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PostPosted: Tue Jan 03, 2017 6:28 am 
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So, I'm only 5 weeks pregnant and tapered quite dramatically prior to getting pregnant (from 12mg down to 0.5mg over a year or so).
When I found out I was pregnant I changed from suboxone to subutex and have already increased my dose to 0.6mg as 0.5 wasn't holding me.
I've heard it's common for pregnant women to require a dose increase in the thiird trimester but what abut in the first trimester? Or is it just the change from suboxone to subutex?
I was really hoping to just stay stable while pregnant and don't want to increase my dose but I also don't like the idea of feeling w/d symptoms as I am concerned about miscarriage, especially as it is my first pregnancy and I'm in my 40s!
I am willing to increase my dose a bit if necessary and, as I am in Australia, that's not an issue with the doctor - he will give me whatever dose I ask for but I don't want to if I don't have to as I'm eager to get off it altogether ASAP.

Any ideas?


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PostPosted: Tue Jan 03, 2017 1:23 pm 
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Hi Vegemite, Welcome! I am so sorry that I don't have experience in this area but I am sure someone will come along who can offer you some advice. I just wanted to welcome you and let you know that you have been heard. Enjoy your day and congratulations on the baby! Very exciting!


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PostPosted: Tue Jan 03, 2017 1:35 pm 
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Vegemite u should really read through this Pregnancy and Suboxone section, you'll find information from a lot of women that's went through the journey ur about to go through. Some chose to try to get down as low on their doses as possible, and some had to raise their doses to stay comfortable and out of withdrawal. It's really a personal journey. Personally I had my 3 children before my addiction started, so I can't say either way what's best. But I do think I'd stay on my regular dose instead of trying to taper and make an overwhelming time even more overwhelming. That's just me, I totally support whatever any woman decides to do. Nobody knows what they'd do until going through something like that.

Dr. Junig, founder of this sight and a psychiatrist & suboxone doctor, had provided a link in another thread something about a study done on the amount of buprenorphine a pregnant mother takes, doesn't have that much effect on the baby once it's born. I'll try to find it, I think it's a link in another thread.... that would be an awesome thing for u to read.

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PostPosted: Wed Jan 04, 2017 1:49 am 
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I think it is amazing you have reduced down that far... how did you do it? I realize the experience can be different for everyone, but how did you go from 12 or 0.5 in that amount if time? Did you have a lot of withdraw? I have been at 2/3mg during my pregnancy and am at the end if it and feel crappy at that dose. I had trouble reducing before i was pregnant too... working out was helping though. Did you so anything in particular to help you reduce down?


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PostPosted: Wed Jan 04, 2017 4:33 pm 
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I reduced by tiny little bits at a time! I was on suboxone film and cut it into pieces. I've been laughed at for how small my reductions are but it really works. I can't cope with big reductions! I actually got off methadone altogether a few years ago in the same way but my horrible controlling ex started buying me heroin because he wanted me addicted so I'd buy it for him! As a result I ended up back on this stuff. I'm so keen to get back off it! That's why I don't want to go up to much during my pregnancy!
I've read a few studies and things but mostly I'm just relieved my doctor isn't like the ones in America! It means I'm able to stockpile a lot too and get prescribed the dose most suitable for me. I get really sad when I read the stories of doctors trying to get pregnant women to reduce when the research so clearly shows we shouldn't be reducing!


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PostPosted: Wed Jan 04, 2017 9:02 pm 
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Yeah... i am pretty miserable at the moment. I would say adjust your dose enough so that you don't feel crappy or too strong of cravings. I have been thinking i might need to find an alternate way to get more of my sub then what my doctor will prescribe me. But i can't really afford to buy it on the streets in that amount. But here i am taking 4mg and still not feeling right, and i am only prescribed 3mg. So i am going to run out early again. Unless i can reduce myself down to 3mg then 2mg.but so not up for that this late in the pregnancy.
You do what honestly feels right to you! You got down to 0.5.that is really low! You have room to go up if you really need to.


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PostPosted: Thu Jan 05, 2017 12:17 am 
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There is a lot of research out there saying pregnant women usually have to increase their dose in the third trimester and that NAS is independent of dose so you are not doing more harm to the baby by increasing. In fact, by going through withdrawal, it is worse for the baby.
Why don't you print out the studies (with links) for your doctor and show them?
I went to my doctor today. He told me not to decrease while pregnant and just let him know if I need more.

