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PostPosted: Mon May 11, 2009 11:27 pm 
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I was addicted to vicodin for 10 years popping 50 pills a day of Vicodin ES or NORCO, I then decided enough is enough, went to the ER and they gave me a list of doctors who deal with addiction. I went to see this female doctor who gave me the 3 hour consultation thing, then put me on 32mg of SUBOXONE, she sold me the suboxone out of her office for $5 per pill, rather then paying $8 a pill at a Walgreens I thought ok why not?...Well 5 years later this doctor STILL had me on 32mg of SUBOXONE! She then must have gotten caught because she was no longer in practice, so I found another doctor who was commited to getting me off, it took 2 years and my last dose of 2mg was March 2, 2009. I looked up all over the internet "How long will W/D's be for this" some said 3 to 5 days some said longer. I am here to tell you I went through withdrawals for 31 LONG A** days and when I tell you this is the hardest thing in life I have ever ever done I an NOT kidding you. I was at the ER 8 times for the CLONODINE patch, I know every one is different but my god, I laid in bed crying...begging for god to take me, it was PURE HELL people PURE HELL!!! Leg twitches AND arm twitches for 31 days straight! Skin crawling, lost 40 pounds from going to the bathroom, weak, vomiting, sweating, depressed like I have never been I couldnt wash my hair for weeks, my best friend had to drive over and wash my hair and do my laundry, your useless!!! I will NEVER EVER recommend to anyone that they go on SUBOXONE even if it's for 2 dam days. This is just MY STORY and MY OPINION. I am sure it had worked miracles for tons and tons of people but even the doctor couldnt understand why I was withdrawling for SO LONG! 17 years of putting a pill or several pills in my mouth took a blow to my body and I just wish I NEVER EVER would have gotten on SUBOXONE. It was the worst experience of my dam life. I just think about Suboxone and I feel like vomiting. Now I feel all the under lying problems I have that I never felt because I was on Suboxone, like 2 bulging disks in my back that are killing me and I need something, I cant even take a 15 minute walk and I am only 37 years old! I am stuck...dont know what to do? This is ny story and Im stickng to it. I hope others out there have a better road of recovery getting off suboxoxe, all I have to say to them is good luck and hold on tight for the roller coaster road to come!! Piece


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PostPosted: Tue May 12, 2009 9:16 am 
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Unfortunately, 2 mgs is a rather high dose to jump off from. My condolences but like any opiate there is a w/d period. With Suboxone, the long half life leads to a longer w/d period. I have had to go a few days without subs and I feel your pain.
Who recommended you stop at 2 mgs? Your doctor? They should have known better. It's not the drugs' fault. The finger should be pointed in the direction of the physician.


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PostPosted: Tue May 12, 2009 10:18 pm 
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2mg? I stopped once at 8mg/day. That separates the men from the boys let me tell you! I could still function though.. I was even able to work

It takes 3 days to set in, then day 4-5-6 are awful, then every day gets a little better.. a total for me it was about a month. Clonidine I have for BP helped, but not the mood swings.

Yeah, it wasn't fun at all, but I was still able to work (maybe not concentrate though!). I functioned... A few days I didn't sleep well due to the restless legs..

One time, I mixed up meds when taking agonists and I didn't take my usual pain med (cant remember what it was, it looked exactly like soething else I had in my safe).. I didn't realize it until late the next night. By then I was well into withdrawal, (sweats, chills, runs) but it didn't really bother me, I just thought I was getting a cold. As soon as I realized my error, it got a lot worse... The mind can really magnify the whole experience.

Why didn't he help you and put you on 1mg every other day? or 1mg every 3 days for a bit? At least its something. Did you tell the doc and did he offer to taper you more slowly somehow? Why not just stay on it?


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PostPosted: Tue May 12, 2009 11:46 pm 
Well, i'm pretty sure you just scared the absolute shit out of anyone just starting on Suboxone.


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PostPosted: Wed May 13, 2009 12:30 am 
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I'm a little disappointed in all you folks, after all the lecturing I do!! I'm kidding-- sort of, anyway! I agree that the dose of 32 mg was too high-- but the 7 year part is not 'too long'. 'Suboxone7years' is doing what many people do; blaming Suboxone rather than blaming his opiate addiction. We don't know what would have happened, had the person NOT had Suboxone, but read the history. The person was addicted to opiates for 10 years! My active addiction lasted only 6 months-- and that was enough to give me cravings even after 7 years of being totally off medications or substances (i.e. not on Suboxone or anything else-- just tons of meetings). So a person who has been on opiates for ten years is SERIOUSLY ADDICTED. After my 6 months of use, I went through treatment that consisted of 3 1/2 months residential (after a week of horrible detox), and then 6 years of aftercare (group twice per week for a few years, then once per week).

