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 Post subject: The Stack Factor
PostPosted: Thu Oct 07, 2010 6:40 pm 
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So I think just had my "aha" moment with regards to my Sub taper. I read up that the half-life of Sub is 72 hours on average. So that means that with every dose, you're "stacking" the amount of medicine in your system.

So I ran a few spreadsheet scenarios. This helped me really visualize the implications of different taper schedules.

Scenario 1: 30 day taper from 4MG, reducing roughly 30% every 3 days down to .168MG = 2MG left in my system when I stop at day 30.

Scenario 2: 60 day taper from 4MG, but spending 10 days at .7, .5, .34, .24, and .16 (rather than 3 days) = 1MG left in my system when I stop at Day 60.

So you can start to see how the longer you spend tapering at the lower doses, the less sub is in your system when you finally stop. A helpful exercise for me.

I am going to stick with this 30 day taper. My probably flawed assumption is that in 30 days my body won't have become dependent on the Sub. I am betting that the PAWS and Pain will be manageable, and my effective "jump" from the residual 2MG of Sub in my body won't produce terrible withdrawal. I figure it cannot hurt to try.

However if I cannot handle any of the three (PAWS, Withdrawal, Pain) I will most definitely go back to 1MG and start a 100 day liquid taper, dropping .1MG per 10 days. I haven't run that scenario yet, but intuitively it is clear that the amount of residual in my system will be very small when I'm done.

Anyone know of any rule of thumb regarding how much sub left in your system at taper's end will produce minimal withdrawals? It would be cool if people tracked this for the benefit of others on the forum and I am happy to start. If anyone wants to take a look at my spreadsheet I am happy to share it.

Tomorrow is my last day at 2MG and I am feeling great. Of course there is actually 14MG of Sub in my system so no wonder I feel good!

If I am totally off the mark on my half-life interpretation and calculations, please feel free to call me out!


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PostPosted: Thu Oct 07, 2010 7:11 pm 
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Quote:
I read up that the half-life of Sub is 72 hours on average.


FYI - the mean half-life of bupe is 37 hours. 72 is the high end of the spectrum. Just wanted to clarify that. Good luck!

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PostPosted: Thu Oct 07, 2010 7:51 pm 
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"My probably flawed assumption is that in 30 days my body won't have become dependent on the Sub."

It seems like I see statements like this quite often. At least in this case, Matt says straight out that his assumption is probably flawed. I just don't think that he, nor so many others, understands why. Here is the deal. Suboxone is not some separate class of drug for a person to become addicted or dependant on. I see so many people talk about not wanting to become dependant or addicted to Suboxone - after they are already dependant or addicted to another "brand" of opiate. I've talked about this before, but it clearly deserves repeating. Here is the deal:

Your body/brain can't tell the difference between Suboxone and another opiate. To be sure, the effect, the "high", the euphoria, between the various opiates differs from one to another. Some are stronger. Some last longer. Some take effect faster. Those are most certainly differences between various opiates. However, your body/brain doesn't become dependant on one type over another. In other words, if you are addicted/dependant on Vicodin - you are dependant on opiates. If you are addicted/dependant on Percocet - you are dependant on opiates. You will not get addicted or dependent separate on Suboxone.

Does that make sense?

The goal is to be able to get off of (or at least not abuse) ANY opiate - whether it is oxy, hydro, heroin or yes, even Suboxone - which is an opiate. If you are dependant on opiates, you are also dependant on Suboxone - even if you have never taken it before in your life. If you are still wondering, "well, how can I be dependant on Suboxone if I have never taken it?" you are still not understanding. Once dependent or addicted on one opiate, you are addicted/dependant on all opiates. Your brain can't tell the difference between Sub and others. To be sure, Bup has all sorts of advantages to it over most all of the other opiates. It would be no different if it were booze we were talking about. No one claims to be an alcoholic but only with beer or with wine or with brandy. They may certainly prefer one over the other, but an alcoholic is addicted to all alcohol. It is no different when it comes to opiates - and to Suboxone.

So, Matt, I hate to have to tell you, but you are already dependent on Sub - whether you know it or not. That does not at all mean that you can't one day be free from having to take an opiate (Suboxone or otherwise). It just means that dependant on opiates means dependant on opiates - regardless of the "brand" of opiate or "flavor" of opiate that you currently happen to be taking.


