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 Post subject: Rapid Taper
PostPosted: Sat Sep 25, 2010 11:37 pm 
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I am new to this forum and I must say it is wonderful.

I am chronic pain patient for 7 years for for about 5 year I have averaged about 60MG or Norco. Though over the past 6 months my dr upped my dose to 40MG Oxycontin and 60MG Norco.

Due to my pain I may need to stay on opiate medication. But I don't want to (I am not a surgery candidate BTW). I am at a cross roads of sorts. I've decided that before committing to staying on my pain medication for a good while, I should first try life without them to make sure I am getting a net benefit from being on them. Problem is I cannot get off them in order to try. I've tried slowly tapering and it is just impossible. I make it down to 30-40mg of norco and my life is too disrupted - depression and complete lack of concentration are the problems. I have a very demanding job and I simply cannot afford this disruption, especially when I am unsure how long it will last.

So I guess you can say I've "lost control" of my pain medication. But I do take it as prescribed.

From what I've read, most folks on this forum tend to favor staying on Sub for a longer time (1 yr) before trying to taper off in order to give the brain time to heal. Is there any chance a shorter stay can work (4-8 weeks) for people? I am interviewing for new jobs and am worried that if they discover I am on Sub they will be prejudiced (ironically I think being on opiates for pain with a doctors note would be less of a stigma). So that's my real concern.

I figure why not try a more rapid taper and if it doesn't work and I am still depressed/cannot concentrate, I can always go back on for a longer stay. It just seems that my only shot and getting off to try life without the pain meds will require Sub in some capacity given my lifestyle.

Any feedback is appreciated. I will obviously discuss this with my doctor but I am curious to hear from those with experience.

Thanks very much.


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PostPosted: Sun Sep 26, 2010 1:47 am 
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Hi Matt, welcome to the forum.

What I hear you saying is that you are dependent on pain meds, but not addicted - ie, you are not abusing your medication/running out early/snorting your OC's, etc. Is that right?

Still, you have developed a tolerance to the meds and when you try to taper off you find the withdrawal symptoms to be too disruptive to your life. And you would like to taper off so you can see what your pain level is without medication and assess how much the medication is actually helping you.

I think in your case, a shorter (4-8 weeks as you said) taper might actually work. Many people, myself included, find it difficult-to-impossible to taper ourselves off short-acting opiates. You might find it easier to taper off of Suboxone, or at the very least you could taper your dose down low enough that you could start to feel where your pain level is at. Also, you'll be able to see if Suboxone could work as a pain-managment medication for you.

Most of us who stayed on Suboxone for a year or more did so because we needed time to learn how to cope with life without turning to drugs, time to fix the damage we did to our lives, time to make new habits, new friends, new hobbies, etc. Since you're not dealing with addictive behaviors, this seems like a bit of a moot point. Length of time on Sub doesn't really "heal your brain", it just gives you time to get your shit together. The length of your taper, however, does have an impact. Once you get below a certain dose of Suboxone, not all of your opiate receptors will be stimulated - which causes discomfort but also causes your brain to turn off those receptors, bringing your tolerance down. If you taper slowly and gradually over a few months, you can minimize the discomfort and bring your tolerance down so that when you stop taking the medication the withdrawal won't be as severe or last as long. Does that make sense?

With a shorter taper, you will still run the risk of having significant withdrawal symptoms and/or developing PAWS when you stop taking Suboxone, but it seems that you have a pretty flexible attitude with regards to either going back on Suboxone or back on pain meds should you find it necessasary.

If I was you (and of course it goes without saying that I'm just a random internet person with my own personal experience to back me up, not a doctor, blah blah) I would start my Suboxone at the lowest possible dose that would keep withdrawal at bay, and then taper as aggressively as you can to get yourself below 4mgs. Spend the longest part of your taper going from 2mgs to nothing. For reference, it took me like 3 months to go from 1mg to nothing - but I didn't have an awful time of it, my withdrawal wasn't bad, and I'm still off Suboxone & opiates 14 months later.

One last thing - there's really no reason why your potential employers would find out that you're on Suboxone. If you have to do a drug screen, you only tell the people at the lab what medications you're on and then the lab can not report you as a positive for those medications. They shouldn't be disclosing what medications you're on to the employer at all.

