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Should I ask doctor to increase my dose?
Poll ended at Fri Jan 28, 2011 1:50 pm
Yes 100%  100%  [ 6 ]
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 Post subject: Raising my dose?
PostPosted: Sun Jan 23, 2011 1:50 pm 
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I'm hoping you guys will be able to chime in before tomorrow afternoon which is when I have my next doctors appointment.

I'm very strongly considering asking my doctor to raise my dose from 2.5mg to 4mg per day. I am kind of scared he will turn me down/kick me out of program though.

I've been on 2.5mg for long time now, i think about 2 years almost. I consider myself stable, but I have to dose 3 times a day and alot of times I do feel like crap. It's very trying having to feel like crap for a good part of every day at work and stuff, always waiting for the next dose. I get by, obviously but a good portion of my time is spent not feeling very good.

I am mainly at this dose because my doctor really pushes at most visits for me to reduce dosage. being down to 2.5mg from my starting 16mg I think is good progress. BUT, I think I am fooling myself. I know that if i were to lower my dose below 2mg or even try to stop I would relapse. I keep telling myself I am doing good, etc. But I know that relapse can happen quickly and that If I keep going on day after day feeling bad and having cravings in between doses that this will end badly for me.

The main thing is I am scared to ask my doctor to raise my dose, especially because I've been on it for such a long time. I'm afraid he will say, you've been doing good on this dose for such a long time, why do you need to raise it now? Because I know that tolerance is not supposed to happen on sub, so I should not need increasing doses over time. I am also afraid if I tell him that I have always been feeling not good on this dose, that I just force myself to live with it, he may not believe me. He may think I want extra sub to sell or something which is definetely not the case.

What do you think I should do? I really think that if I went to 4mg it would improve my quality of life big time, but I don't know if asking is worth the risk of losing my doctor....


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 Post subject: Tell him!!
PostPosted: Sun Jan 23, 2011 2:04 pm 
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Good grief....these doctors do give us a hard times. (Disclosure: Not all doctors!!)

You should absolutely tell your doctor that you cannot go down anymore and that you in fact need to go up on your dose. Tell him that you have bee trying to convince him and yourself that you are doing okay, even when you aren't, because you haven't wanted to feel like you are letting him down and you don't want him to think badly of you in any way. Tell him that you are afraid because you KNOW you are going to relapse if you are pushed any further. The only responsible thing for him to do with that information is increase your dose. I mean, SHEESH! Even 4 mg isn't a high maintenance dose! People don't generally do well at all when they are pushed off Suboxone too quickly by their doctors. If you decide at some point that you want to taper off Suboxone, then it has to come from YOU! And knowing you will relapse, well, your honesty with yourself may save your life.

I've been through a tough time with a doctor and he dropped me (and then took me back) but my faith in him was shattered; I mean it was actually traumatic because it was such a shock. With my current doctor, we have a clear understanding. He has promised me he is not going anywhere. I had a heart to heart with him about my fears of that after what I went through with the other guy. Actually, I wrote my current doctor a letter and read it to him. He made me sign a contract and I made him sign one too. Tell your doctor your fears and ask him to give you at least his word that you can feel comfortable speaking openly with him and that he will not dump you for doing so, and then ask him to shake on it. I know they are the all-knowing doctors and all, but they expect certain things out of us (patients) and we have the right to expect the same sort of things (respect, honesty, reliability, etc.) You shouldn't have to feel this worry. In my opinion, you are being really responsible by recognizing the risk of relapse and drawing the line so it doesn't happen.

Good luck!

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: Sun Jan 23, 2011 2:06 pm 
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Considering I don't know too much about your situation, but based on that little knowledge, I would agree that you might benefit from a higher dose. 2.5 mg is solidly below the ceiling. Your opiate receptors are likely not saturated, thereby causing you to have cravings. The idea of sub is to be above the ceiling and to KEEP you above the ceiling to address not only withdrawals but also (maybe especially) one's cravings.

If it were me, I would be honest and tell the doctor that with every dose drop you've been fighting more and more cravings and how much you fear relapsing. I hope your doctor understands the whole ceiling level concept and listens to your concerns. Let us know how it turns out.

