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PostPosted: Tue Dec 13, 2016 10:47 pm 
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Hey Gang

I'm sure a few of you recall my current doctor dilemma. But, here's a brief history for those whom aren't familiar.

I induced on Suboxone about 7.5 yrs ago. Took 32mg for a short period. Reduced to 24mg. Became pregnant and was switched to 24mg of Subutex. Remained on 24mg of Subutex throughout my entire
pregnancy. Delivered a happy healthy baby boy without any NAS.

I switched doctors about 5yrs ago. My current doc is really great and has helped me work through some pretty deep issues over the years. I've never put a timeline on my treatment, but came to realize being on the lowest possible dose while still addressing my addiction is probably the best bet.

Over the past couple years, I've successfully reduced from 24mg to 4mg. I'm very proud of this success and my overall recovery success. However, I don't feel I'm ready to reduce any further right now and I definitely have no intention of tapering completely off. I've communicated this to my doctor many times, but he has failed to respect my feelings and has scheduled me to reduce to 3mg beginning this
Friday.

I've begun reducing myself to 3mg over the past week to make things easier....and I'm having a very difficult time. Although Im not ready to reduce, I'm going to give this 3mg dose an honest shot. However, with the holidays, a week long family vacation, and possibly being forced completely off in the next few months....I've went ahead and scheduled an appt with my previous Sub doc.

I pick up my 3mg script Friday. My appt with this second doc is next Monday. Im not going to fill the prescription I receive on Monday until I've given this dose at least a couple weeks. If I can't stabilize and need to get it filled, shouldl there be any issues legally or with my doctors or pharmacy (being that I just filled a script from another doctor less than 30 days prior)?

I'm a cash patient, so I'm not worried about insurance issues. My main concern is how to transition smoothly from one doc to another if need be. I've been with the same doctor for so long, I wanna make sure I'm doing everything correctly. Im going to email or schedule an in-office appt. to give my current doctor one more opportunity before I switch (because he truly is a great doc). I'm just trying to cover all my bases. The last thing I want is to be out of town, in withdrawal, and can't reach my current doc or get an appt with a new one.

Any feedback is greatly appreciated!


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PostPosted: Wed Dec 14, 2016 11:07 am 
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Marie I have to abmit, I don't know the ins and outs of switching doctors but I'd do exactly what ur doing......exactly lol because I'd hate to leave my doctor too but I couldn't be forced to taper really low like that if I wasn't ready. I pay cash too, and I've wondered how different it would be to switch if I had to. I don't wanna switch doctors ever, but if I was being forced to taper then I would have to. I would think as long as u didn't overlap ur scripts, it should be ok. Don't fill one script til the other has ran out or whatever. Ur pharmacist should also be able to answer ur question. If it were me, I'd go to my pharmacist and have a quick talk and tell him/her everything.....they could answer everything.

I know I didn't help much lol but I just wanted u to know that I would be taking the exact actions that ur doing....I'm not sure I'd have even stuck around to try the 3mg though lol I would've panicked and moved to the next. I get really nervous when it comes to dropping my dose :)

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PostPosted: Wed Dec 14, 2016 1:22 pm 
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Thanks so much for your response Jen!!
It helps so much just getting this out and knowing someone can relate!

When my doctor first started reducing me a couple yrs ago (I've lost track of time, but I believe it was about 1.5-2 yrs ago), I was PETRIFIED! He dropped me directly from 24 to 16....16 to 12....12 to 8. Those first few reductions were sooooo hard on me mentally!

It got easier and easier though....as I became stronger in my recovery and realized the previous reduction didn't kill me. Lol! I had a HUGE fear of going below 8mg though....something about getting under one solid 8mg tablet really scared me. I did it though! I can honestly say I didn't have a true physical response to any of the reductions until I reduced from 6mg to 4mg. It's taken me most of this year to adjust to that dose.

Now, that I've been trying out the 3mg (I officially pick up my lower dose Friday but have been reducing myself over the past week), I'm waking up in withdrawal, feeling a lil odd when I dose, and then I'm in withdraws again a few hrs later. SUCKS!!
I guess I wanna give it a fair shot, because I was eventually successful on the 4mg. But, I just don't think I can maintain this level of physical symptoms for months and months. I also really wanna feel secure that my doctor isn't going to force me off.