I must admit to a bit of skepticism over 7yrs report, just because Suboxone was not available in the US until 2003-- so I don't know how he/she got to 7 yrs of use followed by the time in withdrawal between 2003 and 2009. Yes, DATA2000 was the act that allowed 'treatment of opiate dependence using opiates on schedule III through V', but Suboxone was not approved or sold until mid 2003. Maybe '7yrs' means '6yrs'-- no biggie, as I tend to exaggerate as well.

'7years' had 10 years to quit opiates-- and then thanks to Suboxone was finally able to get free. And after 7 years of freedom, she complains about 20 or 30 days of withdrawal?! She also blames that on the Suboxone-- but you also have to blame it on the 10 years of using before Suboxone! What makes 7 years think that all the withdrawal is just Suboxone's fault? 7years, let me point out to you that you COULDN'T quit the other drugs-- but you COULD quit the Suboxone. What does that tell a logical person about which one is harder to get off?

I have detoxed more than I ever wanted to... and I have seen many, many people go off many things (I'm medical director of a large residential center in addition to my practice). As I have pointed out, I couldn't walk during my detox! People going off Suboxone tend to go to work and complain about how sick they feel-- people going off agonists tend to like in a bed in a detox ward or at home, and they don't complain-- because they are too weak to talk! I'm sorry you felt miserable, 7years, but have you ever 'jumped' from 30 mg of methadone? Or come off heroin? You must have at least seen the movies-- they call it 'kickin'' because the legs kick constantly. That was MY detox-- I lost 30 pounds, and for days I was up around the clock, legs kicking, body shaking and shivering, sweating like crazy, nausea and diarrhea at the same time-- after a month I could walk about 50 feet without needing to sit down and rest-- and that was a huge improvement!

But none of this even gets to the real issue. 7years, how do you plan to stay clean going forward? Given the time factors I mentioned above, you couldn't have been clean for more than a couple months so far-- opiate dependence is a relapsing condition. Everyone is certain it won't happen to them, but... it happens to even those who are working a very intensive recovery program. That is why the recommendation, more and more, is to STAY on Suboxone! Yes, if you are a masochist who wants to watch your family get destroyed, go out on the quest for 'pure sobriety'. But I recommend against it. My own relapse occurred after 7 years of very good recovery-- I was 'all AA and NA' for years before my relapse. If anyone thought I would return to that life, I'd say they were crazy fools. But you know what? People DID say I was flirting with disaster when I stopped meetings... and they were right.

Now we have Suboxone, so people like 7yrs can enjoy freedom without the work of 90 meetings in 90 days followed by years of aftercare. That is fine-- but it isn't really fair, after enjoying the freedom the medication gave you, to claim that you didn't really need it, and wish you hadn't taken it. You very well might be dead or in prison had it not been there. In light of that, a month of feeling sick is a good deal-- better than the work I put into my freedom. But your work is just starting, if you are so convinced you will never take Suboxone. Feel free to stop back in a year and boast, if you are still clean-- and I hope for your sake that you are. But I often point out that the people who complain about Suboxone are usually people with a few clean months, as those people have themselves fooled into thinking they are all done with addiction... I have put offers out on some of the Subox-hater sites asking for someone with 5 years clean to talk to me-- and so far, I haven't found a soul.


Last edited by suboxdoc on Wed May 13, 2009 12:37 am, edited 1 time in total.

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PostPosted: Wed May 13, 2009 9:05 am 
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Sub7years--first your blaming the doctor for putting you on 32mg, then your blaming the new doctor for keeping you on it for 7years, now your blaming the detox on Suboxone.

First, if 32mg was too much then why on earth did you keep taking it?
Second, if you didn't want to be on it for 7 years, why didn't you do this detox earlier
Third, you are an opiate addict and your body has been dependent on opioid drugs for almost twenty years, did you honestly think the detox was going to be easy?


Finally, this is just my opinion, but everything about your post screams "DON'T GO OFF THIS MEDICATION RIGHT NOW!" to me. Your clearly not ready to stop the "blame" game and just face the fact that life dealt you a shitty hand and you just gotta play it and make your life good despite it (or to SPITE it)....and if your not ready to face that, how are you going to face what it's going to take to fight the urge to use every single day (and for a quite a while it will be every minute of the day)? Also, you jumped off 2mg (after tapering for two years) in an "I want this NOW!" sort of way, rather than taking the time and patience (which you will need an abundance of to stay in recovery without Suboxone) to continue your taper and do this in a way that would not have left you so sick.


