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PostPosted: Fri Jan 29, 2010 1:20 pm 
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hey all, the way my sub doctor does his program is like this, and im scripted to the following meds along with my suboxone:

Zoloft - 50mg 1 time daily
Xanax- 4mg throughout the day as needed
Ambien - 10mg 1 time at bedtime

its a 100 day detox:

first month you take 24mg a day (3 8mg tablets)

second month i take 19mg a day (2 8mg tablets)

third month i take 8 mg a day (1 8mg tablet)

then unless hes got something else planned and just hasnt said anything about it thats it. wouldnt just stopping suddenly after 3 months of daily use and have been taking 8mg daily the month before quitting cause withdrawal? if so how "bad" or intense will it be? i see people say their tapering off of .5mg a day and the like, and when i was using recreationally i would be able to take 1-2mg of sub and be straight if i couldnt find any dope.

am i being over prescribed and taken for my money lol, will i kick stopping ct from 8mg a day? any advice? opinions?


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PostPosted: Fri Jan 29, 2010 3:03 pm 
Hi Reeferz. I'm going to refer you back to your original post in the "induction discussion" section of the forum. You might want to reread the responses you were given there.
The answer to your question as to whether you will "kick" if you cold turkey off of 8mg/day of Suboxone is: almost certainly Yes you will. I have to wonder how much experience your prescribing doctor has with Suboxone. His 'plan' doesn't make a whole lot of sense to me. He has you on Xanax and Ambien now, which in all likelihood you don't need while taking 24mg/day of Sub. Those meds typically are not needed until people get down to the final steps of tapering/stopping Suboxone. He's got you on relatively high doses of Sub all the way through this "100 day detox." I don't get it. Unless he's planning on weaning you further down after the initial 100 days. I'm assuming you discussed this with him and he's told you that is NOT the plan and he really is planning to take you completely off Sub at the 100 day mark.
I'm not a doctor and I have never tried to quit Suboxone (been on it 6 1/2 months and now take 3-4mg/day). I have done a fair amount of reading however, and as I told you in my reply to your first post here, the people who jump off at 8mg/day are not happy campers! One of the forum moderators did it about a year ago, if I'm not mistaken, and he said it was tough. Most of the horror stories you'll find from 'Sub-haters" are from jumping off from too high a dose and from not tapering long enough. You need to really do some research and talk to your doctor some more about this. I don't think his plan is at all realistic. If he's going to insist you be off Sub in 100 days, you're going to need to do things differently than he's recommending. Starting with getting down to 8mg/day asap. For me and for most everyone else (your experience may differ) getting down to 8mg/day is NO problem.....minimal if any w/d symptoms. Perhaps stay at 8mg for a couple weeks then drop on down to 4-6mg/day for another few weeks and spend the remainder of your time tapering to 2mg and under. From what I understand the key is to taper as low as you can (down to 1mg or less per day), even skipping a day between doses towards the end of your taper, and then.....maybe stopping Suboxone won't be too painful. You can find plenty of tapering stories right here on this forum.
If your doctor is completely unflexible and unwilling to work with you on this, you might want to consider changing docs. This is real important and you need to do it right....what's right for you and will give you the best chance at long-term sobriety. Remember too that Suboxone, in and of itself, is NOT going to be THE answer to your addiction. For most of us a lot has to change in our lives. And that takes time, certainly more than 100 days.
I wish you luck and maybe some others will chime in here with some other ideas for you.