Good idea with the pharmacist! I'm gonna have a chat with him Friday when I pick up my script. Part of me feels like maybe I shouldn't even fill it and use my extra tablet over the wknd...and then fill the script I get Monday. But, I just don't know what's best. What do you think?

If my doctor would guarantee me he's not gonna push me completely off anytime soon (he's talked about doing so for the past few months), I'd be willing to give the 3mg a longer chance to adjust. But,
I can't seem to get that from him.


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PostPosted: Wed Dec 14, 2016 2:39 pm 
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I'd move, you are no longer on the same page with your recovery.
Doesn't sound like your doctor is going to listen and let you stabilize and proceed when you are ready.
I don't know you and maybe he believes your recovery is rock solid and you can be taken off the Suboxone. Doesn't sound like you are ready, however.
If you find a new doctor just be upfront with what you have on hand. Discuss when to fill his Rx. We all have our habits or 'rules' on what we allow or don't allow. He should be looking at prescriber data base anyway so should know your Rx history.
he=she=any other pronoun you chose, I'm not a horrible misogynist, just an older writer struggling in this world we live in today.


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PostPosted: Wed Dec 14, 2016 2:50 pm 
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Honestly marie, just going on how I'd feel or what if do if it were me and if I wasn't ready to go below 4mg, I'd try out my new appointment before filling anything. Now that's because I'd be afraid to fill another script to soon (but ur pharmacist could clear that up for ya when u talk to him about what they'd rather u do). If u go ahead and fill that script for 3mg, you'll be stuck with it. I definitely don't know the rules with all that and I've often wondered about that in case I'm ever forced to taper lower than I would be ready for. So I'm like u in wondering what would be ok and what wouldn't, hopefully someone will answer that f or a know.

I started out on 16mg and eventually my doctor dropped me to 12mg and mentally I panicked lol. Then after awhile, I dropped myself to 8mg because of wanting to save $, and I did good with that. Now I'm not sure how ready I'll be below 8mg, so I can completely relate to ur situation. If I wasn't ready to drop to 3 then I'd check out the other doctor and see what he/she says. It could turn out to be a great decision for u, and if it isn't, u still have ur other script for 3mg. Honestly, to me, it's covering all the bases. Now hopefully there's nothing wrong with that and I don't see any reason it would be. At the end of the day, if ur doctor isn't listening to ur pleas, then u gotta think of urself and do what's best for u. Now this is only what I'd do personally, because I've gave this a lot of thought over the yrs. I definitely encourage u to make what decision feels best for u. I worry a lot lol so I always try to cover everything that could go wrong :)

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PostPosted: Wed Dec 14, 2016 2:54 pm 
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Thanks for that answer docm2! It seems like her dr isn't listening and trying to push her down lower than she's comfortable with, I agree :)

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PostPosted: Wed Dec 14, 2016 3:17 pm 
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Hi Marie,

I'm still very much a rookie, but I can't help wondering if you'd have an easier time cutting back if you went at it more gradually. As I understand things....dropping down from the upper ranges should be fairly easy. So that dropping from 24 to 16 all in one jump isn't likely to be all that difficult. But now you're under the ceiling effect I believe. What you do from here on might involve WD symptoms of you do too much at once. A 25 percent drop in one's accustomed opiate dose is huge...perhaps not quite so drastic with a partial agonist like bupe....but still significant I'm guessing.

Of course if you're not ready than you're not ready and i don't see why your current physician doesn't respect that. I'd switch doctors too if i were you.But if and when you are ready I don't think you have to suffer WD symptoms of you go from 4 Mg, say, to 3.5, or even 3.75. Just something to keep in mind for future reference.

If I have any of this wrong I hope someone comes along and corrects me. I'd hate to be giving bad advice

Best of luck
Godfrey


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PostPosted: Fri Dec 16, 2016 4:03 pm 
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Jen, DocM2, and Godfrey

Thanks so much for your responses! It really means a lot!!

Jen- I really appreciate your putting yourself in my shoes. If I didn't like my current doc, my decision would be much easier. It really helps though to know I'm not thinking way out in left field!

DocM2- I think you're absolutely right. I keep wanting to change my doctors feelings regarding my treatment. Even though I feel like he's given me no ultimatum, I've still been fantasizing opportunities to help him change his mind so we can be on the same page. I think I've known for awhile deep down that I needed to move on.

