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PostPosted: Tue Mar 23, 2010 2:41 pm 
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Hi, I have been on suboxone for 13months and have been down to 2mg for the past 3 months. I recently had oral surgery (two weeks ago) and I toughed it out with 800mg of ibuprofen. Everything was okay until I got the stitches out. My gums got infected that day after they took the stitches out and I was in excruciating throbbing pain. I went to my doctor who first prescribed the subs and explained what happened and he put me on dilaudid 8mg's four times a day. I never really felt anything from the dilaudid which I found surprising.

I have been taking the dilaudid and no subs since last thursday. Yesterday, in a moment of addictive behavior I took the rest of the dilaudids which was (13 8mg pills) because I just wanted to see if I could feel them and I wanted to get back on the subs. I know how wrong it was, and I do feel guilty about it, but that's not the point of this post. My question is that I haven't had any dilaudid since 9PM last night which was almost 18 hours ago. Is it safe to take my suboxone now or will I go into precipitated withdrawal? Please help? Thanks for your time!


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PostPosted: Tue Mar 23, 2010 6:37 pm 
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I applaud your doctor for actually giving you a halfway decent dose of pain medication. I am very curious to hear if the pain meds actually worked when you took the large 13 pill dose? Did that push through the suboxone and work?

To answer you question, many people look more to an amount of time with starting Suboxone. What you really need to do is look at the withdrawal symptoms that you are having. You want to be in "Mild to Moderate" withdrawal in order to SAFELY start back on Suboxone. If you can get your hands on a Clinical Opiate Withdrawal Scale (COWS), most experts suggest being at a level of at least a 5 while some prefer scores of 15 or higher. It doesn't matter how much time passes for you to get there. If it's 3 hours or 3 days - it won't matter so long as you are having withdrawal symptoms. If you go to www.naabt.org you can find a copy of the COWS. As a practical matter, you likely know what it feels like to be in mild to moderate withdrawal. Pay attention to your body. When "those feelings" are there (elevated heart rate, sweating, restlessness, bone or joint aches, runny nose, GI upset, etc.) you should be safe to go back on the Suboxone.

Hope that helps and welcome to the boards. Tell us more about yourself and hang around for a while.


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PostPosted: Tue Mar 23, 2010 6:54 pm 
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Welcome JenX -

The following is what my suboxone doctor instructed me to do when I had a procedure last year while I was on suboxone. At the time I was (still am) taking 24 mg/day.
I was told that me IF I needed to take pain meds to take them for up to a week then go back on the suboxone about 12 hours after my last dose of pain meds. He told me I did not have to be in withdrawals to go back on the suboxone - just for my initial induction.

Obviously this is different from what Don had to say and I certainly don't mean to confuse you. Again, this is not my opinion, but my suboxone doctor's instructions.

I'm sure you'll get other responses, but if I were you I would call your suboxone doctor and ask him for specific instructions. Be sure to give her/him all the details. Let us know what they tell you.

Again, welcome to the forum

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PostPosted: Tue Mar 23, 2010 7:06 pm 
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I think calling one's doctor makes the most sense and that is actually what I was going to suggest. The only problem is, that 13 pill dose. That is going to tend to throw things off a bit and may not be something she wants to tell her doctor about. Yet - it is this pretty large dose that could make getting back on Suboxone a bit of a challenge. Certainly, if you don't think your doctor will make much of it, that's the route to go. Your doc may just not take kindly to that one time large dose.

Perhaps others will have some additional suggestions.


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PostPosted: Tue Mar 23, 2010 7:15 pm 
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Thank you so much for your post. I did get a hold of a COWS sheet and will proceed accordingly. It's 22hours since my last dose of dilaudid and I still am not feeling much withdrawal. I find this odd because I thought dilaudid was a relatively short acting opiate.

Anyway in answer to your question. I did not take 13 pills at once. I took them all yesterday, starting off with 6 pills and an additional 2 pills every hour until I exhausted my supply. I did not feel a buzz, but I did get rather itchy.

Fwiw I am a small woman 5ft 2 110lbs. I was addicted to opiates and benzos for the past 10 years, pills only no needles or H.


This seems like a really great forum!


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PostPosted: Tue Mar 23, 2010 7:24 pm 
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Jen,

I believe that Melissa's advice is safe. I had surgery and unfortunately, my doctor wasn't helpful like hers or yours. Either way, I took the last of the percocets in the evening, went to bed, and when I woke up in the morning just started the suboxone again. It had only been probably 12 hours and I was fine.

My new doctor actually told me if I need another surgery (which is quite possible) she would just marginally reduce my sub dose prior to surgery, then prescribe painkillers, and resume a normal dose of sub after.

For the first sub dose it is important to be in withdrawal. In a situation like this, you should be fine.

Cherie


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PostPosted: Tue Mar 23, 2010 7:41 pm 
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Wow! I now have many responses.

Thanks everyone! I really appreciate all of your responses. Don is definitely right about me not wanting to tell my Dr about the over indulgence. I definitely don't want my Dr to think twice about prescribing myself and other "addicts" proper pain relieving meds.


