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PostPosted: Fri Jun 25, 2010 5:17 pm 
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Hi everyone, I have been on 12mg of subutex for the last 2months and have recently re injured my back where I will have to start taking norcos as prescribed by my doctor again until the pain subsides. I have already had one lower back surgery and currently Iam in a lot of pain that is just unbearable :(. So I guess my question is how long should I wait before taking the pain meds from my last dose of subutex? I dont think I need to be in withdraws, but again Iam not sure. Any info would be greatly appreciated! Thanks !


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PostPosted: Fri Jun 25, 2010 5:36 pm 
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Hi Joseph,
You don't have to wait at all, but be aware that with the sub in your system the Norcos may not have any effect for a couple or a few days.
How do you feel about having to do this? I understand the medical need for it, but do you think your recovery could be in danger? I only ask because I know for me it would be. I'm just thinking you might have some feelings about this that you might want to share. Did the suboxone do nothing for your pain at all? Did you try adjusting your dose to more frequently? That helps for my pain, but that's just me. My pain isn't back related and I know how unbearable back pain can be.
Will you have someone hold the pain meds for you so you don't take too many?

I'm really sorry you've been put in this position and I completely understand the need to do this. I wish you the best and hope you'll share more with us if you're comfortable doing so. Take care and I hope your pain becomes more manageable.

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PostPosted: Fri Jun 25, 2010 5:53 pm 
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Thank you for your concerns hatmaker! Yes iam very nervous about doing this but the sub is not currently helping my pain and it has been excruciating for about a week now:( My girlfriend has control of the meds which we are keeping in the safe and we took the battery out of the safe so it can only be opened with the key not with the pin# Lol.... These are the precautions I have to take to make sure that I don't over do it. If I take the pain meds only until the pain subsides and take them as directed would you consider this to compromise the progress I have made towards my recovery or would this be considered a relapse? Iam not sure how to take this mentally, but iam trying to stay positive about the situation! Anyway thank you for the advice


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PostPosted: Fri Jun 25, 2010 6:01 pm 
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I think I know the answer to my question about it being a relapase and the answer is NO! As long as I don't abuse the meds I'am going to consider it medically necessary and not to be a compromise to my recovery.


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PostPosted: Fri Jun 25, 2010 6:03 pm 
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If you take them as prescribed, personally, I don't consider it to be a relapse. Like you said, you're in excruciating pain and you deserve to be treated appropriately. Just because you're a recovering addict doesn't mean you don't deserve pain control like anyone else would. I hope I didn't say anything that sounded otherwise. I'm glad you hear your girlfriend will be helping you with it. It might be tempting for you to take it when you don't need it, to get high, or too take too much, and I hope you will use your support systems - including this forum - to help you deal with such issues. It can be done...you deserve to have your pain treated, Joseph, just remember that.

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PostPosted: Fri Jun 25, 2010 6:30 pm 
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YAY!I think it's great your GF has them and has them in a safe at that! Good thinking! you are doing the right thing. You don't deserve to be in pain and you are being responsible about taking pain meds. Great job! I'm so sorry you are in pain though :-( I hope you get well real soon so you can get back on the sub!

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PostPosted: Fri Jun 25, 2010 6:36 pm 
I agree with you guys.....This would not be a relapse in any form or fashion. I'm sorry you are in such pain. I just wanted to add that I also agree that you can start the Norco any time. My concern is that if taken as directed which I'm assuming would be 1-2 every 4-6 hours and I'm hoping they are the 10/325mg, that still won't be enough hydrocodone to get you anywhere in terms of pain relief being that you've been on 12mg of Subutex for 2 months. My Sub doctor told me that if I ever got into a pain situation while on anything greater than 4-8mg/day of Sub, he would write me for oxycodone in relatively high doses or Dilaudid or something like that. So don't be surprised if you find that the Norco aren't cutting it for your pain until you've been off the Subutex for at least a couple of days, if not more. I hope I'm wrong and you get good relief right away. As Hatmaker said, you deserve pain relief. I just feel like some of the doctors are not very well educated when it comes to providing adequate pain medication for people on buprenorphine.
Anyway, I hope you get to feeling better. And don't feel bad for having to do this. Hopefully, your back will get better soon and you can switch back to the Subutex and be right back on track again. I guess one good thing is that you don't really have to worry much about the Norco 'feeling' like a relapse.....it sure isn't going to get you high if taken as directed......our opiate tolerance is so darn high because of our past abuse and from being on bupe that, as I implied above, it would take a boatload of something really really strong to make you feel anything at all!