Ok on a gentler note, I gotta ask this: nothing in your post really says why you want off Suboxone? Is there something about being on it that is worse than being in active addiction? Some side effect you just can't live with? Is it just because you think you shouldn't be on it OR is it because Suboxone is doing its job and therefore your convinced your "over" your opiate "thing"? If you were miserable because of side effects I could understand putting yourself through a quick detox...I mean if you take a medication to feel better and it makes you feel worse, I can understand wanting to get off it. BUT, you've been on it a long time now. It's done a fantastic job keeping you alive and you say it stopped you from popping short-rush-enacting opiates every four hours.....so whats the hurry now? What is so important about getting off Suboxone that your willing to go through this horrible withdrawal, risk relapse and risk your LIFE, to do it? It may sound dramatic, but thats exactly what you've done. You've risked your life, here. Do you have ANY idea what your chances of overdosing are right now? 8times more likely than it was the last day you took Suboxone.....and I know your saying "NOt me, I am not going to use. I know what I am made of!" but remember, when you made that decision (not to use) you were still taking Suboxone, your were thinking clearly and the Suboxone was quelling those urges and cravings--Suboxone was making it EASY to say "no"......but Suboxone isn't on board anymore, and your sick...so you have no way of knowing WHAT you will do from one minute to the next.

I know I sound really...a**hole-ish....and I am not trying to discount your feelings or story. Its just hard to read a letter like this and not be frustrated....

And for anybody out there reading this, don't be scared because you don't have to jump off Suboxone at 2mg....you could spend the time continuing your taper down as low as you need to....and for that matter, is there really anything that says you HAVE to come off Suboxone at some point? There is no rule that say you HAVE to get off it, once you get on it. Think about it like you would any other med (because it is just like any other med)....if you needed thryoid medication you wouldn't assume you would be getting off it some day, right? If you had epilepsy, diabetes, bi-polar disorder etc etc etc--you would most likely consider any medication you took to be a life long therapy, because THOSE ILLNESSES ARE LIFE LONG ILLNESSES and so is addiction....so once you find a medication that works, there is no rule that says you have to stop taking it, right?


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PostPosted: Wed May 13, 2009 10:19 am 
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The post by about '7years' was placed in several categories in this forum-- I just found them, and deleted all but this one. If anyone finds more let me know! Putting them all over crosses a line in my opinion-- from sharing info to advocacy, and this whole site was created in order to avoid that sort of 'advocacy'. The multiple posts of the exact same material, along with the skepticism I have about the truthfulness of the post (since Suboxone wasn't sold until 2003, it is not possible to have been on it '7 long years', make me wonder if I should block that person-- I won't, because we want to share info of ALL types. But I do ask the person to post in ONE place; if you are on some sort of mission, please take your mission elsewhere.

I am open to suggestion on this matter.


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PostPosted: Wed May 13, 2009 1:40 pm 
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Hey everyone..

Arm-me.. A very good rebuttal and you're right.

Doc: You're right as well. The multiple posts are bad though. They were not a mistake since they were several minutes apart, so it was done on purpose. I'd say give him/her a chance to reply. If there is no reply, then regard it as 'spam'.

I hope no one read me wrong. Yeah I stopped at 8mg/day and it wasn't fun, but it wasn't 1/4th as bad (even for 3 weeks of it) as 48hrs of no oxycodone when you're taking 70mg/day. Of course, I just state the experience from a withdrawal standpoint, but don't state the desperation, pain, hopelessness and depression I felt for several months afterwards. THAT is the hard part! Quitting is easy really, and even the withdrawal isn't all that horrible. Staying that way is very, very, very hard. I had always thought the opposite was true (quitting is hard, staying off is easy) but boy was I wrong. Its easy to forget how bad the withdrawal can be. If not, there'd be no such thing as an opiate addict, because the withdrawal alone would keep us away.

I think its a good thing that is DOES have withdrawal, because if it didn't, well use your imagination.


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PostPosted: Thu May 14, 2009 11:49 pm 
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The point of this forum is to share information. I set it up (along with my good buddy JJ) because I was annoyed by the personal attacks that go on at other sites when one tries to talk about Suboxone. I have no problem with heated debate, but the debate should be about the drugs-- not the people.

I raised some questions about the post by 'seven years'; I pointed out that Suboxone has only been available for 5 1/2 years, so I doubted the veracity of the story. The 'seven years' part was a lie, so I knew that the person was doing more than sharing an honest opinion, but rather was exaggerating to make a point. When the same post turned up in three places on the forum it became more obvious that the person was trying to lobby a certain way of thinking, rather than share her story. But I didn't ban the person for that.

Tonight there were a couple more posts, this time going off on me, and saying that this blog was 'biased'. In short, the posts were insulting to me, and to the blog-- something that I have put a great deal of effort into. I can take an insult-- I have been attacked pretty aggressively on the blog and youtube by the 'suboxone haters'. And I deal with anger all the time in my practice. But in a forum, anger quickly becomes a distraction; suddenly everyone is spending time and energy posting about an argument, rather than posting about opiate dependence. My whole motivation for this forum was to get away from that crap... so I deleted those posts. I again point out that I did not take action even when the seven years person posted fiction in three different areas, all within a few minutes of each other... I took action after being accused of being 'biased', when in fact I had cut the anti suboxone person a break.