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PostPosted: Sun Sep 26, 2010 7:33 am 
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See if you get a reply like that on any other forum in the world !!!


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PostPosted: Sun Sep 26, 2010 7:34 am 
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Matt -

I didn't read all of DOQ's post but in the 1st few paragraphs I can say that I might differ in opinion somewhat. First of all, I think she and I share the opinion that you shouldn't have a problem with employers because I have never head of a single employer who tests for suboxone so they would have no idea. Secondly, since you aren't addicted to the pain meds and are just dependent, you would really be taking suboxone for pain control and not detox.

In terms of a shorter suboxone duration, my suspicion is that you would experience the EXACT same feeling with your discontinuation of the suboxone as you would from the full agonists. I don't think your plan will work. Being on suboxone doesn't actually allow for your brain to heal except at extremely low doses of it where all of the receptors aren't blocked. So potentially you could start at the lowest dose possible which might be 2mg per day or 4mg per day or it could be higher than that and theoretically you would decrease at about 10% every week to two weeks until you were off of it. Tapering at these low doses would require a liquid taper more likely than not and you would probably want to research that really well. There are several posts under stopping suboxone that discuss liquid taper methods. Doing it this way is the only way I can think of where you wouldn't experience significant PAWS which is what you were describing before.

On top of all of this, I suspect that your pain will be much higher when you initially get on the suboxone because your mind is used to being a bit clouded in order to block the pain. There is a rebound effect to some extent and the pain increases exponentially when you first go off pain meds. It takes time and patience to figure out if that is the amount of pain you would experience long term, or if some of that will lessen.

Another point is that if your pain is intermittent and not constant, it is possible you could turn to suboxone for pain management instead of the full agonists you have been using. The downfall with the full agonists is that you will always require more and more in order to manage that pain. Your tolerance WILL increase as this is a side effect of the medication. There isn't necessarily anything wrong with that. It is just a reality of it. Some pain responds well to suboxone. For example, I take suboxone for pain. I have hidradenitis suppurativa stage 4 and although there are days where the suboxone doesn't rid me of pain entirely, it does enable me to function fairly well anyways and I have settled for this as opposed to long term full agonists. I also have peripheral neuropathy which responds extremely well to suboxone. I am on 10mg per day and if the pain worsens, I can still increase my level of suboxone if I needed to in order to control that pain.

Hopefully there is some food for thought here and I wish you well. Take care!

Cherie

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PostPosted: Sun Sep 26, 2010 9:18 am 
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Diary of a Quitter wrote:
What I hear you saying is that you are dependent on pain meds, but not addicted - ie, you are not abusing your medication/running out early/snorting your OC's, etc. Is that right?


Hi - wow what incredible advice. Thank you. This is truly an amazing forum.

DOAQ - I definitely would run out early. in fact the "60MGs" of Norco was actually a handicap for being prescribed 40 or 50MG but taking it at a rate of 60MG. But it was always with the same doctor who must have known because he is the one who kept writing the scripts. He never said a word to me about it and he is a reputable pain mgmt doc. Other than that - no. No snorting/abusing the medication.

I appreciate the thoughts about work, drug screens, and sub. That eases my mind a lot.

It actually sounds like you were both giving me similar advice. What I am experiencing is PAWS from the full opiate agonists. A shorter term taper on Sub might do the trick of avoiding the PAWS while permitting a more comfortable withdrawal than I am used to. but that's not a 4-8 week proposition, it's more like a 12 week proposition. And I should get to 2 MG as fast as possible and then spend no less than 2 months tapering from 2MG to nothing. BTW, I found the liquified taper method and I will certainly use that! Some discomfort is inevitable, but it should be better than tapering from the full agonists. But the real question is whether 3 months of a sub taper is long enough for my brain to get used to not having opiates around (i.e. avoid the PAWS). I can also test if I can handle the pain without pain meds. If either doesn't work, I am flexible to go back on the sub or my pain meds.

Please let me know if I summarized this wrong. I'll definitely share this information with my doctor to get his thoughts before doing anything.

