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PostPosted: Fri Dec 11, 2009 12:40 pm 
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I've been on methadone off and on for over 30 years. Most recently for the last 16 yrs. I switched over to Suboxone 12mg about 1.5 yrs ago. I started a slow taper about 4 mos ago and am down to .50 mg... which from what I understand is 500 mcg. I've been at this level about 3 wks and for the most part feel OK... or normal... whatever that might be for a 55 yo addict.

Before getting into the taper, I want to relate my own experience regarding the "switchover" It was a very difficult process and I personally don't recommend it for people who have been on methadone maintenance for a lengthy period. Fortunately, I was allowed 2 weeks hospitalization while moving over. This is because there was a time factor which resulted in being tapered 10mg daily until 40mg methadone over to 12 mg suboxone.

Looking back... I wish I would have tried to go ahead and withdrawl completely. It was that difficult. Most methadone patients slowly taper to 30mg and then move. I'm sure this would have been much smoother.

I've known dozens of methadone maintenance patients over the years and [of those] only a small minority take their prescribed dose on a consistant basis. Many patients take less than their regular daily dose and keep a reserve for emergencies and other important events in their life. We generally take more methadone when we have a party or social gathering to attend or must do something stressful like a dr appt or invasive medical exam or test. I mention this because the strategy does not work with Suboxone.

Most addicts know that Suboxone is 75% buprenorphine and 25% naloxone which is an antagonist. Naloxone and the properties in bupe prevent opiates from fully attaching to the brain receptor... which is what gives us our high. What most people don't understand is that Buprenorphine is a only a partial agonist which acts at the mu opioid brain receptor and has antagonist actions at other opioid receptors Therfore, not only does suboxone have the antaonist nalaxone in it but also has the partial antagonist buprenorphine in it. This is why many former methadone patients... who switch to suboxone... feel and believe this is a politically cruel drug. This may or may not be true. What is true is that suboxone was intentially developed for use with addicts as a deterrent to abuse. The pharmaceutical company, Reckitt Benckiser, admits to that. Naloxone was [supposely] added to deter and prevent injecting with needles. However, Bupe alone without nalaxone also has antagonist effects. So if you are thinking of asking your Dr for subtex... you still aren't going to get anything near like methadone or other full agonists.

There are many reasons and motivations for choosing suboxone over methadone... including convenience, economics, employer drug testing, and geograpic availability. Most employer drug tests don't specifically test for bupe yet. You can also get 28 day 'take home doses' much quicker with suboxone. And many of the govt "free" programs [like for Veterans] are moving more and more towards suboxone over methadone.

If you are on methadone and being pressured to switch to suboxone... then you should be prepared for a potential big change in your lifestyle. That is... if you have used methadone as described above. If you used methadone as prescribed... there should be no problem after the 'adjustment period'... which can last for as long as 6 mos.

I'm not saying methadone is a better way than suboxone. not by a long shot!! Just like Methadone... Suboxone is a life saver for people who are addicted to pain killers and/or street drugs. In fact... suboxone can motivate people like myself to either conform to the prescribed dose or taper off. Which gets me back to my reason for posting.... tapering.

First off I've found tapering down on suboxone has been much more tolerable than any attempt I've made on methadone. At least so far... Thats the good news. The bad is that I'm afraid the final jump off will be at least as bad or perhaps worse?? I've tried to jump at 1mg and only made it about 40 hrs.

My question to those who have successfully quit... is it better or any different to continue to taper from here or to go ahead and JUMP now? I like the comparison someone used to pulling off a bandaid quickly or slowly... or else diving into cold water or wading in slowly.

I've also read about using the "Liquid Conversion" method tapering 100mcg every week or two... starting from 1000mcg which I believe is equal to 1mg. Since I'm already at 500mcg, should I also continue at 100mcg increments and drop off completly from 100mcg? Or else take the plunge and suck it up.

I know there are plenty of factors to be considered including duration of use, health, and age. My health is OK but age and duration is going to be against me.

