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PostPosted: Wed Oct 06, 2010 10:04 am 
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I need some help here !

Quick facts
3 yeas on Subutex - Brand
Approx 6-8 mg daily dose (2mg tablets, dosed usually 3-4x per day)

3 Months ago, tapered down to 6mg. This was a major accomplishment.

Then one morning, I got lower right quadrant sharp pain. Labor style pain. I knew it could only be one thing. A man's worst friend. A kidney stone. A popped 2 mg subutex, hoping it would help. It didn.t.

I was rushed to ER. Cat Scan revealed 4mm urinary stone. They ignorantly insisted on IV drips of diuladid, even though I told them I was on subutex. People should wear bracelets, as ER's seem to be clueless

They claimed the pharmacists said the diuladid would work It was useless. They gave me Taradol, this worked. But can only be taken for 5 days, as it's super hard on the kidney.

They gave me a 2nd shot of diuladid against my will. Sent me home with Norcos.

DILEMA. Been on SUBUTEX FOR 3 YEARS. But need pain relief. After many discussiona dn research I decided to simply up my dose from 6 to 8mg daily. This didnt help my pain. It then got increased to 10mg daily for my pain.

THIS DIDNT HELP.

I was a warrior for 1 month. I stayed on subutex hoping I could just pass the stone, and then taper back down to 6mg. Nope. Didnt pass it.

Finally, after missing work for 1 month, with, debilitating pain, that the sub did not help at all, I made a decision.

GET OFF SUBUTEX and GET ON A SHORT ACTING OPIATE FOR MY PAIN.

But here's the dilema.

#1 GOAL: Not to go into withdrawl while having a kidney stone
#2 GOAL: Get Pain Relief. But with 3 yrs on subutex, and most recently at a 10mg daily dose for 1 month, and previoulsy a 6-8mg dailyt dose for 3 years, how long would it take for the new opiate to work ?

DAY 1: 7AM, Took 2mg of Subutex
11AM Took 30mg Oxycodone HCL---Didnt get sick, but no pain relief

DAY 2: 24 hours off subutex. Taking Oxycodone HCL. We chose this since we felt after 3 yrs on subutex, it would cover my pain, and maybe not send me into withdrawl.

Fast forward to DAY 7 today.

This has been hell.

Subutex appraently is still in my receptors. I tried switching Norco and Oxycodone. The problem is this. MAJOR PALPITATIONS, ANXIETY, HI BLOOD PRESSURE. INSOMNIA. WITH DRAWL SYMPTOMS. EVEN at 6 DAYS after SUB, and this is on 180mg of OXYCODONE HCL per day.

I need some reassurance.

When will the palpitations go away ? They ony happen after I take an oxycodone. Is this because the xoycodone and the remanants of the sub are competing for the receptor sites.

I heard that it takes 7 half-lifes for a drug to be completely eliminated. Well, with subutex, it's half-life is 36 hours. So 7 half-lifes would be about 11 days.

I never dreamed that after being on subutex, and need to switch to an opiate for severe pain relief, it:

1) Would fully work even after 36 hrs, 48hrs, 72hrs, 90 hrs, etc. This is scary if someone has an emergency. For this reason I think subutex is horrific.

2) Even if you switch to a full opiate agonist (ve sub which ias a partial), you still get withdrawl effects. In my case palpitations, which I am taking clonodine to control. But how long will I need to take clonodine while on Oxycodone or Norco ?

3) Why won't the new opiate that has been induced not cover all my bases so as to NOT have acute withdrawl symptoms ?

4) Also, how many days after stopping subutex does it take to get 100% pain relief ? All the sites sa 24-36 hrs. Hogwash. I am at 120 hrs now, and still, ater taking 20mg of Norco, it doesn't work like it did 10 years ago when I took it for dental work.

If anyone has experienc with swtiching off subutex to another opiate for pain relief in an emergency situation like mine (KIDNEY STONES KILL---I still can't work, and the oxycodone / norco is not working fully)

I wold say for pain relief, the oxycodone / norco is working at this point 50%.
There is no mental or high, thats for sure, but again that is not my reason.

