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PostPosted: Wed Apr 05, 2017 7:40 pm 
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Hi,

I'd previously posted mentioning my pain/suboxone doctor had been in an accident and I couldn't get anyone to cover, and replies were very helpful. I discovered his issue is that he is not covered for liability while on medical leave, and hence was no longer writing scripts. He was surprised the psychiatrist he sent other patients to wouldn't Rx for me. The short reason is, I am medically complicated and he doesn't want to prescribe it with my other medications, but doesn't want the liability of not prescribing it.

Long story short, I tried weaning with cutting the strips and got from 16mgs to 8mgs, but I felt awful with withdrawal. His partner (Who is a pain doc, but doesn't have a suboxone waiver) Rxd MSContin 30mgs every 6 hours to keep me out of withdrawal (We decided to calculate the equivalent dose to 12mgs buprenorphine), and a five day supply of ativan till the bup wore off. But to be blunt, that unleashed the beast, and even every 6 hours, I'm getting withdrawal signs in between the doses, I metabolise opioids very, very fast. I see the doctor again in 8 days. (The office has a very strict policy of not writing any new opioid scripts within 28 days or I'd be back now). My PCP gave me some clonidine 0.1mgs with the pain doc's knowledge for rough spots.

The pain doc who wrote the morphine said if the morphine didn't work out, he could try methadone. But what I read, its a nightmare to get from methadone back to subs in the end.

This doctor is very willing to work with me, and listens to my input. He wouldn't prescribe subutex or suboxone and label it for pain, which was my pharmacist's suggestion, because he is just flat not comfortable prescribing a drug he never has before. I can understand that from his perspective.

Do any of you guys have another suggestion? I was thinking maybe an equivalent dose fentanyl patch every 48 hours because I get into withdrawal very fast after taking those off, but am stable in between times and when my sub doc gets back (within a few months likely), it might be a smoother transition than methadone. This doctor is very sympathetic and willing to help in any way he can short of prescribing the suboxone for pain, and willing to try different opioids. I've called several more sub docs, and none of them are taking new patients.


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PostPosted: Wed Apr 05, 2017 10:14 pm 
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Hey anonvet,

Maybe give this a try to see if you can find a new bup Dr: This is from a poster in January that needed a Dr in a hurry. Here is what Mike_1979 said. "Here is a very helpful website that totally made my day. Hell the DR emailed me 10 minutes after I registered. You simply do a small history of your drug use and they locate the optimal DR in your specified driving range. Very impressed..." https://www.treatmentmatch.org/TM-pat-login-reg.php

IDK on what to say on opiates for you ... Fentanyl isn't as long acting as methadone, but its still long and prior to restarting bup, it takes more time to WD from than short acting opiates.

From Dr J: "About the fentanyl, yes-- it causes precipitated withdrawal for a long time because of the long half-life of fentanyl. Many people think it has a short half-life, but that's because it redistributes into fat cells after peaking in the brain. That pulls it from the blood and brain, and then it takes much longer to be metabolized by the liver. I recommend people stay off fentanyl for a good week before starting buprenorphine."

"Many people who come for induction have used multiple opioids. The one that causes the most discomfort is methadone. Fentanyl can cause problems when used constantly at high doses, for example in people who are using or abusing fentanyl patches every day-- because in those cases the fat stores of the body get saturated with the drug, and elimination relies on metabolism by the liver, which is a slow process."

Thank you for your service. Gosh so sorry this all has come your way. Appreciate it if you will keep us posted... Best, P

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Did well on Suboxone. Stopped May 2011.
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PostPosted: Wed Apr 05, 2017 10:52 pm 
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Thanks for the info. I really appreciate the info, and didn't think about fat redistribution, that's a really good point. I have been signed up with the treatment match site for months. I just live in an area with a lot of demand, and a short supply of sub docs, and most of them have the policy that they give priority to the area that their practice is in. I'm also limited by being on disability and Medicaid.