Sorry for such a long post but felt the need to provide some help/info to other methadone patients along with my request for help.

Ethan

PS: I hope this posting isn't interpreted as a debate on whether methadone or suboxone is better... because that is not my intent. I just want other long-term addicts on methadone to know my own experience regarding switching to suboxone and tapering.


Last edited by suboxfreedom on Sun Dec 13, 2009 11:10 am, edited 1 time in total.

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PostPosted: Fri Dec 11, 2009 3:21 pm 
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I did a liquid taper and got down to about .3mgs before I jumped. In my opinion it was worth it to do the extra tapering - it worked for me, I had minimal withdrawals and I recovered pretty quickly. My energy was probably 80% recovered after 30 days and 100% after 60 days. I tapered from .5mgs to .4mgs and then from .4 to .3mgs. I stayed at each dose until I felt that my brain had acclimated.

I don't think that the taper method is totally responsible for the withdrawal experience though. I really tried to cultivate a positive attitude about tapering and stopping and I also tried to be in touch with what was going on with me mentally and physically so I would make good choices. Exercise, meditation, eating well, and spending time laughing also played a big part. I wanted to make sure I had a solid ground beneath me before I threw out my crutch, you know?

If you think you're ready to stop your medication (and you've talked about it with your doctor), you could just stop taking it and see what happens. If you get to day 5 (or whenever) and you're in some kind of hell that you can't deal with, you can always take a small amount of Sub and go back to reducing your dose from there. That was my attitude when I stopped at .3mgs. I knew I had to start school 30 days from then and I wanted to be on the mend by then so I took the opportunity to go for it - but I also knew that I could go back on and taper even lower if I needed to. I was pretty surprised about how not horrible it was - it was no worse than having a cold. Sleeplessness was the hardest symptom for me, but even that was fixed by a few doses of ambien. I think I took 5 of the 30 pills I had.

Can you point to some reference for what you said about bupe having antagonist effects at the other opioid receptors? I'd heard that the activity at Kappa was poorly understood, but not that there was antagonist activity there. I'd like to read more about that. And the naloxone in Sub is inactive when taken sublingually, so that shouldn't have anything to do with how bupe attaches at the receptors.

Anyway, good luck to you and let us know how it goes.

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PostPosted: Sat Dec 12, 2009 11:48 am 
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Thanks Jack... Congratulations on getting off Subs!!

I dropped to about .40 two days ago and am fine so far. I've decided to try tapering at about 100mcg levels until I get down to 100mcg before dropping. The duration of use and my age will be BIG factors on my eventual withdrawls. So I'm taking it extra slow. At my age we don't hurry anything much.... and I get the meds free from VA hosp so that's not an issue.

I agree with your thoughts regarding attitude and including physical and social aspects to your life prior too and during withdrawls.

I believe the following is the definitive guide to info on Buprenorphine

www.buprenorphine.samhsa.gov/Bup_Guidelines.pdf

I've also read about the antagonist effects Bupe has on the Kappa brain receptors but I don't know how that translates into maintenance or withdrawls. I suspect the experts don't know either. I personally believe the antagonist properties of Bupe and nalaxone can actually suppress the natural occuring development of dopamine and it's ability to attach to the brain receptors of Suboxone maintenance patients.

I was on on methadone [most recently] for nearly 15 years and had naturally occuring highs and lows in moods and perception of life experiences. Suboxone is completely different in that it produces a more level feelings and moods. No extra good highs and no bad lows. It's almost like an anti-depressant. This works well for most people but not me. I can handle the lows as long as I know I have the potential and ability to experience the highs too.

This is one of the reasons I believe you see so many people wanting to get off Suboxone and not Methadone. How many postings do you see of long-term methadone patients wanting to taper off?? Far fewer than Subs...

Here is what I found: Buprenorphine is a partial agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor. Naloxone is an antagonist at the mu-opioid receptor.