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PostPosted: Sun Jan 23, 2011 3:23 pm 
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Are you taking the bupe for pain? I have to wonder why you're dosing 3x/day? By all means....ask for an increase...the only way to know if it will help you is to try!


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PostPosted: Sun Jan 23, 2011 3:27 pm 
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Thanks for the posts, no I am not taking for pain. If I dose 1 time per day the cravings are extreme halfway through the day. W/o dosing multiple times I cannot sleep, and basically am in what feels like full blown withdrawals by the end of the day.

I think that if I were at the 4mg ceiling I would be fine to dose 1 time a day. I didn't know about the ceiling before I started reading these forums, and it's been so long since I was on anything more than 2.5mg with 3x doses a day that I can only vaguely remember how much better I felt. I do remember that when I was on the 8mg tabs and dosing with a half a one per day once a day that I felt great. No craving, no w/d feelings. I wish those days were back again :(


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PostPosted: Sun Jan 23, 2011 5:23 pm 
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I forgot to mention earlier - at low doses it's usually best to dose more than once per day. Many people feel withdrawals and cravings if they only dose once daily at such low doses.

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PostPosted: Sun Jan 23, 2011 5:58 pm 
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I recently asked my doc for a dose increase from 2mg to 8mg per day. When he asked why I told him the truth. At 2 mg I had the urge to use, and did in fact attempt to use. At 8mg I am well above the ceiling and don't have any cravings. Even 4mg may be enough for you. But go ahead and ask the doc - it's your recovery and ultimately your life on the line.


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PostPosted: Sun Jan 23, 2011 7:53 pm 
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Thanks for the reply Lilly. How long have you been on sub? How long have you been taking 2mg? Just wondering so I can relate to my current situation.


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PostPosted: Sun Jan 23, 2011 10:38 pm 
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Hey Jobe,

I have to say if your having trouble and considering using again then you must ask your doctor for an increase. I really, really doubt that he would drop you just for asking. If he has any clue as to how big a nightmare addiction is, he will glady raise you back up. You are most certainly well under the ceiling at your current dose and I would encourage you to get that dose back up.

I know you have made fantastic progress dropping all the way from 16mg to 2.5mg and I'm sure there is a good part of you that is saying "shit, I made all this progress down to 2.5mg just to throw it all away and go back to 4mg", but I would much rather see you up your dose than to have you throw your sobriety away!

Your doctor may need a some convincing. I would just be totally honest and tell him that you fear using again.


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PostPosted: Sun Jan 23, 2011 11:07 pm 
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After reading all of your posts I have decided I'm going to ask him. I will let you guys know what happens after my appointment tomorrow.

Thank you all for your support! And wish me luck :)


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PostPosted: Mon Jan 24, 2011 7:12 pm 
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Wanted to give you guys an update after the doctor visit.

I went in there and was so nervous that when they took my bp it was 144 over 77 and they said that they would have to take it again in a few minutes. So they put we in the waiting room and I tried to stay calm. The second time they took it it was normal :).

Anyways when the doctor came in I told him about how I thought I might relapse and that I wanted to be truthful etc. We had a pretty long talk and he assured me that he would not kick me off the program. Which was good. Then I asked him to increase my dose to 4mg and he didn't want to do it! He said he did not think that would help me and basically said it was all in my head. To make a long story short I told him I didn't think that was the case and that I wanted to try a dose where I could take it only once a day rather than 3 times a day. He eventually agreed to raise my dose to 4mg a day, and I'm due back in 2 months to tell him how it is going.

Thank you guys for all your support. I don't think I could have mustered the nerve to ask him without you guys.


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PostPosted: Mon Jan 24, 2011 7:26 pm 
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Hell Yeah brother, way to stand your ground!!

I can't tell you how happy I am to hear that you got your dose back up to 4mg. That is fantastic news!!!!

I certainly understand why you want to dose once per day, but to go from 3 doses per day to one dose per day may be problematic in the beginning. Could I get you to consider going to twice a day dosing before you go completely to one? Just a thought.

Thank you so much for updating us. I know you were on my mind today and I was really, really hoping you would post with good news. Thanks again for the update.