Godfrey- Thanks for the reduction suggestion. Yes, I think it would be easier to slowly reduce from
4mg to 3mg. 1mg dosent seem like it would be a big deal. But, at lower under the ceiling doses like this it is....at least it is for me. I've been trying out 3mg for the past week. It's difficult to know for sure exactly what I've been taking (as I'm currently breaking up a 8mg Buprenmorphine tab). I was hoping the reduction would get easier. But, today makes a week I've been taking less than 4mg and it actually
feels like it's even more difficult now than the first few days. I'm assuming that's due to using up the stacked Bupe that was in my system.

I took the plunge and made an appt with a doctor I used to see at the beginning of my treatment. He's
not my preferred choice (as he always felt like a script doc, in/out in 15min). But, at least I'll have another prescriber while looking for a better one. I also decided to be proactive and call my pharmacy to make sure I won't run into any problems filling a script from this second doc so soon after filling my new 3mg script. My pharmacist assured me that wouldn't be a problem.

I fill my 3mg script tomorrow (thought it was today, but I've been so crazy I guess I misread the script)
I see the second doc Monday. So, I'll keep you guys posted.
Thanks again for the support!!


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PostPosted: Wed Dec 21, 2016 11:39 pm 
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So far so good!

Just wanted to update the thread. I really appreciate all your responses!

My appt with a new doc (whom is actually the 1st doc I started with about 6yrs ago), was Monday.
It went well, but I think I should probably take my time after the holidays and find a better one.
This doctor isn't unethical, but he's just always felt like a "script doctor"....in & out in 15 min tops, exuberant prices ($350/month as apposed to the $160/bimonthly I was paying), pretends to listen, and
sais one thing but the polar opposite at next appt.

He did get me in very quickly though, which I appreciate...as I didn't wanna be out of state on vacation...possibly in withdrawal from the reduction and unable to reach my doc or get an appt with a new one. I communicated that this lower dose just isn't working for me. And, before I could even request to go up to 4mg he wrote a script for 8mg twice a day.

There's no way I'm gonna increase myself that much. I'm gonna continue trying to stabilize on the 3mg for at least another week or so. If I'm still struggling after that, I'll go up to 4mg. I feel a bit guilty for having so much extra. But, I'll be able to save 12-13mg a day with this doctor....which does lend a layer of security in this scary "finding/keeping a great maintenance doc" world.

I'm really happy I called my pharmacy ahead of time to make sure I wouldn't run into any issues filling a new script from a different doc just days after filling my lower dose prescription. I spoke with the owner/head pharmacist when I called whom assured me I wouldn't run into any problems. However, when I attempted to fill the new 16mg prescription today another pharmacist there put up a road block and a major look of disappointment. I made her aware of my previous conversation with the owner and then they filled the script.

I totally understand them being cautious, as this medication is highly regulated. Although I don't intend to take 16mg/day, they don't know that....they only see me filling 4mg for most of this year, then 3mg, and then a significant increase to 16mg days later. I guess it shouldn't bother me, but I felt ashamed getting the 16mg script filled. I felt judged and like I had disappointed my lil friendly mom & pop pharmacy.

I know I shouldn't worry about what others think of me & my recovery though. I KNOW who I am and I know what my goals & achievements are.


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PostPosted: Thu Dec 22, 2016 8:15 am 
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Hi Marie,..

Thanks for updating. I've been following this thread in part because I'm also switching docs.
I needed one who would be willing to write a prescription for me while traveling to another part of
country for a couple months. The new guy is an actual psychiatrist...the old fashioned kind who gives hour appointments and is clearly interested in helping. He's also got no problem writing the needed script for me.
The first doctor is a typical one man script mill. Doesn't listen well, spends no more than 5 minutes with you,
starts writing script the second you sit down. I would have loved the guy were I still active and he
was writing some sort of narcotic for me. I can't imagine how much money he must make.

He's got three locations and the place I go to i always jam-packed. 180 bucks ....always cash of course...
times infinity. Nice work if you can get it. :D Plus the clinics themselves...or at least the one I go to
is pretty much a dump. Cold in winter, pretty depressing all around. The rent must be dirt cheap. The last time I was there
I swear every person in there was sneezing and coughing to beat the band. I don't know how I escape without a cold. I felt like I was on some hospital ward.