Here's a quote and hyperlink from the best article I've found on it:

Because of the physiologic changes or psychological stressors of pregnancy, many women required buprenorphine dose increases to control cravings for other opioids during the course of their pregnancy.

http://www.medscape.com/viewarticle/739191_4

It says that on average, pregnant women need to increase their dose by 5.9 mg throughout pregnancy and on average 2.5mg increase in the third trimester


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PostPosted: Thu Jan 05, 2017 1:42 pm 
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Thank you for the article. Both my sob and OB doctors know this information (that studies don't show a link to dose amount and occurrence of NAS, and that dosage increase in pregnancy is often needed). But they both firmly believe a lower dose decreases the overall risks. And they don't want to prescribe me a higher suboxone dose if a medication for depression is what i actually need. So that has to somehow be figured out...except I am still firmly taking 4mg a day, not 3mg as prescribed. So i don't know how he is going to handle me now. Seriously making me feel like I relapsed or something, when i just feel like i need a higher dose.


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PostPosted: Thu Jan 05, 2017 4:12 pm 
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Your doctors are effing idiots!!! If I lived near you I would go to their offices and bitchslap them up their heads!

I hope that the doula gets in touch with you very soon! Her level of expertise should help calm your fears and provide you more specific answers to your questions. She is your best bet at this point. I'm still wishing you the absolute best. She may have suggestions for a different doctor too.

Amy

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PostPosted: Fri Jan 06, 2017 2:33 am 
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Hi Amy,
I talked to her tonight. She does not agree with the lower dose and wants to speak with my doctor. My OB,when i told him about her and that i wanted to see her, for some reason said that my sub doctor wouldn't find much stock in what she had to say, but if i see a physciatrist and he or she could pinpoint what is withdraw and what isn't, then that would be better. They tried to get me in with this one physciatrist that i didn't see anything about treating addiction or pregnant women on his site. I would think you find more validity in someone who has worked closely with a particular population of people, and therefore has more first hand knowledge and experience. Just because someone has a higher degree doesn't mean they know everything. She is going to advocate for a higher dose, but what worries me a bit is that she still thinks i should have been switched to subutex, which many seem to think this but both my docs have said the suboxone is fine, that no added risk has been found with the naloxone. It worried me that she reacted strongly to me still being on suboxone and not straight subutex. I worry if she says that to my doc it will undermine her in his eyes. Why do some people think naloxone is an issue and others dont?


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PostPosted: Fri Jan 06, 2017 10:14 am 
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Oh my goodness!! Finally!! I am soo happy you spoke with her!!! I am soo happy she is going to speak to your doctor. I've read some of Dr.J's posts about Subutex Vs. Suboxone in pregnant women. Most prescribe Subutex to pregnant women just because the Naloxone is an extra medication. So instead of taking 2 medications, one is better. That is the only reason. Suboxone isn't bad for pregnant women.


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PostPosted: Fri Jan 06, 2017 1:52 pm 
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Agree w Htown. Also, have your doula understand Dr J's articles before making an issue of changing you from suboxone to plain generic buprenorphine aka Subutex, a brand name that no longer exists. its now generic buprenorphine. Your primary goal is to get your dose increased, not add in other unneeded changes that may only irritate and distract your prescribing Dr. Keep your Doula on point, don't allow her to make it 'project creep' where she tries to make too many changes bc then it puts your main goal at risk. Also, just bc preg/addiction is not on a Psyche's website can still mean they are well versed w it. You said they 'tried' to get you in w a psyche dr. Means there is no opening? if so, a thought, you might look up psychiatric addictionologists who might have an immediate opening once they understand your needs.

Can't even begin to tell you how impressed and amazed I am w your strength and courage. And grateful for how hard you are trying. Proud of you. Your story and willingness to keep going in the midst of the pain and angst you are experiencing is inspiring. Its a privilege to read and and be allowed to share in your story. Wishing you my best, P

