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 Post subject: Please help me
PostPosted: Wed Sep 30, 2015 11:19 am 
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I have been on suboxone for about 2 years my husband has been on for 3 or so. We have recently upped our own dosages and have been buying them off the street. Stupid I know but it has a euphoric and good feeling. I feel Luke I can function on suboxone and clean and get up in the am when I take it so I take it throughout the day to help give me a boost I guess is what I'm looking for. So now we have blown through money owed to others and bill money. I'm lucky to still have a house and car right now just to support our habit. We have fallen back into old drug habits. This has been a horrible and regretful ride for us. Now I have been looking into suboxone detox programs so we can both get off cause we want to not have to depend on any drug and there are no rehabs for suboxone. My habit now has us way worse then it was before with opiates well for me my husband used a lot in his day but I have been a picky user. Does any one know of a rehab or detox that takes suboxone patients. I have called a lot in my area . Kingston, ny and nothing. Thanks for reading.


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 Post subject: Re: Please help me
PostPosted: Wed Sep 30, 2015 2:17 pm 
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Hello SOS,
Seems to me you have a couple of choises here. Either go to an in patient rehab or get with your dr and you both start a taper plan.
The reason there aren't Buprenorphine detox places is because the detox is so loug. Detoxs off regular agonst take 5 to 7 days. With sub your just getting started by day 8,9 10.mostly..so in house overall is the best bet.
Im not going to get into the whole sub abuse thing here. But honestly, imo,you two want off the one thing that is saving you from relapsing on opiates. Buprenorphine.
Ya it would be great to "be off everything" but to me from what im reading here you don't sound ready. .If ya can't take sub right how are you going to live without other opiates? I dont get it..
You like that Boost?, how can you live without it? , hey just my opinion.

Taper or inhouse rehab....


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 Post subject: Re: Please help me
PostPosted: Wed Sep 30, 2015 3:30 pm 
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Were you and your husband ever in recovery with suboxone or have you been abusing it since you got on? I have a really hard time believing that especially with an increased dosage you are feeling high or euphoric on it. It doesn't make scientific sense. It just doesn't happen with bupe, especially after 2 or 3 years on it.

Why do you think you haven't been ready for recovery? Bupe is an excellent recovery tool, but only for people who want the recovery. I'm very glad that you two aren't taking up spots in a suboxone program, because there are so many people who are serious about recovery and they can't find a sub doctor with room for them.

What detox program won't take people who are on any opiate? I don't believe that you can't find a program that will help you for at least a couple of weeks. If you have the money they will take you.

You know, this post doesn't add up to me, which makes me suspect that you are here trying to stir the pot. I don't know why you would think that anyone here knows how to locate a sub detox place near Kingston, NY if you can't do it yourself. This is not a question that gets asked here unless someone is trying to diss sub. We have a whole section on stopping suboxone. If you're for real start reading it.

I'm sorry that this is not the same warm and fuzzy greeting I would usually give to a new member and someone looking for help. Your post just seems very inauthentic to me.

Amy

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 Post subject: Re: Please help me
PostPosted: Wed Sep 30, 2015 5:06 pm 
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Hey SOS,

I don't know how ur getting any euphoria off sub, especially since you've been on it for 2 yrs. If u could get any type of high from sub the majority of us on it would never make it with enough medicine til our next doctors appointment. We'd all be abusing it cause we're addicts, we wouldn't be able to control ourselves. Like Amy, I don't see how it's possible. There's lot's of ppl who over take their medicine trying to get more out of it or just because our addict mind tells us more is better, but they eventually realize that it's just a waste cause it doesn't do any good. U need to just stop, and take less (8 mg), u won't even have withdrawal because of the ceiling effect. Like razor said, if ur not able to stay straight on suboxone, how would it work on nothing? Definitely something to think about.

As far as rehab goes, the one I went to before I started sub, took ppl who had been on sub. The normal opiate users were given a 5 day detox and the sub users were given a 7-8 day detox (which clearly wasn't enough time). That was in Tennessee not anywhere near u but just explaining that ur best bet is to just stop taking extra and go to 8 mg. I don't understand how u could be worse off on sub than u were on the other opiates u abused in the past.

