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PostPosted: Sun Feb 07, 2010 9:28 pm 
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After searching high and low for some clarification on my questions and concerns related to my suboxone use (what everyone describes as an extremely high dose), I am left anxiety ridden and even more confused than before. Everyone I talk to about my confusion with suboxone has a cousin, sister, brother that knows the answer...but they always seem to give me conflicting information. I decided I would go straight to my docs (my primary care and sub docs) for answers and was convinced that they could give me the 411. Well, once again I am left with conflicting information and confusion. As a last ditch effort, I did some research online and stumbled across this site......thank god!! Finally some clarification and insight from those who are living it.

Here's the deal, I've been using suboxone for over a year and half after coming off of a pretty serious addicition to opiates (oxy's, perc's, vic's, dilaudid, morphine, etc). I had convinced myself that I wasn't addicted because I was able to hold down my modeling career, finish my degree, become an exec at a great company....and besides, I was originally prescribed these meds and went to pain management as the doc ordered. That means I can't be an addict..right??? WRONG, it became very apparent when before too long I was buying them off of friends and taking way more than needed....but always had some pain to justify my use. Although I knew with my diagnosis of fibromyalgia and/or lupus (depending on which doc you believe) there was a very good chance I would need opiates in the future, I decided that I didn't want to live a double life chasing pills (I always needed more than they prescribed) and searched out a doc to give me an RX for subs. Throughout my addiction I was able to hold down a successful modeling career and finished college and became an exec for a great company.

Now I find myself at a dose of 24-32 mg's of suboxone a day, putting off much needed surgery, and suffering through back pain on a regular basis. My sub doc is a really nice guy who never seems to have any concrete answers for me and immediately discourages any conversation that I initiate regarding my desire to come off of the subs or have surgery. His answer is always, "don't worry about coming off of subs....why would you want to if it works....you can stay on these for the rest of your life". When I press the issue of surgery, he simply reassures me that there are ways to handle pain during surgery while on subs. He doesn't seem to want to elaborate and I've been waiting for him to give me a game plan for over 3 months!! Everyone I talk to tells me that I better not try to take pain meds while on the subs because I will get violently ill, as it will push me into immediate withdrawls. Others tell me that I need to get off the subs for over 4 days before the pain meds will take effect. People often tell me I'm taking way too high of a dose on the subs for my size (5'6" and 120lbs) but I've never heard anyone say that size is a factor in dosing. I thought it was dependant upon how much and how long your were using (at my worst I was taking 5-6 oxy 80's and mixing it up with perc 30's).

Sorry to be so long winded but I'm really trying to get some insight on these issues and I want to make sure I include all the relevant factors...lol. Here are my questions:

* What can I do to be sure that I am able to tolerate the pain during my surgery?
* Knowing that nobody can say for sure, as they are not my doctor......can someone tell me if my dose seems high?
* Will I get violently ill if I take pain meds too soon?
* About how long would it take to get the subs out of my system?

I know that my list is a hell of a tall order....but if someone can shed some light on any part of this, it would be greatly appreciated. I am at the end of my rope and starting to wonder if I made my situation worse by using the subs.


