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PostPosted: Mon Jan 31, 2011 3:13 pm 
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Someone Help!
I am 37 weeks pregnant and I have been on suboxone/subutex for almost 2 years now. I started on 2 a day (16mg) and went up to 3 a day (24mg) and that was my maintinence dose for the most part. I was very content at that dose and never had problems/cravings. When I found out I was pregnant I was already like 5 months along, my doc had been trying to ween me back down to two a day and I was struggling, but when he found out I was pregnant pretty much forced it on me. I have struggled through my whole pregnancy with this lower dose and It has made the entire experience horrible and uncomfortable. About 6 weeks ago he raised my dose 4mg, so now Im on 20mg. It helped a little, but not much. I don't understand why, if I am having such a hard time reducing, why can't he just put me back on the maintinence dose that worked so well before!!!??? I am so frustrated! I ran out of meds early this month cause Im fed up of feeling like this, and he threatened to kick me out of my program! I never relapsed since starting suboxone--never once failed a drug test and always followed my treatment program to the letter! I don't want to be on this forever, I want to eventually ween off, but not until I am ready. I think maybe I should look for a new doc? He makes me feel so guilty about being on this during my pregnancy and asking for a higher dose, telling me that my baby's going to suffer horrible NAS if I take any more than I am currently on. I read that's not true. I read about moms on 30mgs who's baby had No NAS, and someone on 1mgs baby had really bad NAS. They say they don't know why this happens. Ultimately, I think staying clean is more important than what dose your on. To each his own. Any thoughts on this? I'd love to hear from anyone with a similar problem...


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 Post subject: Yikes
PostPosted: Mon Jan 31, 2011 3:54 pm 
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I'm so sorry this is all happening to you. Man oh man, it's so confusing to figure out what the right thing to do is, isn't it? I had a baby on Subutex. I found out I was pregnant when on somewhere around 12 mg or 14 mg. I rapidly weaned down to 3 mg by week 6/7, just because no one would tell me what to do!!! I was trying to wean as low as I could before the placenta formed. I was switched to Subutex because at least that way I was avoiding the Naloxone and I spaced my doses exactly eight hours apart to minimize the amount in my system at any one time. I stopped at 3 mg because my body went nuts and I was truly afraid of losing my baby at that point. I had my Sub doc saying, "don't drop down to fast or you will cause a miscarriage and it's better for the baby to withdrawal on the outside; but I'm not sure so ask your OBGYN." I had my OBGYN saying "I don't know. Everything will probably be fine; I'm not sure so ask your Sub doc." I got so frustrated I gave each one the other's name and #. My OB sent me to a neonatal specialist who followed me closely, and he was confident I'd be okay but his partner lady, the genetic specialist told me "What's more important to you? Having the medication to make you comfortable or your baby?!" OMG, talk about a knife to the heart!! I felt so guilty and hated myself. In the end, I had a perfectly healthy baby with no NAS. My best advice for you is that like you said, there are incredibly varied experiences and no one can tell you for sure what will happen. I AM surprised you had such a tough time weaning and wonder why you could not get your dose lower. However, I'm not in recovery for opiate addiction so I absolutely cannot say how intense an opiate craving is and it's certainly better to not have relapsed! I'm curious if your OBGYN has been any help or what he/she has said. You are where you are. You're almost ready to deliver. For the next little while, try splitting and spaces your doses and drink lots and lots of water, as in a gallon a day. That's what my doctor had me do. Get your OB more involved and just accept what the worst scenario may be and know that even if your baby does have NAS, it will be treated and it will end and then your baby will be okay. Fetal alcohol syndrome is a lifelong disorder. NAS is a temporary problem. I'm not at all minimizing it, but I'm just saying that it's not the end of the world, which it can feel like when you are facing the possibility of it. DO NOT crash down on your Sub dose. It is really, really quite dangerous for the baby!! I absolutely could have given myself a miscarriage with what I did, which gives me chills to think about as I type this and my little sweetie is laying with her head on my leg. Look, my other daughter was born 11 weeks early, and I was on no meds at all aside from vitamins. It just happened. She was on a ventilator and really, really sick and stayed in the NICU for two months. Sure, it was insanely sad at the time, but life goes on and she's a happy, healthy, brilliant little lady now and that tough stuff is just a distant memory. And my little one right here....well, if she had gone through NAS, we would still be right here cuddling and be just fine now. Do you see what I'm saying?