I also still have a script from first doc. I'm just going to hold onto it in case something goes wrong.
I don't know what that could be, but the thought of running out is pretty terrible. I plan on mailing it back
to him in a couple weeks when I'm feeling more comfortable with things. Just Godfrey doing what he
does best...being neurotic :)

I want to say that I really admire your sincere approach, especially that you're willing to give the 3 mg a try. I really think your last doctor is being unreasonable... shouldn't this be your decision....and it's obvious you're a trustworthy patient.

Wishing you well.

G.


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PostPosted: Thu Dec 22, 2016 8:49 am 
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I know the time is nearing when I will need to change also. Nothing is causing it, except for my doctor's age. I feel as though she'll be retiring soon, and I don't like the other docs that are in the same clinic that she's in. My neighbor also uses that same clinic and sees the main doc that's 'over' the place..and he's a total ass to her. He's had her on 16mg for 3 years and she's even asked him to go up just so she would have a little more comfort ..she has scoliosis and legitimate pain probs, but he won't hear of it.
My doc on the other hand is very willing to listen. Last appt (2 mos ago) when I told her that I had almost run out, even though I'm at 24mg/day...she asked what happened, that I had been doing so well for 3+ years now... I was brutally honest. I told her that I have legit pain and that sometimes I take some extra..and with the colder weather..arthritis..etc..I had taken a little more than I should have.
Her response was "lets go up to 28mg/day ..or 3.5/day for the next 3 months to get you caught up"...

I've been to docs that "punish" you for your slips. You took too much this time? Oh, let's LOWER your dose even more. The doc I was with before this one was exactly like that. That story would piss off any person who listened..

My daughter broke her ankle..and the doctor I was seeing was in the same building as the ortho doc that my daughter was referred to...what luck! So, my daughter had a follow-up visit that was one week prior to my sub doc visit in that same building..
So I call my sub doc, and explain that to them. I tell them that I have to take my wife to work, to keep our 1 vehicle..so I can bring my daughter to her appt this week..and that my appt is next week, only 5 days later (daughter's was on Thurs, mine was on Tues). "sure, that's no problem. That wont be an issue at all"...
But when I get to my appt 5 days early (after my daughter finishes her ortho doc visit)...my doc acts like I've committed treason. Tells me I'm early and shouldn't have run out...etc etc. I told him I hadn't run out and that I explained that my daughter's ortho appt was the same day in the same building..and that I only came because I needed to save money on gas since we only had 1 vehicle..
And how hard it was for me to get an hour away from home when my wife had to work..
Didn't matter. He was reducing me from 16mg to 8mg because I was 5 days early.
Told me if I didn't make anymore mistakes, in 3 months he would look at going back up to 12mg.
I was furious.
I left that doc office in a rage..tried not to curse but couldn't stop myself.
I started out with that doctor when he had no sub patients at all. He was in the small town that I live in, seeing patients in another docs office because he had no office. I stayed with him....he moved to Bham, in a big multi-doc office making plenty of cash..since he didn't accept insurance. He had used his quick success with sub to get him bigger and better, all within a year. But I was his first patient on sub. I followed him when I heard he was coming to my small town, right up until he opened...and switched from the doc I was seeing in Dadeville (who saw patients in his wife's practice after 5pm)...and he was totally a pill pusher. He would give the person in the next room a script of oxy, then come give me a script of Suboxone.
It was a solution to a problem to see him, so I only stayed because he was doing me a favor..

But once I got home, the madness from what happened with this doctor reducing me because I was early...didn't cease. I called the office manager..told her....faxed her info showing my daughter's appt..
I told her it wasn't right..
she would call me back after she talked with him.

Next day...I called again..She said she had spoke with him, and she was sorry, but there was nothing he would do. I came early and violated the terms of my agreement with him. I told her "you people are the ones that said it would be fine because the reasons I was coming early...you told me so. I told you I wasn't out of my meds, and that I was only coming early because of my daughter..and you said it would be OK, that you would explain to him why I was early"...
she blabbered something and it just infuriated me even more. I finally said "you know what, fuck it. There are plenty of doctors doing what this quack does ...and I can easily find another one. You can tell mendoza I said he's fucking fired." I said a few more things, but I won't put that here.
She finally hung up on me. But, I found another doctor rather quickly..the one I'm with now.

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PostPosted: Thu Dec 22, 2016 11:31 am 
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Marie don't feel guilty about saving up extra, in this day in time u gotta have a bk up. I think u did things very smart! Just like talking to the pharmacist, that's the very first person I would have checked with :)

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PostPosted: Thu Dec 22, 2016 11:44 am 
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"...and how hard it was for me to get an hour away from home when my wife had to work..
Didn't matter. He was reducing me from 16mg to 8mg because I was 5 days early.
Told me if I didn't make anymore mistakes, in 3 months he would look at going back up to 12mg.
I was furious."