I hope this helps u a little and u realize that taking all this extra that u say ur taking, is not giving u any type of high.

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 Post subject: Re: Please help me
PostPosted: Wed Sep 30, 2015 5:27 pm 
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Please do not mistake my post for me downing sub's I'm not cause at a point it did amazing things for us when we first got on my husband who never thought he would break free from opiates finally got to a point that he could go to family functions not nodding off I was at a point where I wasn't spending rent money just to get High. I double checked with my husband if when he does take it does he get a good or euphoric feeling he says yes sometimes. I know for myself personally it is a feeling of euphoria but not all the time.Im totally willing to admit or consider it being in my head. Webeach take three a day one in am one in afternoon and one in the evening. Maybe the way I take them. Depending on amount of sub's I take. Some times u have to take less cause I can't afford more.

I have been calling any local and in Penn and Nj and even my own doctor to find a inpatient rehab but no one will take us even separately because we are on suboxone they said we can detox off and then do rehab. If anyone may have explanation as to why we have increased our meds or feel high when we do I'm open to them. Any better understanding would be great.


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 Post subject: Re: Please help me
PostPosted: Thu Oct 01, 2015 2:10 pm 
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Okay, couple things I'd like to say.

1.) I totally understand your latest post. I get a little mood boost from Subs too. It's not much, not like a full agonist (e.g. heroin, the 'codones, etc), and it doesn't hit me in a rush; feels mostly like a general sense of well-being; but still, something is there. I think the reason this hasn't gone away is partly that I'm naturally sad and uncomfortable, so even getting to "normal" for other people feels good for me; and partly because I used to sometimes skip a dose so the next one feels more powerful. If you ever skip or vary doses (as you say you do, I believe), that's probably a part of it.

2.) That said, taking more Subs doesn't increase this feeling for me at all. I experimented and found that 4-8mg gets me just as good as 24mg (although I take another dose in the evening because I feel like it wears off a bit, but that could be psychological). Others have said similar things in this thread (and indeed all over the Internet). I'm guessing it's because of the ceiling dose for bupe, combined with the fact that it's only a partial agonist for opioid receptors. So why do we want to take more and more? I think it's because of "addict thinking": we're used to indulging ourselves, and we're used to "more is better". I've stopped trying to take more and more, now that I realize it's pointless and now that the craving to do so is vanishing over time as I get more and more used to living a "junkie-free life". Maybe this could happen for you too.

3.) If you want to get off Subs, I totally support that. They're not for everyone and not for every situation. But, that said, I think razor55 makes a really good point. If you're having trouble with cravings that you always give into now, then won't it be just as bad -- or worse -- once you're off bupe? Where will the extra self-control come from? In my experience, sometimes saying "no cigarettes at all ever" (for example) is easier than saying "only one cigarette a day". That's how I quit smoking, and that was years ago now, without a single relapse! (I'm proud of that, heh.) Thus, maybe you're thinking that being totally clean will be easier than being on bupe. But opioids have not worked this way for me; I always relapsed no matter what. So I'd just recommend thinking long and hard about what will be different -- if anything -- this time.

Good luck, and feel free to message me any time, for anything!


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 Post subject: Re: Please help me
PostPosted: Thu Oct 01, 2015 10:48 pm 
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I'm having a bit of trouble with the original post. People on buprenorphine-- at least those taking at least 4 mg every day-- develop a blood level of the drug that is above the level necessary to create the ceiling effect. In other words, blood levels of that amount or more result in the same amount of mu receptor activation. Maybe the writer's perception of 'euphoria' is very different than my perception of euphoria... but there is no similarity between the use of opioid agonists and the use of buprenorphine medications. After treating over 900 people with buprenorphine, and talking daily about the effects of the medication with those people for the past 9 years, I have NO doubt about that fact.

If you truly believe that you are getting 'high' off buprenorphine, I have to wonder whether you've actually been taking heroin up to now.