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PostPosted: Tue Mar 23, 2010 9:00 pm 
Hi Jen. Sorry I didn't reply and welcome you sooner. It's been a bit busy in my life lately!! No worry though....looks like you got plenty of good responses. I will add to your list a little bit though, just reinforcing what's already been said. I saw my doctor today and, ironically enough, asked him about this very thing. I am now taking 2-3mg/day (you're on 2mg/day right?) Asked my doctor if by my being on this low of a dose, if I needed pain relief for any reason, how hard would it be to break through the bupe? He said with my dose being under 4mg/day it shouldn't be too big of a problem, especially if at 2mg/day or less. He said he would Rx something "strong like a pretty high dose of oxycodone or possibly dilaudid" to treat pain for the time necessary and then go right back onto Suboxone the next day. He said there should be no precipitated withdrawal from that short of a course of full-agonist opiates. So there you have my Sub docs opinion along with the others. Personally if it were me, I would probably be just paranoid enough to want to wait at least 12-24 hours after my last dose of pain medicine. I've heard what precipitated w/d is like and.....no thanks!
Another thing I wanted to ask about was - no buzz at all with all that dilaudid?! and just having been on 2mg/day of Sub? I would've at least expected you to get something out of it. Nothing huh?! Did it even take care of your pain?...surely it at least did that!! I hope so or you'd be suffering....mouth pain is some of the worst pain ever!!
Also, how are you feeling about the old addict behavior coming in on you with those last few dilaudids? Are you upset about it or worried in any way? What do you think that behavior meant in terms of your stability in recovery if anything?
Once you get back on your Sub, do you plan to go back to the 2mg/day again or change your dose? You're on a pretty low dose, so are you planning on continuing to taper off and just remain at a low dose for a good while? Just curious...
I sure hope your mouth is feeling better and that you'll get back right on your Sub and feel good soon! Keep posting!


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PostPosted: Tue Mar 23, 2010 9:47 pm 
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Hey Setmefree,

Thanks for both the response and the welcome. Yes, I am on 2mg a day and have been for about 3months.

As far as pain relief from the dilaudid I'm not really sure, as I still needed to take the ibuprofen with it to achieve complete pain relief. Pretty weird, huh?

As far as my feelings regarding my day of indulgence... I am upset with myself for giving into my addictive behavior, but am trying to not think too much into it. I know that pain is a trigger for me, and mouth pain particularly got me started on opiates years ago to begin with. This event has proved to me that I am not ready to come off of the subs completely. I am happy however, that I feel no need to try and get more pain meds. I did not enjoy the past couple of days where I was slightly obsessing over when I could take my pills and how many I had left, and all the garbage that goes along with active addiction.

I plan on going right back on 2mg and continuing on that dose for awhile, and then tapering off completely when I am

Thankfully ( no offense to anyone) that I do not belong to a 12 step program anymore that would really make a huge deal of my slip up. I just celebrated a year off of everything except subs, and am now trying to live with some substances in moderation. No prescription meds or hard drugs of course. This is actually really thought out, but will save it for a more appropriate post.


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PostPosted: Wed Dec 28, 2016 12:55 am 
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hi jen x i just wanted to take a minute to explain to you why you had to take the ibuprofen to get full pain relief.... opiate "pain killers" dont actually kill the pain... what they do is block the pain receptors from recieving the message that your body is in pain, therefor the pain is still 100% there your just tricking your body into believing its not... the ibuprofen and other NSAID (non steroidal anti-inflammatory drugs) such as tylenol naproxen motrin they work on reducing the inflammation at the site of the pain, and since inflammation is what causes pain they actually help to diminsh the pain itself... so NSAIDs should really be called pain killers and opiates just called pain maskers


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PostPosted: Wed Dec 28, 2016 9:38 am 
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The last post was in 2010, so it's a pretty old post :)

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PostPosted: Thu Dec 29, 2016 8:16 pm 
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Hi nicryanmartineau,

Like Jennjenn said, it's an old post but that really doesn't matter much if the subject is worth talking about.

You made a good point about opiate pain relief. Whenever I have dental work done it's the NSAIDS that I take and not the opiates for the exact same reason you stated. And that was way before I ever had a problem with pain pills. They never worked with dental pain, only Aleve or Ibuprofen seemed to do the trick.

Once I heard a doctor say that if Aspirin were invented today it would be a prescription medication. Nothing like plain old Excedrin to put to rest a headache.

Thanks for posting and welcome to the forum!

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PostPosted: Thu Dec 29, 2016 9:15 pm 
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Hey rule,

I"ve had the same experience. I'd always kick up a fuss to score my Vicodin, but if the tooth was
really bothering me I'd grab a couple of tylenol. Never ceases to amaze me, how well that
stuff works.


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PostPosted: Fri Dec 30, 2016 9:52 am 
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Anytime I've ever had dental work done....it's ibuprofen that is the lifesaver for me. Even when I had all 4 wisdom teeth taken out when I was 26, it was ibuprofen that controlled the pain. I 100% agree....I guess I should have said that earlier instead of being to focused on it being a 2010 thread.

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