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PostPosted: Sun Feb 07, 2010 11:28 pm 
Hello Bella and welcome to the site! You are in the right place to find support and good information!
Firstly, you are certainly not alone in this. There are many of us here on the forum who, like you, were very highly functioning opiate addicts. Some of us didn't stop and seek help until something happened to force us into realizing how sick we really were, while others simply got tired of chasing pills and living a lie. We have found great relief and help in Suboxone as part of our efforts to get and stay off the opiates.
In my opinion, you are on quite a large dose of Sub, especially given the fact that you've been on them for over a year. Dosing requirements differ from person to person, of course, and from doctor to doctor. But from my own experiences and from the reading that I have done, anything over 16mg/day is kind of overkill. I am not a doctor or an expert, but if I understand correctly, burenorphine has a ceiling effect....in other words, once you are at the ceiling, you derive no additional effect from taking more. That ceiling is usually at 16mg/day or so. With few exceptions, you will find that if you ask many people who are on Suboxone what happened when they dropped their doses from 24mg/day or higher, down to 8-12mg/day or so, they will say "absolutely nothing."
Have you ever tried to decrease your dose? If you have not, perhaps you could go ahead and give it a try and just see what happens. Personally, I had no problems at all dropping from 16mg/day to 12mg/day then to 8mg/day within a pretty short period of time (~6weeksish) I dropped to 4mg/day not too long after that with very minimal effects as well. I think you'll hear that type of scenario time and time again. In my opinion, there is no reason to take more of any type of medication than is necessary to alleviate your symptoms. More is not always better, in other words. If you withdrawal symptoms are kept away and your cravings are minimal and manageable at 4-8mg/day, why take 24mg/day?
As far as your surgery...you will have to work closely with your physician on that one. But I will tell you what I know and give you my opinion, for what it's worth.
First of all, if you take pain medication while you are on Suboxone......NO you will not get violently ill. That is what happens when you take Sub too soon after taking pain pills and it is called precipitated withdrawal. That is why you can't start Suboxone until after waiting a while since taking your last pain pills. What will happen if you take pain pills after taking Sub is.....NOTHING! The Suboxone has your opiate receptors 'loaded' so that the pain pills cannot work. Make sense? Now, if you're on a lower dose of Sub (ie 2mg/day or so), your pain medication might work some but probably would not get you high.
Generally speaking, if you have a planned surgery or procedure in which opiate pain meds will be necessary, you will need to stop your Sub about 3 days prior to the surgery so that the pain meds will have a chance to do their job. Then, once the need for opiate pain meds has passed, you'd wait 24 hours or so and restart your Suboxone.
In emergency situations, hopefully you'd have good medical care and they would be aware that because you're on Sub, it's gonna take a hell of a lot of opiate to 'break through' the Sub that's in your system, but it can be done.
Another thing is that during surgery itself, you'd probably be under a general anesthetic which doesn't have anything much to do with the Sub. The anesthesia would manage your pain during surgery without the need for opiate medications. However, after surgery, you'll need pain control and that usually does involve opiate. Hence the need to be off your Sub for a few days prior.
Hope that helps a little bit. I can think of no reason why you would need to be on that high a dose of Suboxone for this long. Maybe there is something I don't know.....have you had multiple relapses? or tried to lower your dose and had problems with it?......I just can't think of very many reasons you'd need that much. But again, I'm not the doctor. But you are certainly entitled to ask your doctor why he/she has not brought your dose down a bit at this point. If your doctor is not receptive, perhaps you can pull up some research or anecdotal evidence that supports the idea that those kind of doses are not necessary. I personally want to be on the lowest dose I can be for exactly the reasons you're going through right now......if an emergency arose and I needed pain control, I want them to be able to break through the Sub as easily as possible. Also, the less I take, the less $$ coming out of my pocket.
Just my 5 cents worth.
Let us know how you're doing. Perhaps others will chime in as well.
Glad to have you here.


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 Post subject: Thank you Set me free!!
PostPosted: Mon Feb 08, 2010 12:23 am 
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[font=Arial]You have no idea how much I appreciate your response. I completely understand what you have explained and it certainly coincides with all of the clinical data I have reviewed.

