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PostPosted: Thu Nov 06, 2014 3:50 am 
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Hello There,

It has been several months since I've been on this forum because it's been about 10 months since I have been on Suboxone. I quit the first time tapering myself down to .5 mg every 48 hours, and then wearing a 25 mcg Fentanyl patch for 3 days starting 72 hours after I jumped off, followed up with restoril and valium as needed with kratom tea for 2 weeks following the wearing of the patch. I was clean off everything for 6 months before coming to Northern B.C.

Here I found a dealer who lived very close to where I attended school and found myself into the same habits again very quickly, however it was much harder to get help here then in a major city like Toronto where I was previously located...I have yet to find a family doctor and my addiction worsened exponentially while I was put on a waiting list to attend a methadone clinic (something I have never been on) Anyways, long story short, I'm stabilized at 40 mg of methadone a day, my doctor is the worst of the worst, the kind you hear horror stories about, will not even discuss things with you, threatens to cut you off methadone every time you ask a question he disagrees with. He will not prescribe me Suboxone, he says the danger of precipitated withdrawal is too great, and he expects me too stop methadone for 2 weeks (as well as all other opiates) before inducting me onto Suboxone. In order to do this, I quit my job, I went to detox and suffered for 5 days cold turkey, and eventually left late on the 5th night and went out and used Dilaudid. He blamed me for this and said I must not want help. It's absolutely insane...

I ended up getting my hands on 15 8mg Suboxone tablets...I was wondering if somebody here could help, I'm in desperation mode and really need to find a way to get clean with these tablets. I was comfortable at 2 mg every 24 hours before, but now my tolerance might be higher so I might require 4 mg for a week or so; I believe I'm the only person in 100's of kilometres from here with these pills so I must treat them with absolute care and respect and treat them like gold. I need to work out a taper plan, and discuss the best way to switch over from methadone to suboxone. I have nobody to figure this out with so any help would be greatly appreciated. Thanks in advance, and just to clarify, this was posted out of desperation as well and may be lacking some details, so any questions will be answered ASAP and clearly, and I look forward to getting clean once again and staying there this time.

Jesse


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PostPosted: Thu Nov 06, 2014 11:30 am 
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Hi WMD, sorry to hear about your woes (and about the terrible Methadone doc you had), but with 15 8 mg Sub tablets (or strips), you should be able to work out a viable taper plan.

FYI I switched from Methadone to Subs last Christmas, and tapered off Subs completely in June. Looking back, I'm sure I could have gotten off Subs in a couple months, rather than the 6 months that I took.

When I made the switch from Methadone, I did the recommended 72 hours between my last Methadone dose and first Subs dose, and it went fine. I took clonidine and seroquil during the 72 hours, which helped, but I think I could have lived without it.

Once you stop Methadone, 4 mg per day of Subs should probably hold you -- on your first day, you could start with 2 mg, and wait a couple hours before deciding whether you need the additional 2 mg. The lower you start with your Subs dose level, the quicker your taper will go.

Coming down on my Subs dose was really easy until I hit about 1.5 mg/day, then I started to experience sleep difficulties and some emotional turmoil. I kept dropping my dose by about 25% -- 33% per week, and it generally pretty manageable. Days 2 and 3 after the drop could be a little tough, but I still managed to complete my work days, and keep going to the gym or pool every day -- diet, supplements and exercise are very important btw, they will help a lot with your taper and detox.

I jumped just over 4 months ago, at a dose level of around .15 mg/day, but I think I probably should have jumped sooner at a higher dose level, and just gotten to it.

Anyhow, post back to this thread, or PM me. I'm in Toronto btw, and my addiction doc (ex-addiction doc at this point) is excellent. If needed, I might be able to ask her if she could make a B.C. referral, if you get into a jam.

Good luck!

-- ji

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"Past and future veil God from our sight; burn both of them with fire."
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PostPosted: Sun Nov 09, 2014 11:27 am 
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As a doc, I have to be careful to say that I'm speaking in generalities... not giving medical advice. People in the US understand the reason for that distinction-- not sure if the climate is the same in BC!