Being a lay person... I have no idea how the kappa and mu receptors work and their relationship to natural occuring dopamine and it getting thru to the brain receptors in Subs patients. I'm highly suspicious though. I think this could very well be an unknown side effect not explained to patients.

Here is what it says about "Partial Agonists"

Partial agonists possess some of the properties of both antagonists and full agonists. Partial agonists bind to receptors and activate them, but not to the same degree as do full agonists. At lower doses and in individuals who are not dependent on opioids, full agonists and partial agonists produce effects that are indistinguishable. As doses are increased, both full and
partial agonists produce increasing effects. At a certain point, however, the increasing effects of partial agonists reach maximum levels and do not increase further, even if doses continue to rise—the ceiling effect. In higher doses agonists can act like antagonists—occupying receptors but not activating them (or only partially activating them), while at the same
time displacing or blocking full agonists from receptors. Buprenorphine is an example of a mu opioid partial agonist
.

I don't have any evidence for this but I personally believe the antagonist properties of suboxone blocks euphoric effects of social use of alcohol and can be a big problem with acute pain. Those who are able to use alcohol occasionally [without abuse] really miss these experiences.

Suboxone maintenance with total abstinence is what works for most people who are addicts. However, there are some people who are on Subs or Methadone who also have a social life which includes occasional alcohol use. These people usually get on the program via the pain management route.

I guess my main complaint and concern with subs is that I don't really believe the "experts" know how a partial agonist like bupe works [in the long term] with an antagonist like naloxone for the well being of their patients.

Their main concern [rightfully so] is getting addicts off the street... but what happens after that. For the "honey moon" period and up to a year or two... it seems to work well. But what about for the majority of patients who need long term care and help?? Who knows... maybe it's good that Subs and it's properties and effects are even better if it motivates people like myself to taper and want to get off completely... I had no such strong motivations on methadone...


Last edited by suboxfreedom on Sun Dec 13, 2009 11:12 am, edited 1 time in total.

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PostPosted: Sun Dec 13, 2009 10:59 am 
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I'm now on my 4th day of about .35-.40. Not using the liquid method yet since my "pill cutter" does well getting 2mg cut into four fairly equal pieces of .50mg each. From there I'm shaving approx 10-15% off the 1/2mg piece. Which is how I come up with the current dose.

I cut out 30 of these and plan to stay take one a day in the morning for 30 days. I will go to the liquid measure from here when I drop to .25mg. I intend to stay on .25mg for another 30 days before reducing one final time too approx .10mg. I plan to drop off from there after 2-3 weeks.

In a way I feel like a weakling for using a method like this... but I'm not as strong and healthy as you young guys and gals in your 20's and 30's. I kicked [mostly cold turkey] a couple of times when I was younger and I don't want to go thru that again...especially at my age.

Anyway, for an update... I felt a little bit of aches/pains and irritability yesterday but very mild. Sleep is OK. One thing I've noticed is that I'm smoking less than on higher doses. Smoking seems to bring on the symptoms.

I don't know that I've ever seen anyone post such a slow and gradual taper but I'm in no hurry... and I want to give my body every opportunity to fully adjust before the next reduction. It's been about 16 yrs since that has happened on it's own so I know it's going to take time.

My hope is that by dropping to such low levels of Bupe [over an extended period] my body with start to actually heal and produce some serotonin and dopamine on its own BEFORE totally off the drug. I don't know if this is possible or not??

I would appreciate thoughts on whether this plan is just a delay of the inevitable and horrible withdrawls or a sound strategy to keep the final symptoms to the bare minimum.


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PostPosted: Thu Dec 17, 2009 10:47 am 
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Once again I'm becoming impatient with this long taper. After 7 days using about .35... I decided to slice off to what looks like about 1/4mg. Was advised in another forum that converting to liquid can be "ritualisitc drug behavior" which makes sense. So I took some time and shaved off 30 pieces which must be very close to .25mg. Now I can just take one each morning [without thinking about it] until my body stabilizes... then I'll go from there. No need to plan beyond this time...


