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PostPosted: Tue Mar 10, 2015 2:11 pm 
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Hello folks, and let me start by saying thank you for your help in advance. So after a year of percocet use (60-80mg daily, always IR) I am preparing to switch to Sub. My two main questions are:

Given that its only oxycodone ir, no extended release opiates, is 24 hours from the final dose sufficient?

Secondly, assuming I wait a sufficient length of time between my final dose of oxycodone and my initial dose of sub, what should I expect? I've read many accounts, some claiming that shortly after taking the sublingual film their WD's were gone and they were functional, able to go about their day. On the other side of the spectrum, I've read where some claim the first day on sub is worse than the usual garden variety wd. I want to ascribe those bad experiences to the user not waiting long enough and so having precipitated wd, but before jumping in I want to know how likely it is. If I wait a full 24 hours after my last percocet to take the strip, what should I expect?

I figure the longer you wait the safer you are, but I am in an unfortunate position in that I can't be out of commission for more than a day. Is 24 hours after oxycodone a good window? I really appreciate any and all advice!


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PostPosted: Tue Mar 10, 2015 3:31 pm 
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24 hours really should be plenty of time coming from the habit you described. The real test is going to be how you feel. If you get to the 24 hour mark and don't feel like you are in wd, then you should wait a bit. But, if you are feeling like you are in moderate wd's and it's been 24 hours, then you should be safe to start.

Are you inducting in a physicians office? If not, let us know and I can post a link to the COWS scale for you.

You are correct in assuming that the one's who feel worse after induction are going through precipitated withdrawals. Inducting from heroin or methadone requires a longer period of abstinence. Your first dose should make you feel good within an hour, if not sooner. The first appointment is always very scary for us, but I promise you it will be worth it.

Let us know if you have any other questions or concerns. Between the whole group we have probably seen anything you can throw at us!

Good luck!

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PostPosted: Tue Mar 10, 2015 3:37 pm 
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HI hgr!

great decision on going on such a life saving medication. I think waiting 24hrs from your last dose should be just fine. Just speaking from my own experience, that is all I waited and I was "back to normal". I felt a bit sedated on the switch from opiates to subs but that went away and I was back to work as usual.

Let us know how everything goes? I really had a great experience switching from opiates to subs. I have been on it for quite a while and it is the best thing I have ever done. I hope you will feel the same.

Good luck!


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PostPosted: Tue Mar 10, 2015 5:08 pm 
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Thank you both for your replies, they are most helpful. I do have the COWS worksheet, and from past experience I anticipate 24 hours will find me well into the Mod-Sev stage. Generally if my last dose of the day is at 9pm, I wake up the next morning feeling horrible, so doubling that amount of time will have me one unhappy camper. So if all goes as planned, tomorrow night at this time I'll be free of perc.

I am quite sure Ill find myself on this forum a lot tomorrow, and I'll keep watching this thread this evening in case any contrary opinions pop up.


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PostPosted: Tue Mar 10, 2015 6:06 pm 
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Just to follow up on QHorseGals ?
Are you inducing in an office, or been given a script to induce at home or...?
Most of my folks induce off a perc habit feel quite well shortly after induction and go on about their recovery/life.
good luck,
DocM


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PostPosted: Tue Mar 10, 2015 7:53 pm 
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Welcome to the forum hgr413! When i switched from oxy to sub i was taking extended release (80 mg) & ir oxy (30 mg-for breakthrough pain) at a pretty high dose. It was about 20 hours from the last ir oxy and 30 hours from er when i took 2mg & was fine. I was actually afraid i wasn't in bad enough w/d to start but the doctor did his thing & said it would be fine and it was. After a couple of hours i was "fine" but not myself. It's hard to explain. I also had a kidney stone brewing and didn't know it so that could be part of why i didn't feel like myself.

The bottom line is i made an educated decision to stop the craziness and use sub because i had to continue working etc. By the end of the first month i was "me" and on my way to Florida LOL I could have gone to work the next day but i was a chicken & took it off.