Some people, early in treatment, think that more buprenorphine makes them feel 'better'. Almost all of those people change that opinion after a year or less on the medication. They come to realize that they were getting a psychological boost from taking the medication-- nothing more. A few people insist that they feel a bit more sleepy or relaxed after dosing-- but when we discuss the details of how they feel, the feelings do not mirror the actual blood level changes associated with dosing. Specifically, blood levels of buprenorphine start to increase about 30 minutes after dosing, and peak at about 90 minutes. The effects that people 'feel' occur much earlier-- as early as ten minutes after dosing, far before any significant increase in blood levels of the drug.

I am a bit suspicious of the original post-- and I think that most buprenorphine patients understand why. There are people who spread the idea that you can get 'high' from buprenorphine-- and the media and law enforcement buys into that claim. But the hundreds of people I have met over the years-- including the people who admit to injecting buprenorphine at some point in the past in an attempt to get 'high'-- all say the same thing. And what they say is consistent with neurochemistry... that if they inject or snort buprenorphine, they feel relief from withdrawal more quickly than if they take it sublingually. Of course, that only happens if they first wait for withdrawal for a couple days. If they take buprenorphine daily, and then inject it, nothing happens. And of course, that is what one would expect--- as the brain has no idea how buprenorphine molecules entered the circulation!

It's not as if some molecules have little labels that say 'injected', and others are labelled 'taken correctly'! Buprenorphine is subject to a ceiling effect at the receptor level-- period.

To the original writers-- if you are serious, I suggest you do what all of my successful patients do. When you feel like taking more, you should distract yourself. Do something else. Focus on the people you know who died from using heroin. Watch MTV for ten minutes. Look at porn. Take the dog for a walk. Talk about politics. Do anything other than focus on how you FEEL.

If you do that, the feelings will pass-- and within days, any urges to take more will go away. But you have to do YOUR part-- and offer up some minimal effort over the situation. I realize that addiction is an illness, and I would never expect anyone addicted to opioids to 'just stop'. But buprenorphine provides so much help-- so much reduction of cravings-- that I RARELY meet patients who can't make it work.


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 Post subject: Re: Please help me
PostPosted: Thu Oct 01, 2015 10:55 pm 
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This is what I was trying to say, SOS. Of course our Dr. J explains things much more understandably and thoroughly than I do. Maybe by reading his response you can understand mine a little bit better.

You're still welcome here to ask questions and get support.

Cheers,
Amy

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 Post subject: Re: Please help me
PostPosted: Fri Oct 02, 2015 10:04 am 
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I think instead of trying to find a detox program you two should try to find a doctor and a therapist who can help you take sub correctly. Since you are spending bill money on the street, I doubt that's going to change once you've detoxed off sub.

As for getting high from sub, that happened to me a couple times. But as Dr J said, it was before I had ever taken any other opiate regularly. If you are seeing a Dr and have the same amount of bupe everyday, you should realize it is not for feeling euphoric. For me and most others I believe, it was for feeling normal and being able to make the necessary lifestyle changes in order to be successful.


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 Post subject: Re: Please help me
PostPosted: Fri Oct 02, 2015 3:18 pm 
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There's no question, in my mind, that buprenorphine makes me feel better. It just doesn't make me feel high; and the mood-boosting effect stabilizes after a period of consistent dosing (so, eventually, taking a pill doesn't give rise any immediate difference -- it's a constant background effect, hard to notice unless I stop dosing for a while).

I think this might be because I have had extremely severe depression for a long time. I felt unable to... well, do or feel anything -- before I found opioids. From childhood onward, I've just been so tired and anxious and sad all the time. I never knew why... I didn't even understand that it was possible to feel different, at first. I would see people get excited over something like a film or going out to eat, and it'd just boggle my mind. How does an activity give rise to any feelings at all? How does anyone have energy to do anything, for that matter? It felt like watching a dog chase a ball: you know that the dog is getting something out of it, but it's impossible to put yourself in a mental space where it does anything for you.

Opioids changed that. I was using oxy all throughout my university days, and it's the reason I managed to get this degree. But, of course, the price was far greater than the benefit. Now, though, with buprenorphine, I am not only not constantly relapsing and spending all my time, money, and effort finding pills or heroin, but I also feel what I imagine "normal" people feel like -- stuff is interesting to me, I can be happy, I can be sad, I can relax, I can stress... it's like I was in a black-and-white film and suddenly someone turned on the color, to use an overused analogy, heh.