As far as my dosing goes, I always felt like it was high compared to what I have read that others were taking to successfully maintain within their treatment. As far as why I'm on such a high dosage, your guess is as good as mine. I hate to speculate or insinuate anything negative regarding my doctors choices, as he truly was a godsend for me in a very dark and depressing time. I've read some pretty unflattering posts regarding his treatment of patients online but I'm not really sure what the status quo is regarding docs that provide this treatment. The truth is he doesn't accept any type of insurance and charges me $100 a week to come in for my RX. The waiting room is filled with anxious patients and our visit usually lasts less than 2-3 minutes. In my case he always refers to the fact that I am a different type of patient that he really needs, as I have a diagnosis that allows me to be classified as a pain management patient. He was open with me that my status allows him the opportunity to see an additional opiate addiction patient. The truth is that I am an opiate addiction patient too but somehow my issues with Fibromyalgia and Lupus puts me in a different group within his patient load. He asked me how many I needed and having heard that your tolerance can be increased in taking this med...I guess I erred on the side of caution and told him 3 a day. I had no experience in this med and really should not have allowed him to let me decide. I have never relapsed or had withdrawl symptoms at all. I'm excited at the thought of potentially cutting down my dosage. So much my sub dosage issue seems to be truly pyschosomatic, as I've always somehow doubted the effectiveness of the little orange pill's effectiveness when placing it under my tongue...lol. Why it's hard for me to grasp the concept that sublingual meds are an extremely effective means of delivering meds into your system, is beyond me....but for some reason, I always have. I only worry that my work will be effected if there are any ill affects of cutting back. I guess I should probably start on a weekend to be sure.

Your the best; thank you![/font]


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PostPosted: Mon Feb 08, 2010 12:42 pm 
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Hi Bella and welcome,

I just want say something regarding your dosage. For the last 14 months I've also been on 24 mgs of sub for both my addiction as well as two chronic pain conditions (including fibromyalgia). Because it's also used to manage my pain, they have me taking 8 mg three times daily. This was per my first sub doctor as well as my new one (after we moved). Apparently when it comes to managing pain, the suboxone is dosed differently. Perhaps this is the same reasoning your doctor is using?

As for surgery, I had an out-patient procedure back in December. I stopped the sub 2 days before the procedure, per doctor's orders. I only needed pain meds (via IV) in recovery. Once I got home I went straight back to my usual sub dosage with no ill effects.

Again, welcome! You'll find so many supportive and empathetic people here.

Melissa

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PostPosted: Mon Feb 08, 2010 1:49 pm 
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Welcome Bella!

So, I'm an 'outsider' with a wife that has an disease called 'undifferentiated autoimmune disease.' That is a fancy word for well - it is like fibromyalgia (before there was a real acceptance - and ability to diagnose it) - and lupus - but not either perfectly.

you said:

"Although I knew with my diagnosis of fibromyalgia and/or lupus (depending on which doc you believe) there was a very good chance I would need opiates in the future, I decided that I didn't want to live a double life chasing pills (I always needed more than they prescribed) and searched out a doc to give me an RX for subs."

In our case, the disease is all about PAIN. Mainly muscle pain - but connective tissue issues, edema, lungs, incredible joint itching, - it goes on and on.

Once the rheumatologists have done all they can with the medications they have suppressing the imunity system... it's all about symptomatic pain management.

My only advice to you is to be sure you take that into consideration as you decrease your buprenorphine dose. Naturally, you want to take as little as you need of Suboxone (buprenorphine) and still manage the pain. Understand, though, that if you are like my wife - this is a real - life affecting situation. We, as a family, have been on the roller coaster of 'I hate PAIN PILL's" I'm off them, or once (before we got old) - I want another baby - so I went off everything (pre methadone) to see if 'it was all in her head' and she was in the FLARE FROM HELL... It took months of recovery - and honestly, the psychological damage may never go away. Can't go back. Later she was diagnosed with a prolapsed uterus - and it required a full hysterectomy.

Anyway - all this blather to say - please use COMMON SENSE with this. Being dependent/addicted while walking the razor blade of FLARE's of your fibro/Lupus is a real and life affecting/altering line for you.

I wish you all the best. I hope you have a good team of people to support you (not just opiate support - but fibromyalgia/lupus support).

Please keep us posted. I am glad you can get enough pain support from buprenorphine - as that is not enough in my wife's case.