The only thing i would change (other than never starting opiates) is i would have listened to the folks here instead of my doctor. He put me on 24 mg & i think i could have

Good Luck! You should be just fine


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PostPosted: Wed Mar 11, 2015 10:46 am 
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Well folks you may now welcome me to the community of bupe users. 22 hours after my last mg perc I took 4mg sublingual film, followed by 4mg more an hour later. The WD symptoms are gone, but I am, for lack of a better word, shaky, or jittery. Its been an hour now, so I am hoping I can consider myself out of the woods as far as PW's. Last evening I found a document online from the FDA which says the period of time necessary to assure perc is out of your system and its safe to start sub is "12 to 24 hours", but I still waited 22.

I'm hoping this shakiness goes away soon


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PostPosted: Wed Mar 11, 2015 11:50 am 
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That's great news Hgr! Don't be overly concerned about that "off" feeling for a few days. Bupe is much stronger than what you were taking and it can take up to a week to adjust to it. The key is to stick with the smallest dose you need to cover wd's and cravings, and stay at that dose consistently. Your body will adjust to the new levels of opiates soon and you will be good to go.

I'm happy that you had a pain free transition!

Q

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PostPosted: Wed Mar 11, 2015 12:27 pm 
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I am almost worried that perhaps it was too good to be true. The shaky feeling abated significantly after I ate lunch. Now its just a lot of drowsiness. I was actually thinking the drowsiness might indicate that 8mg wasn't enough and I should take 2mg more.

Also, last night I had a long chat with an MD specializing in addiction medicine ($15/mo subscription gets you unlimited questions and follow ups) He laid out a full plan for transition for me as well as got all technical talking about receptors and such. Overall his advice was pretty much identical to what I received here, except that he said dosing should be twice daily.

Quote:
While the medicine does last for 24 hours, its effects are significantly diminished from hour 16 to 24, which we resolve by taking it twice daily


Any thoughts? Hours 16 to 24 are likely the hours I am asleep, so as long as I am not waking up due to discomfort, I'm good, but I'd like to see what you all think


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PostPosted: Wed Mar 11, 2015 1:09 pm 
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Since it seems like you are doing this kind of on your own, it's really going to come down to personal preference IMO. He is absolutely correct in that the effects of bupe wear off somewhat before 24 hours. Mostly, those are the analgesic effects, which is why we recommend patients who are using suboxone for chronic pain dose every 6 hours. For example: if your dose is 8mg per day you would take 2mg in 4 doses, every 6 hours.

For patients who are using suboxone for addiction only, we recommend once daily dosing because it eliminates the habit of reaching for a drug every time you have a craving or thought to use. If your dose is high enough, it should last the full 24 hours and even beyond that. When I first started treatment I wouldn't feel that I needed to re-dose at the 24 hour mark, because I started on 8mg and it was a high enough dose to cover my symptoms. Bupe will stack in your system at doses above the ceiling and can last for a very long time. The key is to find the right dose that will hold you for that amount of time. Most people find that 8mg is plenty for them in the beginning, and more than that is usually wasted.

6mgs sounds like a pretty good dose to try to start on for you. If you feel you need a bit more for the first day or two you could certainly go up to 8mg, but I wouldn't go any higher than that. After the bupe has a chance to fill those receptors, I would bet that 6mgs will hold you fine for the full 24 hours. Either way, it's going to take a few days of adjustment for you to get an accurate picture of how you will feel. Figure out where you want to start and stick with it for at least 3 days before you make any changes.

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PostPosted: Wed Mar 11, 2015 1:10 pm 
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Hey hgr :)

Glad to hear ur appt went good. Now as to ur questions about jittery and sleepyness, this is absolutely normal at first. It's honestly been a side effect for tons of ppl who start subs. The sleepyness lasted about a month for me. I don't remember if I had jitters or not but I know others have. This will happen weather u dose once or five times a day IMO. And its something u just have to endure at first. It will go away I promise. This medication is a lifesaver, but unfortunately it has these side effects with some ppl and there's not much u can do but wait it out.

As far as dosing twice a day, if ur not a pain patient then u shouldn't do it but once a day. The reason they split ur dose when u go for ur induction is just to make sure ur not gonna have any reaction. That's what my Dr told me. After that, once a day. Doing it twice a day is only repeating the addict behavior we all have. This medicine has a long half life. U could take ur full dose and not even feel like u need ur next dose the next day. (U still take it, I just mean u shouldn't feel bad or sick til well after the next day). So IMO u should only dose once a day and the tired and jittery feeling is very normal and it will pass.