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PostPosted: Fri Jan 06, 2017 3:35 pm 
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Thank you HTOWN and Pelican!
I am going to email her and ask that she not bring up the naloxone component for the reasons of it distracting from the main objective.
The physciatrist they found is the only one covered by my insurance in the area (which nikki said she has been trying to get covered by them and keeps getting rejected. This new insurance my company switched to is bull shit! At least i have something though). But he is taking a 6 week leave and then not excepting new patient's. And i know he could have experience working with people like me, but i would like to see someone who reaches out to people like me in particular. Like "hi,i am here and i can help".
And that was really nice what said Pelican. I have been feeling like i am being week for not continueing to struggle through with the lower dose. And feel i have lost all my strength. Yesterday in particular i took 8mg throughout the day. i think i was actually feeling exhaustion from the remaining cold and then it being first full day carting my son back to preschool and daycare and then having to get in 9 hours at work to make up for lost time... but by the time i talked to nikki at 7:30 pm i was able to do so without crying, which i have been tearing up when i talk about anything slightly stressful. I don't like that i used it that way but it sure felt good to not feel like an anxiety riddled ball of teary eyed dispair. Plus i actually bonded with my baby some, stroking and talking to my belly bump without feeling like i was forcing it...oh..and my girlfriend thinks that 4mg is the highest dose i should ever need because that is the dose she has been at since she started suboxone when she got pregnant and she has been on it for over 4 years now. At the 4mg dose (which she doesn't have her own script and i think that is the most she can get unless she gets her own script). She said 4mg is perfect for our weight and height. I wanted to tell her that is not a valid theory, that it has more to do with metabolism and each person is different. But i am not sure if that is correct. I just know that even taking 4mg still feels like a struggle right now. But maybe it wouldnt be if i had the support of my doctor so all this havoc i am experiencing would go away. I just don't agree with my friend though that 4mg is the right dose for both of us. She said she thinks if i take 6mg it is just being used for covering up my depression. She has also always been able to take it once in the morning and be fine all day, whereas if i try that i feel like crap in the evening and have trouble sleeping. I have always needed to split up my dose, which she has repeatedly tried to get me to take once a day. She has all good and loving intentions, but her perspective has made it hard for me to try to explain to her what i am feeling/ experiencing. Even though she could be right...i am not one to think what i think is the only way. I just know what i feel.
So... it is really wonderful having you guys. I have always been discouraged from using these type of forums. I am glad i finally stopped listening to that and reached out.


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PostPosted: Fri Jan 06, 2017 10:01 pm 
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Oh my goodness, finally!! Every time I posted on this thread and tried to encourage you it has seemed like it hasn't made a dent in your depression. Now that you've talked to your doula and have heard the kind and encouraging works of Pelican and Htown you have perked up so much and sound like you have some hope. That is exciting news!

Aren't our regular members here great??? They bring so much experience and compassion to their advice. I think that the could practically run the place by themselves!!

I just can't tell you how good it is to hear an upbeat tone to your voice!

Amy

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PostPosted: Fri Jan 06, 2017 10:31 pm 
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Amy, i really wish i had you up here! I honestly don't know if i would have pushed so hard to help myself if it weren't for you and the others on here. Before i posted here i thought i was messing up and being selfish by taking the higher dose, and just being weak by not just dealing with the discomfort and struggle. You all showed me that what i am feeling is not unreasonable and i feel more able to advocate for myself. I still am wanting to cut myself, so i think that is something seperate. Any stresser comes up and i want to slice my arm...But having this issue with my suboxone certainly is a stressor! I am not saying that getting a higher dose would make me not want to cut anymore,but it would take away a huge stresser.
Heads up..my appointment with my sub doc is on tuesday at 10:30... i will once again have to tell him i am taking more then prescribed. I am nervous of the outcome and am sure i will be on here to tell you all aboit it!


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PostPosted: Fri Jan 06, 2017 11:27 pm 
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I can't express how happy I am that we have bolstered your self confidence and ability to stand up for yourself. I honestly wish I could come up to Washington to help you too! Is there a possibility that your doula could attend the appointment with the OB with you? She most likely has experience with walking the fine line between helping to educate an OB without being arrogant about it.

I am still hoping that you can print out some of Dr. Junig's articles and the one article I found that says that dose doesn't affect outcomes, and bring them in a folder for the doctor to read.

We are always on your side, so don't forget it!!

