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PostPosted: Sat May 26, 2012 9:25 pm 
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I have decided I want to try and taper off the subutex for personal reasons. I am in a very good place in my life, have an excellent support system, great job, education, etc. etc. etc. I have been on subutex since 2007, jumped off once before and had a bad experience, and went back on it primarily for pain which has been pretty well controlled since.

I went from 16mg down to 10mg in 2 weeks and of course that was no big deal although you can feel it a little and I don't care what anyone says. You just don't have withdrawal. But you do start to get insomnia which is my primary symptom when I stop anyway or at least the most annoying.

I had surgery today and they gave me fentanyl & dilaudid in order to rip the subutex off the receptors which seemed to work pretty well. I will have to be on dilaudid, 4mg every 4 hours for the next 4-5 days I suspect.

The first question is whether or not I am supposed to take the subutex at the same time as the dilaudid which I suppose I can ask my doctor about. But if she says yes, the question is whether or not I want to do this.

If I just take the dilaudid for the next several days, will this make it easier to taper the subutex?

When I pick back up on the subutex after can I just start at a really low dose and see how I feel increasing it only if needed?

For me, when I taper, the easiest way at higher doses is to take much less than the typical dose for 2-3 days and then on the 3rd or 4th day I will just take a little more to help boost the level a little and prevent withdrawal. So for example, going from 16 to 10 mg I took just 8mg for two days and on the 3rd day I took 16. Then the next three days I took 8mg again and on the 4th day took an extra 4mg. Then I went another 2 days taking 8mg and on the 3rd day I took another 2mg. Once I got to 8mg the intent was to split the dose in two taking 4mg twice daily and do the same thing. Take 4mg for a couple days if tolerated and on the 3rd day take another 2mg. I hope that makes sense. Taking less for a couple of days and then on the 3rd taking the target dose actually makes the target dose feel really good and it seems to last in my system quite a while before I notice a reduction. Of course I have never tapered below 8mg before.

Any thoughts here?

Cherie

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PostPosted: Sat May 26, 2012 11:28 pm 
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First of all - HI THERE HOW THE HELL ARE YOU JACKCRACK!!! Long time no see. I have missed you presence around these parts.

I'm glad to hear that you're doing well and that you're feeling in a good place to taper. And glad that your surgery went well and that your pain meds are working.

As to whether to take Sub with the pain meds...I guess it depends. You could mix a low dose of Sub (1 or 2 mgs) with your full-agonists and possibly get better pain relief and not feel any withdrawals during the time you're on pain meds. This is becoming a more and more common way of treating acute pain in Sub patients. It worked for me with kidney stones and a couple of other people around here have had good luck with it. Then maybe you could wean off the full-agonists and stay at the lower dose of Sub and continue to taper from there?

I don't know if just taking the dilaudid by itself for several days will make it easier to taper or not. Some people have said that a few days out from surgery they started to really feel the withdrawal from Sub to the point that the full-agonists weren't really working so they just switched back to Sub and dealt with it.

I guess being off Sub for a few days would bring your tolerance down though...but so would being on just a low dose of it for a few days. Ha - I'm not very helpful am I?

I do understand your tapering method. When I was tapering sometimes I needed a "booster" dose to get me through a rough patch. It does help. I think most of us who have made it through the taper process have discovered that you just have to kind of figure it out as you go along because we're all different and handle the process in our own way. The one constant that I've seen in success stories is to listen to your body and take your time. Tedious, but effective!

So good to see you - keep us posted as you do this thing.

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PostPosted: Sun May 27, 2012 1:31 am 
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Hello JC,

You were one of the first posters I remember when I started coming to this forum!

I wanted to add that I just had surgery and I took 1.5 mg Sub along with my pain meds. worked like a charm.

also:

I have been tapering from 8mg starting in January and got down to 1.5 with little to no discomfort. Using the sub film strips, i can cut up pretty accurate pieces and went by 1 mg or .5 mg steps for 1 or 2 weeks each time depending on how i felt. It's been pretty easy so far.

I have been staying at 1.5mg because of the surgery i had but i am getting back to it now...

:)
gb


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PostPosted: Sun May 27, 2012 7:29 am 
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Thank you to both. This is actually helpful. You know how it is when you start making a plan especially out of something unexpected. You need all the ideas and opinions you can get and then you take a leap of faith somewhere.