For the record, I AM biased! I think that those who try to cure their own opiate dependence without a maintenance medication or a recovery program are making a huge mistake. I think that the time has come to treat opiate dependence like any other fatal illness. I think that people who blame Suboxone are usually angry that they are addicts, and Suboxone is easier to blame than accepting the fact that they are opiate addicts for life, not because of Suboxone but because of their own behavior. Finally, I am biased in favor of Suboxone because of all the times I have been flamed for mentioning the medication on other sites.

If anyone is interested, by the way, in being a 'moderator', please let me know. Your job would be to help keep the forum on point. Just send me a message or e-mail. :wink:


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PostPosted: Sun May 17, 2009 9:22 pm 
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The fun continues.. I had to delete a post.. Harassing a doctor is never really a good idea. I clipped out a few things that I'm sure will be seen.

Quote:
And then he tries to ban me fromk the site. NOT HAPPENING


It just happened again.. In fact, I banned your whole internet provider :) Keep it up, and I can ensure that they'll ban you from having service. I'm not a doctor, just an internet expert, and I know a thing or two :)

Quote:
I was told anyone that has anything negative to say about suboxone this doctor freaks out!


He doesn't freak out about negative comments, He he doesn't like someone trying to scare someone away from Suboxone. How would you feel if someone read your post and decided against suboxone, only to end up dead from an overdose? Suboxone isn't a perfect drug and I'm sure the doctor would wholeheartedly agree with that statement, but, at least we have SOMETHING that will help.

Quote:
I thank suboxone for being there for me, it saved my life yes!

Good. Than it served its purpose.

Quote:
Just because I am not a suboxone fan, what you only want to hear positive about it?

WHY DID YOU TAKE IT FOR 7 YEARS THEN?!

Maybe you should go back on Suboxone, or something to chill you out. sheesh.


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PostPosted: Sun May 17, 2009 10:02 pm 
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Well, the debate is 6 or 7 years.. Apparently, its 6 years. Since I'm a math major, its 5 years, 361 days to be exact. There is no time so I can't get it down to seconds!

This is too much fun, but unfortunately anger leads to bad things usually....

In order to sleep tonight, I had to know whether suboxone has been out for 6 years or not. Apparently, its not

[Federal Register: May 22, 2003 (Volume 68, Number 99)]
[Rules and Regulations]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

42 CFR Part 8

RIN 0910-AA52


Opioid Drugs in Maintenance and Detoxification Treatment of
Opiate Addiction; Addition of Buprenorphine and Buprenorphine
Combination to List of Approved Opioid Treatment Medications

AGENCY: Substance Abuse and Mental Health Services Administration
(SAMHSA), Department of Health and Human Services.

ACTION: Interim final rule.

-----------------------------------------------------------------------

SUMMARY: This interim final rule amends the Federal opioid treatment
program regulations by adding buprenorphine and buprenorphine
combination products to the list of approved opioid treatment
medications that may be used in federally certified and registered
opioid treatment programs. The Food and Drug Administration (FDA)
recently approved Subutex[reg] (buprenorphine) and Suboxone[reg]
(buprenorphine in fixed combination with naloxone) for the treatment of
opiate dependence. These two products will join methadone and
ORLAAM[reg] as medications that may be used in opioid treatment
programs for the maintenance and detoxification treatment of opioid
dependence. Opioid treatment programs that choose to use these new
products in the treatment of opioid dependence will adhere to the same
Federal treatment standards established for methadone and ORLAAM[reg].
The Secretary invites public comments on this action.

DATES: This interim final rule is effective May 22, 2003. This interim
final rule is also being presented here for public comments. Written
comments must be received by the Substance Abuse and Mental Health
Services Administration (SAMHSA) on or before July 21, 2003.

ADDRESSES: Comments should be submitted to the Division of
Pharmacologic Therapy, Center for Substance Abuse Treatment, Rockwall
II, Room 6-18, 5600 Fishers Lane, Rockville, MD, 20857; Attention: DPT
Federal Register Representative.

FOR FURTHER INFORMATION CONTACT: Nicholas Reuter, Center for Substance
Abuse Treatment (CSAT), Division of Pharmacologic Therapy, SAMHSA,
Rockwall II Room 6-18, 5600 Fishers Lane, Rockville, MD 20857, 301-443-
0457, email: nreuter@samsha.gov.
SUPPLEMENTARY INFORMATION:

Background

In a rule document published in the Federal Register of January 17,
2001 (66 FR 4076, January 17, 2001), the Substance Abuse and Mental
Health Services Administration (SAMHSA) issued final regulations for
the use of narcotic drugs in maintenance and detoxification treatment
of opioid addiction. That final rule established an accreditation-based
regulatory system under 42 CFR part 8 (``Certification of Opioid
Treatment Programs,'' ``OTPs''). The regulations also established
(under Sec. 8.12) the Secretary's standards for the use of opioid
medications in the treatment of addiction, including standards
regarding the quantities of opioid drugs which may be provided for
unsupervised use.
Section 8.12(h) sets forth the standards for medication
administration, dispensing and use. Under this section, OTPs shall use
only those opioid agonist treatment medications that are approved by
the Food and Drug Administration under section 505 of the Federal Food,
Drug, and Cosmetic Act (21 U.S.C. 355) for use in the treatment of
opioid addiction. The regulation listed methadone and levomethadyl
acetate (ORLAAM[reg]) as the opioid agonist treatment medications
considered to be approved by the FDA for use in the treatment of opioid
addiction.
On October 8, 2002, FDA approved two new opioid treatment
medications, buprenorphine and buprenorphine combination for the
treatment of opioid addiction. These medications are controlled under
schedule III of the Controlled Substances Act (``CSA,'' 21 U.S.C. 812).
See final rule published October 7, 2002 (67 FR 62354). By adding these
two medications to the previous list of approved opioid treatment
medications, the Secretary allows OTPs to use buprenorphine and
buprenorphine combination for the treatment of opioid addiction. OTPs
will apply the same treatment standards that were finalized on January
17, 2001, for methadone and ORLAAM[reg].

Summary of Regulation

The opioid treatment program regulations (42 CFR part 8) establish
the procedures by which the Secretary will determine whether a
practitioner is qualified under section 303(g) of the CSA (21 U.S.C.
823(g) (1)) to dispense certain therapeutic narcotic drugs in the
treatment of individuals suffering from narcotic addiction. These
regulations

[[Page 27938]]

also establish the Secretary's standards regarding the appropriate
quantities of narcotic drugs that may be provided for unsupervised use
by individuals undergoing such treatment (21 U.S.C. 823(g) (3)). (See
also 42 U.S.C. 257a.)
This interim final rule does not change any of the provisions in
subpart A (Accreditation) or subpart C (Procedures for Review of
Suspension or Proposed Revocation of OTP Certification, and of Adverse
Action Regarding Withdrawal of Approval of an Accreditation Body).
Instead, the rule provides for a minor amendment to subpart B,
Certification and Treatment Standards. The rule amends only one section
of subpart B, section 8.12(h)(2) Medication administration, dispensing,
and use.
Under 42 CFR 8.12(h)(2), OTPs are limited to using only those
opioid agonist treatment medications that are approved by the Food and
Drug Administration under section 505 of the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 355). This section notes that ``currently the
following medications will be considered to be approved by the Food and
Drug Administration for use in the treatment opioid addiction: (i)
Methadone; and (ii) levomethadyl acetate (LAAM).'' The effect of this
rule is to add buprenorphine and buprenorphine combination to this list
by adding a new item (iii).

Justification for Interim Final Rule

The Administrative Procedure Act (5 U.S.C. 553) requires agencies
to follow certain procedures for informal rulemaking, including
publication of proposed rules in the Federal Register with an
opportunity for public comment. Section 553(b)(B) allows agencies to
dispense with prior notice and opportunity for public comment if the
agency finds for good cause that use of such procedures is
impracticable, unnecessary, or contrary to the public interest. Section
553(d)(3) permits the Secretary to waive the 30 day effective date if
it is contrary to the public interest.
The Secretary has determined that good cause exists for publication
of this rule without prior notice and opportunity for public comment
and without a delayed effective date since such procedures are contrary
to the public interest and unnecessary. It is contrary to the public
interest to deny OTPs' access to this important new medication for the
treatment of persons addicted to opioids. As compared to methadone and
ORLAAM [reg], buprenorphine and buprenorphine combination are
particularly useful in treating patients who have had a shorter course
of addiction. Similarly, it would be contrary to the public interest to
deny patients access to such prescription drugs from OTPs particularly
in areas in which there are no physicians who have obtained a waiver
under the Drug Addiction Treatment Act of 2000 (``DATA,'' section 3502
of Pub. L. 106-310).
To further elaborate, while OTPs may continue to use methadone and
ORLAAM [reg] for medicated assisted treatment, buprenorphine and
buprenorphine combinations will provide OTPs with an important
additional option for the treatment of addiction. Indeed, because of
its ``partial'' agonist pharmacology, buprenorphine will provide
programs with more flexibility in finding the most appropriate
medication for each patient. It would thus be contrary to the public
interest to delay the availability of buprenorphine products.
In addition to the public interest in having buprenorphine and
buprenorphine combination products available for treatment use as soon
as possible, prior notice and comment procedures are unnecessary.
Currently, the rule states: ``OTPs shall use only those opioid agonist
treatment medications that are approved by the Food and Drug
Administration * * * for use in the treatment of opioid addiction * *
*. Currently the following opioid agonist treatment medications will be
considered to be approved by the Food and Drug Administation for use in
the treatment of opioid addiction: (i) Methadone; and (ii) Levomethadyl
acetate (LAAM).'' Because the buprenorphine products have been approved
by the FDA as required by section 8.12(h)(2), the proposed modification
is technical in nature in that it simply adds buprenorphine and
buprenorphine combination to the list of FDA-approved medications that
may be used by OTPs. Thus, comment is not necessary before finalizing
this change to the regulation.
Although we are making the rule effective immediately without first
obtaining public comment, we are providing for a 60-day comment period
after publication. Specifically, we seek comments on the applicability
of the existing OTP rules to these newly approved medications.