But the million dollar question is WHEN ?
When will the crazy palpitations and panic, anxiety go away. It hits 30 minutes after taking oxycodone. It seems that Norco for some reason doesnt produce as intense of palpitations, but there still there after a norco. That's why I tried 2 different opiates, since they are all different, and I thought maybe the problem was not the subutex metabolism, but oxycodone being stimulating. But nope, it subutex withdrawl at 7 days.

HELP!!!!


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PostPosted: Wed Oct 06, 2010 10:56 am 
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I just went through this kidney stone problem in June.I was in Brazil at the time and had a sonogram showing one stone in each kidney.The only thing they gave me per ER visit(about 3 in a week) was something called Buscopam Plus.It's a not narcotic but shoots straight to that urinary area where the pain is.Not having time to get my stones smashed I arrived in The US taking Buscopam Plus in tablet form and abusing Codeine! at the same time...30 30 mg's a day.A gram a day if you will.
In the US I went to the ER in New York City and they shot me up with 2 Morphine 4mg iv's and told me the catscan showed no stones! must have passed them.So no prescription for anything.I was luch I did in fact pass them because I never had the pain again.Although I was abusing Oxycodone and Morphine tabs by then.Shortly after that I found Suboxone.

Anyhow I'm no doctor but if the Oxy and other stuff is not working for your pain,I would go back on the Sub and find something else that is not a narcotic like Buscopam if they have that here in the US to suppplement the Sub until you can get an appointment to smash the stones.Two Weeks max maybe?Then you done.

Good luck
Tony


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PostPosted: Wed Oct 06, 2010 10:57 am 
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Are you saying that you're having withdrawals from NOT taking the subutex or do you think it's from taking the oxy? It IS possible that you're simply not taking enough oxy to counteract the tolerance you've built up from being on sub so long. But taking the oxy or norco will NOT CAUSE you to go into withdrawals.

As for when you will get pain relief from the full agonists - no one can say for sure. It's not just a matter of time, but you also need MORE opiates than the "normal" dose, again, because of taking high dose buprenorphine. I hate to tell you this, but some people have been off sub for a month and still had a tolerance problem with "regular" pain meds.

Also, I had to have a surgical procedure back in April while I was on sub. All I got for pain relief was Vic's. I had to take about three times the prescribed amount, but I WAS able to get pain relief and stay out of w/d. With that said, mine was a minor surgical procedure.

It's possible that what you need to do is take MORE of the oxy/norcos. I'm so sorry you're in this mess. I've never had a kidney stone, so I don't know the pain personally, but I've witnessed my husband have one and I know it is excruciating. Hang in there let us know how you're doing.

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PostPosted: Wed Oct 06, 2010 11:04 am 
I'm really sorry for you. Wow....what a mess! Kinda crazy how long it's taking to get any relief at all from full-agonist opiates. I'm telling you the more I read and learn, the more convinced I am that pain and buprenorphine is a set-up for major nightmares! It has been a concern for me from the get-go of my treatment with Suboxone. So much so, that I got myself down to as low as I could as fast as I could. Even still.....on as little as a couple milligrams a day, I think this stuff, escpecially after being on it a good while has our receptors so loaded and blocked that I don't know what if anything will break through it. I've heard of a person being off bupe as long as a full month and pain pills still not working like they should. Scary business!! Now I would think that what you've been taking might be enough to at least keep you out of withdrawal, but apparently not. I think we all (doctors probably especially) underestimate the power of bupe. When we're on ~4mg or more a day over an extended period of time, we are driving our opiate tolerance astronomically high (not that it wasn't already high on our former DOC) but for some of us, the bupe drives the tolerance way higher. I realize that's in large part why the drug works as it does, but it sucks that that's the price we pay for it.
You really have been a trooper by trying to get through this without switching from Sub. Is there any way at this point that they could just give you a general anesthetic, break up the stones and let you pass them and be done with it? I don't think that's the norm to put someone 'under' to do this procedure, but since it's unlikely you'd respond to conscious sedation because of your opiate tolerance, maybe?
I don't know. Wish I had more for you. It's really a sucky situation to say the least. Maybe someone with more experience with this will chime in. I've been fortunate enough during my year plus on Suboxone to not have severe pain. But I do want off the stuff sooner than later so as to avoid ever having to go through what you're going through.
However, I would be remiss not to add that the benefits of Sub for most of us outweigh these types of events. The drug literally saves the lives of addicts every day. The problem isn't really with the drug.....it's with the fact that all these smart doctors and pharmaceutical companies can't step up to the plate and come up with a reasonable plan of action for us addicts who are treating our disease with buprenorphine.
One more thing....with your dosage of Sub, I'm not surprised that even 30mg of oxy isn't touching it......As I understand it, it would take twice that to even be at a near-equal playing field. But I'm no doctor or expert. Just someone who reads a lot!! Hang in there buddy!


