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PostPosted: Mon Feb 21, 2011 4:00 am 
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Would you still be clean?

I'm interested to know as my recovery has been struggling a bit this year, mainly since I've realised that my freaky liver metabolises suboxone extra fast & doesn't offer any blockade...


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PostPosted: Mon Feb 21, 2011 8:18 am 
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Interesting question. You know, my first reaction was that I don't think the blockade has had any effect on my not relapsing. Then I thought about it and looked back. There were times when I remember thinking all those regular addict thoughts - just once, blah blah blah. So I'd have to say in the end that yes, the blockade has helped me to stay off full agonist opiates. It's great that sub stops the withdrawals and cravings, but the whole blocking of full agonists is also very important to the whole process.

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PostPosted: Mon Feb 21, 2011 10:49 am 
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It's an interesting question, no doubt. I think knowing that it blocks the effects of full agonists helps a lot mentally. I don't feel like I'm at risk of using or anything, but sometimes if I am going through a difficult time, or maybe working on something very intense with my therapist, I have had some fleeting thoughts (as Hatmaker just suggested) along the lines of "oh, just a few oxys right now would be nice" BUT, I think, knowing that suboxone would block the effects of those oxys helps to push my thinking back on track, because in reality it would be a waste of time to try to get high while taking this stuff and really if I'm having thoughts about using while on suboxone, then maybe I should be looking at the dose I'm taking.


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PostPosted: Mon Feb 21, 2011 10:59 am 
Junkie said,
".....really if I'm having thoughts about using while on suboxone, then maybe I should be looking at the dose I'm taking."

I've got to agree 100% with that statement. If I'm on the 'right' amount of Sub, I hardly ever think about using. However, I will say too, that knowing I'm 'blocked' is just one more layer of protection against me thinking about doing something I shouldn't. I'm not stupid, therefore, I'm not going to waste my time trying to get any benefit from taking something I know beyond any doubt, will NOT work!

edit: So tearjerker....are you saying that even if you're taking 4mg/day or more of bup, you can still take an agonist and get the full effect? If so....dang, I'm sorry....that would make this whole thing even harder! Could you please tell more about that. (Sorry if you already have and I missed it somehow)


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PostPosted: Mon Feb 21, 2011 11:05 am 
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For me, knowing that Suboxone would block the effects of opiates was a huge reason as to why I didn't use. It was especially important for me to know this about Suboxone during my first few months of treatment because that's when I still wanted to use the most. I knew it would be a complete waste of time, money and running around if I did try to use though. There were several times during my Suboxone use, even though my opiate receptors were full, that I had thoughts of using, but didn't because of the blocking effects.

Tearjerker, in your case, maybe taking your Suboxone more than once per day would help? Just a thought.


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 Post subject: A Cyber Friend
PostPosted: Mon Feb 21, 2011 2:24 pm 
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A women I know of from another recovery forum was the main reason I got on Bupe. She rattled my cage for years to get off the Norcos/Soma that I finally made the call.

Problem is, getting to know her better through e-mail, she still takes her DOC, Percs, every month. She goes off the Sub and uses up her month supply of Percs in less than a week. Yes, I am afraid for her life, but she's in PA and I'm in Ca.

Next time we chat I'll have to ask how long she goes off the Bupe before taking the Percs. If my memory serves me correctly, she said the Bupe had no effect on her ability to get high on it and she never mentioned any lapse of dose before taking her DOC. Does that make any sense? I thought it blocked the effect of opiates.

I think I'll call her tonight and find out.