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PostPosted: Thu Dec 17, 2009 12:49 pm 
Congrats on your progress thus far! It sounds like you are doing pretty well with your taper. I've been on Suboxone a little over 5 months and have gotten myself down to 3mg/day with minimal difficulty, realizing that the going does not usually get tough until down to under 2mg/day or even less. So I have no experience in dealing with withdrawals or coming off Suboxone in the final stages. All I know about it is what I've read about the experiences of others. Your plan for weaning seems well thought out, sound and reasonable. I agree with you in that when it's my time to wean and discontinue Suboxone I want to take it as slowly and easily as I can. I firmly believe that will be key in my success and key in helping ensure against relapse when I'm off Sub permanently. I'm going to need to feel that the transition to "drug-free" living is as seamless as possible.
I also agree with your theory that doing this so slowly and carefully might help some healing to take place in your brain. I would only assume that by decreasing the amount of drug on the receptors over time, especially when down as low as you're going, the natural processes will begin to resume and you'll start producing more of the natural endorphins on your own. That's exactly what I am hoping for.
As far as the liquid taper somehow being "ritualistic drug behavior", I'm sorry but that sounds like BS to me. How is that any more ritualistic than methodically shaving off little shards of Sub and separating them out for daily doses and such? I just don't quite follow the rationale there! But hey....whatever works!
Again - Congrats on a job well done so far! Keep being patient and keep posting how things are going for you!


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 Post subject: Great Point!
PostPosted: Thu Dec 17, 2009 2:07 pm 
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Very good point there SetMeFree. I agree that there is not much difference between preparing your medication using a liquid method over using a cutting and slicing method. I can see how any of these methods could become a "behavior" for addicts. That actually does make some amount of sense. However, you are very correct, in my opinion, that the method used really doesn't matter. Be what it is, I'd use whatever works the best.

I also am thinking more and more how so many seem to put pressure on themselves about tapering or quitting Sub that really is not needed and so counter productive. I'll try to form some thoughts about that and post it. The bottom line though is we should never feel at all the same about quitting Sub or tapering Sub as we do about our drug of abuse. That seems to be exactly what happens though. People seem to feel just as bad if they need to stay on Sub longer than they had hoped just as they would about staying on their drug of abuse. They are not at all the same. Not even close.

Don't be so darn hard on yourselves. So long as you are moving towards the goal, you are succeeding! Please don't forget that. A slow, cautious, sometimes one step forward, two steps back approach is still moving towards your goal - in the long run. Please don't see any of this as some sort of failure.


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PostPosted: Thu Dec 17, 2009 5:16 pm 
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I agree with setmefree and donh. Very good advice!!

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PostPosted: Fri Dec 18, 2009 11:08 am 
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Thanks guys... The only difference I can see between Liquid and Shaving is with the liquid... I'm told you need to prepare it every 2-3 days to be sure you are getting a fresh and correct dose. Also use syringe type dispenser. By shaving off 30 in advance, you don't need to worry about dosage and dispensing. I'm sure either way works as long as you are well motivated and committed.

I don't know why but it seems that I see many more Bupe patients who want to taper off as compared to Methadone. I'm not sure whether it's the cost or because you just can't get any kind of buzz with Bupe. If you go to the Methadone Forums you won't see anywhere near the activity about stopping that you see at Subs forums. Anyway, I guess thats another story.

Today is my 1st day at .25... it sure is a little piece. I plan to stay on this dose at least 2 weeks.


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PostPosted: Fri Dec 18, 2009 10:57 pm 
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I made up the liquid Sub solution every 10 days and just kept it in the fridge. It worked fine.

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PostPosted: Fri Dec 18, 2009 11:38 pm 
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 Post subject: Liquid & Veterans
PostPosted: Sat Dec 19, 2009 10:49 am 
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Good to know about Liquid experience. I will keep that option open if I taper below current level.

Hi Payton... I've been following your progress in the other thread and am very proud of you!!