Actually on that note, I am going to see a different doctor about the sub. My current pain mgmt doc has been pushing me to "just taper" from my pain meds. Problem is I cannot! I tried! He doesn't work with Sub. I feel like this sub route is another route that might result in success. So I am seeing an addiction psychiatrist. Even though I don't feel like I am necessarily an addict per se, I figure maybe this doc can help me with cognitive behavioral therapy (in addition to Sub) or other stress management tactics to lower my pain threshold a little. Not a cure for pain, I know, but maybe another tool to help me cope with the pain without the opiates. I really want to give life a go without the opiates. If I need to go back on them - so be it. But there is no question that there is a downside to life on opiates. The ups and downs, the constipation, the general preoccupation with when I have to take my meds. I feel like I owe it to myself and my family to see if these downsides are truly outweighed by the pain control I get.

Thanks again for the nice replies. I'll probably check back in with you all if you dont mind (after I see my new doctor).


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PostPosted: Sun Sep 26, 2010 11:40 am 
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matt -

First let me say that jackcrack makes some really good points & I'd encourage you to take what she's saying into account.

I'm glad to hear that you are going to see an addiction psychiatrist with the hope of developing some new skills for coping with your situation. You said you were starting to take more of your meds than prescribed, so I'm sure you're able to see how easy it is to slide from responsible use of pain meds to misuse, then abuse and addiction. So good for you for deciding to get that in check sooner rather than later.

If you do decide to try the Suboxone taper, I would just say: remain flexible. Like jackcrack said, you will need time to determine what is rebound pain, what pain is going to stay, and how you will handle it. You will need time to develop other ways of dealing with that pain, and time to see how you react emotionally/psychologically to the change in medication. Since you already know that you react to withdrawal with depression and lack of concentration, you might want to work with your doctor on a plan for how to deal with those symptoms.

Most of all, listen to your body and your mind as you transition to Sub and start to taper. Don't push yourself too hard and too fast just because you have some time limit in mind. You might find that you are able to taper steadily for a while, but then come to a point where you just need to stabilize for a bit before you can decrease your dose again - and that's totally ok. Trying to push yourself too fast is just a recipe for disaster, and really, it's not such a huge difference in the grand scheme of things if your taper takes 6 months instead of 3 - after all, you are coming off of 5 years of fairly heavy medication.

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PostPosted: Sun Sep 26, 2010 12:13 pm 
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Matt - I know of VERY VERY few people (none in fact) who have been able to taper on their own from long term full agonist use. What your doctor is asking/expecting isn't very reasonable. I am only saying this just in case you have beaten yourself up over it at any time (although you don't sound like you are). It is just a VERY hard thing to do and in fact is probably almost impossible.

I do hope you will return and check in letting us know how things are going. Everyone is welcome here and we would sure love to have you around :-)

Cherie

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PostPosted: Sun Sep 26, 2010 1:11 pm 
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Jackcrack wrote:
Matt - I know of VERY VERY few people (none in fact) who have been able to taper on their own from long term full agonist use. What your doctor is asking/expecting isn't very reasonable. I am only saying this just in case you have beaten yourself up over it at any time (although you don't sound like you are). It is just a VERY hard thing to do and in fact is probably almost impossible.

I do hope you will return and check in letting us know how things are going. Everyone is welcome here and we would sure love to have you around :-)

Cherie


Cherie - Thanks so much for that thought (and your earlier thoughts). Yours as well DOAQ. It has been such a struggle just to simply not increase my medication dose. I really see the line between dependence/tolerance and addiction as being very fine. I also view it as a flaw in the pain mgmt field frankly. All of the doctors (pain mgmt, ortho, neurosurgeon, physiatrist, etc.) I have seen for my condition over the years are good, compassionate doctors who want to treat the pain. But try broaching the subject of addiction and anxiety and their roles on the state of your pain and medication use and it becomes instant taboo. I've really given it the college try to taper from my medications and simply couldn't. So no Cherie - I don't feel bad about it. I would bet that most pain patients struggle with these exact same issues.

I also see it as a great opportunity for doctors who want to understand addiction, pain, and the and complex interaction between the two. I just don't see how a doctor can be good at treating pain without having some knowledge of addiction as an arrow in their quiver so to speak (whether on their own or through partnership with another doctor).