JI, you did well in your transition-- for reasons that I don't think anyone understands. SOME people have very hard transitions when going from methadone to sub. I've had people wait a week or 10 days, and still have bad precipitated withdrawal. Again, I don't know the reason for the difference. I've even had several patients who had zero withdrawal when stopping suboxone-- whereas most people know how unusual that is!

The main thing: If somenone does precipitated withdrawal, he/she should NOT try to treat it with any opioids. Clonidine helps, in small doses-- around 0.1 or 0.2 mg every few hours. Higher doses will make a person dizzy upon standing. Benzos are also helpful for the short term.... but if I person is taking benzos and then goes back to significant doses of opioids, they can easily overdose.

A person who gets precipitated WD should just keep taking the bupe or sub each day, as scheduled. Precipitated WD never lasts very long-- unless you start trying to treat it with opioids.

JI had the ability, strength of will, or whatever to make it work. Many people are NOT able to use buprenorphine to taper off opioids. I hope you can-- but don't beat yourself up too much if you can't. JI is an exception-- which you'll notice if you keep reading this forum!!


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PostPosted: Tue Nov 11, 2014 9:51 am 
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Scary to hear about people suffering PW when starting Subs 10 days after their last dose of Methadone...but as an addict, I have to say I'm a tiny bit skeptical, too. In active addiction, we lie constantly about our drug use, and it's possible that people weren't staying opiate-free the entire time.

Maybe the final Methadone dose level relates to how easy a Subs transition goes? In Ontario, the Subs guidelines don't allow doctors to prescribe the switch until Methadone patients are under 30 ml/day. My recollection is that I was down to 20 or 25 mg/day when I transitioned.

Thank you for the comments, Suboxdoc, but I think "strength of will" had little to do with my transition, or staying clean since my jump in late June -- "powerless over drugs and alcohol" is literally true for me. I have no idea what is keeping me clean; I just follow those "few simple rules" out of the Big Book, and the obsession to use remains gone.

I learned this lesson all over again during the past couple weeks -- I quit vaping (eCigs) cold turkey on November 1st and, again, have no idea how I'm staying nicotine-free. I tried quitting smoking a year ago, and absolutely could not do it, hence the switch to eCigs. I've been vaping so much in recent months that I starting to feel winded at times, even though I do cardio 5 times per week.

I don't know why quitting is working now; I desire a vape (or a cigarette) a couple times a day most days, but there is no power behind these urges. The obsession has been removed.

-- ji

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-- Rumi, Sufi poet and teacher


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PostPosted: Mon Dec 29, 2014 8:26 pm 
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Hi guys,

Thank you so much for the responses; I've had a bit of a breakthrough with my doctor, he told me if I can get onto Suboxone myself without having to go through their process of going to detox and suffering for days until they decide to give me any, if I can do it myself, then he said he will prescribe it for me. So I have about 10 8mg Suboxone and I'm going onto day 5 since my last methadone dose at 50mg ( I was only on 50 mg for two weeks and before that 40mg for about 2 months ) I've started to notice some hefty withdrawal symptoms and was going to take my first sublingual dose of Sub in the AM of my 6th day depending on how intense the withdrawal is. I'm scared of going into precipitated withdrawal, but it has never happened to me before as long as I waited 24 hours since my last opiate dose. If I feel really shitty tonight and need to make it through the night I was planning on taking a dose of hydromorphine (dilaudid) a short-acting instant release opiate to make it through the night and upon feeling withdrawal symptoms tomorrow afternoon (roughly) I will take my induction dose of suboxone, manage myself until Friday (my doctors appointment) and hopefully he will prescribe me suboxone and then I will begin the process of tapering myself off suboxone slowly over the next two months until I can be completely clean. Any feedback would be greatly appreciated once again. Any physicians advice likewise greatly appreciated. Hope to read some responses and look forward too being rid of the monkey on my back once again. Thanks.

Jesse.