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PostPosted: Fri Jan 29, 2010 5:22 pm 
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Reeferz, that's a butt-load of drugs. I've zero problem sleeping all full up on Suboxone, even while tapering, so all that extra stuff is unnnnnn-necessary in my mind. The first night I did take an Ambien, because I hadn't come up to full dose of Suboxone. From everything I've heard, coming off of 8mg after 3 months will be a killer. Might as well just go cold turkey now. But I tell you what I'd do if that was all I had access to. I would take home all the sub that doctor is giving you. After 1 week, I would start tapering down as fast as is comfortable to 2mg per day. This will probably only take 1 to 2 weeks, but could take longer. I did it in 1 week with very little suffering. Like the sniffles for a couple hours per day. (I prefer 1mg every 12 hours for evening out the level in your system.) Then you can use all the massive extra Suboxone you will be acquiring to taper nice and slow when you get ready to. I don't really know anything about those other drugs. You do not want to get addicted to Xanax. Withdrawls from that can kill you and suck worse than the worst, baddest most aweful withdrawals from any opiate. I would only take the barest smallest amount of xanax the first day or two and only if it actually helps with anything like bad anxiety. I don't really know anything about Zoloft. I thought I read somewhere that withdrawals from that was unpleasant. I'd research that if I were you. Oh yeah, what setmefree said about having those other drugs at the end is true. I'd save some for that. But not take that stuff during.


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PostPosted: Fri Jan 29, 2010 5:52 pm 
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Reeferz, i agree with them that is alot stuff to be taking. Usually xanex or something like klonapin is giving at the very end of using suboxone. I would taper off by goin down from 8mg a day then 6mg to 4mg then to 2mg. I am currently taking 1 mg a day and im even goin to work my way to .25 mg a day til i try and stop taking suboxone.


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PostPosted: Fri Jan 29, 2010 6:18 pm 
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thanks for the info guys, im going to lower my dose to 8mg a day asap and horde the rest for a slow taper after this is all over.

im also going to think about finding a new doctor. i shoulda known going to a sub doctor who also does pain management, botox, testosterone injections and a few other things was sketchy.


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PostPosted: Fri Jan 29, 2010 6:38 pm 
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oo, oo, get some botox, go through withdrawals, but look good while you're doing it! ;)


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PostPosted: Fri Jan 29, 2010 7:15 pm 
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Reef - You said it...HORD what you can. Get yourself down as low as you can and stockpile the extra that he is prescribing you. Also stockpile the ambien and stuff that can help when you come off. If you can get your hands on a boat load of sub which you will end up with as he's prescribing tons of 8 mg pills to you you'll have plenty of time. Also, if you say you took 1-2 mg of sub when you were using and were straight....why not just jump down to 1-2 mg now? How long have you been on sub? If you can get down to 1-2 mg you'll have months worth to taper as you choose.

Refer your doc to this thread and this site....these docs need to wake up! Mine is a moron...this site is my real doc. He's the guy who writes the scripts. that's it.


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PostPosted: Fri Jan 29, 2010 7:23 pm 
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Reef - You said it...HORD what you can. Get yourself down as low as you can and stockpile the extra that he is prescribing you. Also stockpile the ambien and stuff that can help when you come off. If you can get your hands on a boat load of sub which you will end up with as he's prescribing tons of 8 mg pills to you you'll have plenty of time. Also, if you say you took 1-2 mg of sub when you were using and were straight....why not just jump down to 1-2 mg now? How long have you been on sub? If you can get down to 1-2 mg you'll have months worth to taper as you choose.

Refer your doc to this thread and this site....these docs need to wake up! Mine is a moron...this site is my real doc. He's the guy who writes the scripts. that's it.


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PostPosted: Fri Jan 29, 2010 7:36 pm 
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I don't know the risk of giving out medical advice poses to this forum, especially as the owner is a doctor. But as a person who is not a doctor, it seems better to say things in terms of what I might do if I were in your situation vs giving direct instructions. It's always best to work it out with your doctor or find a doctor that works for you if possible.

I'm not sure I'd direct my doctor to a thread where a patients refer to their doctors as morons. (Not that I know of any threads that do that.) But I think there are some blogs and posts by the hosting doc that might be more well received by another doc.

Another site that has some great advice in another area of interest of mine was recently given a cease order by the AMA for potentially giving out medical advice (selling non-controlled nutrients, and describing their benefits.) They basically had to completely let go of their domain name and then rewrite some of their wording, so they are back in business, but what a hassle.


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PostPosted: Fri Jan 29, 2010 7:49 pm 
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I referred my Doctor here and and he is a mooron...many are not well educated on suboxone and suboxone use....Many people on here share thier experiences and what has worked that is why there are so many happy people on here. We share and if that person only takes one persons advise like thier doctors....they may end up in a bad way. I have read your post and if I am correct you are on the subjohn program not the exact program your doctor put you on. People may read your taper thread and take it as medical advice. I think there has been some good suggestions to the poster........I am not a Doctor but I did stay at a Holiday Inn Express last night........


