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PostPosted: Wed Oct 07, 2015 10:17 pm 
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Hi guys, this is my first post here! I am happy to be apart of this community. I just began my Suboxone maintenance program but I have a question about it.

I am aware that many doctors over-prescribe Suboxone. I believe that my doctor has, being that I am on 16mg/day and if I take more than 4mg at a time I get very nauseous. I am aware that I should be following the prescription and I will once I titrate myself up. See, he was very insistent on 16mg even after I told him that 8mg has worked best for me in an inpatient setting. His rationale was that that was a controlled environment so I didn't need as much to keep my cravings at bay. I see where he is coming from, and I plan on complying once it's possible.

My question is, until that happens, is it possible that when I go in next week for the follow up visit, is it possible that the urine sample I provide would alllow him to see that I am not taking as much as he prescribed? I am worried to rock the boat on the first week. Any insight on this is much appreciated! Thanks!


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PostPosted: Wed Oct 07, 2015 11:24 pm 
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The vast majority of UA's are qualitative, meaning, just checking that the bup is there and sometimes a metabolite. Also checking that other stuff that shouldn't be there; is not. Until you get a feel for your doctor and how he handles these situations go with the flow and take what you need. They will not know unless they watch you take it. If you are in an inpatient program do you get monitored? If you can stay at 8 mg a day, and are well controlled that would be great. Keep posting, I am interested in how this will go for you and how you negotiate the transition from addiction to health with your doctor.


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PostPosted: Thu Oct 08, 2015 12:01 am 
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Hi and welcome to the forum and sub maintenance,

I cannot answer your question but someone should be along soon with the advice.
I imagine they could check for levels of sub in your system but then again, they could just be testing that it is actually in your system and whether your using anything else.

Just remember at the end of the day, your the one who makes the decisions. Your doc can only give advise. I started on 8mg and within a week I needed to be bumped up to I think 12 or 14. Another week and a half later I am on 24mg. That's where Im happy and not craving at all really. My doc wants me on 32mg but I say no because im feeling good and fine on 24.
I personally would call him and explain how it makes you feel and if he is any good, he should make a suggestion that helps.
Im in Australia and the cost does not change depending on dosage, maybe where you are that could be part of it? Maybe he is just trying to make sure your covered completely now your not in a controlled environment, like he said but the nausea must be very off putting.

Please let us know how you go after seeing him.
Good Luck

Mel


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PostPosted: Thu Oct 08, 2015 12:54 am 
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Thanks for your input! I am not in an inpatient setting so i will be able to continue taking the amount I deem fit.

I definitely plan to continue to post, I really need to keep myself talking to people about recovery and this is a great place to do so not to mention I learn a ton.


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PostPosted: Thu Oct 08, 2015 7:26 pm 
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Hey Vico welcome to the forum!!

Glad to hear ur doing well on an even lower dose than ur prescribed. I agree with dock, and also that gives u the chance to put ya some suboxone bk for emergencies if u needed it. U never know what might happen and having a little extra can be a lifesaver.

Seems like ur off to a great start!!

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PostPosted: Thu Oct 08, 2015 10:32 pm 
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Welcome! I have a feeling that the reason your doctor wants you to be on 16 mg especially at first, is to make sure that you are over the ceiling limit of suboxone's effectiveness. In other words, he wants to make sure that your receptors are covered with buprenorphine (sub's active ingredient) so you will have no cravings and feel no withdrawals.

Is 4mg taking care of all your cravings and withdrawal symptoms? Because that is important. For the sake of your UA I would try to work up to at least 8mg next week. I don't have a very good read on the types of testing that is done to show how much bupe is in your system, but I assume to getting up to a higher amount will help. I tapered down from 16 mg a couple years ago slowly, but with ease. I'm at 2 to 3mg now and that works for me. I'm just saying that it's very possible to taper later.

One more thing. As you are going up in amount, save the sub that you're not taking. It's a good idea to hang on to some extra sub just in case. My son, the science nerd, keeps telling me that the zombie apocalypse is completely impossible, but it still is a good idea to keep some extra! :)

Amy

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PostPosted: Thu Oct 08, 2015 10:56 pm 
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I'm surprised that there is so much variability to what docs prescribe! In the US, Reckitt Benckiser used to send regular mailings emphasizing that 16 mg is more than enough for most patients, and that doses over 24 mg are NEVER indicated. But I still here, now and then, of methadone clinics in the US that have partially converted to buprenorphine, and give doses over 24 mg to patients... and now you describe getting 32 mg in Australia. Realize that buprenrophine is VERY potent; the range of dosing before opioid addiction treatment was in the MICROgrams! It would be like giving someone milligram doses of fentanyl. 32,000 micrograms is a LOT of buprenorphine!

The answers about the testing issue are spot-on. Some docs just measure for the presence of buprenorphine, and others measure levels. I think that the latter group are misguided, and frankly I wonder about the first group to some extent as well. I would like to think that I spend enough time to actually 'know' my patients, and that I have some ability to separate the people who are serious from the scammers. Of course if I assume everyone is a scammer, I'm never going to get to know anyone very well!

The effects of buprenorphine plateau, as everyone here knows... so taking a full dose is not going to raise tolerance significantly higher than taking a barely-adequate dose. The nausea may come, at least in part, from the metabolites of swallowed buprenorphine-- the part of the dose that doesn't get absorbed through the oral mucosa, but instead gets swallowed, absorbed by the intestine, and broken down at the liver. Many docs measure this breakdown product, called 'norbuprenorphine', to make sure the patient has been on the dose for a number of days-- and not just taking it the day before the appointment.

I wish all patients could be honest with their docs-- as I believe in the old saying, about addiction, that 'secrets keep us sick'. But I realize that things get in the way.... in the long run though, maybe if patients told their docs about the nausea that they are getting, and the reasons they resist large doses, those docs would learn and adapt their practices. Then again, maybe that's hoping for too much!


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PostPosted: Fri Oct 09, 2015 1:26 am 
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Hi Vicoman. I merged your two threads since they asked the exact same question.

Cheers,
Amy

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PostPosted: Fri Oct 09, 2015 2:40 pm 
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Thanks for all of the responses guys! This is quickly becoming one of my favorite forums :) and yeah I'm saving the extra doses but I'm working my way up to full doses slowly but surely to make sure I don't get nausea.


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