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PostPosted: Fri Jun 25, 2010 8:55 pm 
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hmmmm. I do agree...Is hydrocodone gonna be enough to take your pain away? Wondering if you will need oxys or Dilaudid.....

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Of course there's such a thing as angels. Only sometimes they don't have wings... and we call them mothers. -Unknown


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PostPosted: Fri Jun 25, 2010 8:58 pm 
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and I'm only saying that cause you have been on 12mgs of sub. I really hope with all my heart yu are doing ok with the norco. Please keep us posted.

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PostPosted: Sat Jun 26, 2010 2:33 am 
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Thanks for all of your concerns and to hatmaker I did not take anything you said out of context and it was all very good info. As far as taking the norcos I personally asked the doctor for them instead of my DOC (oc's) because I felt that I would be less tempted, but a drug is a drug is a drug is a.......... Today I only took 8mg and I am going to try and hold off from taking anything until as long as possible so I can try and get some relief from the pain meds (which I am pissed about taking). I didn't really think about it, but I will have to put myself into withdraws before switching back to subutex :( I guess the only positive I can see from this is after the pain subsides and I switch back to the buperenorphine is that I think I will be able to start back on 6mg since I will be in withdraws I will induce myself at a lower dose until I get situated again. Arrr what a process this is going to be, I haven't experienced WD's in just under a year and the thought is horrifying. I think I need to go take a walk and get some air I will be back to ttyl and thanks everyone for all the support.


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PostPosted: Sat Jun 26, 2010 4:32 am 
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I was wondering if I waited until I started feeling the minor effects of WD's then took the norcos if they would even keep me from withdrawing. Does anyone have any advice or experience in taking something along the lines of norcos after using subs and how or even if they worked to keep the wd's at bay let alone the pain away. Thanks again for for everyone's advice I really need all I can get right now.


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PostPosted: Sat Jun 26, 2010 7:49 am 
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I had surgery in April and needed pain meds for a few days afterward. Since I'm on a pretty high dose of sub (16-24mg/day), I tapered down for two weeks prior to the surgery - down to about 4-6 mg. I was given Vicodin for the pain. Because of the sub I took more than the average/normal dose to address the pain. Withdrawals weren't an issue, as like I said I only needed them for a few days.

I don't know that waiting for minor W/D symptoms to kick in will help allow the Norcos to keep such symptoms at bay. I think your concern that the meds won't be enough to keep those symptoms away is legitimate. Is the doc who's giving you the meds that same doc that prescribes your sub? If not, is your sub doc aware of the situation? Hopefully your doctor(s) will be open to giving you a higher dose to both address your pain and keep you from going into withdrawals.

I'm so sorry you have to go through this, Joseph. When will you be starting the pain meds?

Hey, something just occurred to me ... Some doctors actually use both pain meds along with a very lose dose of suboxone together to address acute pain. Have you read the article I posted about treating acute pain in bupe patients? (It's in the "Links" topic.) You might want to print that out for yourself as well as for your doctor to read. The paper is from NIH, which is a well-recognized and respected organization.