Now I'm painting with a full palette; I finally get why people chase the ball, so to speak.


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 Post subject: Re: Please help me
PostPosted: Fri Oct 02, 2015 4:56 pm 
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Well said Crossfinger. I felt the same as you until methadone and suboxone came along. Like night and day. I was depressed most of my life until I tried opiates. Unfortunately once we scratch that itch with opiates we can't unscratch it and our paths are altered forever. Thank god we have ORT. I can live a normal life and do. The problem now is finding doctors and pharmacies that will do thier jobs properly. Oy, what an uphill battle that is!

I have a doctor that makes me come in every month for my script ( of methadone) and each month he says the same thing. " I'm not going to keep doing this for you" and then he does it....He says he only supplys ORT for detoxing, not maintainence so he wants me to find someone else to help me. I'm looking but it's hard to find a doctor under my HMO that has not reached the 100 patient cap that will do long term ORT.

I can't believe how many folks on this forum and elsewhere are in the same boat. Anyway, I like what you said about depression and how this medication has changed your life and you see color where you once only saw back and white. We all know that feeling...........

thanks for sharing.......megster


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 Post subject: Re: Please help me
PostPosted: Fri Oct 02, 2015 9:00 pm 
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So I spoke with my Dr today told the truth about taking more. She kinda asked what I wanted to do? Uggghhh I thought that I came here for the answer. She said pretty much she didn't know if she wanted to prescribe me more or give me an anxiety pill but then it was one replacing the other... So pretty much she gave me the same shit she always does make an appt with the therapist which she even tried to book one ( they can only schedule one week out and the schedule is always full) I explained to her that I have been trying to get the same appt for the last 8-12 months that I have been actively asking for. I was reading a lot of info about suboxone zubsolve and bunavail today and felt the regre of starting it and she agrees to taper me off but that the relapse rate is high which I'm aware of but at the rate I'm headed I feel like I'm in despair spiral. Will I ever live ablife clean of everything? Will I ever have a normal outlook on life? Not wanting to get high or not searching for happiness in a pill. Christ save me.


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 Post subject: Re: Please help me
PostPosted: Fri Oct 02, 2015 10:30 pm 
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SOS, it's hard, yes, but it's never impossible. I rarely get spiritual here and even more rarely talk about the Bible, but here I go.

Have you ever read the part of the Bible that says that you can move mountains with just a mustard seed of faith? I doubt a lot. I try to cling to the words that Jesus is reported to have said, but I have a lot of doubt about various things. So I always cling to this, that if I have faith the size of a mustard seed I can move mountains. And my prayer, based on my mustard seed of faith is "I do believe, Lord. Help my unbelief."

Yes, it is possible to live a life where the torture of cravings is not hanging over your head, but you have to choose recovery every day to make that a reality! You must find a philosophy of belief that works for you. It's not always easy to find that.

Amy

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 Post subject: Re: Please help me
PostPosted: Sat Oct 03, 2015 5:32 am 
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Hi SOS,
I feel your desperation, I really do! However after reading a few posts, echo the same concerns relayed by razor.
I empathise with how you must be feeling.
We want the same outcome for you and your husband.
It's clear what you want right now but does your husband equally share the same goal?
As a couple living together in active addiction, I can only imagine the complexity of practising and maintaining sobriety.
If you want off subs you will need a solid plan especially beyond Rehab.
We want to be here for you and I hope you have some luck in finding suitable resources.
Please hang around and keep us updated.


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 Post subject: Re: Please help me
PostPosted: Sat Oct 03, 2015 10:55 am 
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Hmm. Really?

There are actually a very very large plenty of people who "get high" from Suboxone. But they're not the people who take it as prescribed. They tend to be the people who start using the drug as purchased on the street and they pretty much all take it by i.v. injection.

The difference between a drug and a poison is not just the dose, but oddly enough it can also depend on the person's intent and history. At least that's so for "getting high" which so far has been poorly studied if at all.