I decided this afternoon to call round local pharmacies to see if there were docs I didn't know about. I discovered the sub doc (addiction psychiatrist, also boarded in emergency medicine) who took care of me in detox came out of retirement, and was willing to see me, and its still a possibility, but to become his patient, I need to see a therapist in the same office (He works for them so he doesn't get the choice), and there's a waiting list, he told me to call back mid April and he said he expects it to take 3 months but to call daily after mid April, sometimes unexpectedly someone drops out.

He basically told me the problem I'm having with the few doctors who are taking new patients but not me is that I have medical conditions and am on other controlled drugs (phenobarbital for epilepsy is the only non-negotiable one, although it would be a knock to my health to lose the valium, fiorocet and lunesta), and they don't want the liability of accepting me while being on them, and they don't want the liability of telling me I have to stop them.

His thoughts were that the best route forward in the absence of being able to get suboxone, was to have my pain doc prescribe methadone, and at my current morphine dose, I would likely need 10-15 mgs twice a day, which is the threshold for stopping before stopping for sub induction, but emphasised I need whatever I need, and he said if my pain doc needs some hand holding, he would be happy to advise.

He also said when my sub doc comes back, and it comes to inducing on suboxone again, he could admit me for a short period to help ease the transition if I am having trouble coping with it. He suggested the other route was a form of morphine called Avinza, which is designed to be 24 hour release, and shortly before induction, convert the dose to instant release morphine. He said its very expensive though, so he's not sure if it'll be covered.

He advised against the fentanyl patch, he said in his experience people relapse hard when they get on fentanyl and the withdrawals are tougher.


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PostPosted: Thu Apr 06, 2017 9:42 pm 
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Hey anonvet,
Really appreciate the update. Thank you. YOU make complete sense - the Dr that won't prescribe a very safe medication, suboxone or another brand or their generic, doesn't. So sorry this is all so hard. Admire your strength and courage to search for help, ask for help and to keep looking for help.

I'm glad to hear your and your prior Drs reaction to starting fentanyl to keep you covered till your bup Dr resumes his practice. It was my doc and I shuddered to think what it could be like for you.

So I'm reaching here - 1) maybe you could ask Dr J, this site owner, for a letter to your pain Dr to please consider prescribing a buprenorphine product to you and 2) Rule and jennjenn both said words in other posts to folks on medicaid - to consider finding the $$ for a private pay bup dr. I assume you're tight on $$ but in the short run, till your bup Dr gets back to reopening his practice, could you consider a private bup Dr for a short while?
IDK what I'd do but I what I DO know is that I admire you for your efforts! Best, P

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Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Fri Apr 07, 2017 6:53 pm 
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i don't have any answers for you. i was just going to mention that i'm also prescribed a barbiturate. my primary care and MAT doctors are fine with it, pharmacy has no issues, but when I look up my hospital records I have tons of red flags referencing drug interactions between the suboxone and barbiturates. i'm on such a low dose of each but according to their system its a problem. i was hospitalized in oct. and it was like asking for an act of god every time i needed to take suboxone which they kept locked up. i ended up declining them and took pieces of the few I had in my purse that they didn't confiscate! (my purse didn't zip and they made me give them all the visible medication bottles I had with me)
good luck! i hope your doctor recovers soon or his partner grows a set and prescribes you what you need.

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PostPosted: Tue Apr 18, 2017 12:04 am 
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I spoke with my doctor. He said he wasn't comfortable labelling buprenorphine for pain, because I have documented opioid dependency problems. He didn't like the idea of methadone because of it being tough to get off, and contrary to the addiction's psychiatrist's opinion he thought it would be easier to get me off fentanyl and prescribed a fentanyl patch. I'm not delighted, but not a whole lot I can do but wear it.

I can understand his problem with off label prescription of bupe for pain, but it doesn't match up with the significantly more serious thing of prescribing narcotics to someone with known addiction history. C'est la vie I guess.