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 Post subject: buprenorphine blocking
PostPosted: Tue Feb 22, 2011 12:55 am 
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When I first got on sub it was presented to me by the doctor as a medication that would block opioids. At first it made me feel high and I had no cravings at all for my DOC (heroin). And I just assumed it would work to block heroin so I never (at first) thought to try using while on sub. I was surprised when I told a friend of mine that I was taking sub to block opioids and he said "well, have you tried to use anyway yet? Everyone always has to try anyway!" I told him NO, because I had no cravings for my DOC at that time and also the sub was making me feel high. After some time I finally adjusted to the sub and it stopped making me feel high. Then...cravings for my DOC started coming back. And also...I talked with the person I could get my DOC from and he said he had heard that it was the naloxone that blocked any other opioids and that the naloxone actually would only last a few hours, maybe 6 hours or so. Now I know that actually the naloxone is inactive when sub is taken sublingually...but anyway, I did try doing heroin while on sub. Sometimes i could feel the heroin but in general relapsing while on sub has been a dissatisfying waste of money. And the blocking effect of the sub does seem to last a long time. Basically i can't ever seem to get any of the desirable effects from my DOC, only the undesirable ones. So yeah, the blocking effect of sub is really important to me. I have thought about trying naltrexone, because I think it might do a better job of blocking opioids than bupe. Because the sub was making me feel high when I first started taking it, I asked my doctor, well, couldn't I just get the opioid-blocking part of the medicine, the naloxone, without the buprenorphine? She said ok, and called in a prescription for naltrexone. Which was confusing, since i had specifically asked about naloxone. I didn't really know what either naloxone or naltrexone was at that time.

But the thing about bupe is that it really CAN help with cravings. Although, unfortunately, my doctor doens't seem to know about this. she says there are 2 different reasons to use suboxoone--one is to keep addicts out of withdrawal while they detox from their DOC--my doctor says she's done this many times with heroin addicts in about 4 days. However, she never actaully explained to me how to use sub for a short term taper. Anyway, according to my doctor the second reason to use sub is on a maintenence program to keep addicts from using their DOC by blocking the effects of the DOC. But if sub only BLOCKS opioids, why not just use naltrexone instead? That's what I dont' understand. Since naltrexone does not cause dependency from longterm use like sub does, wouldn't that make it more desirable?. I think the truth is that the buprenorphine in the sub DOES help quell cravings. I STILL can't seem to get my dose exactly right, but what I have found is that if I take the right amount of sub I finally will forget all about craving for the rest of the day. But I'm STILL not certain what the right dose is and I'm still trying to take as little sub as possible. The problem with only taking a low dose of sub (I'm talking 1 to 2 mgs) is that it seems like the sub doesn't block other opioids as well at a low dose AND it doesnt' help cravings as much.

So, I actually have an entire bottle of naltrexone that I've never used. Never even took one pill. Frankly, I'm afraid to. I actually wonder if I would be better off on the naltrexone, as long as I took it ever day. My doctor seemed disappointed when I told her I didn't want to use the naltrexone after all and wanted to stick with sub. She didnt' understand why either...I told her, well, the naltrexone won't work if I dont' take it, and I think I just won't take it and will use my DOC instead if I can get it. Another thing, btw, my doctor has to this day NEVER discussed, not even MENTIONED at all EVER even a single word about precipitated withdrawal. Not in regard to sub OR naltrexone. She must know about precipitated withdrawal..but she never gave me any instructions for either sub or naltrexone regarding how long to wait after last dose of DOC or anything like that. I was just today reading a thread about people using naltrexone to help them detox and everyone says precipitated withdrawal is absolutely hellish. So...I'm afraid to try the naltrexone, although, like I said,
I am wondering if maybe it would be a better maintenence medication for me than sub is...but I'd have to really take it every day, or at least, take it when my DOC might be available. And I guess the main problem with naltrexone has been that a lot of patients tend to just stop taking it.

Also, if anyone is reading this who has experience with precipitated withdrawal, either from sub or naltrexone (but i'm particularly interested in the naltrexone experiences), even though I certainly believe everything Iv'e read about how it is a hellish experience I still don't clearly understand what makes it so much worse than regular withdrawal. Can anyone clarify that, specifically? I read people describing it as days or weeks of withdrawal packed into a matter of hours, but I don't understand what that means. Is it that it is like the absolute WORST and most violent of possible withdrawal symptoms hit you continuously for several hours? I do understand the severity of the symptoms will depend on when you last used an opioid and, I would assume, also depend on how MUCH of whatever opioid you normally take, but anyway, the terrible symptoms of PW would be, something like this?--- explosive diarrhea and vomiting and drenched in sweat, hot and cold flashes, hideous depression and cravings and wanting to die and also entire body aches, also, a shooting tingling through your body and possibly also involuntary jerking of your legs and on top of all that there is zero possiblity of being able to sleep? My other question is how long do the effects of PW from naltrexone last? I did see a very informative post on another thread but I'm still unclear because that person talked about taking a second and third dose of the naltrexone after a certain number of hours. What happens if you take only one dose of naltrexone and you get PW? I take it that the naltrexone wears off within a matter of hours (like 6 or 8 hours?) so...does that mean that PW from naltrexone only lasts about that long? But if you only take one dose....then the PW will end but then you'll be back to regular withdrawal from your original DOC? And as for PW from sub....does PW last longer if it's from sub because the effects of sub last so long? But in either case, whether from sub or naltrexone, what happens once the dose on antagonist wears off? The PW is over but you're still in teh early stages of opioid withdrawal? Or does it give you some sort of "head start" like I guess is the idea with "rapid detox"?

