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PostPosted: Thu Apr 13, 2017 2:37 am 
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I have some concerns for a friend. She's been taking Suboxone lately mainly because she tried to stop abusing Tramadol and Codeine/Acetaminophen tablets and experienced unsettling withdrawal. The Suboxone she's taking isn't prescribed.

Tramadol withdrawal can be quite nasty, but the thing that concerns me and makes me think Suboxone is a positive step is the fact she was taking at least 10 OTC Codeine/Acetaminophen tablets, and sometimes more than 30 a day. She's a really tiny woman, and she wasn't doing any cold-water extraction. I can't imagine what kind of harm all that acetaminophen/paracetamol was doing to her liver.

That being said, buprenorphine is quite a potent opioid compared to codeine, and even though she says she's taking 2 or 3mg Suboxone a day, it's still in effect entrenching her opioid habit even if it's stopping her taking the pills. Her GP prescribes Suboxone but is apprehensive to get her onto the program at this stage for this reason.

What do you guys think. Is Suboxone for codeine too much? It appears she has her heart set on opioids at this stage...


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PostPosted: Thu Apr 13, 2017 11:34 am 
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Hey Teejay,

I appreciate your concern for your friend very much. And you're right about the poor gals liver. I have no idea of course whether or not she's getting high on the subs, but even if she is it's a far better choice than those literally tylenol poisoned codeine tabs. Just another example of how the government "helps" us addicts. Bet you 10 million bucks the tylenol does far more harm than the codeine.

Best advice I think it so support her just like you're doing. See if you can't get her into a rehab or 12 step group or some sort of recovery program. IN the meanwhile, it seems to me subs are the way to go..She should I think be seeing a sub doctor of possible. That could be an important first step.

Best wishes,
Godfrey


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PostPosted: Thu Apr 13, 2017 12:33 pm 
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I always flip flop bk and forth in my mind over stuff like this. In one frame of mind I'm thinking... if someone has a low tolerance or on a not so strong opiate, I think that they should really try other options first before entering suboxone treatment. But then in a different frame of mind, I think..... well cravings are cravings and before long it'll be very possible that this person will go on to stronger opiates and why not go the buprenorphine route to keep from losing everything like a lot of us have. So I honestly don't know. But in the end, it's better safe than sorry and bupe is the safer alternative if that were to happen like Godfrey said.

I do wish that I would've started suboxone treatment way way sooner than I did because I would have a totally different life today if I had. Knowing what I know now, I wish I would have done it before my life became so out of control.

I guess, for me, it would depend on the person and how far their addiction has progressed. Cravings are cravings and it doesn't care what opiates ur taking, they're still powerful enough to take over. That's when suboxone is absolutely needed, because they'll be powerless very soon regardless most of the time.

If I was just basing it on myself and my past, I'd say do the suboxone treatment before it gets worse. But that's solely on how I was in the beginning stages of my addiction. Cravings are a beast that usually leads us farther in the darker direction. I know this probably didn't help at all lol :) like I said, I could flip flop bk and forth on this topic all day and still not have a solid decision.

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PostPosted: Thu Apr 13, 2017 10:18 pm 
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Yes, a tough call for the reasons mentioned. I wrote a post years back about Vicodin use treated with buprenorphine, with the same concerns. I hate pushing tolerance higher. But at the same time, tolerance almost always ends up higher eventually, and SO many bad things happen during that time.

It probably makes the most sense to treat opioid addiction using buprenorphine, no matter the tolerance, if it is apparent that the patient will not be successful with any other options. The person addicted to codeine, tramadol, and hydrocodeine will quickly become happier and healthier on buprenorphine. My concern is that about 6 months later the person will be blaming buprenorphine for his/her problems, and write that he/she 'should have just stopped without buprenorphine.'

I don't know how to prevent that. But I make sure to NEVER talk someone into taking buprenorphine. Yes, I think it is a great medication and I strongly recommend it when writing here... but in the office, with this situation, I don't start it unless/untill the patient is practically begging for bupe treatment.


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PostPosted: Fri Apr 14, 2017 10:01 am 
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Quote:
It appears she has her heart set on opioids at this stage...


TeeJay, you are always such a careful wordsmith and your writing is very clear so I wanted to clarify.
Is your friend looking for the euphoria and other effects of opiates? If so, then she really isn't ready for Suboxone, would suspect she would continue to dabble back and forth. Is she ready for the recovery road?
I have started someone on Suboxone with a similar tolerance but like Dr J they have to really
'want' Suboxone and are ready to commit to stop the madness and start recovery.


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PostPosted: Wed Apr 19, 2017 4:34 am 
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She hopes Suboxone will get through this semester of university. She had 8 or 9 months clean off everything in NA and relapsed a couple of months ago, has started her first year at college and basically wants to function while she's at uni. Her plans are then to go to detox in the mid-year break.

I encouraged her to find a prescribing doctor and to at least get advice. Don't know if she has.


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