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PostPosted: Wed Oct 06, 2010 11:19 am 
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hatmaker510 wrote:
Are you saying that you're having withdrawals from NOT taking the subutex or do you think it's from taking the oxy?

I am having palpitations only after taking an Oxycodone. With the Norco's also, but milder. I am not sure if it's the subutex withdrawl and a competeition, or that Oxycodone is too stimulating. Norco seems to not cause the same level of palpitations. Clonodine 0.1 is my new best friend for now.

It IS possible that you're simply not taking enough oxy to counteract the tolerance you've built up from being on sub so
long. But taking the oxy or norco will NOT CAUSE you to go into withdrawals.

This was a concern going in. But 180mg of oxycodone hcl per day is what my average is. Today is DAY 7 post subutex. Maybe the palpitations will get lighter as the Bup gets metabolized.

As for when you will get pain relief from the full agonists - no one can say for sure. It's not just a matter of time, but you also need MORE opiates than the "normal" dose, again, because of taking high dose buprenorphine. I hate to tell you this, but some people have been off sub for a month and still had a tolerance problem with "regular" pain meds.

Also, I had to have a surgical procedure back in April while I was on sub. All I got for pain relief was Vic's. I had to take about three times the prescribed amount, but I WAS able to get pain relief and stay out of w/d. With that said, mine was a minor surgical procedure.

It's possible that what you need to do is take MORE of the oxy/norcos. I'm so sorry you're in this mess. I've never had a kidney stone, so I don't know the pain personally, but I've witnessed my husband have one and I know it is excruciating. Hang in there let us know how you're doing.


Thank you for your kind words. I was so proud of myself prior to this kidney stone I was tapered down to 6mg of bup, and doing the slow taper plan. Then kaboom ! Kidney stone.

Bup is great, but if you ever need pain relief, a major dilema.

Interesting note--I do get pain relief from the opiates. There is no doubt. I cant tell you what %. But let's say at least 50%. But here's the interesting thing---no euphoria, and feel good feeling. In fact like I said more like the opposite anxiety and panic.

I was told by a pharmacologist the following:
To figure out how long it takes a drug to leave your body, multiply its half life by 7.
So bup has a half-life of 36 hours. 36 X 7 = 252 Hours. Approx 11 days to get it out.

Also, there are medical journals that demonstrate that it takes up to 11 days for the the bup to be eliminated via fecal matter / stool.

So 11 days just to got most of it out.

I think 11 days is the minimal. I am gonna make an unscientific guess of 21-30 days to get eliminated out of your body.


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PostPosted: Wed Oct 06, 2010 1:41 pm 
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I passed a kidney stone while I was on Suboxone. I was taking 4-6mgs per day, at the ER I got IV dilaudid and toradol which worked though it wore off more quickly than usual.

At home I had percoset, which didn't do shit UNTIL I took it along with a small dose of Suboxone. I took like 1-2mg of Sub and then took the percoset. I didn't get high/euphoric, but the small dose of Sub kept me out of withdrawal without occupying all of my opiate receptors and then the percoset was able to give me pain relief.

This method worked for me and it has worked for others, but it doesn't work for everyone for some reason. Have you tried taking a tiny bit of Subutex, like 1mg, along with your full-agonists? It might help.