The yada-yada about Suboxone having low abuse potential is the marketing hype of the applicant, Reckitt-Benckeser, which had a huge profit motive to distort the truth and paint the drug as benign compared to straight agonists. But the manufacturer can "prove" anything they want as long as they design the lab experiment and the FDA has no incentive to give it a truly critical review. It's Cui Bono. Same as for heroin being marketed as non-addicting in face of widespread morphine addiction.

Because the films were so easy to hide in US mail to people in the Albuquerque, NM Metropolitian Detention Center the going price a few years ago as reported by KOB-TV news and others was $40 per film. Friends of mine who have been there confirmed the high prices paid in jail. The people paying that price were sure as hell getting high from it.

P.S. "reality" is whatever pays the bills and makes a person feel that they're doing good in the world. It's completely understandable that Reckitt put that yada-yada out there. But I'm really surprised to see it being accepted so completely by those with an interest in being blind to Suboxone being a drug of abuse by those who purchase it on the black market and use it by i.v. injection. Nobody could ever get IRB approval to study the "likingness" of i.v. Suboxone tabs and films by opioid-naïve subjects who are the ones fueling the black market appeal of this drug. What effect does the naloxone have when this drug mixture is injected? Nobody knows. Could it be some kind of weird potentiation going on? Why not?

P.P.S. Albuquerque may be unique in incidence of Suboxone use by non-addicts because of all the programs we've had to make it "accessible" even to the homeless. Multi-million dollar programs that were probably reported on in drug abuse journals. They made it so easy to get that everyone who wanted it could get it. No ID?; no problem! And no time for a drug screen to verify opiate use. And maybe that's why people in the jail here were paying $40 for a film.

suboxdoc wrote:
I'm having a bit of trouble with the original post. People on buprenorphine-- at least those taking at least 4 mg every day-- develop a blood level of the drug that is above the level necessary to create the ceiling effect. In other words, blood levels of that amount or more result in the same amount of mu receptor activation. Maybe the writer's perception of 'euphoria' is very different than my perception of euphoria... but there is no similarity between the use of opioid agonists and the use of buprenorphine medications. After treating over 900 people with buprenorphine, and talking daily about the effects of the medication with those people for the past 9 years, I have NO doubt about that fact.

If you truly believe that you are getting 'high' off buprenorphine, I have to wonder whether you've actually been taking heroin up to now.
.....


Last edited by wishdoctor on Sat Oct 03, 2015 12:40 pm, edited 4 times in total.

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 Post subject: Re: Please help me
PostPosted: Sat Oct 03, 2015 11:22 am 
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Wishdoctor I'm not sure if ur wanting to argue or what. In my area in Tennessee, I know before I started suboxone treatment 4 yrs ago, sub strips were going for 30 dollars, and u want to know why I would have paid 30$ for it.....to keep from being sick with withdrawal because I couldn't find my drug of choice that day. I've been in jail several times during my active addiction and I know for a fact that ppl will pay 10$ for a cigarette. Anyone that's been in jail can verify the over the top prices those ppl pay to get anything. I also know of an incident when a lady was half beat to death for not sharing a .5 klonapin (spelling?). So that's not saying that they're getting high, these ppl are sick and been off their medicine for awhile. I was too, I'd have gave a kidney for some relief from withdrawal when I was in jail.

Someone that's wanting to get high and has money in their pockets, which will they choose on the street if they have the choice.....oxy or a sub strip?

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 Post subject: Re: Please help me
PostPosted: Sat Oct 03, 2015 12:08 pm 
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Your doctor is risking prison for doing this. It's PLAINLY illegal for anyone but a licensed methadone clinic to use methadone for opiate detox. It can only be prescribed "for pain." That said, there can be some PCPs who will give you a 1-month supply and be willing to play dumb about it, but anything more and all it would take is a phone call from a pharmacist (or maybe your HMO!) to state authorities questioning whether it's legit. And most all states have electronic scrip monitoring.

If your HMO is paying for the pharmacy bill, then they have an incentive to question it as coming from a doctor who is illegaly scripting a C-2.

