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PostPosted: Wed Feb 08, 2017 9:11 pm 
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Okay so let me start by saying I've been on subs for two years now, almost exactly. Extremely devoted to my recovery and focused. I started at 20mg and I'm all the way down to 2mg now, a bit of an aggressive taper, but I want out. Suboxone seems to get stronger and stronger and I keep having to drop the dose. I have awful side effects: water retention, swollen legs, trouble keeping erections sometimes, and I just feel the subs. Like that feeling when you take too much and you don't give a fuck about ANYTHING. I hate it. I work out like a maniac and I'm not seeing the gains I used to. I should mention i drink a lot of caffeine and smoke ecigs. Those are my pedestrian addictions. My doctor basically says I'm crazy and should feel the opposite considering I've been halving my dose about every 6 weeks. WHAT IS GOING ON?


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PostPosted: Wed Feb 08, 2017 9:31 pm 
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Because of the ceiling effect of buprenorphine, most people find little difference between 20 mg and 4 mg. Most people start having more withdrawal as they drop below 4 mg, but buprenorphine is blocked by specific liver enzymes called 'cytochromes', specifically cytochrome cyp 3A4. That enzyme varies in potency between individuals, and is also blocked by a number of medications. You don't list your age or the medications you are taking, but you may be a slow metabolizer, in which case you will be maintained by very low doses of buprenorphine.

Understand that over the years, people have listed many, many symptoms at this forum 'caused' by buprenorphine. In fact, I can't think of a symptom that has NOT been blamed on buprenorphine at some point. Water retention and swollen legs? That is one symptom, since they are essentially the same thing. Is it caused by buprenophine? Who knows. But they've been selling TED hose to prevent leg swelling, from water retention, for decades-- long before buprenorphine was around. Even your other symptom, 'not giv(ing) the fuck about anything', is related to water retention and leg swelling, because people who don't do anything, who spend too much time on the couch, are more likely to develop water retention and leg swelling. The flow of blood and lymphatic fluid from the legs depends on the 'skeletal muscle pump'-- i.e. the contraction of leg muscles of the legs 'squeeze' the fluid and push it upward, toward the heart.

You also don't mention your weight. But a very common 'symptom' in men is a lack of exercise, leading to obesity, leading to inactivity and leg swelling. I'm not even getting into smoking, which exposes you to many, many substances that are likely far more likely to effect your cardiovascular system than bupe.

Maybe you are actually an active, healthy man who has been beset by side effects from buprenorphine. But then we have to figure out why it did that to you, and didn't do that to the patients who I see, some of whom play tennis, and one who runs marathons.

I think you get my point... and yes, this is probably a 'pro-sub' web site, only because people here tend to play devil's advocate with these issues. For YOUR benefit, I would encourage you to keep an open mind. No matter whether your problems are, or are not 'sub-related', you will do better if you stay as active as possible, as that will reduce water retention. Smoking, as you likely know, is not doing much to improve your health either.

It is possible that your testosterone level is on the low side; all opioids can reduce testosterone levels, buprenorphine less than agonists. A low testosterone could explain the 'not wanting to do anything', which can lead to the other symptoms.

You will likely start having withdrawal symptoms soon if you continue your taper. I've written many, many times that most people on buprenorphine find, over time, that they need less buprenorphine to feel stable. But there is really know way to explain 'feeling' the buprenorphine, because of the ceiling effect and the nature of tolerance. Maybe the 'not feeling the fuck like doing anything' (I think I got that right) is actually WITHDRAWAL... and the 'feeling something' is the relief of that withdrawal.

Whatever the case, it sounds like you're ready to be done with buprenorphine!


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PostPosted: Wed Feb 08, 2017 9:46 pm 
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I would definitely agree with you, about the symptoms being related to lack of exercise or low testosterone. But I lift and do crossfit everyday(one recovery day a week) and I did mention this in my original post. I dont just workout to maintain, I take it very seriously and my max lifts are impressive. I'm 26, weigh in at a muscular 200 lbs at 510 and otherwise extremely healthy. I don't take any other medications.

Water retention and swollen legs yes are basically the same symptom but are not always mutually exclusive. I know suboxone makes me retain water, having never had these symptoms in the past except for a 6 month stint about 8 years ago when I took suboxone, I also had these symptoms, and they went away when I stopped.