Jonathon, that's just flat out malpractice. He can't....or absolutely shouldn't....punish a patient by REDUCING
your much needed MEDICATION. Truly unbelievable how bad some of these guys are.

I understand many can't afford...or even find such a luxury depending on where they liv, but I think most people are better off with a private addiction psychiatrist, The guy I see is in his 70's, an old fashioned Freudian, and unbelievably laid back about prescribing. He doesn't know much at all about the medication he's so laid back about...I think he must have taken a quick seminar or something in Suboxone 10 years ago and has long forgotten whatever it is he learned there, but I feel perfectly comfortable
given the depth of info available right here for no cost whatsoever

Around here addiction psychiatry is a cottage industry. They take a few extra courses long after med school and earn the right to call themselves addiction specialists.

By the way, I worry too about my doctor's age. Selfish of me I know, but suppose he dies, or retires or whatever. That's the addict in me. Always scanning the horizon for potential threats...


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PostPosted: Thu Dec 22, 2016 5:36 pm 
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Around here addiction psychiatry is a cottage industry. They take a few extra courses long after med school and earn the right to call themselves addiction specialists.

http://www.asam.org/public-resources/wh ... specialist

To be able to call ourselves an addiction specialist it takes an additional year of training.
I think there are about a total of 4000 doctors with the training to put up the Specialist shingle.
They are a small slice of Suboxone providers. You can use the data base from the URL provided to see if a doctor has addiction credentials.


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PostPosted: Thu Dec 22, 2016 7:13 pm 
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Hi Doc,

Well if the guy I'm seeing has had a whole year of training I'll be very surprised. He was sure bupe in high doses would have a pain killing property for one already addicted to opiates. Didn't seem to be familiar with
the ceiling effect.

I can't speak for the others. But if he's able to call himself an addiction psychiatrist I can't help wondering if other's really aren't well equipped do so either..

But I what I should have said, and as I recall meant to say, was that the bupe clinics....4 of which are within easy driving range from my home...all of them cash businesses with about 5 minutes devoted to each patient...are the cottage industry. Nothing wrong with that per sen although def. not ideal. They're certainly needed.


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PostPosted: Fri Dec 23, 2016 5:03 pm 
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I appreciate any doctor who prescribes Suboxone/Buprenmorphine.....as it's such a life-saving gift to us!

And, although it sometimes feels greedy and wrong that many Sub docs only accept cash and charge hundreds per visit.....I do understand the extra risk & scrutiny they're making themselves vulnerable to.

I was initially induced by a pastor of a church (whom was also a general physician, pain specialist, and Sub doctor). To gain access to treatment, you were required to attend his church several times, attend a couple weeks of group therapy, AND volunteer at his church. This was ALL before gaining an indication appt with him. It was strange, but free and I was totally desperate to finally break my cycle.

After that, I started seeing a physiatrist (whom is actually the doc I just went back to). I never witnessed him doing anything unethical. I just eventually wanted a doctor closer to my home and one who'd actually listen. Maybe this doc does listen....it just doesn't feel like it when he's looking down writing your script the total of 5min you're in/out of his office. Even with waiting room time and urinalysis, I don't recall ever being at his office for longer than 20min.

The doc I just ended treatment with is a physiatrist as well. However, his office is in a very nice part of town. There's tons of privacy....to the point that you almost never see other patients. And, he always spent at least 20-30 min talking....not just about your meds, but also anything you felt important to bring up. He really seemed to strive treating the whole person, instead of only their addiction. He truly helped me work through some deep issues over the years. I was very pleased with his treatment the entire 5yrs I was in his care. He just didn't have the same outlook about maintenance as I do. I told him from day one that I had no intentions putting a timeline on my treatment and I thought he respected that decision. However, he slowly started pushing me off. He's helped me in so many ways, I really didn't wanna part ways. But, I've realized my recovery is mine and mine only.

There are good, great, and crappy physicians in every avenue of medicine. I do completely sympathize with patients whom don't have a choice (because the ONLY doc available is a total quack). But, I also feel our recovery is what we make of it. When we stop blaming outside forces for our disappointments and failures, we truly gain control of our life and our happiness!


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