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PostPosted: Thu Oct 07, 2010 9:25 pm 
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DonH - I get what you're saying from a big picture perspective and the booze analogy is certainly helpful. I admit I am no expert, but I know that as a pain patient when I grew tolerant to my dose of Norco, I would get rotated to an equivalent dose of Percocet (and vice versa). And I'll tell you - it worked. The new opiate would be far more effective than the old one for my pain. My doctor referred to this as "cross-tolerance" meaning that just because you grow tolerant to one opiate, it doesn't mean you are as tolerant to other opiates that your body hasn't seen before/for a while. Maybe I am assuming that tolerance and dependence are the same when they're not and I am missing something.

I've been advised on this site that a 30 day taper probably won't work or if it does it will be an exception. But what's amazed me is that so far I've moved from 6-2 MG without ANY discomfort. But I also understand that there isn't much difference between 6 and 2 MG. It's when you get below 2 that you are in a state where not all of your opiate receptors are stimulated. So I suppose that will be the real test of whether I have an easier time tapering from Sub than Norco. But my hope is that there is sufficient lack of cross-tolerance between OC and Norco (what I was previously prescribed) and the Sub. I am hoping to strike a balance between taking enough time on the Sub to combat the PAWS (from by OC/Norco therapy) while spending a short enough time so that I don't build a full tolerance to Sub, thus making it less painful to withdraw from.

I'll know within a few days I suppose because I am almost there.


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 Post subject:
PostPosted: Thu Oct 07, 2010 9:29 pm 
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hatmaker510 wrote:
Quote:
I read up that the half-life of Sub is 72 hours on average.


FYI - the mean half-life of bupe is 37 hours. 72 is the high end of the spectrum. Just wanted to clarify that. Good luck!


Thanks hatmaker - I'll have to re-run my models!


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 Post subject:
PostPosted: Thu Oct 07, 2010 10:46 pm 
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Matt,

You are certainly giving this a lot of thought. I would like to ask a favor of you. If you do this taper and it is successful, will you return here every 3 to 6 months or so (or just stick around infefinitely) and let people know how you are doing? Even if you relapse or are having trouble, or if you are doing amazingly well. Will you do this for the next several years in fact?

The thing is, for those of us who have been around a while, we see posts like this from time to time. But then these people disappear. Some of us will be around here for a very long while. When a new person pops in here with questions or want advice, we often draw on the experiences of those who have passed through. But there is no way of knowing how accurate that is when we don't get updates and those updates could be highly useful for other people just like you.

I would hate to tell people this method isn't likely to work when in fact maybe you try it and are totally successful with it and disappeared because there was no need for you to be here any longer.

As a side note, maybe we should make a sticky for people who have quit where they can come back and post. Maybe a survey post that asks something like "For those of you who have successfully gotten off sub, how long have you been opiate free?", or something like that. Only problem is you can't come back and edit your entry to increase the amount of time you have been off of it, but you can certainly come back and post there. Anyone else have any better ideas? Kind of like a one stop shopping for people to quickly see the method the person used, i.e. liquid taper, fentanyl patch (that new thing MW is trying), rapid detox, jumped from 4mg or 2mg or whatever, etc. Or maybe something like a survey sticky asking people who have remained opiate free for greater than 6 months after discontinuation of suboxone these questions and then inviting them to come back and update their comments when they have more time. Just a thought.

Cherie

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 Post subject:
PostPosted: Fri Oct 08, 2010 8:13 am 
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Cherie

Yes. You have my word. That's why I am doing this. I have no illusions that this particular method may very well not work and frankly I am here because I know I may need turn to the community for help, counsel, encouragement. I would say its only fair for me to stay around when I'm eventually successful (I believe I will find the right equation sooner or later) so that others can benefit from the experience.

So yes.

I do think that if I am off my taper and feeling well my visits will be fewer than they are now. So having a sticky or special forum to come back and easily find my original post, or a special place in general to make updates, would be very helpful.

Matt


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 Post subject:
PostPosted: Fri Oct 08, 2010 2:06 pm 
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Matt,

You're heads in the right spot. You are dependent on suboxone because you were dependent on opiates BUT your tolerance is not the same. Tolerance is how much you actually need to feel ok.. the more you take with opiates for example, the more you'll need. Sub is more potent so your tolerance of course will be lower.. it was for me.. if I took a whole sub I'd be puking but I could do ten bags of dope and be fine. go figure.

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 Post subject: Update
PostPosted: Sun Oct 10, 2010 12:56 pm 
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Just an update....