Anyway, if anyone has any PW experiences to share taht might help clarify my confusion about exactly how PW works, I'd appreciate the info.

Sorry to get off topic there, as for the blocking effects of sub...for me that is an absolutely crucial part of the medication....but the quelling of cravings is probably even more important.


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PostPosted: Tue Feb 22, 2011 5:55 am 
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setmefree wrote:
edit: So tearjerker....are you saying that even if you're taking 4mg/day or more of bup, you can still take an agonist and get the full effect? If so....dang, I'm sorry....that would make this whole thing even harder! Could you please tell more about that. (Sorry if you already have and I missed it somehow)


There's been a lot to read in this thread.

Setmefree, yes, that's pretty much the case. At the moment I'm taking 8mg of suboxone per day, 4mg morning and 4mg at night. Here's the interesting fact. In the past when I've been on subutex / suboxone, 4mg has easily offered a full 24 hour blockade. Taking my drug of choice before 24 hours post dose would be a complete waste of money and time, and usually leave me just hating myself for trying.

However, since I've been on sodium valproate (depakote / epilim) treatment for my bipolar, it seems I metabolise suboxone a helluva lot faster than I once did. Before I didn't need to split my doses, now if I don't the subox doesn't hold me 12 hours. If I have my 4mg at 9am, if I've used at 5pm or 6pm in the afternoon I still get a near enough to full effect from my use. In the periods I've also been on an SSRI / SNRI (cymbalta / effexor / pristiq), I've found that I have even less blockade effect, and I can pretty much use within 4-hours post suboxone dose and still get the same effect.

My prescribing doc said I'm probably an ultra-fast metaboliser, and epilim / antidepressants activate certain liver enzymes (CYP2D6?) to the extreme point where suboxone just aint as effective as it should be.

Dang! Still, it beats methadone.

Autononymous, a typed about my experiences with PW in here - http://suboxforum.com/viewtopic.php?t=214


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PostPosted: Thu Feb 24, 2011 8:01 am 
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autononymous wrote:
I am wondering if maybe it would be a better maintenence medication for me than sub is...but I'd have to really take it every day, or at least, take it when my DOC might be available. And I guess the main problem with naltrexone has been that a lot of patients tend to just stop taking it.



Naltrexone, which is generally marketed as "Vivitrol" does nothing to stimulate any of the receptors in your brain that are stimulated by suboxone or methadone or full agonist opiates. Thus, in my view, it is not a very good alternative for "maintenance" at all. It's also got a much, much shorter half-life than most drugs used for maintenance, which makes it ridiculously easy to stop taking and then relapse.

I had this discussion with my doctor last year and he was willing to put me on it once I tapered off suboxone, but with my history of chronic relapse we both decided it was a better idea for me to find the lowest effective dose of suboxone (which is turning out to be about 6mg it seems) and just maintain there.


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 Post subject: PWD with naltrexone
PostPosted: Thu Feb 24, 2011 11:24 am 
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Autonymous,
You asked if anyone had an experience with pwd after naltrexone.
I have but not while on Sub. Many years ago while I was inpt for Vicodin detox (I had been using about 20 ES/day at that time) I told my psychiatrist/addiction dr that I was willing to do whatever I needed to stay clean this time and that even meant taking naltrexone. (I didn't want to take it before because I felt it made me depressed) We had been talking about my first treatment and how I ended up relapsing after about 4 years clean off of opiates (but I had been drinking during that time). And what I was saying to him was that if he wanted to Rx me Naltrexone after I got out of detox I'd be willing to take it. The other thing I was trying to do was to "follow direction"...and be willing to do things I didn't want to do for my recovery and that included self prescribe.