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PostPosted: Wed Oct 06, 2010 1:51 pm 
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The way I see it is there is nothing that makes stone pain go away completely.I would keep taking the Sub,ditch the oxy's and schedule a date to get the stone pulverized.Also remember the longer you are on painkillers the better chance of a full blown relapse can occur.

Go get the stones pulverized now!There is no need to suffer like this.


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PostPosted: Wed Oct 06, 2010 1:55 pm 
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Actually, studies show that the recovering person is at higher risk of relapse when they are left with untreated pain than when they are taking full agonist opiates to treat the pain. Just FYI. I believe that's in the paper posted under the "Links" section for treating acute pain in sub patients.

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PostPosted: Wed Oct 06, 2010 1:56 pm 
Wow, that sucks, sorry you're in so much pain. Dr. J said that a maintenence dose of Sub is roughly equivalent to 60mg of oxy per day. If you are on 180 mg of oxy you definately shouldn't be in withdrawal. Is it possible you have an infection? After I got in an accident I went from 12mg/day of sub to about 60mg or oxy and or hydro a day with a high dose of ibuprofen. While I don't know how much it really helped the pain, I did not feel any withdrawals from the Sub while on full agonists. Can they give you any more torodol at this point? I've heard several people say that it's an excellent non-narcotic pain med. Hope you feel better soon.
Lilly


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PostPosted: Wed Oct 06, 2010 1:59 pm 
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I have to admit, this scares the crap out of me. Sorry I don't have anything constructive to add. Hang in there!


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PostPosted: Wed Oct 06, 2010 2:41 pm 
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Lilly wrote:
Wow, that sucks, sorry you're in so much pain. Dr. J said that a maintenence dose of Sub is roughly equivalent to 60mg of oxy per day. If you are on 180 mg of oxy you definately shouldn't be in withdrawal. Is it possible you have an infection? After I got in an accident I went from 12mg/day of sub to about 60mg or oxy and or hydro a day with a high dose of ibuprofen. While I don't know how much it really helped the pain, I did not feel any withdrawals from the Sub while on full agonists. Can they give you any more torodol at this point? I've heard several people say that it's an excellent non-narcotic pain med. Hope you feel better soon.
Lilly


10mg of subutex was just a recent dose to ease my pain for the last month--I was actually on 6mg prior to the stone.

Toradol works greta--better than anything. It worked even better than Diuladid in the ER...but it's super hard on your kidneys, and you can only take it for 5 days. It can actually cause kidney failure, not a good idea when you have a kidney stone, and your kidney's are inflamed. So Toradol is not applicable here.

The Oxy's and Norco's are giving me pain relief for sure. There is no doubt. But no euphoria or opiate high like before.

The issue here is the left chest tightness and anxiety after taking an OXY or NORCO.

Anybody know if OXY's cause anxiety ? Vs. NORCO's. ? (I heard that Oxy's are a more 'stimulatin' opiate vs hrdocodone (Norco, vicodin), which are more warm, fuzzy, and calming.

That's why I have both. I am playing around to see which one will do the job.

But I am amazed that a 50 faily dose of hydo/oxy with ibroprofen did the job.

Here is what Im gonna do--I have an idea...rather than taking high doses of opiates...lower the dose and take more frequently...this may ease the withdrawl.

IE half a norco (10/325), which would be 5/170 every 2 hours....this would be a total of 12x times a day. But 1/2 each time...so the total would be 60 hydrocodone per day. And less than 2,000mg of tylonel.

Maybe the more frequent dosing will mimic the subutex's mechanism...since I having gone from a super long acting agonist to a short acting.

I think the trick could be not in the amount but the frequency of dosing...

Hopefully, the palps will leave soon. Clonodine does help though.


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PostPosted: Wed Oct 06, 2010 4:14 pm 
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Are you going to actually do something with these stones or just keep popping pills?I'm sorry but I have not seen anything in this thread about the remedy.
When you went to the ER complaining of pain and then having the test come back with the actual size of the stones,they didn't set an appointment for you to get them pulverized? If it's an Emergency they have to help you get the procedure done after they determine you in fact have the stones if I remember correctly.