What ur worrying about and questioning is very normal. Everyone has questions and thinks they may need to do it this way or that way, so ur actions are very normal. It took me a good 2 weeks to a month to really get settled in and used to sub. So give urself some time to adjust, I promise u will be A-ok :)

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PostPosted: Wed Mar 11, 2015 1:14 pm 
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Gosh Q....we sure think alike ;) Sub Sistas!!!

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PostPosted: Wed Mar 11, 2015 1:22 pm 
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LOL

Great minds think alike! :D

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PostPosted: Wed Mar 11, 2015 1:41 pm 
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I'll stay where I am at then. I started with 8 (4+4) and I have to say other than the slight drowsiness I'm feeling pretty good. I'm actually surprised at how well this has gone. I'm just kinda worried that it might infact be too good to be true and I'm going to puke or poop my pants any minute.


And you're correct qhorsegal, I'm doing this solo, albeit with someone I trust implicitly here present. The advice I got on the "Ask a Doctor" app is the extent of consultation I've had.


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PostPosted: Fri Mar 13, 2015 1:34 pm 
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I am officially a fan of Suboxone for treatment of opiate dependency. Based on all the horror stories I almost didnt take that step, but the encouraging words on this forum gave me the testicular fortitude to give it a shot and in summation -

*22 Hours after my last perc I took 4mg, then another 4mg of sub
*Within an hour my WD was gone and I felt better than I had when on oxycodone
*Today is my 3rd day on sub and I've had zero discomfort, the transition was seamless
*I have more energy and am more functional than I was prior

I'm going to post in the "My Addiction Story" section so I won't take up too much space here, but I wanted to thank those of you who were quick to respond to me original post and were kind enough to help me work up the nerve.


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PostPosted: Fri Mar 13, 2015 5:18 pm 
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I'm very happy for you, and your testicular fortitude! :lol:

Thank you for taking the time to post about your success! We love adding these stories to our forum so that others can see the GOOD side of suboxone treatment. It's a shame that most people only take time to write about it when it goes badly.

I look forward to seeing your new thread, and I hope you will stick around.

Q

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PostPosted: Sat Mar 14, 2015 7:01 am 
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hgr413 wrote:
I'll stay where I am at then. I started with 8 (4+4) and I have to say other than the slight drowsiness I'm feeling pretty good. I'm actually surprised at how well this has gone. I'm just kinda worried that it might infact be too good to be true and I'm going to puke or poop my pants any minute.


And you're correct qhorsegal, I'm doing this solo, albeit with someone I trust implicitly here present. The advice I got on the "Ask a Doctor" app is the extent of consultation I've had.


Glad things went well for you! This cracked me up...


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PostPosted: Sat Mar 21, 2015 11:55 am 
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"Based on all the horror stories I almost didnt take that step..." I can really relate to this! I considered Suboxone 3 years ago but saw so many horror stories I decided against it. Unfortunately, the bad stories seemed to sift to the top of the search engines back then. I believe the efforts of this site and the NAABT are beginning to change that. Fortunately, I came across the FACTS and began treatment a little over a month ago.

As to the sleepiness; I found that it really helped my sleep...I'm doing really well since starting Suboxone, without too much daytime drowsiness.


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PostPosted: Sun Mar 22, 2015 1:23 am 
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Morphing, I'm so glad you were able to start sub when you needed to, after finding a way past the "horror stories". I have a hard time believing that those stories come from people who were serious about recovery and using suboxone as directed. I do have some empathy for those people whose doctors failed to describe suboxone realistically, but I also wonder why they didn't do any research on their own! If they had I'm guessing that they would have run into a few red flags!

The drowsiness should continue to dissipate as your body gets used to the medication. I'm happy that you've found us! Keep posting!

Amy

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PostPosted: Sun Mar 22, 2015 2:23 pm 
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Hgr,

Congrats on your transition! I was shaky/felt off for a couple of days after my transition too, but it went away soon after that.

You have found an amazing resource in this forum. There are really awesome people here, so anytime you need help, advice, etc., this forum is a lifesaver. For example, QH gal is always so supportive and her
advice/input is stellar and spot-on.

Anyway, good luck and congrats!

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