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PostPosted: Wed Apr 21, 2010 2:14 pm 
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My experience as a doctor in recovery is that I will not put anyone on Suboxone longer than 3 weeks. This is not to say that there are not people who require longer treatment; however, I have found Suboxone and Subutex are the hardest detoxes of any of the detoxes I perform. I have success with these detoxes, but they take months and are difficult.


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PostPosted: Wed Apr 21, 2010 9:06 pm 
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Welcome Dremland
I obviously believe in long term maintenance of suboxone because I beleive it gives me the time to work on my self without having cravings and withdrawl. How long have you been subscribing suboxone/subutex? Out of the all the patients you have prescribed (if you could give us an idea) do you know how many are still sober? Based on the research that I have done and the experiences shared on this site is that although some have a hard time with detoxing others have done ok with a slow taper. The Dr that runs this site is obviously an advocate of long term use and has asked that anyone that has taken suboxone/subutex and sucessfully tapered and has not relapsed in 5 years to share their experience. I recently had to find a new sub doc because I was moving to a new state and I found that out of about 20 doctors there was about 5 that beleived in your theory. I am not arguing with you about this I am curious to know what has the success rate been like for those that have only been on it for 3 weeks then had to get off.........What was the relapse rate or even death rate. I look forward to hearing more from you and your experiences if you can share them with us. As you will find most of us on here are pro sub and go to therapy or 12 step programs in adddition to using this medicine so we are always interested in what our doctors think. For me if I only took this mediicine for 3 weeks I would probably relaps because before suboxone all I did was think about getting opiates....doctor shopping..scheming up something to get opiates and I am an executive with a Fortune 50 company. I just know that I have been on this program (now subutex) for 12 months and my life is so much better today. I attend AA 4 to 5 times a week...breakfast meetings on the weekend and therapy with a counselor once a month. So I would really be interested to see how your patients are doing now that they are off the sub.......anyway welcome to the forum we are always glad to have a new member. Thanks.

Jim.


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PostPosted: Wed Apr 21, 2010 9:52 pm 
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As people here know, I do not agree with the idea of 3 weeks on Suboxone-- accept perhaps as a stepping stone into long-term residential treatment. We now know that short-term use of buprenorphine has no utility for long-term treatment of addiction, and of course why would it?

What you are saying, esentially, is that you do not prescribe buprenorphine. I cannot imagine any reason to prescribe it if you are using for less than six months, since we know that use shorter than 6 months is followed by a relapse rate of over 90%. So why use it at all, if you are only going to pull the rug out from under the person?

I also strongly disagree with your comments about detox, and wonder how many patients you have treated. I have started buprenorphine on about 450 patients over 5 years of practice, and have 100 patients on it now, most of whom who have taken it for a number of months or years. I have helped a number of people stop buprenorphine and have found it to be MUCH easier than stopping an agonist; not even on the same page. People already know what stopping an agonist is like; most people cannot walk, cannot eat, and cannot even consider sitting at a computer and typing an e-mail. On the other hand most people who stop buprenorphine continue to go to work the whole time, or take at most a day or two off. They sit at the computer, typing out long stories about how horrible they are feeling... while the person withdrawing from an agonist is in bed, wrapped in sheets to keep the legs from kicking, and jumping up now and then only to race to the toilet. Anyone who has been through detox knows what it is like.

The main thing wrong about the statement that bupe w/d is worse than agonist w/d is that anyone who works with addicts knows full well that people DO NOT TAPER OFF AGONISTS, AND THEY DO TAPER OFF BUPRENORPHINE-- SOMETIMES. That is the strongest argument about 'which w/d is worse'. How many people reading this thread were able to taper of oxycodone? Or methadone? How many?

This thread will likely scare some people; I ask that those people keep in mind what else they have heard; that 'people on buprenorphine are stoned all the time', for example. People on buprenorphine know how true THAT is; I consider the statements about bupe w/d to be along the same line. I've seen quite a bit-- and I have not seen anything like what the originator of this thread is describing.


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PostPosted: Wed Apr 21, 2010 11:38 pm 
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<b>dremland</b> Welcome

Dr. Junig expressed quite eloquently my own thoughts regarding your approach to treating addiction with buprenorphine. I sincerely hope that you reconsider your position... if not, I have little doubt that you will have some dead patients on your hands.

Why in heavens name would you prescribe Suboxone to a patient that is addicted to a full agonist when you feel that it is a more addictive medication? Surely you realize that after only three weeks of treatment an individual has not had enough time out of 'survival mode' to have changed their basic behavior concerning their drug of choice. What makes you think that when you cut the patient off from their Suboxone that they won't experience the same exact withdrawal symptoms and long lasting PAWS that they would have anyway from chronic use of their perferred opiod? How do you expect someone who has never had a sober week in their adult life to be 'cured' after three weeks of treatment? Don't you think someone like that would be better served with long term suboxone treatment?

As a career corrections officer, I have personally witnessed thousands of people go 'cold turkey' from just about every opiate there is. I've spoken at length to so many of these people, and I have never heard one say that withdrawal from buprenorphine was worse than that of heroin, morphine, methadone, oxycodone, or any other full agonist - it just isn't so. If anyone did in fact tell you that, it's because some people often think that their last detox was the hardest, even if it is relatively mild compaired to what they have been through in the past. I have attemped sobriety from long term oxycontin/morphine addiction and from suboxone - they are not even in the same league my friend.