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PostPosted: Fri Jan 29, 2010 7:58 pm 
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you are correct, I am on the subjohn program, LOL. The detour I've taken is that instead of jumping off at 1mg, based off of the information I've read on this site, I am tapering in smaller increments first. My doctor told me I could start tapering as soon as I wanted and as fast as I was comfortable.


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PostPosted: Mon Feb 01, 2010 1:24 am 
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Hi Reeferz,

Wow, that is alot of medication. The xanax especially - many people on it take less an a mg. When using I took 6 mg per day. I'm surprised your doc gave you that much with the suboxone. That's dangerous in terms of your respiration. Depending on how long you've been taking it, you may very well have withdrawals from that, too. Just my 2 cents from personal experience. Not a doctor but I watch House.

Good luck and please keep us posted as to how it's going.


Melissa

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PostPosted: Mon Feb 01, 2010 1:39 am 
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I recognize that this thread started a number of months ago, but wow-- that program that was described is messed up! And as pointed out, starting a high dose of Xanax at the same time of starting a high dose of buprenorphine is about as bad advice as anything I have heard in a long time-- and very dangerous as well.

I'm glad you managed to live, despite your doctor!

As for tapering, you all know where I stand. I would suggest giving a go off buprenorphine one time, and if it doesn't work out, don't try again for at least 6 months or a year. Too many people get hung up in the constant battle with buprenorphine to an extent that they miss out on the whole point of using it-- which is getting to a once per day AM dose, and forgetting that you are even taking anything.

To even consider tapering, I recommend that you are dosing once per day with buprenorphine and not thinking about it all day long. If you are forgetting to take it now and then, that suggests (to me, anyway) that you might be ready to try going off of buprenorphine. But if you still have a 'relationship' with using, where you think about it and dose multiple times per day, a taper is only going to result in bad things. It may even be coming from the addict in you who is looking forward on some level to being able to use.


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PostPosted: Tue Feb 02, 2010 12:03 pm 
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I havent read all the replies, so sorry if I repeat something or am off topic.
First of all, like everyone else, Im not a doctor and I dont play one on TV, but I would like to give my opinion on your situation based on what Ive read as well as my own experiences:
24mg of suboxone is EXTEREMLY high to begin with. Unless you had some massive heroin addiction, I dont believe there is ANY justification to ever go on that high of a dose, period. Second, I did have some sleep issues on suboxone, but nothing that required anything more than benadryl or melatonin. If you take any advice from me at all, then take this: DO NOT take the xanex. That is the most insane thing I have ever heard a suboxone doctor prescribe a patient who has addiction issues. Benzo addiction is faaaaar worse detoxing off of than opiates. If you get a script for xanex, get it filled and save it to use VERY VERY SPARINGLY when you detox off the subs.
If I were you, I would let him give you the 24 mg, but I would take either 4 or 8mg a day. Period. Go as low as you can to start out with that takes your cravings away. You can save the rest of the script to properly taper off. It sounds insane, but the only people I know of that had little to no withdrawals are the ones who went really low and slow (Im talking down to .25mg a day, which is like 1/32 of a pill, no lie).
I jumped off at 8mg and MY GOD it was bad. Keep posting here and follow what works for other people.


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PostPosted: Tue Feb 02, 2010 12:26 pm 
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re: 24mg is too high. My understanding is that the administering doctor is supposed to estimate a little low the dose of Suboxon based on your reported use, and then increase if necessary based on your response to the initial dose, and then monitor you daily until your dose has settled out. In my case I was given 16mg initially, and then the next day I was given another 8mg for a total of 24 because I was still experiencing withdrawals. I'm not entirely sure what my daily use was at the time. I was shoveling oxycodone, hyrdocodone and tramadol into my body using different methods, in addition to other opiates I could get my hands on. I told my doctor I needed about 250mg of Oxy a day to keep from getting sick, but I had noticed that last week that it was taking me a lot more to get high, so I think I had actually been taking more of late. My point is, 24 is appropriate if 24 is appropriate. I would definitely take the minimum amount it took to feel OK, and start tapering down as soon as you feel OK. Not sure what people are preaching around here, but it seems to me that after you've gone a week to 10 days, you can taper down to 2 - 8mg pretty easily, and then you can choose to either stay at a maintenance dose or start tapering to get off Sub depending on your situation.