See my recent post about reaching once-weekly-visits of MMT after eight years of Suboxone where the only drugs which have ever given me relief from depression are opioids.

megster wrote:
... I have a doctor that makes me come in every month for my script ( of methadone) and each month he says the same thing. " I'm not going to keep doing this for you" and then he does it....He says he only supplys ORT for detoxing, not maintainence so he wants me to find someone else to help me. I'm looking but it's hard to find a doctor under my HMO that has not reached the 100 patient cap that will do long term ORT. ... Anyway, I like what you said about depression and how this medication has changed your life and you see color where you once only saw back and white. We all know that feeling............megster


Last edited by wishdoctor on Sat Oct 03, 2015 12:24 pm, edited 2 times in total.

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 Post subject: Re: Please help me
PostPosted: Sat Oct 03, 2015 12:12 pm 
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I have a doctor that makes me come in every month for my script ( of methadone) and each month he says the same thing. " I'm not going to keep doing this for you" and then he does it....He says he only supplys ORT for detoxing, not maintainence so he wants me to find someone else to help me. I'm looking but it's hard to find a doctor under my HMO that has not reached the 100 patient cap that will do long term ORT.
Megster, is your doctor really providing methadone as a monthly script for ORT? If so you need to come up with an emergency plan, what he is doing is illegal and could cause him to lose his DEA registration and state license. Methadone can only be used for ORT in federally accredited facilities. Methadone can (and is) used in pain medicine clinics but they need to be very clear they are not treating addiction or preventing withdrawal, that they are treating a specific condition that is causing pain.
She kinda asked what I wanted to do? Uggghhh SOS - I often ask my patients what they want to do. Usually very early each visit, sometimes they have specific ideas, often planted here or similar forums. I'll use their ideas in formulating the plan, if I don't like them I will explain why and brainstorm a plan acceptable for both of us. I don't pretend that we are equal partners, but I do listen.


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 Post subject: Re: Please help me
PostPosted: Sat Oct 03, 2015 2:36 pm 
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Docm2, You are right. Pain docs can't prescribe methadone for anything but pain I undertand this. They can't be someones personal methadone clinic but indeed I am there for pain. I have fibromyalgia that if goes untreated leaves me wracked in pain and unable to function on every level. So yeah, my pain is real and physical which is why my primary care doctor is authorizing my trips to the pain doctor.

The tricky thing is that I also suffer deep refractory depression which is the kind of pain that needs a psyche doctor to treat but finding a psyche doctor under my HMO that will prescribe methadone or suboxone is a tall order. So it has been falling on my current pain doctor who for whatever reason struggles with keeping me.

He does not communicate which is the biggest problem. If he would say why he can't continue seeing me I would understand if what he said were true but he's not offereing any reason. Not one!! It's not that he's telling me why and I am refusing to hear it. He's not telling me why. This is not the CIA I'm dealing with here. It's a doctor under my HMO that I was referred to by my primary care doctor that I am paying for. In return for payment I expect either his services or that he tell me why he can't perform any services and send me to someone that can. Or not.

But tell me something!

Not rocket science. Not CIA. Just a damn doctor that will either treat me or in the very least tell me why he can't. Instead he comes in grumpy and angry, tells me he can't keep seeing me, writes me a script for a month and walks out. I've been there at least 4 times now and each visit is less than 5 mins! What is interesting is that he never tells me or his front office not to make me another appt. So of course I make another appt. he sees me again saying the same things AGAIN, I ask him why he won't talk to me and tell me what is going on, he does not answer, writes me another script walks out and so it goes.

It's a very odd situation. I've never been through this with a doctor. Thankfully I have a great primary care group and psyche doctor that are trying to help get this medication for me. They admit that the system is broken and many things need to change. They are just not in the position to change them nor am I.