So I've taken the bull by the horns, determined to seek the counsel of an addiction specialist so I can carry on with this objective of mine (to test the cost/benefit of being on the pain meds). DOAQ your advice about moving at my own pace is very sage and I will heed it. It is really great to know there is such a thoughtful and caring community available to bounce ideas off of. I appreciate your responses to my posting. I promise I will stay in touch. My first meeting with the addiction doctor is this week - I promise to check back in and let you know how it goes!

Best,

Matt


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PostPosted: Wed Sep 29, 2010 11:28 am 
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Matt.. I found this on another forum and hope it helps to subside some w.d symptoms. However you must know that I am down to pinhead size of an 8mg suboxone.. but I started my taper from 2mg on Sept. 8th so I'm doing quite well, I have been already eating lots of bananas tho, using a heating pad, hot showers do help and I've been taking xanax when I need it oh and NewPhase which helps me tremendously with night sweats and mood siwngs/depression.. I'm getting everything else on the list in a few minutes so I can keep you posted in how it makes me feel. Good luck!!

The Thomas Recipe for Cold Turkey Withdrawal

PLEASE NOTE: I am not a doctor, simply a long-time Rx opiate junkie who has had many opportunities to develop a way to detox. This is a recipe for at-home self-detox from opiates based on my experience as well as that of many other addicts. It is not intended as professional medical advice. It is always wise to make sure none of the recipe ingredients or procedures conflict with medications you may be taking. Likewise, if you have any medical condition, disease, allergy or any other health issue, consult your doctor before using the recipe. Thanks, Thomas

For the Recipe, You'll need:

1. Valium (or another benzodiazepine such as Klonopin, Librium, Ativan or Xanax). Of these, Valium and Klonopin are best suited for tapering since they come in tablet form. Librium is also an excellent detox benzo, but comes in capsules, making it hard to taper the dose. Ativan or Xanax should only be used if you can't get one of the others.

2. Imodium (over the counter, any drug or grocery store).

3. L-Tyrosine (500 mg caps) from the health food store.

4. Strong wide-spectrum mineral supplement with at least 100% RDA of Zinc, Phosphorus, Copper, Magnesium and Potassium (you may not find the potassium in the same supplement).

5. Vitamin B6 caps.

6. Access to hot baths or a Jacuzzi (or hot showers if that's all that's available).

How to use the recipe:
Start the vitamin/mineral supplement right away (or the first day you can keep it down), preferably with food. Potassium early in the detox is important to help relieve RLS (Restless Leg Syndrome). Bananas are a good source of potassium if you can't find a supplement for it.

Begin your detox with regular doses of Valium (or alternate benzo). Start with a dose high enough to produce sleep. Before you use any benzo, make sure you're aware of how often it can be safely taken. Different benzos have different dosing schedules. Taper your Valium dosage down after each day. The goal is to get through day 4, after which the worst WD symptoms will subside. You shouldn't need the Valium after day 4 or 5.

During detox, hit the hot bath or Jacuzzi as often as you need to for muscle aches. Don't underestimate the effectiveness of hot soaks. Spend the entire time, if necessary, in a hot bath. This simple method will alleviate what is for many the worst opiate WD symptom.

Use the Imodium aggressively to stop the runs. Take as much as you need, as often as you need it. Don't take it, however, if you don't need it.

At the end of the fourth day, you should be waking up from the Valium and experiencing the beginnings of the opiate WD malaise. Upon rising (empty stomach), take the L-Tyrosine. Try 2000 mgs, and scale up or down, depending on how you feel. You can take up to 4,000 mgs. Take the L-Tyrosine with B6 to help absorption. Wait about one hour before eating breakfast. The L-Tyrosine will give you a surge of physical and mental energy that will help counteract the malaise. You may continue to take it each morning for as long as it helps. If you find it gives you the "coffee jitters," consider lowering the dosage or discontinuing it altogether. Occasionally, L-Tyrosine can cause the runs. Unlike the runs from opiate WD, however, this effect of L-Tyrosine is mild and normally does not return after the first hour. Lowering the dosage may help.

Continue to take the vitamin/mineral supplement with breakfast.

As soon as you can force yourself to, get some mild exercise such as walking, cycling, swimming, etc. This will be hard at first, but will make you feel considerably better.

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 Post subject: Update
PostPosted: Wed Sep 29, 2010 11:53 am 
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Hi all

Update. Went to dr. He seems decent.

He agreed to the following plan.

3 week taper on subutex.

