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PostPosted: Mon Jul 01, 2013 11:10 pm 
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Okay folks, maybe I should stop reading, but I've got a bad, BAD feeling now the this new doctor has taken me headlong into a cement wall without me knowing it.

He started me at 24mg per day (8mg 3x daily). I've read bits here and there about that being a high dose, but then I was on a high dose of Oxy so I just ignored that, thinking well obviously I guess I'd be on a high dose of this as well. I would see comments about others that were on Oxy at even greater doses than me who were induced at like 2mg, and after my induction I couldn't see how on Earth that would EVER do the trick (no matter how long the wait). I posted in the other thread that I was wanting to do a taper from the Sub, but if I'm understanding what I'm reading correctly I may be screwed blued and tattooed on that end. The conversions I've found from buprenorphine 24mg daily are to an INSANE amount of Oxy that no living creature could take and survive!

Has this guy gone and gotten my body now hooked on a massive new substance that would make my Oxy intake look like child's play?

I'm sorry, I know you're probably about tired of me, but my mind is just racing a mile a minute now and not knowing what is true anymore of what I'm reading all over the place.


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PostPosted: Mon Jul 01, 2013 11:38 pm 
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No Snap, you're not screwed...yet. LOL. But that is why so many of us have suggested that you should drop to a much lower dose as quickly as possible. 24mg of buprenorphine is exponentially higher than the dose of oxycodone you were on. If you stayed at 24mg for awhile and then for some reason went back to the oxycodone you would need quite a bit more than what you were on before to equal the higher tolerance level. All of that being said, you aren't going to experience this immediately. Taking the high dose of subs for a few days probably won't raise your tolerance that much, but the longer you do it the harder it will be to get it back down. I would bet that you could drop fairly quickly to 8-12mg and not feel much difference in the level of pain control you are getting, if you continue to dose 3x per day. Small doses, multiple times per day seems to be the key in pain control with subs. Also, you could check into adding tramadol to your pain control plans. Tramadol is one of the only prescription pain medications that can be taken with suboxone safely, and it seems to be a great option for breakthrough pain.


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 Post subject: You will be ok
PostPosted: Tue Jul 02, 2013 12:06 am 
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Snap, Just like what TD said in an earlier post, you need to do what is best for you. In my humble opinion I believe you could safely and effectively reduce your dose dramatically and be ok. Everybody is a little different but the sub is very powerful medication, I cant stress that enough, the sub is very powerful. I also like the idea that you dose 3 x a day for your pain management. I would try to reduce down dramatically the next several days. I was given 16mg to start but I ended up going down to 4mg in the first week and kept reducing down to .25mg in a little over 5 months. I did not have all the information I needed and since then have learned a lot more about this medication as well as addiction. Please get informed, you will be ok, the main thing you were trying to do was get off the oxy and avoid WD's as much as possible. You can still effectively do that. The problem some people make is they have no plan for themselves to deal with on going pain, addiction issues, triggers, etc. that lead people right back on the merry go-round of narcotics or sub. use. I can totally hear how much you care about yourself( by the way that is huge for being successful in recovery). I am no expert, and I hope others with more experience will chime in here, you will be ok. Ciao


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PostPosted: Tue Jul 02, 2013 12:30 am 
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qhorsegal, that first line you wrote makes me want to hug you. Instantly calmed me down a bit. I'm assuming that the past three days at 24mg will not yet have made me dependent upon 24mg, even though it did stop Oxy WDs, and that I can still drop as I was planning. My brain was processing it as, "Oh no, I've gone and let this guy put me on something that is equivalent to googads of the Oxy I WAS on and now am dependent on a much higher level of opiate." From what I think you're saying, that is indeed not the case (YET - but would be with extended use at the 24g dose). I'll have to ask him about Tramadol at my appointment tomorrow. That's very interesting to know, but I thought Tramadol was a narcotic as well? I'll have to check on that.

JustDoIt, I read elsewhere that breaking up the dosing helps the pain, and I'm doing that. May just need to give it more time, I don't know. But I'm definitely dropping from 24mg. You made the same point in a previous post about having a plan for pain management in place during this induction time, and I'm going to take that to heart. Should've done it already - it's common sense, but I've never been accused of having and abundance of that.

I was just thinking right out of the gate he got me on something much more problematic. But perhaps a week or so wouldn't cause a serious problem if I get on reduction ASAP.

I'm so sorry folks. If I were y'all I would boot myself! I have the be the neediest most frustrating "inductee" you've all dealt with! Just know that I am one grateful, appreciative needy and frustrating inductee :)


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PostPosted: Tue Jul 02, 2013 7:11 am 
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also wanted to add that you cant always trust the accuracy of those conversion charts.

in theory 24mg of bupe might be equivelent to alot of oxy however, suboxone yas a celing and oxy dosent.

the celing dose of bupe is said to be 8-12mg. Meaning more than 12mg of bupe wont have any extra effect. A person could take 12mg and one hour later take another 12mg and that extra 12mgs wont do a damn thing, because that person has already hit the celing.

so why do people even bother taking a dose any higher. The idea is they are trying to keep the levels in there blood above the celing, so the receptors are always full, and for addicts thats important. By having their dose above the celing they never have to "feel" their dose come on or wear off through the day, the levels in their blood are always above the celing. I dont feel like i did a good job explaining the celing effect so i would suggest you read about it on your own, or watch dr. junigs videos about it.

And it also means that you should be able to drop frop 24 to 12mg basically overnight without feeling any bad effects.