Down to 1.5 MG per day. Moving to 1 on Tues where I'll stay for 3 days. Then I'll go to a 15 day liquid taper for the remainder.

So far so good. It's kind of interesting. I dose twice a day. So right now I am doing 1MG in the morning (8 or 9 AM) and .5 in the evening (5 or 6 PM). Since I lowered to 2MG I've started to have a slight PAWS "window" from 2PM to my evening dose. The only issue is difficulty concentrating. But I just push through it. I try to get my more mundane tasks done during this time. Actually when I keep busy with simple tasks, it helps take my mind off it.

Having pain but so far motrin and massage is keeping it at bay. I am also deep into biofeedback which I think is helping quite a bit.

Another interesting observation (for me anyway) I found a pretty cool site for converting opiate doses (aside from their use of the word narcotics rather than opiates which is annoying):

http://www.medcalc.com/narcotics.html

According to this I am taking the equivalent of somewhere between 18-38 MG of Norco/hydrocodone. When I tried my slow taper of Norco I was not able to get any lower than 20MG. I was a mess. Depressed, couldn't concentrate. Much different than how I am feeling now. So it's got me thinking positively.

I'll update again when I'm into my liquid taper (or if something else happens off plan).

Matt


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PostPosted: Thu Oct 14, 2010 10:36 pm 
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Just finished 1MG. Start my liquid taper tomorrow! I am very excited. It starts at .75. I'll continue the move down 30% every three days.

I am feeling great mentally. The PAWS seems to be decreasing for me a little (knock on wood). It's been 16 days since I started at 6MG and I have 15 more to go - all below 1MG here on out.

Pain on the other hand.... :( Have to plow forward though. So far I am dealing with it reasonably.

I'll update in a few days with my views on whether the liquid taper is effective for me.

Matt


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 Post subject:
PostPosted: Sat Oct 16, 2010 2:20 am 
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I just wanted to wish you well, and tell you that you're doing a really good job so far, and that you are helping a lot of other people out by posting about this. Thank you! And good luck!


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 Post subject: I had to
PostPosted: Sat Oct 16, 2010 3:10 am 
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I had to write this because it's from my heart.

Melsie, I want to openly salute you. This is not something I consider should be in a private message. I have written openly about you before & don't care if this is boring anyone, but I am doing it again. You are such an inspiration to this forum and to me. There is no one you won't take time to say a kind word to. You were one of the first people I met here and you are one of the big reasons I stay.

I think that in our kind of problems and situations, we are so so fortunate to have someone like you. Someone that truly knows how we are feeling and reaches down in her heart to help. You are here because you have the same problems we have but, you put them aside when we are hurting and for that, my friend, I THANK YOU!!

God bless you and shower you with strong, positive feelings.

Forever grateful, Queenie


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PostPosted: Sat Oct 16, 2010 11:10 am 
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melsie

Thanks for the kind words. I am now down to .75mg. I tried the liquid taper yesterday for the first time. If you'll recall I prepared 7.5MG per 10ML solution. I also like to dose twice a day. I took .5ML in the morning and, at least psychologically, I wasn't thrilled with it. It felt like 5ML was just a couple of drops in my mouth and I didn't feel like I was absorbing much. I didn't feel great during the day (not horrible, but not as good as I was doing before). Last night I went ahead and shaved down 1/4 of a 2MG pill to be approx .375 MG. I actually preferred this and felt much better. I felt like I could still look at the small pill chunk in the mirror occassionally and watch it dissolve then swish the saliva around in my mouth for awhile (sorry to be so detailed).

I in no way mean to demean the liquid taper. I understand it has worked great for many people. Just a personal preference at this point. I am thinking about recreating the solution so that I can take 1ML in one dose (rather than .5) and see if that makes a difference.

Other than that I saw my doc yesterday who seemed very pleased with my progress. Overall I feel good. I've had zero withdrawal. The PAWS is NOWHERE near where it was when I did my slow Norco taper. I am having a little difficulty sleeping but I am able to take .5MG Klonopin at night which is helping a lot. So I am feeling really good about my Suboxone decision thus far.

Jury is still out on pain though. The pain is definitely getting worse as the taper progresses. But I am sticking to my plan of NSAIDs (occasionally), biofeedback, and light exercise. I am pretty sure that if I cannot take the pain, I'll try to use Sub for pain control at a low dose.

14 more days to go and I am done. That's when the real test begins and I will certainly be posting about how everything is going.