If that doesn't work move to plan b of stabilizing at 1mg and trying a slow taper for 3 months using the liquid taper. He wasn't aware of the LT but had no objections.

If that doesn't work go back on pain meds or stay on subutex if it helps the pain.

Remember the definition of "work" equals manageable pain and paws.

Only thing - he said I have to wait 48 hours from last dose before starting. Is that right??? It's been 17 hours and I feel pretty lousy already.

Thoughts?

Matt


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 Post subject: More update
PostPosted: Wed Sep 29, 2010 5:37 pm 
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A little more color for you all (my last update was done on my Blackberry).

First off let me say that I took 4MG of Sub about 18 hours after my last dose of OC and Norco. I felt like I was definitely in at least mild withdrawal. I felt absolutely fine afterward. 4MG is plenty (see above for my history of medication use). But I guess we'll see how long it lasts/if I have to take more before tomorrow. But I definitely did not go into a precipitated withdrawal.

I liked the doctor and thought he seemed very knowledgeable/competent. I took him through everything and he was in full agreement. He definitely seemed like he will let me take my time and do what is comfortable for me. He wrote me for 60 2MG Subutex. Here are our plans:

Plan A - 21 day taper: I'll go from 4-6 MG (we'll see if I need another 2MG before the day is over) down to .25 or maybe .125. I'll use the liquid taper once I hit .5 mg.

Plan B - I am going to go all the way with the taper and then see how I feel. If I am having terrible PAWS or the pain is just too unbearable, I'll move back to 1 or 2MG and get stabilized and see where I am. If I can settle in with reasonable pain control, I'll then move to a 3 month taper from 1 or 2MG. This will obviously be all about the liquid taper. It was a little funny to me how the doctor had never heard about it, yet didn't in any way object to it. His point was that it is really all about what is comfortable for me, which seems to be what you want to hear from your doctor.

In either case above, I've agreed to work with the doctor on cognitive behavioral therapy to assist me with managing stress for both the pain as well as PAWS if it rears its ugly head. I've committed to trying this out to see if I can manage the PAWS and the pain without opiates.

Plan C - After giving the CBT a fair run, if I am in too much pain, I can always switch back to the pain meds. Or if I discover Sub helps with pain control I can stay on that. But I am really, really hoping I can get off medication and manage the pain on my own, PAWS free.

Wish me luck. I will keep a journal on my progress if anyone is interested (at least through the Plan A).

Matt


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PostPosted: Thu Sep 30, 2010 9:05 am 
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Good luck Matt! I did not do the liquid taper but if it's easier for you then try it. I actually just broke my sub into pinhead size crumbs toward the end. I have to say this is day one of NO suboxone so far!! I know it's early but mornings are usually the hardest for me and this morning I felt fantastic (very minor skin crawly's) but that's it!! The L-Tyrosine and mineral supplements I bought yesterday have already made a world of difference. I highly recommend it. I also have xanax in case the Tyrosine makes me feel anxious. I am over the worst, I can feel it... and I wouldn't trade it for the world!!

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PostPosted: Thu Sep 30, 2010 9:35 am 
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luvlafdesign wrote:
Good luck Matt! I did not do the liquid taper but if it's easier for you then try it. I actually just broke my sub into pinhead size crumbs toward the end. I have to say this is day one of NO suboxone so far!! I know it's early but mornings are usually the hardest for me and this morning I felt fantastic (very minor skin crawly's) but that's it!! The L-Tyrosine and mineral supplements I bought yesterday have already made a world of difference. I highly recommend it. I also have xanax in case the Tyrosine makes me feel anxious. I am over the worst, I can feel it... and I wouldn't trade it for the world!!


luvlafdesign - I am happy for you! Congratulation! Were you on Sub for a while prior to tapering or did you go right to the rapid taper like me? I'd be interested in knowing your story.

Thanks for the advice on the supplements. So far so good with this taper, but of course it just started. I expect that in my final week and for weeks afterward I am going to feel lousy. So maybe these things will help. I'll check em out.

Best of luck to you.

Matt


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PostPosted: Thu Sep 30, 2010 1:19 pm 
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hi matt!

I was about to reply to your first post but read through to see that you got some great advice! I think you are so awesome for trying this route.

I hope you are doing well!

Jessica

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missH wrote:
hi matt!

