribing 4mg, he wrote a script for 16mg/day.
To make a long story short, I'll be able to have a nice lil stockpile.

Even though I was experiencing withdrawals, I was determined to give the 3mg dose a fair shake.
I'm proud to report I maintained 3-3.5mg the past month! I ended up using the 2mg tablets my previous doc prescribed me. Now I'm wishing I had more 2mg tablets. I'm pretty good at breaking up a
8mg tablet. But, it's difficult to know for sure exactly how much you have when you're breaking down a
8mg tablet....to try and make 2mg doses......I've been taking a 2mg tablet in the morning and another
half or 3/4 of one in the evening.

My question is:

Can anyone recommend a great pill cutter?

Are there pill cutters that cut pills into quarters?

Would it be extremely odd to ask my pharmacist to fill my "8mg twice/day" script with 2mg tablets?



I feel slightly guilty about not telling him I don't need a script for that High of a dose. But, he's a very
wishy-washy doc (one of the reasons I sought another doc yrs ago). I'll be able to stockpile an extra 4 months of medication for every 30 day script he writes at this dose. That's seems like a good insurance policy in this unsure maintenance world.

I'd also like to give myself a big thumbs up for trying to tough out the reduction, and for my desire to stay at this dose. Early in treatment, I would've probably taken extra....had I scored a stockpile like this! It really makes me feel like I've come a long way in my recovery!

Any suggestions are greatly appreciated. I take plain Buprenmorphine. So, strips aren't an option.


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PostPosted: Sun Jan 15, 2017 12:46 pm 
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I don't know anything about pill cutters. I've never used one. But I did want to give u a big thumbs up for ur reduction! If this forum had a thumbs up emoji, you'd get one from me lol. I just realized I talk about emojis way to much :)

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PostPosted: Sun Jan 15, 2017 12:48 pm 
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Good morning Marie, You could always ask the pharmacist to cut the pills for you. I am prescribed one 2mg strip, three times per day. I only take it twice per day which allows me to have a nice little stock pile for emergencies. My Doc is fully aware and she is really just wonderful. I usually text her to make an appointment and she is always available. She has even suggested that the stockpile is good so if I don't want to see her monthly. I pay 100$ cash each month. I thought that was really nice of her as it is less money in her pocket that way. I don't know what I would do if she decided to retire! We just got notice that there are going to be changes to our prescription coverage, so I am concerned about that. They might make me switch to a generic form of suboxone. I really don't like the idea of messing around with what has worked like a charm for me! Have a wonderful day!


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PostPosted: Sun Jan 15, 2017 3:26 pm 
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Thanks so much Jenn!!

Michelle, I totally get not wanting to mess with a good thing.
I know it would be much easier to switch to strips now that I'm on these lower doses.
But, Ive been taking plain Buprenmorphine for almost 6yrs now. Funny, because I was completely happy on regular Suboxone when I first started treatment. My doc at the time (who's the doc I actually just went back to), kept trying to switch me to Subutex. I know most patients would jump at this opportunity, but the Suboxone was working for me and I didn't wanna change anything.

Once I became pregnant, he said I HAD to switch....so I did.

It's funny, I was petrified the 2mg tablets wouldn't be effective....as I'd been breaking up an 8mg tablet for the past year. But, they ended up being just as effective and I really like KNOWING exactly how much I'm taking. Guess I'll just hafta try out a couple cutters and see how it goes. I'm just worried I may be unintentionally slightly increasing my dose my breaking them up myself.


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PostPosted: Mon Jan 16, 2017 1:20 pm 
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Marie,

No, the pharmacy won't change a prescription even though the strength is the same. They can only dispense what is written by your doctor.

So he won't give you the 2 mg films? Too bad, that's what I have and it is very easy to cut them in half or quarters, etc. There is even a cutting guide tool available from one of our members here for the films, although I haven't seen it and don't know if it's made for the 8 or 2 mg film.