If I could afford the methadone clinic I would go but I can't pay that kind of money out of pocket. Especially when I am already paying for insurance. The methadone clinics here cost 10 and 12 bucks a day. I don't have that kind of cash laying around. Not only that but they are too restrictive. After 3 months you get 1 day take home. after 9 months you get 6 days of take home. after 3 years you finally get 27 days of take home. that may work for some but it does not work for me. i wish it did because the roller coaster i'm on with the " legitimate doctors" is crazy making.......

thanks for listening.......and all the best from sunny san diego, ca....... :D


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 Post subject: Re: Please help me
PostPosted: Sat Oct 03, 2015 3:51 pm 
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wishdoctor wrote:
The yada-yada about Suboxone having low abuse potential is the marketing hype of the applicant, Reckitt-Benckeser, which had a huge profit motive to distort the truth and paint the drug as benign compared to straight agonists.
[...]
Because the films were so easy to hide in US mail to people in the Albuquerque, NM Metropolitian Detention Center the going price a few years ago as reported by KOB-TV news and others was $40 per film. Friends of mine who have been there confirmed the high prices paid in jail. The people paying that price were sure as hell getting high from it.
[...]
But I'm really surprised to see it being accepted so completely by those with an interest in being blind to Suboxone being a drug of abuse by those who purchase it on the black market and use it by i.v. injection.
[...]
They made it so easy to get that everyone who wanted it could get it. No ID?; no problem! And no time for a drug screen to verify opiate use. And maybe that's why people in the jail here were paying $40 for a film.

  Very interesting and thought-provoking post! As I've mentioned in this thread previously, buprenorphine has given me mood boosts before, and so I agree that it's not impossible that it could be abused. I think most others are referring to the effects of a constant, consistent dosing regimen, though, when they say that it doesn't have a "high"; and this is true. But it'd definitely be incorrect to claim that the first couple doses can't be enjoyed -- back in the day, my friend and I would buy Suboxone to get high if nothing else was handy.

  That said, there are a few things in the above comment that I'd like to expand on a little, because I don't fully agree with some of what I infer from it (which you may or may not have actually meant to imply -- I recognize that "I inferred" doesn't mean "you implied"!).

1.) I think it's true that buprenorphine does have low(ish) abuse potential. There are some studies floating around on both sides of the issue (though more to the "low potential" side, I think), but none -- as far as I know -- that say it has equal or greater "PfA" than full agonists, at the very least. If such a study came out, I'd certainly question it as much as a study that claimed no abuse potential! That is to say, there's definitely some potential there, as some people clearly enjoy it -- but I would wager a goodly amount that it is no one's drug of choice; i.e., if it's being abused it's largely just replacing withdrawal or a more expensive drug*, not sobriety.

  I also hold this "low PfA" position based on anecdotal experience (which can be unreliable, to understate drastically, but also must reflect reality to some degree). I can confidently state that in my experience, no one purchased bupe who had access to any other opioid. (Thus why it's seeing use in jails, where any drug is at a premium and desire for relief from real life becomes desperate.) It's just not as good, and the ceiling effect means that long-term abuse isn't an option. I only ever witnessed it purchased by people who were already addicted to other opioids, and wanted bupe to help keep them going through to when H or oxy was available again.

  There was some enjoyment to taking it, at first, in my experience; what we mainly liked was that it lasted a long time; but no one who wasn't already addicted to opioids seemed to like it at all, and we just used it when desperate. ("$20 to last us the next two days... shit, we better get a strip." Interestingly, someone who wasn't addicted was appalled by the duration... seems to be a junkie thing, to like that bit.) Some people claim that they don't really like even full opioid agonists, so I think you'd have to really have a love of opioids beforehand to get anything from bupe -- which is a very "flat", muted version of the full-body massage from morphine or heroin. All of the sickness and fuzziness, not even half of the euphoria.

*I say that bupe is less expensive than other opioids because that's definitely been my experience; even considering $15-20 for 8mg (as it was around here), it's potent enough that a lot of addicts can halve or fourth that 8mg dose and be "right", and that's without considering injection. Compare $15-20 for a point of heroin, which is gone in a few hours if snorted and doesn't last much longer if injected. Everything is going to be much more expensive in jail, of course. That's also why injection is used for Suboxone, I'd wager: it's not that it gets you higher, it's that it stretches out your supply. I've never injected Subs, but that's absolutely why I (and my former friends) turned to the needle for H. I have heard that buprenorphine injection doesn't even give a "rush"... it's just "thrifty".

