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PostPosted: Fri Aug 30, 2013 11:01 am 
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It has been years since I have posted in here. A quick summary.... my then teen addict is now a 23 year old pregnant addict in recovery. Over these absent years we have tried everything including methadone and she has been on suboxone 17 different times, each time ending in failure as she dropped off. Never was she truly ready to be in recovery and never would change her people, places and things.... so skip ahead here several years of living hell (the stories would shock some of you) and she is now older, pregnant and has turned away from all using friends, holds a job, goes to meetings and counseling and is currently on 2 mgs. a day of prescribed buprenorphine. She was taking hit and miss suboxone off the street in her early pregnancy and then she came home and I got her to a doctor ASAP who prescribed for her. She is doing amazing in her recovery and is 37 weeks pregnant. Now for the questions...i am pretty well educated on this subject but after researching again for hours I cannot find the answers to a few of my questions...I have read that even 2 mgs is pretty strong dose and equivalent to 20 or 30 mgs of morphine...I also understand that as a partial agonist, bupe only binds to a ceiling effect. So one question is at 2 mgs are all receptors covered but say just not as buried or are just some covered?? Do the covered receptors still allow her brain to create some of its own endorphins are does the 2 mgs create all the endorphins she is getting?? Does her brain at 2 mgs "heal" so to speak to a degree and does her brain "retrain" itself to create its own endorphins or does she have to be totally off ALL opiates at any milligram??
My other question is after having read a hundred different stories of pregnancy, delivery, birth and addicted babies....do you think at this 2 mgs that her baby will be born addicted and will it withdraw?? Most of the stories I have read said their babies were fine but noone ever gives the dose they were on..........any and all responses will be greatly appreciated and very helpful.
AND I must add that Dr. Junig, all those years ago when I was so desperate to save my daughter...each and every single thing he told me was true and spot on and everything that he said would happen did happen. My girl has become perfect text book example and I thank God every day that she is still alive and in recovery. She was 17 when i first came to this site. She has been through agonizing hell that any addict will "get." Her depth of deprivation is what books are written about. She has been raped, beaten, traded, sold, sold herself, witnessed murders, lived in the streets, shivered in the cold, starved, died and been brought back at least 5 times and in between would have clean time, just to do it all over again. Like I said I am so grateful she is still alive.


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PostPosted: Fri Aug 30, 2013 12:09 pm 
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Hi! and welcome back to the forum. I am so happy your daughter has gone back on suboxone to treat her addiction. What a great choice especially since she is going to be a mom. I truly do not think that suboxone passes thru the placenta so the likelihood of the baby having withdraws is minimal.

At 2mgs, most of her receptors are full with Suboxone, especially with her taking it every day. Her receptors will heal and go on to produce endorphins of their own.

I do recommend that she stay on Suboxone for a long time. This is a medication that will treat her addiction, if taken properly and at the correct dose.

I am sorry that your daughter had to go through so much pain. But here she is now in recovery and doing great.

Suboxone truly is a helpful medication when taken every day correctly. I know that it has made me a better parent of my twin boys. I am engaged in their lives, and hold a great job, thanks to getting my life in order and off opiates.

I wish you and your family well and Congratulations on the new addition to your family!


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PostPosted: Fri Aug 30, 2013 2:10 pm 
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thankyou so much for your reply. I am truly blessed to have my daughter back. One of the reasons she would never stay on long term, other than she just was not ready is because we have no insurance. she has it right now because of the baby but after the baby is born two months later she will be without insurance again. Do you think since her receptors are covered, will she have to wait until she is off teven the 2 mgs for her brain to create its own endorphins or is that happening now?? That is one of my biggest questions. Again, thanks for writing back!!


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PostPosted: Fri Aug 30, 2013 2:20 pm 
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Hi Mom, and welcome back. I do not know the answers you are seeking but many here have gone through pregnancies while on Suboxone so I'll let them share their knowledge.

I deleted the other thread. You only need one going at a time. If later on you want me to move this to another section, just ask. Also edited the title.

What a horror story you've witnessed. The good news is that your daughter is now in recovery and can still start over with a decent life. Congratulations on being an almost grandma!

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PostPosted: Fri Aug 30, 2013 4:49 pm 
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Welcome back! When I initially began reading/coming to SuboxForum you were making your initial posts about your daughter. I had some butterflies in my stomach as I opened your thread as you being back likely meant something negative had befallen your daughter. I do remember Dr. Junig responding in detail to your question about the endorphin system 'healing itself.' I'm not going to cut and paste but you should consider going back and reading what he had to say to you all those years ago; the answer is still the same! :)

Again, welcome back!

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PostPosted: Sat Aug 31, 2013 11:59 am 
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thank you for the replies, yeah i posted in the pregnancy forum first but didn't get replies so I tried here. i am still searching for my answers. I did try to go back and read the old threads but I could not find that particular thread. It really wrenched my heart to read what I did get through I was just unable to keep searching. I will look again to try to find it. Myself I have come a very long way in my own recovery of being codependent. It took me years to struggle through it. I now am better equipped to help my daughter as she seeks her OWN recovery. As I have read here again many things come to mind and I have even more questions. I see that an every other day dose would be better but for now she is even taking the two mgs and we split even that up to where she takes a little 3 times a day. Otherwise she does have phantom cravings or perhaps the real deal. When she has the baby perhaps she will bump up a little but I hope she stays just where she is. Although she does OK and maintains I still feel she stays just on the edge all the time.