Analysis of Economic Impacts

The Secretary has examined the impact of this interim final rule
under Executive Order 12866. Executive Order 12866 directs Federal
agencies to assess all costs and benefits of available regulatory
alternatives and, when regulation is necessary, to select regulatory
approaches that maximize net benefits (including potential economic,
environmental, public health and safety, and other advantages,
distributive impacts, and equity). This interim final rule does not
establish additional regulatory requirements, it allows an activity
that is otherwise prohibited. According to Executive Order 12866, a
regulatory action is ``significant'' if it meets any one of a number of
specified conditions, including having an annual effect on the economy
of $100 million; adversely affecting in a material way a sector of the
economy, competition, or jobs; or if it raises novel legal or policy
issues. A detailed discussion of the Secretary's analysis is contained
in the recent opioid treatment final rule published in the Federal
Register of January 17, 2001 (66 FR 4086-4090). That notice described
the impact of the opioid treatment regulations, analyzed alternatives,
and considered comments from small entities.
The Secretary also finds that this rule is a not a significant
regulatory action as defined by Executive Order 12866. The rule merely
adds buprenorphine and buprenorphine combination products to the list
of medications that may be used in the detoxification or maintenance
treatment of opioid dependence. If opioid treatment programs choose to
use the new medications, the new medications will be used in accordance
with the standards set forth in the January 17, 2001, final rule (66 FR
4090). No new regulatory requirements are imposed by this interim final
rule.
For the reasons outlined above, the Secretary has determined that
this interim final rule will not have a significant impact upon a
substantial number of small entities within the meaning of the
Regulatory Flexibility Act (5 U.S.C. 605(b)). Therefore an initial
regulatory flexibility analysis is not required for this interim final
rule.
The Secretary has determined that this rule is not a major rule for
the purpose of congressional review. For the purpose of congressional
review, a major rule is one which is likely to cause an annual effect
on the economy of $100 million; a major increase in costs or prices;
significant effects on competition, employment, productivity, or
innovation; or significant effects on the ability of U.S.-based
enterprises to compete with foreign-based enterprises in domestic or
export markets. This is not a major rule under the Small Business
Regulatory Enforcement Fairness Act of 1996 (SBREFA).
The Secretary has examined the impact of this rule under the
Unfunded Mandates Reform Act of 1995 (UMRA)

[[Page 27939]]

(Pub. L. 104-4). This rule does not trigger the requirement for a
written statement under section 202(a) of the UMRA because it does not
impose a mandate that results in an expenditure of $100 million
(adjusted annually for inflation) or more by State, local, and tribal
governments in the aggregate, or by the private sector, in any one
year.

Environmental Impact

The Secretary has previously considered the environmental effects
of this rule as announced in the final rule (66 FR 4076 at 4088). No
new information or comments have been received that would affect the
agency's previous determination that there is no significant impact on
the human environment and that neither an environmental assessment nor
an environmental impact statement is required.

Executive Order 13132: Federalism

The Secretary has analyzed this interim final rule in accordance
with Executive Order 13132: Federalism. Executive Order 13132 requires
Federal agencies to carefully examine actions to determine if they
contain policies that have federalism implications or that preempt
State law. As defined in the Order, ``policies that have federalism
implications'' refer to regulations, legislative comments or proposed
legislation, and other policy statements or actions that have
substantial direct effects on the States, on the relationship between
the national government and the States, or on the distribution of power
and responsibilities among the various levels of government.
The Secretary is publishing this interim final rule to modify
minimally treatment regulations that provide for the use of approved
opioid agonist treatment medications in the treatment of opiate
addiction. The Narcotic Addict Treatment Act (the NATA, Pub. L. 93-281)
modified the Controlled Substances Act (CSA) to establish the basis for
the Federal control of narcotic addiction treatment by the Attorney
General and the Secretary. Because enforcement of these sections of the
CSA is a Federal responsibility, there should be little, if any, impact
from this rule on the distribution of power and responsibilities among
the various levels of government. In addition, this interim final rule
does not preempt State law. Accordingly, the Secretary has determined
that this interim final rule does not contain policies that have
federalism implications or that preempt State law.

Paperwork Reduction Act of 1995

This interim final rule adds buprenorphine and buprenorphine
combination products to the list of approved medications that may be
used in SAMHSA-certified opioid treatment programs. The interim final
rule establishes no new reporting or recordkeeping requirements beyond
those discussed in the January 17, 2001, final rule (66 FR 4076 at
4088). The Office of Management and Budget has approved the information
collection requirements of the final rule under control number 0930-
0206.