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PostPosted: Mon Jan 24, 2011 7:44 pm 
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Thanks Romeo :)

You think I should do 2mg morning 2mg night to start?

Funny thing is my doctor obviously doesn't know about the ceiling effect thing and he did admit "I am not an expert", which I thought was odd because he's been prescribing these to me for going on 4 years now. I know I've been selling appliances for 5 years and I pretty much consider myself to be an expert in appliance features.

Anyways I'm very happy it worked out and I'm happy that I found people who also know about suboxone and are willing to be supportive. Thank again man.


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PostPosted: Mon Jan 24, 2011 8:16 pm 
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I'm glad to hear it worked out for you. As for dosing with the 4 mg, well, you could be fine with once a day, or you might need twice. I'd only suggest that you remain flexible and listen to your body. I really hope the dose increase will help your cravings. Let us know how it goes.

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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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PostPosted: Mon Jan 24, 2011 8:19 pm 
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Hey Jobe,

If I was in your shoes I would do 2mg in the morning then 2 mg in the evening. I would stay there for a little bit and make sure I was good to go at that dosing schedule before going to once per day.

Just a side note, I never dosed once per day, my doctor never mentioned it to me. I dosed twice per day.


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PostPosted: Mon Jan 24, 2011 8:55 pm 
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You would think the ideal would be once per day dosing, to get away from that "I need to take a pill" state of mind. If you just take one in the morning it becomes a habit like vitamins and you don't have to think about it all the time. When you dose 3 times a day like I do and are under the ceiling like I apparently was, the amounts that I am taking each dose are not enough, so I constantly are looking forward to the next dose. To me this seems like the same mind set I had when I was using, going through your days waiting to take the next pill.

I tried explaining that to my doctor but I don't think he understood. He told me he didn't think dosing one time per day would help me; he explained that doing that was old addict behavior but I think it is just the opposite. To me, addict behavior is taking doses multiple times per day to fulfill the "I need to take a pill" state of mind. Just my thoughts, but that is what I'm trying to get away from. Hopefully if I can dose once per day I an forget for most of the day that I am even on sub, like I remember doing when I was first starting out taking 16mg a day.


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PostPosted: Mon Jan 24, 2011 9:10 pm 
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I agree with everything you just said about once daily dosing, as do many, many others. Taking a pill when we feel bad is exactly the mindset we addicts need to get out of. So I think you striving to dose only once per day is a very reasonable goal. The problem is that 4 mg is around the ceiling and you might see benefits from twice daily dosing. But like I said, be flexible and just give it a try. In theory, 4 mg should last at least 24 hours - especially once you get and keep those receptors saturated. So maybe dose twice daily for several days, then try only once. If after a few days of that you feel that the dose isn't lasting the full 24 hours, then you can go back to twice daily. That's how I would do it. Good luck.

Oh and I think the fact that you're thinking about such things and exploring your behavior is very healthy. It should steer your recovery in the right direction. Keep up the great work.

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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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PostPosted: Mon Jan 24, 2011 9:31 pm 
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Jobe,

I find that borderline pitiful that your sub doctor would compare once a day dosing to addict behavior!!

There are definitely some sub doctors out there who really don't understand sub or addiction for that matter. My doctor certainly didn't have a firm grasp on the proper use of sub. She wrote all my prescriptions with instructions to take my meds twice per day. I wish I knew then what I know now, I would have dosed once per day from the beginning.

I must say I like your thinking regarding once a day dosing, actually I'm impressed!


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PostPosted: Wed Jan 26, 2011 11:51 pm 
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Hey,
I was just thinking that you might try suggesting this site to your Doc ..........you never know,it might help him to understand a little better.


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PostPosted: Thu Jan 27, 2011 1:43 am 
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Hi Jobe, I was reading your posts and thought the same thing that Pab314 said. Maybe you can tell your doctor about this site.

I told my Sub doctor & my counselor about this site and they tell me that I am very knowledgeable when it comes to subs. They seem to respect that & they work with me when I have a problem. They listen to me & take into consideration to what I say. I can tell they know that I know more about subs than some other patients. They seem impressed.

Good luck & keep us posted.

Queenie


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