Please spend at least a few days reading through the different topics in this forum. This is the cream de la creme of Suboxone sites - there is no better on the web. Please reconsider your approach - peoples lives are at stake.


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PostPosted: Thu Apr 22, 2010 1:53 am 
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I bet you guys this isn't even a real dr just someone trying to get us all wild up. this is hands down the best sub site on the net and people from the outside don't like it. There would be a lot less dead addicts out there if people weren't so ignorant to the fact that long term sub treatment works better then any other method.


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PostPosted: Thu Apr 22, 2010 2:04 am 
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dremland,

Boy, I'm really glad that you were not my psychiatrist. I was in no way ready to stop Suboxone 3 weeks into my treatment. I was still a mess and was not physically or mentally prepared to go through withdrawal and PAWS.

My doctor was fairly relaxed, play it by ear, kind of guy regarding the length of time on Suboxone. My insurance only covered it for 1 year, but I was prepared to pay after that if needed.

Long story short, I spent my time on Suboxone working hard on my recovery, identifying relapse triggers and making plans and developing skills to counter those triggers, building healthy relationships, cultivating coping skills, working on my physical health, and getting a social life that didn't involve drugs.

I went back to school, finished my Associates degree and started a program to become a Chemical Dependency counselor. I worked at my job and participated in my family life.

All told, I was on Sub for 22 months. My doctor hadn't really tapered a lot of patients off Suboxone, so I found help here and figured out a way to taper off my medication with almost no adverse side effects. My withdrawal was mild and short, and all the skills I learned during my time on Sub were put to use to get me through the process. If you care to read about it, check out the Liquified Suboxone Taper topic in Stopping Suboxone.

Eight months off Sub I'm still working and going to school full time. My life is good, and I spend time here to try to give back some of the help that was given to me during my time on Sub. I'm so glad I had an open-minded doctor and the resource of this forum.

I think dremland, that if Suboxone and Subutex are the most difficult detoxes you preform, you are most certainly DOING IT WRONG. I tried to detox of OC and dilaudid and compared to that, Suboxone withdrawal is a trip to Disneyland.

_________________
You can't stop the waves, but you can learn to surf.

-Jack Kornfield


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PostPosted: Thu Apr 22, 2010 8:27 am 
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Dremland,

Thanks for posting. It has been suggested that you may not be a doctor and just someone coming on here to yank our chain and get us annoyed. Regardless, I am always glad when someone posts something like this because it keeps a thread alive that people come and read and then they can get the REAL TRUTH about suboxone from the rest of us. Hopefully, it saves someone's life who decides to find a new doctor who believes in longer term suboxone, or an addict decides to try suboxone because maybe it isn't as bad as everyone says, etc.

I can say from personal experience that suboxone withdrawal is NOT the worst out there. I have done 2 weeks (best case as it could have been 1 week) of oxycontin withdrawal coming off about 280mg per day and I have done 3 months of suboxone withdrawal coming off 12mg per day and can honestly say Dr. Junig is totally correct in that I used to miss days and days of work when I was in oxycontin withdrawal and only missed 1/2 day of work for the suboxone withdrawal and that was because my power was out and I needed to go to the ER to get some comfort meds anyways. I could have gone to the ER on Sunday but I kept waiting it out to see if it would just go away and get better. I left the ER, filled my scripts, fixed my hair and makeup, and went to work; something that was NOT possible in oxycontin withdrawal.

I posted on another thread yesterday and when I map out the symptoms from oxycontin versus suboxone withdrawal I will say I had about 50% of the symptoms I had with oxycontin withdrawal. The symptoms I did have all seemed to be treatable with some other pill like clonidine, ativan, trazadone, and immodium. I don't know if there is a pill for the hot/cold sweats, yawning, watery eyes, vomitting I had with oxycontin withdrawal. Also, in my opinion, it is the hot/cold sweats and vomiting that are the most debilitating.

I see no point in 3 weeks of suboxone. I am grateful for my long term suboxone and have a wonderful life that I LIVE every day without the obsession of opiates on my mind.

Cherie


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 Post subject: Withdrawal from Suboxone
PostPosted: Thu Apr 22, 2010 12:37 pm 
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Hey all..I'm actually at work so I'm going to make this quick... I actually just left my Psychiatrist whom prescribes me Suboxone. I asked him how he actually handles tapering patients off Suboxone. He basically told me it obviously depends on how much his patient is taking but he generally tapers them over several months. I asked him do you prescribe anything for the withdrawals of Suboxone. He then told me there is no need to as he has never had anyone complain of the withdrawals from Suboxone. (Obviously this is just MY doctor’s experience with his patients) He said they are minimal and not even close to a full agonist. He has been prescribing Suboxone for years now and fully believes in long term treatment. Just figured I'd throw that out there from a doctor that actually prescribes Suboxone long term.


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PostPosted: Fri Apr 23, 2010 6:22 pm 
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It's actually astonishing how much bad information is out there, even among medical professionals.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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