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PostPosted: Fri Jan 02, 2015 8:29 pm 
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So I took my first dose of Suboxone yesterday and I took about 4 mg, 2 earlier in the day and 2 later at night. I did go through some precipitated withdrawals for the first time ever; It was not pleasant to say the least but now I'm worried that the doctor here won't be prescribing me anything. So any advice to help figure out the best taper plan I can would help. I have 10 8mg tablets left and any advice is greatly appreciated. I hope to hear a response from you guys. I'm feeling pretty suicidal...I hope I can get off this addiction as pain free as possible. hope to hear a response from some people...thanks in advance.


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PostPosted: Fri Jan 02, 2015 9:01 pm 
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WD,
I just read though your thread here. First off, please know that you can do this.
As Dr J said if you do have some PW S do not take any more opiates, just take your sub
slowly, 2mgs at a time. Over the next few days you should, hopefully get there. Its been a few
days now and as loug as you stay off other full agonst opiates you can make it.
As far as this dr Not taking you, I dont understand why he is doing this if and when you induce.
This makes zero sence to me. At any rate, if he said you come in inducted, then you will hopefully get your meds.

Man, just stay calm, dont use, and keep taking your Buprenorphine. ..
Sorry your having a ruff time. Go back over this thread and reread what Dr junig has said.
I dont know if this helps you or not, but hang in there, keep looking forward and you ll get there..


Razor..


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PostPosted: Fri Jan 02, 2015 10:19 pm 
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I did end up using a bunch of shit today, cuz I thought it would help but I felt nothing after close to a gram of good H....so should I just wait another 24 hours or so and start taking the sub again you think Razor? I wouldn't have if I read this first but I thought it might be the best thing I could do to get some sleep.


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PostPosted: Fri Jan 02, 2015 10:43 pm 
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First i want to say i have no experience myself with methadone but i do have a close family friend who did the methadone to suboxone switch and he did wait many days. His doctor had a heart & gave him comfort meds for a few days. He had to go everyday to the doctor & they checked his symptoms with the COWS scale. When he was in moderate w/d's after being meth free for i think 7-10 days ( i just remember it was a long time) the doctor gave him 2mg of suboxone and 4 hours later 2 more etc.

So, IMHO i think you should forget about "hours" and print out the COWS scale - get someone to evaluate you and when you are in moderate w/d's take a tiny amount of sub. My concern is you have so many different opiates in your body now it's a risk to go by hours. Unfortunately we all have to be in crappy w/d's but if done properly we are not sick once we take the suboxone. What date is your doctor appt? Why would he go back on his word? He did say if you got on sub he would write a script.

This is easy for me to say and i almost hate to say it but i want you to succeed so i will ask you to make a Plan and Stick with it. No more H no more anything - just accept we have to be sick to get well.

Last thing, once you are successfully on the suboxone why do you want to taper off so fast? Do you have a recovery plan? A cravings plan? Addiction is so hard!

I want you to succeed and i am sending you "good Vibes" LOL Keep us updated and hopefully your doctor writes you a script so you can create a solid plan for a sober life.

Success can be yours and so can a good life!


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PostPosted: Fri Jan 02, 2015 11:10 pm 
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Thanks dude.

I worry about him, because I missed my appointment today, I couldn't get out of bed, still can't...and because I still have H in my urine tests, but I guess I won't know until next wednesday now...I will definitely be reminding him of his promise to me, And I hope things to go my way...my problem is im such a junkie I don't know if just being well is enough for me...my anxiety and depression is so intense and I have so little help other than just maintaining...sometimes the cravings to get high are just to intense...I've done a gram of H today, which is 4 times my normal amount, and i wasted alot of money for no reason...it's a joke...I'm currently unemployed and am 500 in debt to a dealer...I have to get myself well enough to go out and find employment..and I do have to work my part-time job on Sunday, so if subs aren't cutting it I believe it's because by the time I hit the ceiling effect of Subs, it still isn't enough to ease my pains because my intense tolerance to opiates...It was never a problem until I had to take methadone for a few months at 50 mg a day because he was not willing to prescribe me suboxone even tho I assure him that I've been on it before for a few years and know that taking 2 mg a day is much better than the methadone, because I still actively was using other opiates while taking the methadone.

I appreciate the good vibes and any help I can get, this forum is really all I have at this point.


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

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