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PostPosted: Tue Oct 19, 2010 12:43 pm 
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Just checking in.... I am on my second day at .5mg and it is definitely getting tougher. Yesterday I tried dosing once (I've been doing twice per day thus far) and that wasn't easy. Last night I woke up at 2AM and fell back asleep in fits and starts.

This morning I took what looked roughly like .25mg and I don't feel great (about 80%). But I can concentrate well enough. Just feel drained though some of that might be from lack of sleep last night. I'll of course take my other .25MG this evening and hopefully that will help with tonight's sleep.

So no withdrawal at all so far which is good, but the PAWS is picking up a little steam. I am going to stick here at .5mg until my body adjusts (which it will hopefully do).

But not changing course yet. It is day 21 of my planned 30 day taper. If I can stick here for 3 more days (or less) and feel OK I'll move to .25 for 5 days which I guess I'll have to dose once a day or go back to the liquid taper.


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PostPosted: Thu Oct 21, 2010 5:30 pm 
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Today was much better - day 4 at .5mg. Small window of PAWS before my evening dose. I was getting worried because yesterday was a little tough. It was also stressful though so maybe I haven't quite mastered the stress management yet.

Tomorrow is supposed to be my last day at .5mg, then I move to .25 mg. I am also thinking about maybe spending a few more days at .5mg. We'll see how I feel.


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PostPosted: Thu Oct 21, 2010 10:31 pm 
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Keep up the good work, and please keep us posted on your progress. As much detail as you can manage regarding your symptoms (physical & mental) is most useful for those of use that tapering but not where you are now..

You've done awesome thus far. Keep it up.

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PostPosted: Sat Oct 23, 2010 10:49 am 
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Just moved to approximately .25mg. I've actually tried to cut .125mg pieces using a razor so I can still dose twice per day. I suspect the chunks are actually slightly larger but close enough.

I'll stay here 5 days. Then move to 1 .125mg dose around mid-day for another 5 days. Then I'll be done.

Feeling pretty good overall. Definitely no withdrawal. I wake up feeling that crummy paws feeling which disappears after my morning dose. Around 2pm the feeling returns and I just deal with it until 5 or 6 when I take my second dose. Usually by the third day the paws feeling lessens considerably, which has been my trigger for continuing to move down.

I'll be real curious to see how long or if the paws sticks around once I finally stop. About 10 days from now. I'll keep everyone posted.


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PostPosted: Tue Oct 26, 2010 9:24 am 
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Ugh, I think I dropped a little too much too fast. Yesterday was not fun. Had an important business lunch and started to get all PAWS-y (is that a word? :D ) in the middle of it. Took my .125 mg dose in the morning but it clearly didn't cut it. I took a .25 mg that night and felt great.

This morning I took .125 again and feel lousy again. So I think I'll take another now. And then one more tonight. That will put me at .375 mg which probably what I should have dropped to in the first place. I'll stay at .375 till I consistently feel decent (hopefully a couple more days).

I'll continue to post.


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PostPosted: Tue Oct 26, 2010 2:38 pm 
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You sound like you have done your research and have a decent amount of knowledge about tapering, but I did wanted to remind you that "the experts" recommend dropping by about 10% and typically never more than 25% at a time when you get to the low doses. What you did was cut your dose in half - and that is a huge drop when you are down below 1 mg. It sort of gets counterintuitive at these low doses. After easily cutting 4 mg or more in one fell swoop at higher doses, you would think, well what harm can cutting a mere 0.25 mg do? It's not the amount of the cut in milligrams that matters nearly as much as the amount of the cut in percentage from where you are at. Cutting "only" 0.25 mg is a huge deal when it cuts your dose in half. It once again calls to our attention just how strong Suboxone is. Even a 4 mg dose seems "huge" when you see the effect that only 0.25mg can have on how you feel.

It sounds like you are back on track. You are likely to feel much better so longer as you don't cut more than 25% at a time. Slow, small cuts is the ticket.


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PostPosted: Tue Oct 26, 2010 6:18 pm 
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Donh - no doubt. I can definitely see (or rather feel) that now. I think I am going to have to try the liquid taper again because it's too hard to measure below .5mg with any accuracy - particularly when you're reducing 10% at a time.

Why on earth do they not make smaller doses for this stage of the taper? It's outrageous. I am going to see my doctor this week and might ask about the film which I'm reading on the board is easier to slice and measure.

Regarding liquid taper, does the temperature of the water matter when dissolving the tablets? As you can see I wasn't a science guy in school.


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