Executive Order 13175: Consultation and Coordination With Indian Tribal
Governments

Executive Order 13175 (65 FR 67249, November 6, 2000) requires us
to develop an accountable process to ensure ``meaningful and timely
input by tribal officials in the development of regulatory policies
that have tribal implications.'' ``Policies that have tribal
implications'' defined in the Executive Order to include regulations
that have ``substantial direct effects on one or more Indian tribes, on
the relationship between the Federal government and the Indian tribes,
or on the distribution of power and responsibilities between the
Federal government and Indian tribes.''
This interim final rule does not have tribal implications. It will
not have substantial direct effects on tribal governments, on the
relationship between the Federal government and Indian tribes, or on
the distribution of power and responsibilities between the Federal
government and Indian tribes, as specified in Executive Order 13175.

Dated: May 5, 2003.
Tommy G. Thompson,
Department of Health and Human Services.

List of Subjects in 42 CFR Part 8

Health professions, Levo-Alpha-Acetyl-Methadol (LAAM), Methadone,
Reporting and recordkeeping requirements.

0
For the reasons set forth above, part 8 of title 42 of the Code of
Federal Regulations is amended as follows:

PART 8--CERTIFICATION OF OPIOID TREATMENT PROGRAMS

0
1. The authority citation for part 8 continues to read as follows:

Authority: 21 U.S.C. 823; Sections 301(d), 543, and 1976 of the
42 U.S.C. 257a, 290aa(d), 290 dd-2, 300x-23, 300x-27(a), 300y-ll.


0
2. Section 8.12(h) (2) is revised to read as follows:


Sec. 8.12 Federal opioid treatment standards.

* * * * *
(h)* * *
(2) OTPs shall use only those opioid agonist treatment medications
that are approved by the Food and Drug Administration under section 505
of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355) for use in
the treatment of opioid addiction. In addition, OTPs who are fully
compliant with the protocol of an investigational use of a drug and
other conditions set forth in the application may administer a drug
that has been authorized by the Food and Drug Administration under an
investigational new drug application under section 505(i) of the
Federal Food, Drug, and Cosmetic Act for investigational use in the
treatment of opioid addiction. Currently the following opioid agonist
treatment medications will be considered to be approved by the Food and
Drug Administration for use in the treatment of opioid addiction:
(i) Methadone;
(ii) Levomethadyl acetate (LAAM); and
(iii) Buprenorphine and buprenorphine combination products that
have been approved for use in the treatment of opioid addiction.
* * * * *


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 Post subject:
PostPosted: Mon May 18, 2009 11:44 pm 
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Buprenex could explain the time discrepancy...seeing as how it has been available since the 1980's. Sure, addiction treatment would have been an off label use for it, but doesn't negate the fact that it would have been possible to get and use for such purposes. It was first used in France in the mid 90's for this purpose

http://www.springerlink.com/content/f483l5v17270r825/

(Edit Jamez70 edited your post to have the URL :)
So I can only assume that knowledge of this use probably crossed the pond in certain circles. Eh, one can only speculate :D


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 Post subject: 7 years suboxone
PostPosted: Mon May 25, 2009 7:23 pm 
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I have been on Suboxone since as soon as it came out. I would tell my psych to keep his ear out for it and one day he called me and said come in for a script. CVS?Walgreens did not carry it yet. This was about 6 years ago (honestly).
I started (after induction) at 16mg and went up to 24 for a year or so but mostly on 16. I cannot imagine being on 32mg for so long. I find that I do not need more than 8mg on some days. And a physician selling the mets out of office at a discount?? And buying it from her for a number of years? Seems odd to me. I got to run to a meeting so everyone there can tell me how I am not recovering because I am still using (according to them, me being on Suboxone). But there is a hot mama that I like so I really dont care mane what anyone thinks. Suboxone saved my life. I used to bang hard!! For last three years of being on Suboxone I used dope only once and nothing happened from a bad because I had the Sub in me system. I am new to this site but reading the comments the site admin (Doc Junig) left it makes me feel calm and more secure about my Suboxone use. I would also like to say is that drug addicts who were addicted to drugs other than opiates have much to say about Suboxone and I think it is because they feel we are getting a "free ride".
Be back later, thank you again.


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PostPosted: Tue Sep 22, 2009 2:31 am 
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This is an old thread, but this particular topic interests me. I am taking 16mg daily, and I think it's too much, but am not really sure how to change it at this point (variables include taper, cravings, etc)

The two huge variables NOT disclosed in her post:

1. What was the exact time period from 32mg to 2mg (can you imagine lowering that amount in say... a week? Maybe 2?...)

2. Have you used ANY opiates since? PRESCRIBED OR NOT.

Without that information it is hard to assign any scientific validity to her post, and while it is her opinion, anyone reading this, should not be worried sick...

(though as I sit here, I wonder if I will ever be able to get off it, and if I am able, what will happen? I have been experiencing some really troublesome side effects taking 16mg daily so far...)