Amy

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PostPosted: Fri Jan 06, 2017 11:40 pm 
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I don't think she can...i live am hour away. Maybe Skype...i will ask her


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PostPosted: Sat Jan 07, 2017 1:26 am 
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And i feel weird bringing in printed articles...like he has already seen those, but is choosing not to find validation in them. He said at the beginning that after checking with others that 2mg is the safest dose for pregnancy so he obviously has some other source that is more meaningful to him. And it does make sense that dose effects outcome, even though the studies show it doesn't (which is pretty odd). But i think what it comes down to is that i am unable to stay at a lower dose right now. It isn't working for me. I continue to have feeling of withdraw and cravings even at 4mg. I took 5mg today and feel exhausted and achy everywhere. I am sure he will just say that is pregnancy,but it sure feels like the sub isn't doing is job anymore,which ultimately is to make me feel stable so i can focus on my everyday life and not have cravings for opiates...right?


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PostPosted: Sat Jan 07, 2017 2:31 am 
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P&L,

Sigh, I'm sorry you have unkowning professionals. I found nothing on 2 mg as safest... nothing found in pubmed, the past 4 yrs searching... anything past that is outdated, imo.

I did find a VERY interesting article presented at the 36th annual meeting, “The Pregnancy Meeting,” of the Society for Maternal-Fetal Medicine, Atlanta, GA, February 1–6, 2016.

Here it is - an article on bup concentrations end up lower during pregnancy. So you r right. I read it to mean that less bup gets in to you... "Pregnancy can substantially alter drug absorption, distribution, metabolism, and/or elimination, possibly leading to changes in the most effective dose or dosing regimen that should be used in this specific patient population." "This study demonstrates that dose-normalized exposure (AUC0→12) to buprenorphine following sublingual administration was approximately 50% lower during pregnancy compared with the postpartum period" These authors are legit: Dr Bastian was a T-32 scholar at the University of Pittsburgh and was supported by a grant from the National Institutes of Health, Ruth Kirschstein T-32 training grant HD 071859 , and in part by grant 2 P50 DA005605-19 A2 from the National Institutes of Health, National Institute on Drug Abuse. Drug analysis was supported in part by grant HD047905 from the National Institute of Child Health and Human Development.

http://www.ajog.org/article/S0002-9378% ... X/fulltext

Know that YOU are not wrong.

Know that YOU are LEGIT and STRONG and are RIGHT!!!

WOWO. so amazed and inspired -- by YOU!!! Wish I had your strength and courage. So much respect to you.

Either generally or w details, one day you can tell your deeply loved daughter, of how you fought for you and she to be in the best health possible, how you worked INCREDIBLY hard for you and she to lovingly join w each other.

So much respect for you, you mentioned not feeling a mothers love -- well, we can ALL see it, you are just down in the weeds -- where the real work occurs -- but trust us, at the 5000 ft level, we see your love - its there!!

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PostPosted: Sun Jan 08, 2017 12:40 am 
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I hate to call my doctor "unknowing". I really respect my doctor which is why i really tried to live with the lower dose... BUT now i have come to fear him and the power he holds over me. It is good to be regulated and held accountable...i don't mind the constant pee tests or any of that. But dealing with the fear of being cut off or completely forced to the lower dose has brought me to feel resentment and fear. feeling like i will not be able to function adequately at the dose he wants me (3mg), which is why i am not taking that dose (been trying to take 4 and struggling with that...seem to feel more normal at 6mg... though today i am at 8mg, which if i am being honest is because i worked my ass off all day getting stuff ready for baby, had become very agitated and pissy and still needed to prepare dinner and knew an extra dose would keep me from crashing or being a bitch to my family..so i know that wasn't right to take that extra 2mg..i should of just said i have to go to bed,which i have done the past 2 nights! ) But that means i will run out of my med...i wouldn't put myself through this stress if i really didn't feel i can function at the lower dose. If i have to go back down to 3mg i will most likely have to stop working early...which means my time with baby is cut short or i possibly quit my job. I can't continue to function through the pregnancy symptoms plus the withdraw, plus keeping up with my toddler. My husband and son will suffer along with me. I am going to tell him all this and pray he will hear me. I am going to show him the article's and ask that he show me the ones he has found that refute me going to a higher dose.
The things you have all said have made me feel justified and i hope due to that i will be able to speak to him in a more stable voice so he doesn't just think"depression".i can't help but deeply fear he will tell me "either go down, or i can no longer treat you"...but if he does then he is not the caring and compassionate man i thought he was. As i get closer to seeing him i grow more fear...the happiness i began to feel is getting replaced with anxiety and fear. So...i am going to go play marbles with my son and husband and try to be present with them.
Thank you thank you all so much!


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