God Bless you and you sweet baby!! Please update to let us know what happens.

laddertipper

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First you take a drink, then the drink takes a drink, then the drink takes you. ~F. Scott Fitzgerald


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PostPosted: Mon Jan 31, 2011 4:31 pm 
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Hello minx and welcome. I'm child-free, so I can't talk about issues regarding pregnancy, but I can tell you what I know about suboxone. 20+ mg is a high dose for anyone who is not taking it for pain. That said, if you need it, you need it. Do you know about the ceiling effect? The ceiling is generally accepted to be at or around 4 mg. At that level the opiate receptors are saturated, but many people need more to KEEP the opiate receptors saturated - this is what accounts for the varied doses between people. That and holding cravings at bay. But once the opiate receptors are staying saturated, say at 6+ mg, any higher doses do very little to nothing extra. This is why people get stable at the lowest possible dose.

The reason I'm explaining this is to say that the chances that you're having physical withdrawals are extremely low. Chances are your discomfort is psychological - BUT that doesn't mean you aren't having the discomfort. But it is a judgment call for you to make. If you're having cravings at lower doses, then you're at risk of relapse and that puts you (and the baby) in danger. Yes, the baby might have NAS, but as you said, it might have it as 4 mg or lower, too.

Also, your sub doctor should put you on Subutex, rather than suboxone. You don't need the naloxone and neither does the baby.

I would suggest you go over to Dr. Junig's blog (SuboxoneTalkZone) and read his many postings on suboxone/addiction and pregnancy. Get as much information as you can. And remember, taking care of yourself IS taking care of the baby.

Good luck.

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PostPosted: Mon Jan 31, 2011 11:35 pm 
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MinxONsuboxone,

Hi. Welcome to the forum. First, and most importantly, try not to beat your'self up. Just being in recovery and on the Sub is far better than the alternative for you and Ur little one. I know it's really scary thinking/worrying about what might happen once Ur baby is born. Im 34wks pregnant myself. My husband and I were scared to death @ first, wondering what effects my medication may have on our baby. U need to try to stay calm though. if Ur really upset and anxious, Ur baby is gonna feel that.
I've been on the Sub for about 16-18 months. When I first started out, I was on a high dose myself (24-32MG). I see my Doc every three months. He has slowly tapered me to 16mg over the past eight months. Whenever I told him I was pregnant, he switched me to Subutex. Are you taking Suboxone or Subutex? If you are on Suboxone, I would definitely ask Ur Doctor to be switched to Subutex. The added Naloxone in Suboxone is just one more medication to have to worry about (worry about what the effects of it on Ur baby may be). Im not gonna lie, I've had a difficult time myself trying to taper. My Doctor even told me that Subutex is stronger than Suboxone, and that it should be easier for me to take less. Well, it has'nt been SO EASY. I haven't suffered any bad physical w/drals, just watery eyes, cold symptoms, and sometimes loose bowels. My thing is the psychological aspect of it. I find that if I try to take any less than 16mg, by the end of the day Im nervous, anxious, moody, and just don't feel right. That being said, I see my Doctor again nxt month, and he's already told me he's gonna reduce me to 12mg. Im really scared, but I had planned on doing @ least a temp reduction before my baby's birth anyways. One thing you might wanna think about is if Ur having a section, you really need to try to cut back a little and even stop taking Ur Sub 3 days before Ur surgery so that you can get adequate pain relief. In the end, if Ur baby does have NAS, just know that it's temp and it dosen't mean Ur a bad Mom.