I will say today that the dilaudid definitely does nothing for me in terms of a high which is just fine. I don't feel as good as I do when I am on the subutex. I feel a little blah. I will probably call the doctor today and ask about the 1.5 - 2.0 mg subutex at the same time as the dilaudid and she what she thinks. But I will only supplement if I have to. I'd like to let myself feel as ill as humanly possible seeing as a have 10 free days off work :-) We'll see hhow long that idea lasts though.

I will keep you posted. Right now I am 2 hours overdue for my dilaudid and feel like my abdomen has been hit by a mack truck.

Cherie

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PostPosted: Mon May 28, 2012 10:19 am 
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So I woke up at 1:30 am and wasn't in withdrawal but didn't feel well either. I was about 4 hours late on my dilaudid and could tell the dilaudid would only avoid withdrawal versus provide pain control. So I ended up cautiously taking about 2mg subutex just to see what would happen. I was fine. Then I took 4mg dilaudid and got good pain control. I am going to stick with this plan today and then just go back to the subutex tomorrow I think as I will be working.

I suspect I will only get away with a slight taper on the subutex. I was at a little under 10mg per day as I was taking 8mg x2 days and on the 3rd day taking about 4mg. I am going to try to get away with taking only 4mg daily once off the dilaudid and see what happens. If worse comes to worse I will increase to 5 or 6. This would still be a success in my opinion going from 16mg per day to 6mg in less than a month.

As soon as I am cleared (2 weeks), I will start exercising and totally quit the smoking. This ought to help the taper. Plus introduce some good vitamins.

Here's the only last issue. I'm 35 years old and ultimately think I would like to get pregnant. I have 1.5 years to do it in before my husband is no longer willing to try (he's much older and has a 26 year old). I don't want to hear it from anyone as both my OB and sub doctor have cleared this and have given me a green light to go ahead despite the subutex. BUT, it also means I can't really do the strips and have to try tapering with pill form.

1) For those of you who have tapered with strips, how did you store the leftover strips? For how long can you store those?

2) For those of you who have tapered with the pill, I know I can get script for 2mg pills and this will make it more accurate (my scripts are free so it won't cost more) and I can get a pill cutter to make it more accurate. Did this work okay for you?

I'm very curious to see how this goes in time. I have to go back to school in Fall and have a new job so I can't afford to be slow. I am going to have to be very careful. But the bottom line is I have about a year to get down to 1-2mg or less. I think this is probably pretty doable.

Cherie

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Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.

- Winston Churchill


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PostPosted: Mon May 28, 2012 11:33 am 
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Dog dammit, it's good to see you back here, jackcrack!! And all ready to start tapering, too.

Your plan sounds good and Diary said pretty much everything I was going to say. Just be prepared to listen to your body and be flexible if need be. But it sounds like you're already in that frame of mind.

I think you are in the best place ever to make your taper work. We're all behind you, I hope you know that.

Keep us posted, my friend. Again, GREAT to see you again.

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PostPosted: Mon May 28, 2012 1:20 pm 
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The strips I have been getting have an expiration date of 4/2013 printed on the package. But the last script I got had 5/2013 on them. So I guess they are good for at least a year. But I know from the pharmacy technician course that I took, and also just from experience with taking expired meds, that most meds are usually good for quite some time beyond the expiration date that is printed on them.

I get 8mg films, and find it very easy to cut them into sixteenths, resulting in a .5mg dose. So if you got the 2mg films, you could easily cut them into a .125mg dose for tapering purposes. Also, after I open each individual pack to cut the film, I just leave the remaining pieces that I am not taking in a little retainer case that I got from the dentist a long time ago. When I was down to 2mg/day for a couple weeks, I would have the exposed film sitting in that case for 3 days, and they worked just fine when I took them. I don't think they go bad too quickly.

The only problem I have had with cutting the films this small is when I get a batch that are brittle, which I've heard others complain of as well. But my pharmacy must have just ordered a new batch, because they have a different lot number on the box now, and they stay in tact when I open them. But I did hear from more than one person on this forum that they didn't have the problem with brittle films with the 2mg ones...just the 8mg films.

I have never tried the tabs. It seems to me that the films would be easier to taper with than the tabs, because you can just cut them with little sewing scissors or a razor blade. It's pretty easy to get an even dose. Hope I could help.


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PostPosted: Mon May 28, 2012 2:38 pm 
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Hey Jackcrack -

Glad to know that you got better pain control with the Sub/dilaudid combo. I'm sure that will speed your healing process.