If he won't give you the films then just use a pill cutter. It'll be hit or miss with the dose though. Even the films aren't an exact science unless you turn it into a liquid formula. We have threads on both the film cutting tool and also how to turn Suboxone into a liquid substance for dosing. I've not done either, only read the posts.

Good Luck!

rule

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PostPosted: Mon Jan 16, 2017 4:18 pm 
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Thanks Rule!!

I'm actually prescribed plain Buprenmorphine. Is that available in a strip? I was under the impression only Suboxone was available in the strip form.

I've been on plain Buprenmorphine for so long, I'm very hesitant to switch.

I only need 3-3.5mg a day. However, my temporary doc (who's pretty wishy-washy) prescribed me 8mg twice/day. I hate to speak up and say I don't need that much....because, I'll be able to stockpile about a
four month supply for every 30 day script he writes at this dose.

I'm gonna get a cutter today or tomorrow. I'm nowhere near ready to taper completely off. But, I'm VERY proud of my success. I realize I've been on maintenance for quite some time. But, I NEVER imagined I'd ever get to doses this low. I'm pretty good at breaking up tablets. But, the "cookie" never crumbles the same way. I'm worried I'll be accidentally taking more than planned some days.

I've also decided to put a safety guard in place. I'm gonna take out three 8mg tablets for the week and not reach back into my main bottle until the following week. So, even if one day's dose is slightly bigger
at least I'll still be averaging the same total per week.


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PostPosted: Mon Jan 16, 2017 6:46 pm 
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I was able to cut my buprenorphine 8 mg tabs into pretty even quarters without difficulty. I used a kitchen knife b/c I've found pill cutters to be problematic, especially with odd-shaped pills (the pill slides a bit to one side and you get totally uneven halves. Quartering is much harder).

If extreme precision is very important to you, getting a good mass (say, down to 1/1000 a gram) and weighing your quarters would be better than eyeballing them. And then when you want to taper, you could make tiny cuts in your dose with precision.

But I wouldn't think precision should matter that much with a long half-life drug like buprenorphine. If one day you're getting 2.1 mg and the next day 1.9, the half-life is so long that such differences shouldn't be noticeable - b/c the 2.1 mg dose is still in your system on the day you take the 1.9. It all evens out, right?

I think small changes in dose are mostly psychological. My doctor told me that methadone clinics sometimes do something called 'blind dosing' where the patient doesn't know how much methadone they're getting. It allows them to slowly wean patients off methadone without the patient suffering the psychological effects of knowing that their dose is going down. She said that sometimes they get patients down to no methadone for a couple weeks (they don't tell them 'hey you're off methadone' until they've been off it for long enough that any withdrawal is long past over) and the patients want to keep coming back, even though they've been told that there's no methadone in their juice!

But you absolutely deserve that pat on the back. Congrats!


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PostPosted: Tue Jan 17, 2017 9:25 pm 
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I usually recommend people paying cash get down to 4 mg or so, then change to buying the film. No, plain buprenorphine products (or other generics) do not come as 'film'; only brand Suboxone comes that way. Once people get to 4 mg per day, they can get by on 10 of the 12 mg films, which cost less than $100. As the dose gets lower they can use the 2 mg film, which allows very, very low doses using a razor blade.

I work for a methadone program outside of my usual practice, and I've learned that there is no need to be side during a taper if the patient tapers slowly enough. With methadone we can reduce by 1-4% every week or two, and at that rate there is no need to miss work. The challenge, of course, is having the patience and motivation to taper that slowly.

I would encourage you to keep an open mind about the film. There isn't enough naloxone to have any negative effect, so anything you 'feel' is likely psychosomatic. It is MUCH easier to divide the film-- especially using the cutting guide that has been discussed on this forum. If you use http://www.suboxsearch.com you should be able to find discussions and links to that product, which sells for less than ten bucks.


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PostPosted: Tue Feb 21, 2017 1:59 pm 
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Hi marie.