I was about to reply to your first post but read through to see that you got some great advice! I think you are so awesome for trying this route.

I hope you are doing well!

Jessica


Thanks Jessica! Appreciate the kind words. I ended up taking the extra 2MG last night (for a total of 6MG on my first day). I am a little disappointed in myself because in retrospect I don't think I really needed to. I was really only mildly uncomfortable and that has to be expected.

As for today, took 2MG this morning and am still feeling pretty good. I expect to make it till tonight to take my other 2. So that would put me at 4MG at day 2. I will stay here for at least 3 more days. So I probably won't post again for a few days (when I make my move to 2MG) unless something changes.

Best

Matt


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I was on suboxone for about six months but I never had to take more than 2mg a day.. EVER.. so it really surprises me that you're on such a high dose for just vics.. am I correct? I was doing at least 60mg of oxy a day and even heroin a good number of times so I am always amazed that doctors even write that stuff for vics or percs.. I read somewhere that it's like using an atomic bomb in place of a hand grenade.. if you wanna compare strengths.. just be aware at how potent suboxone really is. I started my taper on Sept. 8th went from 2mg to 1mg for about a week then after that about .5mg for a week then just crumbs the remainder of the time until today.. I am still suboxone free today and feel good!! I'm so excited, you have to put your mind to it. Try to keep busy if you're feeling anxious or sleep when you can it will help pass the time. Any other questions don't hesitate to ask.

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I'm sorry I just read your story.. now I know why you're on such a high dose. I have to say of all the opiates I've done Norco is a new name to me.. is that more along the strength of oxys?

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luvlafdesign wrote:
I'm sorry I just read your story.. now I know why you're on such a high dose. I have to say of all the opiates I've done Norco is a new name to me.. is that more along the strength of oxys?


Norco is 10MG of hydrocodone - so it's like Vicodin. I was taking 6 per day in addition to 2 20MG Oxycontin.

I am only staying at 4MG for three days (I just started) in order to get past the worst of the WDs from Oxycontin and Norco. Then I am moving to 2MG. I'll only stay there for 3 days then move to 1MG. This is a total taper of 21 days. I gotta say I am comfortable, but not 100% so I am feeling pretty good about where I am at. I do understand that Suboxone is strong.


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That's about how long it took me to taper. You sound like how I felt when I tapered that fast so I think we're one of the lucky few.. I had withdrawals but nothing I couldn't tolerate. I also don't know how much of that was because of the NewPhase medicine I took from day one. When you get down to crumbs, break them as small as you can.. take them what you feel you need to (once a day) you might be able to skip a day but need a crumb the next.. don't get discouraged because the majority of the sub will be out of your system so the crumbs won't have nearly as long of a half life.. then you will be able to just stop. This is day 2 with no suboxone and I feel tired and don't like the panic attack feelings I get but if I start feeling that way I try to keep busy or take a xanax here and there (only if I need it as addiction to this scares me more than opiates) I can't tell you how much of a difference that Tyrosine has made for me and I noticed it within a day. My head is clear, I don't feel depressed or don't feel like using anything. The last time I tried to quit sub I felt extremely depressed and had some crazy thoughts so if this is your weakest point go spend ten bucks on Tyrosine.. What happens when you use opiates for so long is that it depletes the dopamine levels in your brain which is 80% of why we feel so shitty.. no dopamine is what makes you feel sadness, anxiety, irritability and frustration Tyrosine REPLACES the dopamine levels.. it makes sense.. read up on it and BUY IT! Good luck anything else just ask.

~Cheryl

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“Only When We Are No Longer Afraid Do We Begin To Live.”


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 Post subject: moving down
PostPosted: Sun Oct 03, 2010 4:56 pm 
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3 Months or More
3 Months or More

Joined: Sat Sep 25, 2010 11:21 pm
Posts: 94
Moved to 3MG today. This is day 5 of 21 for my taper. So far so good, but we'll see how I feel in a few days when I make the move to 2 and my move to 3 finally catches up with me. From all my research on this board, there doesn't seem to be much of a difference between 4 and 2, so I guess the real test is when I go from 2 to 1.

But feeling good I must say. Got everything I need for my liquid taper once I hit 1MG.

I'll check in when I move to 2MG in a few days.


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

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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