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PostPosted: Fri Aug 10, 2012 8:16 pm 
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Hey I started Suboxone in May, so I have been on for about 10 weeks now. I have a few questions about it.

1) When taking my medication (film), am I supposed to swallow at all during the 20 minutes or so it is dissolving? A nurse I know told me that it doesn't matter with film medications, as long as they are dissolving under the tongue and I'm not eating/swallowing them. But I've heard a ton of people say that you shouldn't swallow at all. When I do that, I'm practically foaming at the mouth with excess saliva hah gross I know. So usually I wait as long as I can, which is about 5 minutes, then swallow whatever saliva is there. I figure that it is mostly saliva I am ingesting and maybe a little suboxone that slipped out from under the tongue? But it tastes like suboxone and I feel like I've been taking it wrong. I don't know, I'm just confused about it I guess hah. Please help

2) Any suggestions for how to prevent myself from getting short-tempered, cranky, irritable a few hours after I take my medication? Usually about 6 hours or so I get a mood swing of sorts. Kinda like when I used to use opiates. Any suggestions for something to help with that would be great, besides the obvious "take more suboxone" because I'm trying to take as little as possible.

3) Are there any long-term physical health effects of taking suboxone? I don't mean laziness, impotency, or a mean streak, which I've heard. I mean stuff like it having an impact on your stomach lining, etc.

4) I started with between 1-2mg and am now between 0.5-1mg after 10 weeks. But when I try to come off it like I have before, I slip into deep depression. Like...BAD. Should I just stay on it for the foreseeable future? Am I taking enough or too much? Any suggestions about my dosage?

Thanks much!


GO PACKERS


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PostPosted: Sat Aug 11, 2012 12:05 am 
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Hi GoPACKGo and welcome to the forum. I'll do my best to answer your questions with what I know and think about suboxone. I've been on it for 3.5 years and have been on this forum and moderating it for a little over 3 years. Although I'm no expert I have picked up a good deal of knowledge about sub and addiction over that time.

1. Swallowing while your film is dissolving: Ideally one shouldn't swallow while it's still dissolving, because you will swallow some of the medication. But if you develop too much saliva and you simply cannot avoid it, then you can't. But try to hold it in there as long as you can. I say this especially because of the small dose you're on. You'll need to maximize your dose. Sublingual delivery of sub doesn't give much absorption as it is so losing due to swallowing on top of that means you're getting even less.

2. Irritability 6 hours after dosing. Are you only dosing once per day? Again, you're on a very low dose. It could be that you're going into withdrawals and that's contributing to your irritability. Are you aware that at such low doses (that far below the ceiling) that sub acts like a full agonist? This is likely why you feel like you did while on regular pain meds.

3. There aren't any known long-term effects of suboxone. Remember, although suboxone has only been around about 10 years, the active ingredient, buprenorphine, has been around for much, much longer and there aren't any long term negative effects from it. The only thing different is the added naloxone. And you can minimize your exposure to that by spitting instead of swallowing your remaining saliva after the film has totally dissolved. May I ask where you got the idea that "laziness, impotency, or a mean streak" are long term effects of sub? I've never heard that and don't see how that can be a long term effect. Chances are if anyone has that to deal with it has more to do with their emotions and how they numbed them for years of opiate addiction and now that they aren't doing that anymore, they don't know what to do with those feelings and it leads to many different kinds of uncomfortable emotions. At least that's my opinion.

4. Depression when trying to taper off. Depression is a part of opiate withdrawal. There are a couple of things you can do other than stay on it for life. You can do a very slow taper, getting down into the micrograms before stopping. If you do that, you can stop with very minimal effects. Also, some people go on antidepressants before they begin their taper. That can help immensely.

If you are on it for maintenance and don't plan on tapering off it any time soon, ideally you should be above the ceiling. That way you won't have the ups and downs of sub acting like a full agonist. Above the ceiling you will have stable blood levels and your opiate receptors will be saturated.

I hope this helps. Again, welcome.

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PostPosted: Sat Aug 11, 2012 1:40 pm 
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hatmaker510 wrote:
Hi GoPACKGo and welcome to the forum. I'll do my best to answer your questions with what I know and think about suboxone. I've been on it for 3.5 years and have been on this forum and moderating it for a little over 3 years. Although I'm no expert I have picked up a good deal of knowledge about sub and addiction over that time.

1. Swallowing while your film is dissolving: Ideally one shouldn't swallow while it's still dissolving, because you will swallow some of the medication. But if you develop too much saliva and you simply cannot avoid it, then you can't. But try to hold it in there as long as you can. I say this especially because of the small dose you're on. You'll need to maximize your dose. Sublingual delivery of sub doesn't give much absorption as it is so losing due to swallowing on top of that means you're getting even less.

2. Irritability 6 hours after dosing. Are you only dosing once per day? Again, you're on a very low dose. It could be that you're going into withdrawals and that's contributing to your irritability. Are you aware that at such low doses (that far below the ceiling) that sub acts like a full agonist? This is likely why you feel like you did while on regular pain meds.

3. There aren't any known long-term effects of suboxone. Remember, although suboxone has only been around about 10 years, the active ingredient, buprenorphine, has been around for much, much longer and there aren't any long term negative effects from it. The only thing different is the added naloxone. And you can minimize your exposure to that by spitting instead of swallowing your remaining saliva after the film has totally dissolved. May I ask where you got the idea that "laziness, impotency, or a mean streak" are long term effects of sub? I've never heard that and don't see how that can be a long term effect. Chances are if anyone has that to deal with it has more to do with their emotions and how they numbed them for years of opiate addiction and now that they aren't doing that anymore, they don't know what to do with those feelings and it leads to many different kinds of uncomfortable emotions. At least that's my opinion.

4. Depression when trying to taper off. Depression is a part of opiate withdrawal. There are a couple of things you can do other than stay on it for life. You can do a very slow taper, getting down into the micrograms before stopping. If you do that, you can stop with very minimal effects. Also, some people go on antidepressants before they begin their taper. That can help immensely.

If you are on it for maintenance and don't plan on tapering off it any time soon, ideally you should be above the ceiling. That way you won't have the ups and downs of sub acting like a full agonist. Above the ceiling you will have stable blood levels and your opiate receptors will be saturated.

I hope this helps. Again, welcome.


VERY helpful. Thanks a lot.

I heard the impotency, laziness, mean streak from a friend of mine who was on it for about a year and a person on this forum as well. I haven't experienced any of it, except the mean streak about 6 hours after dosage.

As far as my dosage, I am only dosing once a day... And where is the ceiling? I should probably increase a little and be above it like you said since I plan on being on it for awhile. I am on it for opiate replacement therapy.


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PostPosted: Sat Aug 11, 2012 2:02 pm 
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The ceiling is said to be at or around 4 mg, but it will vary from person to person, depending on their chemical make up and their metabolism. For example, some people when they taper down have trouble with withdrawals when they get under 6 mg, so their ceiling might be closer to that, whereas I went down from 16 to 4 with no withdrawals, so I know for me, my ceiling is somewhere below 4 mg. Hope that makes sense.

Oh and the other thing that can cause that "meanness or irritability" is withdrawals - acute and/or post-acute. I think I forgot to mention that the first time around (and I'm in a hurry so I don't have time to re-read my original post).

If you decide to go up in dose, you could go slowly and stop when you get to feeling more stable with less ups and downs. You want your blood levels saturated so it doesn't act like a full agonist, but the partial agonist that it really is. Plus the higher the dose the more it will block other opiates in case we do relapse.

Glad I could help. Good luck.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


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