I don't mind sharing a few things. First off I'm a little cautious and usually try to disguise myself a bit because VA Dr's sometimes cruise these forums to learn more about what Bupe patients are really thinking. The VA only started offering Subs in my city a couple of yrs ago. Most don't want guys like myself [long term addicts] to taper and will throw you out of program if you don't follow their directions to the letter. I don't want that to happen until I'm sure I don't need them.

TBH.. I'm actually a couple of yrs older and went to Vietnam in 1970 as an 18 yo kid. I was with the 4th Infantry Division near An Khe in the Central Highlands. Like many others... I came home with shell fragments and a heroin habit. The heroin habit was much tougher to recover from than the wounds.

VA Doctors can be difficult to get along with.. About a year ago one told me... "Your lucky to get FREE meds". I didn't say anything because he could make things tough for me. But I should have told him something to the effect... NOTHING is free, least of all VA medical health care. It was paid in full by our brothers who didn't come home.

There are a lot of good VA Dr's and many who aren't so good. The latter are there because they can't make it in private practice after they pay their insurance premiums. It's mostly the luck of the draw who you get. The rest of the country is going to learn [what most Vets already know] about Govt Health Care... if the current Senate Bill passes and is signed into law.


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PostPosted: Mon Dec 21, 2009 8:56 am 
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PostPosted: Mon Dec 21, 2009 12:39 pm 
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Your dad must have went to the war at least a year or two before me since I was with the 1st infantry in Ft Riley, Kansas before going over. Most of the 1st came home late 69' and early 70'. I went over July of 70' [home may 71']and was assigned to 4th Division. By 1970.. all who went over... were sent as replacements and were assigned to units as needed. We didn't go over with the companies or batallions we trained with... which sucked.

For the first couple of mos in country... those who had been there awhile... avoided new guys like the plague. Mainly because we didn't know shi* and could do something stupid and get them killed. This is one of the main reasons a lot of young guys gravitated to drug users. We looked for anyone who was friendly... Not much drug use before 68' when most units trained together and were deployed as a batallion or brigade. I bet your dad didn't have that particular problem. But he most likely saw much more action than us. Our contacts were mostly ambushes, harrasments, probes, and mortars/rockets. Nothing full scale like 65'-68'.

The worst part of coming home with wounds and drug abuse history... was the VA offered [and highly recommended] methadone pain mgt and maintenance. At no cost. They still do but are moving away from that to Bupe.

Anyway, I'm into fourth day at .25 and doing OK. Very minimal discomfort. Mostly the easy stuff like occasional sneezing, yawns, teary eyes. I changed my plan [again] and have decided to remain at this level for at least 30 days and will decide what to do from there.

Ethan

PS: To Setmefree- congrats on getting down to 3mg. Based on my experience...don't think you will have much problem if you decide to taper to 2mg and onto 1mg and further. The slower you go... the easier it will be. I took at least 30 days at each drop


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PostPosted: Mon Dec 21, 2009 2:43 pm 
Thanks so much SuboxFreedom! I continue to feel good at 3mg. I've been on that dose for a couple weeks now...I think. I've not been very good at keeping track to tell you the truth. For me, it really seems that I do better not having a set plan with my taper. I know that would never work for others, but it's working okay so far for me. Everyone is different. Given that it's holiday time, I'm not going to push my luck and try to taper any further until I'm stable at 3mg for a couple more weeks.
I'm glad you are doing so well at your current dose. You're really getting low now! That's awesome! I am more and more convinced that's the only way to go. Like I and others have said, getting down under 4mg/day or so is pretty easy - almost more a mental thing than anything else. All I've experienced so far is a runny nose and a little achiness and restlessness of the legs at night but very minimal. Those symptoms were mild and passed pretty fast too. I wonder if the symptoms we experience when tapering or stopping Sub are very similar to the way we experienced withdrawals (cold-turkey style) from our original opiate of choice. I wonder because I would always get a runny nose first of all when out of opiates. And my #1 worst, most painful and annoying symptom was my legs. Interesting I think. Obviously our body doesn't know Sub withdrawal from oxy withdrawal and so forth. But it seems like I hear varying scenarios when people talk about their withdrawal from Sub, some people saying it's so much worse, some so much easier.
In any case, I'm so glad you came here to post your experiences. Diary of a Quitter was also so good to post her slow liquid taper. You guys' stories are so helpful to me and others who plan to taper and go off Sub eventually.
Good work and keep it going!