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PostPosted: Tue Jul 02, 2013 8:53 am 
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Beautiful Disaster...I started to mention the same thing about the ceiling effect. It would be a good thing for you to read about that Snap, just so you can understand what it is and how it works. However, because you are taking it for pain management I'm not sure how much the ceiling plays into it. I don't understand enough about the analgesic effects of suboxone to give a clear answer on if the ceiling level will effect pain control. I know doses over the ceiling don't add to the effects of subs in the normal sense...but what about for pain control? Does anyone know?

As for the tramadol...yes it is technically a narcotic. But, it is a synthetic opiate and for some reason it is often prescribed with suboxone for breakthrough pain. I do need to mention however that tramadol can cause problems if not taken as directed, so be careful with it. It has some kind of a unique SSRI effect to it that is kind of specific to that drug and if taken regularly will need to be slowly discontinued as any SSRI would be.

Good luck at your appointment today!

Q


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PostPosted: Tue Jul 02, 2013 10:33 am 
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the reason i brought up the celing effect is because the op used a conversion chart for 24mg of bupe = x amount of oxy. On a chart that might be accurate, however because of the ceiling its not accurate in real life. Basically any dose over the ceiling will not have an effect on the central nervous system(cns). 12mg is the max your brain/receptors can use. So if a person wanted to accuratly gauge the effect the bupe is having on tolorance compared to oxy, that person would want to enter in 12mg of bupe on the conversion chart (even if the dose is 24mg, because remember the extra 12mg just basically stacks in the system because it cannot be used by the CNS)

That being said im sure the amount of oxy that would be comparable to 12mg rather than 24 is not so scary tolorance wise...lol. I dont know how well i explained that or if it makes sense. Its really hard to compare bupe to other narcotics on a conversion chart because there are just so many factors like bupe being only a partial not full agonist and the ceiling ect.

Also i believe from what i have read that bupe works better for pain management in doses UNDER the celing, and also like qhorse and justdoitforu mentioned multiple doses throughout the day. The reason for a dose under the ceiling is because you want to try and NOT have all of your receptors constantly full, so that way when you dose it WILL have an effect. Smaller doses multiple times a day equal pain managrment with buprenorphine. Im not a foctor snap, but you could try maybe 4mg say 3 times per day. If it works than great if you have wds or less pain relief you can always take more. It might take a few days to really notice a difference because you have been on a dose well above the ceiling, and it can take a few days to get your levels below the celing and free up some receptors for pain relief.


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PostPosted: Tue Jul 02, 2013 12:29 pm 
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Another thing to keep in mind is bioavailability of sub. Depending on how much you salivate, hold the liquid in your mouth, etc. makes a difference in how much you're actually absorbing. I salivate a lot, so I don't think my absorption is the greatest. I also spit out the leftovers. I also wanted to say that after being on 16mg for 4 months, I dropped overnight to 8mg. Didn't notice a difference, other than I was less sleepy. I stayed on 8mg for 2 weeks while I was on vacation from work and I felt fine. When I went back to work I went back up to 12mg. Most days I take 4mg three times a day. If I'm a little more achy than usual I'll split it 4 ways, taking 4mg, 4mg, 2mg, 2mg. On rare occasions that I'm a lot more sore than normal I take 4mg, 4mg, 4mg, 2mg. I try to never take the whole 16 that I'm prescribed per day. It's nice to have some saved up, just in case. I'm sure my pain level doesn't even compare to yours, but sub is really strong and one of those combinations might work for you. I agree with everyone that 24mg is too much, especially once you've built some up in your system. My original plan was to do a quick detox with sub, then see what my pain level actually was, and then I had no idea where I was going to go from there. But the sub has worked so great for my pain, that I decided to stick with it. At least until science comes up with better options for me. Only problem is, I have no clue how my doctor feels about long term treatment. I guess if he doesn't believe in it, I'll have to find someone who does. Even though it's a pain in the ass taking these films 3 times a day, it's so much better than popping 8-10 pills a day, and still being in pain at times. And I don't obsess over the sub, like I did the oxy. Quite the opposite. I used to always think about when I could take my next pill. Now I'm like, yuck, it's time for my next dose, lol. You might have to experiment a little, but I'm sure you'll find what works best for you, with the least amount. It just takes a while to mentally adjust to the less is more idea. Took me about 4 months to finally accept that. I wouldn't stress too much about it right away. Give yourself a little time to get used to the whole thing. It's a pretty big change!


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 Post subject: Too Much
PostPosted: Tue Jul 02, 2013 2:38 pm 
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I agree with you Snap, 24 mg's is too much. What everyone told you is spot on. When I was induced they gave me the same amount and I went home and threw up. Knew it was way too much right off. After a few days I dropped to 16 mg's, then about a month later dropped to 8 with no ill effects at all.

The best way for you to get pain relief is to take smaller and more frequent doses. Once you get stabilized you can start tapering till you feel it's the right dose for you. Another pain patient I know from here used to take 24 mg's split up during the day. Now he takes 1 mg several times a day and feels much better. Who knows, maybe the same can happen to you.

Good to hear your induction went okay. Welcome to the Sub Club.

R

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PostPosted: Thu Jul 04, 2013 4:03 pm 
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Hey Snap, just wondering how you're making out. Haven't heard from you in a few days. I actually couldn't even get on the past couple days. Just thinking about you and hope you're doing ok. Hope you're having a nice 4th of July :-)


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PostPosted: Fri Jul 05, 2013 4:59 pm 
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Thanks for replying all. Going to do an update now.


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