  So, to sum up, people can get high from bupe to some degree (if they're not on a program but rather haphazardly acquiring it when desperate), but it's got a lower potential for abuse than other opioids, and it's my belief that it's just keeping addicts functioning rather than sucking in people who would otherwise be sober. You couldn't keep dosing every day and maintain any sort of enjoyment in it, and I can't imagine that many sober, opioid-naïve individuals would be attracted to its weird, "flat" version of the opioid high.

2.) I think that it's also much preferable for someone to be using buprenorphine than for them to be using any other opioid. If we've got people paying $40 for a strip, well, at least they're not going to be overdosing and dying. Injecting isn't great, but no one is going to be injecting buprenorphine unless they're already injecting other, more dangerous things. And, since buprenorphine also makes it more expensive to use any other opioid (as you'll need higher and higher doses to feel them), it's probably only going to be used by people already in a bad way, and it's likely the best option for them in those circumstances.

  That was my situation; after obtaining buprenorphine illegally, I realize that it had gotten rid of my cravings for a full day... and I wasn't nodding-out, stumbling-around, mumbling-incoherently high, but just in a kinda good mood. I think that choice to try buying a strip of Subutex, in desperation when H dried up, is what saved my life. Now it's not getting me high any more, and yet I'm still clean! It's amazing to me.

  So that program in Albuquerque you mention -- well, of course it'd be better if no one was diverting the Suboxone they got, but I think it's still a great program that is saving lives. Taking any look at the benefit of making Suboxone available to addicts vs the cost of possibly, possibly bringing Suboxone to an otherwise sober individual... well, it's not going to be a close-run thing, I think, however you calculate the QALYs. I am certain that there wouldn't be less drug use in jail if it was closed... just more people withdrawing or using heroin or [*]codone. We have already seen, plenty of times, that the proportion of the population using drugs remains about constant, barring very drastic changes in either direction (e.g., executions for drug use on a tightly-controlled island city will lower use -- but not eliminate it, in fact -- yet even freely available drugs don't seem to make usage rise much or at all, assuming a general background level of drug availability beforehand; see Portugal, Prague, Uruguay, etc).

  I know of at least one other addict who came to Suboxone the same way I did (with diverted Subutex), and it certainly saved his life too. My best friend, the one who told me about Suboxone in the first place (but who didn't have a family to help him get into a bupe program, like me), died injecting heroin. He might still be around if my city were more like Albuquerque.

Quote:
I doubt your jail in TN has a MMT program such as our MDC here where anyone who tests positive for opiates on intake can START on methadone maintenance in jail!

Thass right. They screen for opiate dependence on intake and they OFFER treatment to those who've never been in treatment.

That's a great program. I had no idea any jails anywhere did that... there are a lot of horror stories about any and all scheduled prescriptions being withheld in jail.

I really can't imagine anyone choosing buprenorphine over methadone for abuse, or paying $40 for a strip if free(?) methadone is available, though! Some people don't seem to like methadone as much as, e.g., morphine or oxycodone, but in my experience, it was just like very-long-lasting morphine -- and also in my experience, people who sneered at Subs jumped for methadone. It was much more sought-after. Subs were almost always there, disdained until emergencies.

There's no doubt that methadone is more enjoyable and more abusable, so if it is free and Suboxone isn't, the only way that I could understand people choosing the buprenorphine is if there is some bar to the methadone treatment (for example: if it takes a long time, requires periodic drug testing for other drugs, requires staying enrolled in the program after release, doesn't seem like it will give high enough doses, or just seems suspicious to inmates who don't think well of telling the law about criminal activity!).

I think if it's a choice between committing to a program that requires one to be drug-free and chained to a clinic even after release (and where you can't even save up doses in order to get extra-high), or getting Suboxone on an ad-hoc basis until something better is available, some might indeed choose the latter. Now, if there were equipotent doses of buprenorphine and methadone both available for $40, see which one is more popular! Methadone is harder to divert due to its manner of dispensation, so in practice it tends to be more expensive and less common than Suboxone. I imagine the situation is the same in jail.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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