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 Post subject: Setmefree
PostPosted: Tue Dec 22, 2009 10:57 am 
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You are absolutely right regarding the no need to taper on holidays... and I hate the restless legs part of WD as much as anything. In fact I'm more concerned about getting past that and the insomnia more than anything else.

I also didn't keep close track early in my taper. It seems the lower I go... the more I watch over things.

Yes I'm pretty low and do not have as much energy yet, as I did at .50-1mg+. To be honest I could always feel a little something after taking .50mg and up, but so far on this level... the "after dose boost" is minimal at best. Which is OK as long as my body adjusts to it. It almost feels as if it's finally time for my brain/body to ante up and start producing some natural endorphins on it's own. I'm pretty sure it could take awhile for this to happen due to the long duration [nearly 16 yrs] of my continous use.

From what I've seen on most tapers around here... many people drop off rather quickly from .50mg and below. I wonder if that could be a factor as it relates to getting past the acute phase and back to "normal" more quickly. I guess I'm wishfully thinking that may be the case with me. I expect to eventually find out.

I think some people might be considering 'cost' when jumping at .50+ [rather fast] and I don't blame them. I would hate to be paying the same amt for .25 as 16mg. Anyway, off to another day in paradise.


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 Post subject: Update- Day 9 at .25mg
PostPosted: Fri Dec 25, 2009 10:13 am 
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I'm at Day 9 on .25mg and doing well. Still stretching, yawning, sneezing and some teary eyes. Nothing to really complain about though and these are starting to diminish... Daughter thought I was bored after yawning at Christmas party. If only she knew...

Have not felt any of the bad WD's with this taper. Begining to wonder if I need to go with full 30 day plan at this level?? May drop to .15 or .20 Liquid in a week or so. But won't make decision until after holiday.


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PostPosted: Sat Dec 26, 2009 11:01 am 
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I woke up this morning and dragged myself out of bed feeling really tired and totally "out of sorts". After about 20 mins I took my .25mg dose and 5 mins later felt much better. It's incredible what a little crumb will do... I had a decent nights sleep so that wasn't the problem. I guess my taper is catching up with me. I'm on my 10th day at this dose and was hoping to start feeling more normal by now.

No withdrawls to speak of but just don't feel well in the mornings. I'm hoping to feel halfway decent in the mornings BEFORE dosing prior to taking the next step. I don't know if that is realistic or not??


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PostPosted: Sat Dec 26, 2009 11:40 am 
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You need to get some exercise so your brain will start producing some endorphins. That and laughing a lot were big factors in me doing so well through my taper. Rent a funny movie and go for a walk.

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PostPosted: Sat Dec 26, 2009 2:16 pm 
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I really don't want to kill what may really have happened for you, but every single bit of science is going to say that it was not the Suboxone that helped you. It was very, very likely the power of suggestion, the power of your mind or something known as placebo effect. It is very well documented that Suboxone, if taken under the tongue, will take at least 20 minutes to do much of anything. While you may be one in a million of people that reacts differently, it is most likely that you had it in your head that this was going to help you, and it did. In fact I have read posts from others on here that have spoken about as soon as they had their medication or their drug of choice in their hand, they already felt better. I know that when I was still using, if I was starting to go into withdrawals and having trouble concentrating, etc., just the fact that I was able to take my DOC made me immediately able to feel better and start feeling normal again. It is amazing how the mind will work.

Whatever was at play, I'm glad that something made you feel better!


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