Good luck and please let us know how you're doing.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


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PostPosted: Sat Jun 26, 2010 9:43 am 
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Joseph,

I don't know much about the strength of Norco. I can say that when I went off sub at 12mg, and 2 weeks later underwent surgery, vicodin was enough to keep withdrawal symptoms at bay but it was not enough to resolve my pain from surgery. I really needed oxycodone in order to alleviate pain to any reasonable level. I too asked for vicodin because it was lower than what I was used to and was afraid to take anything else. But I was miserable for about 2 weeks following surgery.

If it were me, I would wait until I felt uncomfortable from some WD before taking the Norco's. I have a feeling they may not work for you. When you switch back to sub, you don't necessarily have to be in WD. It depends on how long and how many pain killers you have to take.

Cherie

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PostPosted: Sat Jun 26, 2010 11:37 am 
H i Joseph - sorry you're going through the back pain. I was recently in a car accident and was given percs and vicodin. I let my sub doctor know right away, and he OK'd me to take twice the prescribed amount because he knew that after being on 12mg of Sub the pain meds wouldn't be very effective. So for a week I took twice or 2 1/2 times the prescribed dose and I really don't think it was that effective (I think the 600mg of ibuprofen was doing more). I was NOT in withdrawal from the sub.

The problem for me arose when I went back to the doc and he gave me refills for the vicodin. I had used pain meds responsibly for a week so I felt "in control" like now I could handle it. Next thing I knew I was taking handfulls of vicodin thinking now I could catch a buzz off it since I had been off sub for over a week by this point. I'm ashamed to admit this - but I know it's ok to say it here, because I'm an addict like everyone else. My downfall wasn't being prescribed painkillers, its was using them successfully and feeling like i could control my use.

I guess there's 2 points that might be of help for you. One is that the pain meds might not be that helpful after being on 12mg Sub (which is a potent amout of opiate). And second, while going on pain meds prescribed by a doc doesn't constitute a relapse, just be careful of what the drug might trigger in you.

I wish you the best of luck and I hope you feel better. Don't underestimate the effectiveness of 800mg ibupfrofen or naproxyn. Also, keep posting. I posted a lot during my ordeal and it helped. In fact, I feel like being here kept me from going way overboard after I abused the vics - it helped me make the decision to get back on my sub. Also, when I got back on the sub I felt that it helped with the pain.
Take care,
Lilly


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PostPosted: Sat Jun 26, 2010 11:46 am 
Also, you shouldn't have to be in WD to go back on sub. Check with your Sub doc to be sure, but you should be able to go back on safely after a short course of vicodin taken as prescribed.


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PostPosted: Sat Jun 26, 2010 7:53 pm 
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Yes my sub doc is the same one prescribing me the norcos and I forgot who asked about the strength of norcos, but they are the same thing as vicodin at the strength of 10/325. I havent taken any subs today, but I did take 2 of the norcos and I can report that I am not in any withdraws nor should I be after my last dose of sub being only a little over 24hrs. ago. Sad to say that Iam in the same amount of pain. Besides the norcos I have 50mg tramadol that I havent taken any of, do you think it would be a bad idea to try a combination of both the pain meds? Some of you suggested that I push my doc to try and presribe something stronger in that the norcos would not be strong enough to break through my tolerance and I fear that you are right, but the doc was cautious of even prescribing me what he did. I don't know what to do, but if the pain does not subside soon I have been thinking about contacting my old pain mngmt. dr. One thing is for sure is that I will not turn to the streets to ease my pain for I know that will only make problems worse in the long run!!! Does anyone have an idea of how long before my tolerance to the subs will reduce where I will start to feel relief from the pain meds? Wow Iam in a dilly of a pickle Lol.... Thanks to everyone again