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PostPosted: Tue Apr 18, 2017 10:43 am 
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anonvet, great to hear an update, thx, was wondering how you are.

Maybe Dr J or docm2 are around? and can better explain or correct my next comments. its not quite the same as an off label prescribing issue. ya, there are weird wonky opioid prescribing laws. Any Dr can prescribe bup for pain diagnosis and that's not an off label use, but only X waiver drs can prescribe for addiction diagnosis. I'm confused on what Dr is treating you now and if he has an X waiver. Also even if they do have the X, its maybe against the opioid rules/laws to switch a a patient's diagnosis from opioid dependency to pain unless pt's truly in opioid dependency remission. Also, some prescription plans will catch the change in diagnosis and not cover bup for that changed diagnosis. Make sense? No of course not and I cannot make any sense of it either. Others??? best to you today! P

PS for the same reasons, methadone is affected as well. can be prescribed by any Dr for pain but not for addiction unless its in a methadone clinic. Make sense -- no ...

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Tue Apr 18, 2017 11:45 am 
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I was addicted to opioids, but have genuine severe pain problems in addition. My original pain doctor has a suboxone waiver, the one who was incapacitated. He decided I'd be a good fit for suboxone and he was right, sometimes prescribing extra pain meds for rough spots (I know theoretically they shouldn't work, but they actually do somewhat.) However, while intentions were good, when he had the accident, other sub docs freaked out I was being prescribed oxycodone and despite me stopping it for 24 hours and handing them the bottle they declined me as a patient. His partner, who is currently seeing me, doesn't have the waiver. He explained when I asked more in depth, he said its just too legally iffy to label it for pain when its been labelled previously officially for opioid dependency. Although he was considering methadone so go figure. He basically says he'll handle me as if I'm a pain patient and do whatever he needs to do to keep me from going into withdrawal, which so far, the fentanyl patch is doing.


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PostPosted: Wed Apr 26, 2017 7:15 pm 
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I called the Medicaid referral line, and found another suboxone doctor who is a family practitioner and ASAM certified. He was irritated I was put on fentanyl and he was not called, he knows the pain management doctor and vice versa, and that he is accepting Medicaid patients. He didn't outright say it, but he implied he thought they were thinking about losing money with him taking over care. He induced me in office today, so far up to 12mg, told me to round it off with the last 4mg strip before bed, then start tomorrow 8mgs BID. He was very understanding of the other controlled drugs I am on (phenobarbital, lunesta, valium) and is fine with me taking them under neurologist guidance so long as I bring the bottles in for pill counts and drug test at every visit. He is seeing me for review in 1 week.

Thanks everyone for the support and replies.


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PostPosted: Wed Apr 26, 2017 7:32 pm 
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glad you found what you needed. that's a relief i'm sure.

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PostPosted: Wed Apr 26, 2017 9:07 pm 
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Yeah, although starting to get the shakes a little, will be happy when the next 4mgs is due and taken.


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PostPosted: Thu Apr 27, 2017 8:01 am 
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Wow...what a story! All that back and forth is quite frustrating, and I'm sure mentally draining.