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PostPosted: Tue Sep 03, 2013 12:30 am 
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Hi-- and yes, welcome back!

All chemicals that activate opioid receptors cause changes in the firing patterns of endorphin pathways. But the changes are more important at the receptor side. I remember an article I read years ago that found similar levels of endorphins in subjects on chronic opioid agonists-- but I don't remember the species (rats, mice, rabbits, etc). The receptors are altered in response to increased activity of those pathways, as the body strives to achieve 'homeostasis'. In other words, the body has ways to tell if something is firing in an abnormal way (like endorphin pathways in a person taking oxycodone for a short length of time), and in response, the receptors have phosphate molecules added to them, which changes their shape and makes the receptors less sensitive. This process continues as higher amounts of agonists are taken, and eventually the receptors are not sensitive enough to respond to endorphins. After stopping all opioids, the 1-2 month wait for withdrawal to end comes from waiting for new receptors to become inserted into the cell membranes. The endorphins are secreted continuously-- probably in greater amounts than normal-- but just like if the person were to take the usual dose of pain reliever, the receptors are not sensitive enough to become activated by endorphins.

There have been several studies looking at severity of withdrawal in babies of women on buprenorphine. About half of the babies have been found to show symptoms. Half, in studies, don't show symptoms of withdrawal. My usual fear, when my own patients have babies, is that the hospital will over-treat, and cause more problems than if they just let the mom breast feed on buprenorphine, and let the little bit of buprenorphine in breast milk help to wean the baby from buprenorphine. I know a person whose baby was kept for months, on a morphine infusion (followed by a methadone taper). That approach is simply crazy, in my opinion; buprenorphine is used in adults to EASE withdrawal, and so putting a baby on a full agonist is only making things worse. THAT SAID... I encourage moms to avoid feeling guilty, despite the nasty 'tsk tsks' that they may here from nurses and other caretakers. I won't repeat myself here, but google 'suboxone' and pregnant, lay off the guilt trip' and you'll see my reasons for that idea.

There is very little benefit from holding the dose of buprenorphine in the low end of the dose range. The 'ceiling effect' means that in order to be effective, people generally need enough buprenorphine in the bloodstream so that the fluctuations from dosing and metabolism result in NO change in opioid effect. The diagonally sloped part of the dose/response curve occurs in the microgram, 10s of micrograms, and 100s of microgram dose range; when you get to mgs per day (1000 micrograms), the effect is bumped up against a ceiling-- meaning higher doses won't cause more effect, OR higher tolerance. Trying to maintain a dose at 2 mg probably will result in similar amounts of withdrawal as if you just took 8 mg per day. The most important safety issue is to avoid relapse; don't miss that 'big picture' from looking too hard at the little picture of absolute dose level.

Good luck-- I'm happy your daughter is getting on track. Re insurance-- remember that most docs prescribe buprenorphine as long as the mom is breastfeeding--- and buprenorphine is MUCH less expensive than Suboxone.


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PostPosted: Tue Nov 19, 2013 10:53 pm 
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OH MY GOSH!! and thankyou so very much for responding SUBOXDOC. I finally logged back in with hopes that I had gotten a response from you and I do appreciate the information, especially on the dosing and on the endorphins and the way the receptors actually behave....
Good news is...........my daughter delivered a healthy happy, perfect baby girl on Sept. 19th!!! The baby showed absolutely no signs of withdraw at all and my daughter was on 3 mgs per day. she still takes the 3 mgs and she does breastfeed which her doctors told her was perfectly safe as very little suboxone enters the breast milk. Her doctor did switch her from the bupe back to the sub and the only problem with it is the headaches that the sub have always given her. She didn't have the headaches on the bupe but they came right back when she switched back to the sub. Don't really know or understand why...but anyway, yes the baby was perfect and both MOM and baby are doing fantastic. My daughter is the best little mommy and has no desire at all to go around any old friends, people, places, or things!! She does however depend on the little bit of sub and she is not ready to stop taking it...one thing I for sure learned is not to sweat that. i used to be so terrified all the time and thus the reason she continued to relapse. Doc it goes without saying that what you told me years ago was 100 % exactly right and every single thing you predicted happened. With that being said, please know I am way more comfortable and educated enough now to not mess with her dose at all. If it takes her more time to be ready then it takes her more time....as for me...I am feeling so very blessed and so lucky to have me daughter safe and alive and no longer in all the danger she used to put herself in while in active addiction. She has become her old lovable self again and each day i thank God for allowing her to be a survivor. She is a wonderful Mommy and I am a very happy and blessed and very humbled Grandma. So thankyou DOC, a very special and heartfelt thank you for all the kind words, encouraging words, the harsh words and everything in between that you have dealt to me during this journey. God bless all of us.


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

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