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 Post subject: The shocking conclusion!
PostPosted: Sun Feb 06, 2011 12:11 pm 
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Ok. I think I figured out what was wrong with my meds/dose. I have been doing a lot of research and reading post's and simply trying to figure out why my meds just suddenly stopped working. The problem wasnt' the dose! The dose is fine, and actually, after all the research I did, I realize now that my dose is probably too high and I am planning on cutting it back to maybe 8mgs a day? We'll see...But let me tell you all what I think happened:
(Im not 100% sure--but I think this is the likely culprit)
I was not aware that the quality of generic Subutex varies depending on the manufacturer. I found this out by reading a post, So--I checked the prescription bottle from last month and compared it to the one I have been getting since I started Subutex. Here's what I learned: Last month my pharmacy gave me the Roxane Labs Generic for the first time. I had been getting the Teva Labs Generic since I started. I did notice when I picked up my script last month that the tablets looked differant, but I asked the Pharmacist and he said that it was the same thing--differant manufacturer, and I thought nothing of it at the time. I started to notice about a week later that my med's did'nt seem to be working at all! It never occured to me that it could be from the differant generic! I started researching this and read that the Roxane Labs Generic is GARBAGE! Many, many people complain that it doesnt work at all! Pheeewwww! I felt so releived hearing this, because it is simple to fix (I will just ask for the Teva Labs Generic from now on), and now at least I know It wasnt' me! So im going to talk to my doctor about this, and I am not going to need my dose increased as I had originally thought. I just wanted to let everyone know about this, maybe it will help someone else avoid the problem I had! Thanks to all who responded! I really appreciate your support! :D


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 Post subject: Just be careful
PostPosted: Sun Feb 06, 2011 2:16 pm 
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I'm glad you figured that out. I know generics can be legally 20% stronger or 20& not as strong as name brand. That's a big margin of error!!

I don't think from what I've read in your posts that you've gotten proper guidance during your pregnancy, as far as your medication goes. I know that people can have babies at high doses and they have no NAS, and people at lower doses can have babies with severe NAS. Still, the whole point is to reduce the chances to the baby, both in the womb and after the baby's born. Gradually reducing your dose to a significantly lower dose will increase the chances that the baby won't have as severe NAS. That's why your doctor isn't wanting to put you back up to your maintenance dose, where you were the most comfortable. However, since you didn't find out until you were 5 months pregnant (which is amazing to me, BTW!) there wasn't as much time for dose adjustment. At this point, you are staring delivery right in the face. I never even got to 37 weeks, Sub or no Sub. My record was 36 weeks. Please, please, please....if you plan to make any changes to your dose or dosing schedule, have your doctor okay it!!! I got so much help when I was pregnant. I had my psych talking to my OB and I saw a neonatal specialist two times a weeks as well. These people were doing research for me and watching me like a hawk. My only problem was that they didn't always agree! It doesn't sound like you've gotten much help of any sort. I even went to meet the NICU doctors to learn more about what would happen if my baby was born with NAS. Thank God she wasn't, but I was ready for it. Have you been given any of this information at all? If not, I think your doctors kinda dropped the ball.

Just out of curiosity, how did you not know you were pregnant? No barfing? Did you get your period? Didn't you feel that butterfly fluttering at 17 weeks or so? I cannot imagine how SHOCKED you were when you found out!!!

laddertipper

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First you take a drink, then the drink takes a drink, then the drink takes you. ~F. Scott Fitzgerald


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 Post subject: Hey Ladder Tipper...
PostPosted: Tue Feb 08, 2011 2:23 pm 
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Hey Ladder Tipper!
Thanks for taking the time to respond to my post. To answer your question as to how I did'nt know I was prego until 5 months...First, I was on Depo for two years, so missing my period was the norm. I missed my last shot (that's how I got pregnant), but since it can take up to 6 months for your cycle to return to normal, I did'nt worry much about it. Also, I did'nt show at all! I am naturally petite, and even at 5 months my stomach was still flat as a board! I actually found out I was pregnant the first time I felt a good sharp kick! After 3 kids, I know that sensation, it's pretty unmistakeable. As far as the rest goes...My Sub Doc is an idiot, and that's being generous (I could think of a lot worse that apply). He has been no help at all, doesnt really know anything, the only thing he did right was switch me to Subutex. My OBGYN has been great, she is familiar with my medication and has tried her best to answer my questions and put my mind at ease. I did get to have a meeting last week with the hospitals anastisioligist and surgion to go over my birthing plan (c-section), and they are both familiar with Suboxone and were very helpful as well. Lastly, I was able to meet with my son's pediatrician a few day's ago to talk about NAS and he was extremely helpful and has experience with infants born on Sub's, so I feel much more confident now than I did two weeks ago. Once again, thanks so much for all your support. This forum has been invaluable to me, and has answered more questions than all my doctors combined! I am going to keep posting after the baby comes to share my experience, in the hopes I can help other woman going through this. Thank you all who responded!


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