I hate change. Not so much if we're talking about underwear, or channels on TV...but when it comes to my Suboxone treatment, and being such a long-term patient that's stable on it, I hate changing just for the sake of changing. I know when I was active in addiction, I would go see a dr just based on a rumor that he might RX pain meds in extremely high doses. I never hit that lucky one that would give me 90 or 120 lortab 10s a month, so I wound up on the street for my pills that I was hooked on.. But now, I just hate changing doctors. Right now I drive about 1hr15min to my current doctor. She's in a "clinic" setting with other doctors who are also Suboxone/pain mgt...
If I didn't get along with her SO very well, I would consider getting closer to home. I actually was told about a doctor, it's been maybe a month ago, who's here locally (15 mins away)...and he's a Suboxone provider. I've been seeing the doctor I'm with now for about 3 years/4 years. If I have a problem, I tell her and she's on-board with most of what I have had to say when we talk. Usually we chat about my kids, or what's going on in life...
My most recent "hurdle" was when I told her that I feel like maybe after such a long time being on Suboxone and stable that I don't know if the same amount is working like it used to...and I asked for a 1/2 per day increase in dosage. I realize how extremely high a dose that is, and testing my theory has been ...well testy...but I've tried reducing my dose -- which causes me to wake up in the middle of the night with sweats...
That's anything below 8mg / day. Especially if I take the 8mg all at once, earlier in the day, and there is a long time between dosing/bedtime/next dose.
Usually around 12mg or 16mg I feel great. No discomfort at all..no sweats.
But, I wanted to be able to store some extra without having the discomfort along with reducing my dose but getting the same RX amount...so I asked for an increase. I'm RX'd 3.5 strips daily..and I'm able to put back some for whatever may happen in the future -- you just never know.
And I told her my intentions..she's fine with it. She knows that I don't intend to put my medicine up for sell on craigslist or divert in any way at all...after over 3 years of not screwing up even just a little (like getting early refills or suddenly calling with "I am out of meds early and don't know why, maybe someone stole my medication?"....) she has faith in me and trusts me, and I wouldn't do anything to break that trust.
But I also realize there is a certain amount of addiction still lingering in my brain...
A small part of my brain is still stuck with the mentality of the groundings in basics of addiction and what causes it all to begin with. I realize that, though, so I'm going to work on that part.

My biggest problem is sitting home all the time, having to find something to make myself stay busy...because I let my brain tell me that I need to take medicine. I know better...all of us here knows better...but, when I sit home all day it's hard to keep my brain from doing that. Once I get back to a job, or something to do besides stay home, it will be MUCH easier.

Right now, I'm playing daddy full-time...and I wouldn't trade it for the world...
When she gets started in school, all this stuff will be a thing of the past, and will be easily fixed...
But until that time, I have to keep myself from allowing my brain to convince me of things that just aren't possible with buprenorphine. I find that to be the hardest part.

My advice is keep yourself occupied...it will do wonders...anything to pass your time when you are sitting home thinking about all of this stuff.

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RIP little brother. Gone, but not forgotten.


Last edited by jonathanm1978 on Fri Apr 28, 2017 12:24 am, edited 1 time in total.

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PostPosted: Thu Apr 27, 2017 11:15 pm 
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You made an interesting point about keeping busy and brain telling you you need to take medicine. I think that is case for me, or at the least, distraction helps me get through the rougher periods. I am going to talk to doc about splitting my current dose to 3 x a day though, maybe not equally, because I just don't think it lasts 12 hours. This current sub doc does nothing but addiction treatment, whether suboxone, vivitrol, methadone or outpatient detox for alcohol/benzo abuse, and I think I'll get benefits from his expertise. He is VERY strict though, I was amazed when he insisted on a strip count, count of the empty foils, verifying their lot numbers and UAs every visit. The only down side is that he requires I see the counsellor in his office and its going to mean ending the current (good) relationship with my current one.


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PostPosted: Fri Apr 28, 2017 12:22 am 
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anonvet wrote:
You made an interesting point about keeping busy and brain telling you you need to take medicine. I think that is case for me, or at the least, distraction helps me get through the rougher periods. I am going to talk to doc about splitting my current dose to 3 x a day though, maybe not equally, because I just don't think it lasts 12 hours. This current sub doc does nothing but addiction treatment, whether suboxone, vivitrol, methadone or outpatient detox for alcohol/benzo abuse, and I think I'll get benefits from his expertise. He is VERY strict though, I was amazed when he insisted on a strip count, count of the empty foils, verifying their lot numbers and UAs every visit. The only down side is that he requires I see the counsellor in his office and its going to mean ending the current (good) relationship with my current one.