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 Post subject: My Experience ...
PostPosted: Mon Feb 08, 2010 3:51 pm 
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Hi Bella1,
I would also like to welcome you to the Forum... I hope you find it as helpful as I did when I first came here!
As far as your dose goes I will only tell what my Dr. told me.. I was using about 300 - 350 mgs. of oxycodone per day when I got into treatment. My induction was done in the DR.'s office 2 mgs. every hour and a half for a total of 12 mgs. the first day. The Dr. prescribed 12 mgs / day and told me to come back on the third day. I did as told but when I returned to the Dr.s office I told him I needed a higher dose thats when he bumped me up to 16 mgs. per day (still my dose a year later) and told me thats the highest dose he would / could write because of that ceiling effect anything higher would be a waste... It may be different for pain mgmt. my Rx was only for my addiction treatment! Anyways just wanted to welcome you and put in my $.02! Best of luck with your recovery and continued success....
Take Care!

God Bless
TW


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PostPosted: Tue Feb 09, 2010 12:02 am 
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Lathedude, your story is eerily familar as your wife's diagnosis is exactly what I've been diagnosed with. Back and forth with positive ANA tests, strange symptoms that at the surface would not be xpected to be related to lupus or Fibro, and varying opinions from a group of doctors that can't seem to agree on much of anything....except for the fact that I certainly have some mixed auto-immune disorder. I appreciate your feedback because I do sometimes forget the levels of pain that I experienced when I was not in remission. While reading your post I had vivid memories of not being able to kneel because of the pain in my joints, crying every morning because I couldn't deal with the pain, and the feeling that things were never going to get better. I wasn't a big believer in natural remedies until I was so fed up and overwhelmed that I decided I had nothing left to lose. I never believed it would work but I've had amazing results with changing my diet, taking supplements, and exercise. Don't get me wrong, there are days that I still have moderate joint pain, migraines, and some intermittent strange symptoms. I just thought I would mention it in case you guys haven't considered it. I don't want to sound like the crazy person that says the cure is in making simple changes to what you eat....because that certainlynot the case and we all wish it was that simple...lol. My reality is that by eliminating all of the foods with preservatives and mostly eliminating refined sugars and caffeine, I was able to have the occasional remission and a lower level of pain. Now combine that with a high dose of sub, I am at a place where I can clearly think, exercise moderately but consistently, and live a life with manageable levels of pain. I can't remember a day of my adult life without pain (I'm sure when I was abusing pain meds I had days that I was pain free but I was soooo high that I don't remember them) but things seem a bit brighter.

One thing that I'm started to realize is that I'm going to be OK either way....if I decide that I should start tapering off the subs or if I decide to get to a manageable dose of sub and stay on it long term.

You are all amazing for giving me your honest feedback regarding your personal experiences and I'm grateful for your kindness.


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PostPosted: Wed Feb 17, 2010 10:46 pm 
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I read some of these and I often wondered the same as in some odd accident or you we're hurt in an er
situation what would they do then. I have often wondered this but never known the answer.. As for coming
off for surgery I do realize that bu not for an Er situation. What would they do? Does anyone know? Lynn

Good for all you that found subs... :)


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PostPosted: Thu Feb 18, 2010 9:05 am 
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I am one of those who has to have surgery while on suboxone (although currently off suboxone). My doctor provided the same limited and unhelpful information. So I went off suboxone for 3 days and had surgery. I was given percocet for post surgery. I did not go into withdrawal or get sick. HOWEVER....the percocet didn't work all that well and I was told it was likely because of the high level of narcotic I was on prior to suboxone (5-7 40mg oxys per day). It worked if I took enough, but I was out very quickly and was afraid to ask for more at that time. I was on 16mg of suboxone at the time I had surgery. With that being said, when I stopped the percs I just went back on the suboxone and it was actually livable. I felt the pain and recall a couple difficult nights, but I was ok. I will also say that I had zero interest in the percocet and couldn't wait to go back on the suboxone because it made me feel more normal. It wasn't nearly as scary as I thought it was going to be.

It will also probably depend on what type of surgery you have and how painful it is.

I am off suboxone and had a surgery at just 2 weeks off recently. I only requested vicodin for pain because I didn't want anything too strong. I jumped off suboxone at 12mg per day this time. The vicodin worked if I took 3 at a time. This is interesting because of how much narcotic I was on prior to the suboxone and used to be able to take 5 vic at once and feel nothing.

All I have is my own experience to share. Hope that helps.


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