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 Post subject:
PostPosted: Tue Sep 22, 2009 1:40 pm 
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rationale - If you think 16mgs is too high for you, I would first suggest speaking to your doctor about it. As far as how you taper down from 16mgs to a more comfortable dose - lots of us around here have done it. When I was on 16mgs I was way too sedated, falling asleep at red lights, etc.

I was taking my Sub in 2 8mg doses. It's been a while, but if I recall correctly I went down from 16mgs to 12mgs (8mg am and 4pm) with no problems. Then I went right down to 8mgs from there (4mg am and 4mg pm). I really didn't experience any withdrawal from these reductions. Later on as I felt ready I went down to 6mg and then to 4mg, which is where I spent the majority of my time on Suboxone. I then spent close to a year tapering off of that last 4mgs - 4 months just going from .8mgs to zero. But my taper was successful and I had very little withdrawals. I stopped Suboxone Aug 2nd and am doing great.

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

-Jack Kornfield


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 Post subject:
PostPosted: Wed Sep 23, 2009 3:16 am 
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Congratulations on your success! I have discussed with my Dr. and am ready to taper, but his only advice was "just go up or down as you feel necessary".... just the think an addict needs, FREEDOM WITH DRUGS. So I have honestly procrastinated starting the taper, as you can see, using fear of EXCRUCIATING (overdramatization) withdrawals as my excuse not to try it yet.

How was coming off .8 to 0, is there a detailed thread on this? (I guess I could search)


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PostPosted: Sat Jul 16, 2011 2:08 am 
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I agree with everything you said. I was on suboxone for 7 years as well. I was also on clonopens and alcohol too, but the suboxine withdrawal was nuts. I had gone to detox and then rehab after to get everything out of system and to feel better. I was rushed in rehab to the ER i was non responsive standing in the shower not even under the water. I was having hullusinations and delusions in hospital, dont know if that from the benzos and alcohol or suboxone. I was only on 8mgs a day, 4 2mgs of it, but i was detoxed off all that stuff in 7 days which is nuts. They said in rehab that its unheard of for people to be on suboxone for people to be on it so long. They don't even know how to treat people like us who been on it so long. I was in hospiatal for 5 days praying to for God to take me, the only thing is i saw God lol. I been sober for 6 weeks as of today and i still have insominia. I to used to be hooked on painkillers as well. I was taking like 20 perk 10s a day plus vicodens with that i didn't even count. anyway good luck to you..life is real crazy normal but good. Every day gets a lil better for me


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PostPosted: Sat Jul 16, 2011 11:45 am 
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dotto1 wrote:
I agree with everything you said. I was on suboxone for 7 years as well. I was also on clonopens and alcohol too, but the suboxine withdrawal was nuts. I had gone to detox and then rehab after to get everything out of system and to feel better. I was rushed in rehab to the ER i was non responsive standing in the shower not even under the water. I was having hullusinations and delusions in hospital, dont know if that from the benzos and alcohol or suboxone. I was only on 8mgs a day, 4 2mgs of it, but i was detoxed off all that stuff in 7 days which is nuts. They said in rehab that its unheard of for people to be on suboxone for people to be on it so long. They don't even know how to treat people like us who been on it so long. I was in hospiatal for 5 days praying to for God to take me, the only thing is i saw God lol. I been sober for 6 weeks as of today and i still have insominia. I to used to be hooked on painkillers as well. I was taking like 20 perk 10s a day plus vicodens with that i didn't even count. anyway good luck to you..life is real crazy normal but good. Every day gets a lil better for me


Wow, you went off 8 mg Sub, Klonopin, and alcohol all at the same time!? You poor thing!!!! There is no way to detox off 8 mg Sub in seven days. And you were doing the alcohol and Clonopin too....that must have been hell.

I've been on Sub a long time and it will be 6 years soon. I think you have something when you say they don't know how to treat people like us who have been on it so long. I've absolutely had that experience. I think being on it long-term makes it substantially tougher to stop it, but I think it's 100% possible if a person goes slowly and gives it time. I was a 32 mg-er and now I'm down to .375 and thinking I'll make it off. Sorry you went through so much hell! I cannot even imagine how that must have felt.....

laddertipper

_________________
First you take a drink, then the drink takes a drink, then the drink takes you. ~F. Scott Fitzgerald


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 Post subject: An Oldie but Goodie
PostPosted: Sat Jul 16, 2011 12:32 pm 
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Thanks LT for bringing this back up in the limelight. All information is good, whether we agree or not. The longer I stay on Sub the more I wonder if it's better to stay on forever.

Time to talk to the doctor...


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 Post subject:
PostPosted: Sat Jul 16, 2011 12:38 pm 
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hi laddertripper"oh i mean Ladder tipper :lol: how much is .375? that sounds a lot lower from i mg.
gee". soon you will be down to nothing. i can't wait to see you completely off those little micro's!you been working hard at it!
i feel like 6 years will be the time i get off. i still have cravings. so sub bus has to be my home. if me or the sub is still around?


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

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