After all these years that I've been on suboxone...and been in these forums (I think since 2012 or so, so I have been on here at least 5 years)...and knowing what I do about how the brain can be SO very strong...I should know better than to do some of the things that I do. In fact, I DO know better. I know I still harbor some tendencies that would freak the hell out of any addiction specialist and cause them to take a really hard look at me and ask "why would you do such things when you know full well what that's a direct correlation with?"...

I just try to excuse myself and write it off, but I indeed know that I still have some deeply unresolved issues with addiction. I know for a fact if Suboxone weren't a part of my life, that I would find some drug...likely opiates...and would be either closeted with addiction, or at a full gallop, head-first into that downward spiral.
My wife has even told me that she sees where I substitute one for another...and since I stopped active addiction to oxy/opiates, I've moved to using various other things in an addictive behavior. Sometimes it's a certain food. Sometimes it's video games...
Example: For 3-4 weeks, I'll buy a certain cereal..and I don't mean a box or two a week..I mean a couple boxes every day or 2...and I'll eat nothing but that same cereal for that 3-4 weeks.
Or I'll find some sort of candy that I like..for example...I've done it with whoppers, reeses cups, chips ahoy cookies...
I go off the deep end and will buy 2-3 packs of whatever...and 2 days later I'm back at the store buying more..

That sounds like I should weigh around 400lbs...not barely 150...
If I hear the words "healthy eating"...I run, fast as hell, in the other direction. But running ...I wouldn't say that. I walk really fast, because running resembles exercise...

Sometimes this behavior spills over into my medicine and how I take it. My brain will tell me that I need to take my meds..
And i've let that go too far...sometimes. Not always the case with my medicine, because I try really hard to control that. But it still happens. I'll even wake up in sweats and I know it's just my brain doing what I'm subconsciously telling it to do (feel like I'm nearing w/ds so I can take Suboxone)...

Beating out what your brain tells you is damn near impossible. But, most people don't realize the things they need to work on in the same manner that I do. I see the things I need to get a big grip on, but I'm just not working on fixing them. Part of it is laziness, part of it is excuses for myself..

But it goes back to addiction in it's entirety...that's what it's all based on...and that's one reason I don't even consider going off suboxone yet. Will I eventually, one day? Maybe...once I've fixed all the things I listed above. But until that point, there is absolutely no reason to look at that as an option in life...because of the things I do, I know what I would wind up doing if I came off of Suboxone..and that wouldn't be a great life choice for me.

I see what's wrong, and I choose to stay on Suboxone because I know the struggle would be too hard if I tried to deal with my issues, and take away the Suboxone from that equation...so I prefer to keep it all under control where I can keep things in check...
It's not a huge problem that I have some addictions to different foods...it doesn't last over several months..or even several weeks... And that's why it's not a big deal..
I'll eat whatever until I get tired of it..usually about 2-3 weeks..
Same goes for video games...I'll play a game for days and days..then I'll just quit for a week or 2..and go back. That's part of the boredom though...and being stir crazy at home...
Once I get into the work force again, that will fix itself...

But staying busy with these type issues can be tough..

What's different for me is that I'm aware of what the issues are and what I need to work on. Many folks don't see it until it's a huge problem, or they have to have someone tell them what the problem is...
I just realize it and do it anyway...
The only thing I don't do is play around with my treatment in that same manner. I adhere to my Suboxone and I don't play games about my sobriety...it's WAY too important.

And I can tell someone else what they need but I can't do the same for myself...(or I know what I need, I just don't do what I need to fix it)...
But...that's just because I'm a professional procrastinator. I'd say it's safe to wager that I have a BS in procrastination (where the "BS" stands for bullshit)..

That's my story and I'm sticking to it.

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DOB: July 1, 1985
October 8, 2013

RIP little brother. Gone, but not forgotten.


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