I feel you pain, I was with a great doctor who encouraged her patients to keep a stash, mostly to avoid having her patients calling her with emergencies needing scheduling. That said, I still built up a fairly large stash as I knew early on in my treatment that I was going to be on this medication for the rest of my life if possible (or until i decide to quit, not someone pushing me off).

Because of this, I have been a bit more proactive in finding what is my minimum effective dose so that I can lower it myself to help build up my stash (having the doctor prescribing me the higher dose. I have come down from 8mg to to 2mg, and that seems to be about as low as I can go, and I had the same problem of how do you cut an 8mg pill precisely. The answer is that you can't. With the small size of the medication dose and the crumbly nature of subutex pills, you can't get precise dosing breaking the pill (and at low doses close to your ceiling that precision is required).

That doesn't mean you can't get even dosing. There are a few ways to go about this, but they all basically involve getting a milligram electric scale. There are several for sale on Amazon for around $20 (make sure you get one that can measure in increments of 0.001 grams, there are plenty that only do 0.01). From here you just have to weight your pill and then divide that by the number of milligrams.

For me, I have 8mg pills that weight .400 grams (my scale says .397). Dividing this by 8 (the number of milligrams of buprenorphine in my pills gives me 0.05 grams per milligram of drug. So to get 2mg, I need to break off and weigh out 0.1mg of a pill. These digital scales have a readout that gives you three decimal places, so you can get very accurate measurements. My scale came with a nice pair of tweezers and a little dish for putting whatever you are weighing into to keep the scale clean and keep what you are weighing from rolling off, so i just break my pill in half, and then crumble off pieces into the tray until I hit the correct weight. If I crumble off a piece that puts me over weight, I pick it out with the tweezers and break that tiny piece in half, or whatever, until I have the precise weight.

Another option, instead of breaking and crumbling the pills, would be to crush the pills into a powder and then slowly pour or scoop the powder for weighing precisely. There are several pill crushing devises on the market, some made for crushing large quantities of pills. You could conceivably crush a month worth of pills and weigh out your dose daily from that.

To take the crumbled up bits (or powder if you go that route), you tip out the dish that you weighed the medication into onto a small piece of paper that you have folded in half and then reopened (I use a post-it note). The fold helps collect the medicine in the center to keep it sliding off, and gives a route for the medication to follow when you tip it under your tongue.

I hope this helps. I wasted plenty of money buying several different pill cutters trying to figure this out. There doesn't seem to be a cutter that can give you the precise results that a $20 scale can easily provide. Good luck!


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PostPosted: Wed Feb 22, 2017 1:06 pm 
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Hi Eris!

Wow! Thanks so much for that info and welcome to our forum!

I also wanna thank Dr. Junig for his response. Doc, I do believe that switching to regular Suboxone (so that I could get the 2mg strips) would be much easier. However, I've been on Subutex since I became pregnant with our son. Fast forward six years later....I've tapered significantly and simply don't feel comfortable changing what works. I understand it's probably just a head thing. I remember my first year of treatment, for some reason my doc WANTED to switch me to Subutex. I refused over and over as the Suboxone was working just fine. Then, I became pregnant and didn't have a choice.

Eris- I really appreciate all the info you provided! I'll definitely look into a scale. I've been able to build a nice stash already....which makes me feel a lot more secure in this sometimes wishy-washy Sub Doc world. It also makes me wanna be more proactive (as you mentioned) to reduce further. That's probably a mind thing too. But, I've always felt better at reductions if I feel like they're my choice.
3mg is the lowest I've been able to go. I think most days I actually end up with 3.5mg....from uneven breaking.

I'm very proud of the success Ive achieved in my recovery and the person this medication has helped me grow into. I know I did the hard work, but I doubt I would have ever found the courage to conquer some of the demons I've defeated while on Sub maintenance. I wish ALL addicts had access to this lifesaver!


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