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PostPosted: Sat Jun 26, 2010 9:29 pm 
Joseph, sorry to hear you're still in pain. I just bought and read Dr. J's e-book today (I don't know why I waited this long). I would strongly suggest you spend the $9.95 to get it. The most informative part was about pain management and use of pain meds for Sub patients. There's really more information than I could repeat here. One point that I do think is pertinent is that a Sub patient would probably need at least the eqivalent of 60mg oxy per day to get pain relief. The problem is that most doctors would be hesitant to prescribe that much to an opiate addict. Probably your only hope would be to have your sub doc talk to your back doc. In the meantime have your tried combining the vicodin with ibuprofen? That is the only thing that helped me. If 20mg vicodin didn't work I doubt tramadol would help. Also is physical therapy, massage or a hot tub an option? I did a lot of physical therapy and I really believe it worked. Hopefully some combination of all of these options will get you through until you heal somewhat. I hope you feel better soon.
Lilly


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PostPosted: Sun Jun 27, 2010 12:07 am 
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I am kinda repeating myself, but I was still hoping if anyone had some insight on how long before my tolerance from subs subsides enough to feel some relief from the pain meds (norcos). About the tramadol I wasn't planning on taking them instead of the norcos but along with them because I know some doctors prescribes them together so I was wondering if anyone had any advice on this either. Its just a tough situation I'm in and I want to make the best decisions from a pain standpoint as well as that of a recovering addict.


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PostPosted: Sun Jun 27, 2010 2:28 am 
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Hi Joseph- I just read thru your post here, and hate to hear you are having pain issues. I did want to give you a little insight, my sister-in-law started on Subs about 2 months ago (I started on them a little over 3 weeks ago) and she ended up rupturing 2 disks in her back about 2 weeks ago. Anyhow....she actually started off taking 10/325 percs..she only took one at a time, and was NOT getting any relief. The doctor had to put her on Roxy's 30mg. and within two days, she finally got enough relief to have an MRI. She then had to have an injection in her back, and she has been getting massages. They wanted her to have another back surgery, and she said NO WAY. Anyhow, she did tell me that NONE of the meds ever gave her that "feeling" again, however, she was able to finally get relief. She was able to switch to Vics for a few days, and and then went back on Subs. I know that everyone is different, and our bodies metabolize differenty, however, my sister-in-law was taking 12mgs. of Subs when her back went out, and she did finally get pain relief. Hopefully you will get relief ASAP!!! I don't know if this helps, I just wanted to let you know that it is possible to get pain relief, it is just a matter of finding what is going to help YOU right now. Please take it easy, and take care of yourself. I hope you feel better SOON!! -Lisa


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PostPosted: Sun Jun 27, 2010 9:29 am 
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Joseph,

Hello. Just wanted to offer some information that will be helpful in regards to treating acute pain while on Buprenorphine. Bupe has a very strong affinity for the brain receptors and when you introduce short acting opiates- it may take a while to get any relief in regards to pain management. There are a number of reasons physicians are concerned about prescribing short acting opiates for pain to someone who is using Bupe for treatment of opiate addiction and these reasons often prevent the physician from treating the pain appropriately. There is not much information available about treating pain in patients on Bupe- this reason alone is going to cause allot of mistakes, many doctors are simply playing a guessing game.

Here are some facts that will help:

*Until bupe clears the body, getting relief from short acting opiods will be difficult and higher than average doses may be required to get relief. Again, doctors usually will not do this for fear of triggering the addict behaviors, legal issues, etc. It is a slippery slope for both patient and physician.

* Non combo opiods are preferred because of the risk of acetaminophen(tylenol) toxicity-the amount of opiods needed to achieve pain management will be greater until the bupe clears the body. (It does take a while for bupe to leave they systems and everyone is different in this situation due to a number of factors.)

* If your injury is going to require long term care, you may want to discuss switching to methadone.Methadone dosing throughout the day or another round the clock long acting med will be the wisest choice for this situation. Bupe should be avoided until you have control of your pain and the problem causing the pain is corrected.

For more information on this, look to the links below:

Nation Institute on Drug Abuse-Challenges in Treating Pain for persons with Substance abuse disorders

Annals on Internal Medicine-Treating Pain while on Buprenorphine

Hope this helps!

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