I dont know what could be causing these side effects otherwise, and it seems coincidental considering my past experiences. Lack of exercise isn't my problem, if anything over training might be and I know that can exacerbate some of these effects. But I rest when needed. It just seemed funny to me that I can basically take whatever dose I want and then in about a month on a particular dose I feel as though it's gotten stronger. And yes I'm aware that suboxone has a buildup effect, citing the average 36 hour half-life, so when I change dose I see it through for about a week before making any assumptions. Also I know what withdrawals feel like, and I haven't felt them. I dont know if the endorphins from exercise have masked those effects for me, which I suppose is possible, but I haven't noted any days where I felt like I was in withdrawal.


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PostPosted: Thu Feb 09, 2017 5:39 am 
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Hello:

Well Dr. Junig seems to have missed a sentence in your original post, but understand he's
an extremely busy physician. In addition to his full to the bursting practice he does volunteer work at a methadone clinic several days a week. And then there's this forum that he founded and continues to run in a very hands on way. He often stops in....though I can't imagine how he has the time considering that in addition to all that he's a husband and father...to answer forum questions, put up informative blog and video posts,,,, and help countless suffering addicts over time without charging a penny.

All this by way of saying your snarky response is something you might want to reconsider.

Best wishes,
Godfrey


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PostPosted: Thu Feb 09, 2017 10:30 am 
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I too think ur response was snarky. I don't know if u were aware that ur question was answered by a real doctor or not but suboxdoc is a doctor and founder of this forum, so he's the person you'd most want to answer ur questions. Of course he doesn't know u personally so please take that in consideration.

Suboxone is unique in the way that the lower dose u take below the ceiling level, the stronger it can become. In other words, ur able to "feel" ur dose around 1-2-3 mg.... for some ppl anyway. Maybe that's what is happening with u.

Have u spoken to ur doctor about ur side effects, if so what does he suggest u do? I think anyone having side effects should be discussing it with their doctor in case something more is going on.

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PostPosted: Thu Feb 09, 2017 1:21 pm 
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Hello Ehale

Have you thought about tapering off suboxone all together? Or at least lowering your dose even more? If I was getting the side effects of "stronger feeling on a smaller amount" I would be absolutely thrilled. If I were you, I would taper to just about crums so I could take the least amount of subs to stave off cravings.

How LOW have you gotten on subs? I have noticed over time that I need less to get the same effect. Not necessarily that the dose feels stronger but I just need less to do the "job" of keeping my cravings at bay. I am thinking it is the build up of bup in my system. Not sure but I feel so lucky to take a medication where you need less and less the longer you take it and not the opposite.

Water retention has always been a common side effect for me when I take any opiate. Subs included. With that, I drink a ton of water and workout lots to keep myself healthy and hydrated.


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PostPosted: Thu Feb 09, 2017 7:19 pm 
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Hi Elhale and welcome to the forum. I don't disagree with my previous posters, but I see mostly frustration in your second post. It is definitely strange that you are feeling your dose more strongly as the dose goes down, but I would pay close attention to what Dr. Junig said about the cytochromes in the liver:

"Most people start having more withdrawal as they drop below 4 mg, but buprenorphine is blocked by specific liver enzymes called 'cytochromes', specifically cytochrome cyp 3A4. That enzyme varies in potency between individuals."

The way individuals metabolize drugs can vary greatly and change the usual effects of a medication. It would be a good idea to be tested by your doctor.

If you are feeling no withdrawal symptoms have you considered stopping the suboxone and seeing how you feel? Then if you start to feel some withdrawals you can take just a small piece until you are feeling a bit better and continue on that amount for a while. Then try stepping off again. It seems like you're in a super big rush, so it seems that it would make sense to try stopping.

Amy

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PostPosted: Sun Feb 12, 2017 10:44 pm 
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Hi Elhale
I didn't think your post was snarky. I can understand when your pour your heart into a post and something gets overlooked etc.

Have you ever tried dosing ever other day or at a different time of the day? Have your eating habits changed at all? Like maybe you spent your evenings trying to score your DOC and now you have free time to hang at home and eat more?

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

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