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PostPosted: Tue Feb 02, 2010 12:37 pm 
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I dont want to get into a debate, because Im sure there are cases where 24mg is necessary, but I read studies on suboxone inductions with hundreds of patients and the max induction dose that it took for any of them to be stabilized was 12mg. I dont have a link to it, but I can try and find it. The doctors thoughts were something along the lines of that some of the patients FELT like they needed more, but that was only because of their addictive brains and habbits.
Im not argueing that some people may need 24mg, just saying what I read.


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PostPosted: Tue Feb 02, 2010 1:11 pm 
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I would not use that "information" to try to coerce someone into doing something like taking less than necessary to feel OK that might make them fail in the transition from their DOC to Suboxone. Without having access to the complete details of the study there is no way to evaluate whether it even applies to current topic. The people in the study might not have included people who were on higher doses of opiates. There's all kinds of other factors in the study that could be pertinent. Without a reference, you could even be remembering it wrong. I very well remember my withdrawal day and induction days.


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PostPosted: Tue Feb 02, 2010 2:44 pm 
Oh please......Puellapea didn't come across as if she was "coercing" anyone to do anything! She's certainly allowed to have an opinion, as is everyone else. If she recalled something she read and wanted to throw her 2 cents in based upon that and her own experiences, she's more than welcome to.
I'm pretty sure we all have the right to have and give an opinion here as long as we keep in line with the rules of posting that Dr. Junig has in place. No one should present their opinion or advice as if they're a doctor or an expert unless they are one, obviously. Honestly I don't see that happening here (not often anyway)
Everyone is different and dosing regimens will differ based upon that fact. What works for one may not work for another. That's why we pay a doctor to prescribe our Suboxone and decide on the proper dose!
I think most everyone here will agree with me on this one:
The reason I reply to posters here and try to answer their questions and/or 'give advice' for what it's worth, is twofold.
1) I think it's so important for us to have a support network. Sharing back and forth on this forum is very valuable in that regard. We can all help each other by sharing.
2) To be of some help in providing information to people, thereby empowering them to be their own advocate.

We educate each other by telling of our own experiences, telling about things we've read or learned elsewhere, etc. Some people are going to have stronger opinions and reactions than others and that's okay as long as there is respect for one another. Nobody here is better than anybody else and unless you've got an MD or DO or PhD after your name and have done a whole lot of work in the field of addiction or a related area, you're opinion is no more valuable than anyone else's. No advice or opinion given here is intended to replace the advice of your OWN doctor. I'm pretty sure we all know that.
Right?


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PostPosted: Tue Feb 02, 2010 3:31 pm 
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Well said setmefree - we all offer opinions - and they are just that - opinions.


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PostPosted: Tue Feb 02, 2010 4:31 pm 
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PUELLAPEA wrote:
...but I read studies on suboxone inductions with hundreds of patients and the max induction dose that it took for any of them to be stabilized was 12mg.


That's not a statement of an opinion, it's an attempt to put forth the idea that something is a proven fact. If there was a link to the studies I wouldn't have a problem with it. But there's not and too often people say things like this and it turns out they remembered it wrong, or only read a part of it and took something out of context, etc.

I totally agree everyone has a right to their opinion, and everyone here should take everything that is said here as an opinion and do their own research and analysis even if the things that are said are not presented as opinions. We're all just here discussing things related to Suboxone. This is just part of my discussion. My only intent is to try to help out others, and myself. Sometimes that includes pointing out when I think someone is making a mistake. Sometimes that includes someone else pointing out when they think I'm making a mistake. I've yet to ever make one, but I still believe the possibility exists ;)


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