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PostPosted: Wed Oct 06, 2010 5:17 pm 
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dontsleep wrote:
Are you going to actually do something with these stones or just keep popping pills?I'm sorry but I have not seen anything in this thread about the remedy.
When you went to the ER complaining of pain and then having the test come back with the actual size of the stones,they didn't set an appointment for you to get them pulverized? If it's an Emergency they have to help you get the procedure done after they determine you in fact have the stones if I remember correctly.


The xray revealed there was no stones 1 week later. This is the inaccuracy of western medicine. I am taking an amazon kidney support formula to relax the ureter and pulverize the stone into powder, plus an herb called chance piedra (which means stone crusher in spanish), and a Chinese herbal formula that has an 80% efficacy rate in china for reducing stones of all sizes.

7 years ago I had a stone for 6 months. The cat scan actually missed it. I eventually had it removed via where they insert a basket into your bladder. Not something I want again. It is very hard to pass the stone when youre in pain.

I didn't give my stone history in my orig post, because I was focusing on the immediate problem at hand, subutex withdrawls and subutex possibly not giving analgesis relief.

My steps:

1) 1st get out of pain (the subutex wasnt working, and currently only minimally allowing other opiates to work)
2) With some pain relief I will pass the stone


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PostPosted: Wed Oct 06, 2010 5:41 pm 
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I'm with Don't Sleep here. I would focus on getting the darn stone out. I'm not an expert but I have passed a total of three stones in my life. It's my understanding that when in the kidney they can do a variety of procedures, including lipotripsy, to blast the stones apart so they can pass. Unfortunately, once they enter the uritor, this can no longer be done. However, what they can, and often will, do is go up and get the stone. You, um, uh, can figure out where they go through in order to get it - no fun, I realize - but still better than being in constant pain over the long run. I was given the choice. My urologist said he'd be glad to go up and get it or we could just let it pass. It did take many, many months and then got "stuck" at the end of the path and that took another month at least until plop, out it finally came. Thankfully, I only had pain for about a week and after that it was really not painfull - it just was very hard to pass urine.

Anyhow, here are my thoughts:

1. Plain X-rays often will miss a stone.
2. CT scans or more importantly the doctor reading them can also miss a stone.
3. Tordol works better than pretty much anything, but you are correct in that it is really hard on the kidneys.
4. It is likely much more the tolerance that is keeping you from getting pain relief than whatever minimal amount of Sub left in your system.
5. Many times no amount of pain medication - even for those not on Sub - can stop kidney stone pain. Think of it this way, unless you are unconscious, even if on a gallon of pain medication, you would still feel a knife cutting into you. The stimulation of the stone can never be totally turned off by medication. Many times you can just keep it to a dull roar rather than so intense that you can't live with it.

At the end of it all, I would really turn my focus on getting that stone out. That is very likely the only way to eliminate your pain.

Sadly, this is yet again just one more example of the fact that there is just really no good way to get pain relief from opiates if you have taken Bup within the last 3 to 5 to even 7 days. Say what you will, this just continues to seem to be the case. At least it would seem that way.


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PostPosted: Wed Oct 06, 2010 6:32 pm 
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Since we both have had stones, we know the pain.

My stone according to the CAT SCAN 1 month ago was at the UV junction. Wehn the stone is here, there is do damage realy ebing done to the kidneys, and sometimes you have pain & sometimes you dont.

But for some reason, it eliminatre appetite most of the time. This is where I am at.

I have the surgery thing where they stick the thing you know where to remove the bladder stone. Would like to avoid that as long as I can.

So the plan for now is try to:

1) eliminate pain and pass the stone
2) Avoid surgery

The herbs I am taking have been proven over centuries to pulverize the stone into powder, almost polish them down to make them pasable.

I actually passed "something' 1 month ago, and it was a celebration. But then the symptoms didnt go away.

I sent the 4mm substance to the lab and it came back 'SEDIMENT'...not helpful.

It is believed the I passed part of the stone and according to my wife--all of it.


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