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PostPosted: Mon Oct 25, 2010 10:32 am 
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Hi - I've been posting about my experiences using Subutex to withdraw from 5 years of opiate pain medication treatment. I am a chronic pain patient who for years was able to "control" my Norco prescription and treat my pain. However starting about 6 or so months ago I started to build a tolerance to the medication, increased my doses (with my doctor's permission), but basically "lost control" - by this I mean I was struggling to lower my dose and when I would increase my dose I was not getting the same pain control I used to get when I increased my dose. I was also having all the awful side effects that come with opiate treatment (constipation, ups and downs, etc.) The only solution presented to me by my pain doc (who is considered to be very good) was to "just taper" and try to spend some time at lower doses to reduce my tolerance or to keep increasing my doses. I felt out of options.

So I went to see an addiction psychiatrist, which was a big step for me. I am glad I did it because in 26 days later I am down to .25mg of Subutex and feeling pretty good. As I've discussed on my last thread, I realize the jury is still out about whether or not I am truly doing well or if PAWS will rear its ugly head when my Sub taper is finished. Also if I will be able to tolerate my chronic pain condition without some form of opiates. I won't bog down this thread with that discussion.

But what I am wondering on this thread is why pain doctors don't also use Sub as a tool to help their patients take a break from full agonists? It's my understanding that it used to be common practice for pain docs to force their patients off their pain meds for a month or so to reduce their tolerance. They only somewhat recently stopped that practice. Why not re-start that concept using Sub as a tool to do it. It provides some (if not complete) pain control and (at least for me) was truly easy to do. I've really suffered very minimal disruption to my life thus far in my taper.

But alas, that doesn't seem to be the view of Sub. I get the impression from my doctors that Sub is either an addiction maintenance or detox tool or it's sometimes a pain management tool. But it's not a tool to help a chronic pain patient regain control of their pain medication that used to provide an immense benefit, but predictably stopped over time as tolerance built up. It all seems very black and white. Your either a pain patient who can taper on your own or you're an addict and you need to get off opiates and here is a sub - a tool to help you do it.

I don't know - I wonder if there is another option here for those of us who suffer from pain but (what should be predictably) run into trouble with pain meds should enough time go by.


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PostPosted: Mon Oct 25, 2010 12:35 pm 
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Hey i know what you are going threw. i was on a very high dose of oxys for 4 years at a 160mgs a day for a serious knee injury. anyways i know what you mean by maybe useing sub to lower tolerance then go back on pain meds. but lets be realistic hear that would just be a huge set back. i guess they stopped this because it defeats the purpose of suboxone/Subutext they use it for pain management for long term in most cases. causes i could live a life on sub vs when i was on oxy all i cared about was oxy an getting high from my meds. while the suboxone takes my pain away an im not getting high but im getting pain relief which is the true goal hear. At the end of the day you would be much better off staying on sub then going back to painkillers for your injurys. i mean just look at the last i think you said 26 days havent you enjoyed not being controlled by norcos an now you can be aware of whats going on around you an get back to doing the things you love with out being high doing them. an i understand when i say being high when your perscribed pain meds is not the purpose but i can tell you my oxy dose was way to to much an all it did after a while was get me so numb that nothing hurt but really my life was falling apart.


all im trying to say is they stopped that cause it truely defeats the true goal of this medication!


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PostPosted: Mon Oct 25, 2010 3:03 pm 
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This is my take and I must say straight away that I'm no doctor. Suboxone wouldn't really be a good way to lower one's tolerance to full agonist opiates for one huge reason: IT RAISES OUR TOLERANCE! That's why when sub patients need acute pain relief it's so hard to get any of them to work. Some people have described being off sub for up to a month and still having a very high tolerance to ALL OPIATES. Suboxone may be a partial agonist and work differently from "regular" pain meds, but to the brain an opiate is an opiate is an opiate. Suboxone indeed raises our tolerance levels, so going on it from regular pain meds to reduce tolerance simply wouldn't work. At least that's how I see it.

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PostPosted: Mon Oct 25, 2010 3:30 pm 
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Beat me to it, Hatmaker, that's the first thing I thought too. The idea, in theory, would be good, except for the fact that bupe tends to raise tolerance.....the only sure-fire way I know of to lower tolerance is to CEASE using all opiates completely. The longer you don't use them, the lower your tolerance will get.


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PostPosted: Mon Oct 25, 2010 3:31 pm 
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Bboy - you mean pain doctors used to do this but stopped? I didn't know that.

Hatmaker that makes sense. I didn't realize that even once you've stopped Sub you remain tolerant to full agonists for a while. That would indeed make it impractical.

My goal remains to get off all narcotics (including Sub) and manage my pain through other means. I will give that at least 6 months to succeed once I'm off Sub. If not I'll move back to Sub if the pain is too heavy. Then I'll move back to full agonists if the pain is still too heavy. It's just too bad. I know that my pain can be managed between 40-60 MGs of Norco. And for a good long while I was able to keep control of that dose. it's too bad there isn't a good tool for pain patients to lower their doses more comfortably once tolerance,dependence, and dose increases invariably kick-in.


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PostPosted: Mon Oct 25, 2010 3:42 pm 
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I think you have a good plan in place, Matt - to wait six months, see how your pain level is and reassess then. Because you're right, you can always go back on sub if need be.

I suffer chronic pain too. But I couldn't handle my pain med use....I was full on addicted. So I take sub for my addiction, but also to management my pain. I take muscle relaxers with the sub, and other than acute situations, I'll never be able to treat my chronic pain with "regular"/full agonist pain meds again. It's just too dangerous for me.

I hope things work out well for you. Keep us posted.

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