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PostPosted: Tue Dec 13, 2016 3:26 am 
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Hi all,

I've been addicted to opioids for the past 8 years, on and off, but mostly on. When I start a bout of dependence, I get extremely high all day on as little as 7 mg of oxycodone, which slowly increases to no more than 15 mg per dose, every three hours before my tolerance stops increasing. My latest bout of addictive use has been going on for about 3-4 months now. This time I'm on a strong Kratom extract every 2 hours, using to equivalent of somewhere between 30-90 mg of oxy per day.

I've tried to stay clean numerous times over the years, but even with rehab and meetings and therapy, it never lasts more than a few months. This is in part because of severe PAWS I experience after I quit. It's so bad that I can be parched with thirst, have a glass of water in front of me, and still not have the motivation to reach for it. The longest I've been clean is ten months, and it was still that bad. I'm short, I can't function without opioids.

Using this Kratom extract every 2 hours has gotten tedious and I feel ready to move from addictive use to some sort of maintenance program. I have 0 desire to get high, I just want to feel normal and functional. To that end, I've signed up for a suboxone induction this coming Monday.

I know the current practice is to induce people on, say, 4 mg initially and work up from there, but I think my situation is a bit different. Based on what I've seen in terms of suboxone' analgesic equivalency, I think even 1 mg would be way too strong for me. I'd probably get very sick, and I'd like to avoid that. The doctor I'm seeing has agreed to let me take as little as I need, telling me I can cut the strips as small as I'd like.

I was wondering if anyone could help me figure out a reasonable induction dose based on my tolerance. I plan on staying on suboxone long-term to help me get away from short acting opioids so I can focus on recovery instead of having a daily schedule that revolves around using. Seeing as how I may be on the equivalent of only 30 mg of oxy a day (but may be on up to 90; I'm dosing 8x a day in any case), would 0.25 mg of suboxone be about the right amount? Too much? Too little?

Thanks so much in advance for any help you can provide, and for your patience.


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PostPosted: Tue Dec 13, 2016 5:06 pm 
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Hello Sandra,

After reading your post, I feel like you are not on a strong enough dose of opiates to really benefit from Suboxone. You are kinda stuck in the middle of needing subs and just needing to get off of what you are on.

But if you really must get on Sub strips, I would take an 1/8 of a 2mg strip. And see how you feel just on that.

Or there is a "Butran patch" that lets out small amounts of Buprenorphine at a time to have a small bit in your system. The latter might be the best for you since you really don't have a high tolerance.


Hope that works for you and good luck if you do decide to induce.


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PostPosted: Tue Dec 13, 2016 5:13 pm 
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Hi Sandra, Welcome! I am sure someone with much more experience in this area will post soon. In the meantime, I can share from my experience. I inducted on 24mgs but did not stay there long. I had the intent of weaning down to as low as I could go, without feeling any symptoms of withdrawl. That is what I did. You are sying that you are going to do that too but in reverse. I personally, think that is a great idea! So, if you are prescribed 2mg strips, cut them in eight with the thought that each piece is .25mgs. Now some may disagree with that as I have read that the suboxone may not be evenly distributed. So, start with one piece and work your way up, I would say to wait 20 min to a half hour before taking more. When do you plan to stop the kratom? That will play a role too. Please, keep us posted so we know how you are doing! Good luck and we are here for you if you need us!


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PostPosted: Tue Dec 13, 2016 7:28 pm 
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Kratom is a tough one. It is being touted as an alternative to Suboxone and Methadone. The promoters were able to get a couple of 'freedom' loving senators in their pocket so the DEA has delayed putting it on Schedule 1 so further 'study' can be done.
I have one Kratom user that after consultation we decided to wean and then use comfort meds for withdrawal. He has not used for the past 3 weeks and is hanging in there. Combination of gabapentin and clonidine. The need for lomotil is past. Never did need anything for nausea beyond Maalox and crackers.
We will meet soon to decide whether to stay this course or to go on Suboxone.
I'm kind of like Raudy and wondering if I am hunting mosquitos with a sledge hammer.
I have put people on Suboxone that have relatively low tolerances but their use was playing havoc with their lives and recovery. As some can attest here even 6-8 tramadol a day can be life altering, but still would be low on the tolerance scheme.


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PostPosted: Sat Dec 24, 2016 3:26 pm 
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Just wanted to post back and update everyone on my experience. I underwent a successful induction yesterday morning, 23 hours after my last dose of kratom. Because kratom has so many different types of alkaloids and hits several different receptors and receptor subtypes, despite being in very uncomfortable physical withdrawal, one of the alkaloids was definitely still active and I was actually feeling pretty good psychologically before taking the Suboxone. This had me pretty worried that I would undergo precipitated withdrawal, but I didn't notice even the slightest bit of discomfort.

I started out with 1/8 mg of Suboxone, which made me about 70% better. After another 1/8, for a total of 1/4 mg, I was actually feeling really buzzed for a few hours. It didn't completely alleviate my withdrwals, but I didn't want to get any "higher," so I stopped at 1/4 mg. I figure there's just some different receptors kratom hits that buprenorphine misses, and that as a result there will be an adjustment period.

This morning I tried to get away with only taking 1/8 mg and I regretted it for several hours, falling into a deep depression (with some suicidal ideation), which went away about 2 hours after taking another 1/8. I think 1/4 mg is right where I need to be.

While part of my depression was definitely chemical, I think part of me is very worried about going on a medication that has a very long period of withdrawal if I ever decide to stop taking it. I'm completely comfortable being on it for life if need be, but I'm worried about the legal landscape, or my doctor retiring some day, or my insurance not covering my medication some day, etc. Luckily, since my dose is so low, the 30 8 mg strips I'm prescribed is enough to last about 2.5 years, which means I can have a bit stockpiled to get me through any emergency situations that may arise.

One other thing I wanted to mention before wrapping up this update: there are a lot of people who say, "Don't switch from kratom to Suboxone! You're increasing your tolerance and trapping yourself further!" However, I'm already noticing some immediate benefits.

For one, I had to dose on kratom between 4 and 8 times a day at various points throughout my usage. By having a medication I only need 1-2x daily, I am not constantly thinking about using throughout the day. If I was going through a stressful situation at work or anxious about something, I would take a slightly higher dose of kratom (or an extra dose) before that situation to deal with it. On Suboxone, I'll have to develop healthier coping mechanisms because of the long half-life. I feel like this sets me up to get really serious about recovery, which I intend to do.

As far as "further trapping myself," I may have done permanent damage to my opioid receptors due to the length of time I was addicted to oxycodone, and thus may need to be on something for good. That being the case, using a long-acting agonist seems like a much better solution for maintenance.

Based on my personal experiences so far, I'd highly encourage any others struggling with kratom (or any other weak agonist) dependency to consider this if deciding whether or not to use Suboxone.


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PostPosted: Sat Dec 24, 2016 5:18 pm 
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"I may have done permanent damage to my opioid receptors due to the length of time I was addicted to oxycodone, and thus may need to be on something for good. That being the case, using a long-acting agonist seems like a much better solution for maintenance."

Hi Sandra,

Very glad things are working out for you. I read your first post with interest. I was especially interested to read that your tolerance doesn't seem to progress past a certain point, if i understood you correctly. Active addicts would likely call you "lucky."

I just wanted to reassure you that it's doubtful you did permanent damage to your opiate receptors. The brain heals. There's a way back should you choose to go "med" free someday.

I almost always qualify what I say by conceding I don't know very much, but I feel pretty confident regarding the ability of the brain to recover from opiate addiction when challenged to do so.

Best,
Godfrey


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