I didn't have good luck cutting my pills with a pill cutter. Maybe my pill cutter was just crappy, I don't know, but it was really hard to even cut a pill in half evenly with the thing.

I had better luck cutting Sub pills with a razor - you know the one-sided razors that you put in the plastic widget-thingy to scrape paint off glass? That worked pretty well and I could cut a 2mg Suboxone into quarters pretty accurately. Smaller than that the pieces were not always equal.

Are you going to taper off completely or just go down to 1-2mgs? If you're just going down to 1-2mgs, then you should be fine cutting the 2mg pills. If you're going lower than that would you consider doing a liquid taper? Let me know if you want any advice or info about that.

I think it's great that you're thinking about having a baby. I don't know if you've been checking in or reading here since we last saw you, but we've had quite a few members have healthy babies on Sub with no NAS. It's starting to seem like doctors and hospitals are not quite as ignorant about Sub as they were a few years ago. Best of luck and have fun trying!

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PostPosted: Tue May 29, 2012 7:58 am 
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All feedback given was helpful. I need to find some kind of container to put sub films in just in case. I have a case that holds my teeth molds for teeth whitening so I will try that.

DOAQ: I may need assistance with the liquid taper but I'm not there yet and won't remember anything, and hate searching around on here for information. Although I think it might be a sticky. So I may be asking your advice and opinions on this in the future.

The plan: Get as low as I can. The last time I quit I jumped and I think my pain receptors went haywire so both pain conditions, the hidradenitis and the neuropathy were just raging and I was highly uncomfortable. The hope has been if I taper slowly and carefully that maybe the neuropathy is livable or less painful and I will again try some other meds to see how those go in combination with the sub when I get low enough. I will always need some kind of pain control for the hidradenitis for sure and probably the neuropathy given there are contraindications for neurontin and lyrica didn't work. We are going to try amitryptaline next. The hidradenitis is intermittent but if I can taper and stay away from sub long enough, it may be I can just take a very very low dose intermittently to control pain. I am terrified of full agonists and hate the way they make me feel so there is zero interest trying these even intermittently.

At 2:00am I felt pretty crappy. Not in full withdrawal by any means but smells, tastes, sweating, insominia, gut aches. Took 4mg subutex. Feel fine now and in fact think I could have gotten away with a little less so I am slightly bummed. It's amazing what a huge difference there is between 2mg and 4mg. Just huge. 2mg yesterday did essentially nothing except keep me out of full withdrawal in combination with the dilaudid. 4mg feels like a full blown 8mg just about. This stuff is just CRAZY! (And I don't mean crazy bad....I mean just incredible neither good nor bad). It's working better than the combination for pain OR I am far better today than I was yesterday.

I think for now I am stuck with the subutex. I have a sub appointment this week however so I will discuss it with my doctor. I think the generic subutex might be easier to cut with a pill cutter than the brand name suboxone. It's a little more dense. I cut two 8mg pills in quarters yesterday without any problem. Only ended up with one small chip which I may use this evening if things aren't feeling well. I cannot cut them any smaller than 2mg however. It may be that when I get super low it will be safe enough to go back to the films just so I can get an accurate and lower dose.

In terms of the films, I did notice that there was a real brittle batch but it seems they fixed that and also made the package easier to open recently so you don't damage the film as easily.

The good thing is that I ended up where I am dosing in the middle of the night. This means I can prepare the smallest dose for my nightstand and the only way I will end up taking more is if I absolutely didn't fall back asleep and actually need it.

Now I need to break the dose back up into 2 doses for am & pm. So depenging on how I feel this evening, I may take 2mg and then in the am take 2mg alternated with 2mg in pm. That would put me at 4mg per day. I can't feel my feet right now which is good.

My doctor told me that suboxone is the new gold standard for pain control during pregnancy. It used to be methadone and now it is sub. She said several of her patients have delivered on sub without any impact on the baby. It isn't desirable but she said in my situation given my age, stability, and reasons for taking the meds, it isn't fair for anyone to tell me not to have a child just because this isn't ideal.

So I'm off for my first shower in 3 days :-) and headed to work. I will keep you all posted.

Do you all think the surgery and pushing sub off my receptors is what made it so easy to go from 10mg +/- to 4mg? Or do you think that's just because it's technically not supposed to be that hard to do anyway?

I will say taking 4mg feels like I went UP in dose, not down.

Cherie

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Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.

- Winston Churchill


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