That night I was given a new pill. I asked what it was and the nurse said naltrexone. I balked a bit...and said "are you sure I should be taking this now, only 2 days into my detox. Won't that cause some trouble?" and he said, NO, the dr ordered it for you to start taking now". I balked again, but I was so sick of trying to take control all the time that I just shrugged my shoulders and took it.

Not long after the worst hell I've ever been in physically began and last for 48 hours...I'd never experienced w/d like that, even off of high dose fentanyl. NEVER. The pain in my stomach, the nausea, vomiting, other gi fun lasted forever it seemed and after the first 16 hours I begged them to let me leave so I could go and use and stop this pwd. I knew what was happening but no one would admit they fucked up. NO ONE and no one would listen to me...I think I slept on the bathroom floor the whole time because there was no point in trying to be in bed with as sick as I was. (thankfully it was a private room) I wanted to die. I was so angry at them and my social worker came to talk to me...like that would help...and I said, "Look, I was doing just fine before he ordered that med so NOW what do I do?" and the social worker begged me to stay and not leave.

Well, they gave me something to try to help the abdominal pain and I think gave me Librium or something....it was not helpful. I had to just endure it. Finally, 2 and 1/2 days later a different psychiatrist came in and started me on Tylox (opiate) and I had to start my detox all over. No one ever admitted to fucking that up...the closest admission was the fact that the new dr gave me Tylox and I never saw the other guy again. What a chicken shit!

So...it's bad. that was why I waited 6 days jumping at 75mg methadone before starting subtuex altho I know I probably could have started it at least by day 3...I was too terrified of ever going through that again...I knew i'd never make it on Sub if I started out in pwd.

and why its so difficult and different? An antagonist kicks off all the opiates that are on the receptors....all at once. and then your brain screams for the normalcy of opiates...tapering gives your body a chance to adjust and the receptors to regulate. But that isn't even pleasant most of the time....PWD, however, is the worst physical pain I've ever been in. I'd rather have three babies back to back without epidural then go through that again.


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PostPosted: Thu Feb 24, 2011 2:38 pm 
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Thanks for the info you guys. One last thing I don't understand about naltrexone and PW though--If you're in PW because of naltrexone....if you take and opiate, won't it be blocked by the naltrexone and therefore have no effect on the PW symptoms? and would that be true of PW caiused by buprenorphine too? Can anyone explain exactly how this works? I'm just wondering about what Chinagirl said about being prescribed an opiate when she had PW.


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PostPosted: Sat Feb 26, 2011 11:55 am 
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autononymous wrote:
Thanks for the info you guys. One last thing I don't understand about naltrexone and PW though--If you're in PW because of naltrexone....if you take and opiate, won't it be blocked by the naltrexone and therefore have no effect on the PW symptoms? and would that be true of PW caiused by buprenorphine too? Can anyone explain exactly how this works? I'm just wondering about what Chinagirl said about being prescribed an opiate when she had PW.


PW caused by naltrexone feels a lot worse than that of buprenorphine, because naltrexone has no partial-agonist properties.

Yes, correct re taking an opiate in PW. It will have no effect, hence why they treat PW with benzos & ibuprofen. However, if you take ENOUGH of any opiate, you can saturate the synapse enough that you can override the naltrexone / buprenorphine. Some opiates work better too for this like fentanyl. This, however is dangerous as your breathing is suppressed by opiates even when the high is being blocked, so you can stop breathing.


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PostPosted: Sun Mar 13, 2011 2:09 pm 
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I would have to also say that the blocker has helped me stay clean. I have had some really bad days and wanted to give and just take one 80. But I knew that it would be a complete waste of money and I would not get shit off it.

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PostPosted: Sun Mar 13, 2011 2:44 pm 
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Hi Sphinx,

I'm glad you were able to overcome your bad days. Suboxone did much the same for me, if I did have a moment of weakness, I knew it would be completely useless to go out and get an 80.

Glad to hear you're doing well.


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