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 Post subject: On a taper I do not want
PostPosted: Tue Jul 20, 2010 5:26 pm 
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Hello friends-

First time poster, long time lurker. Here's where I've been and where I am: I am 53 years old, male, professional, and in a good place with almost every aspect of my life. Except Suboxone. I have been an addict my entire life. Started with alcohol at 16. Not a daily drinker, but always drunk when I did. Started smoking pot in college and continued through my 20s and early 30s. Added cocaine in my late 20s for a short, crazy, unsustainable time. With the help of my wife, 12 Step programs and a good psychologist, I stopped everything. I became a runner. First recreational, then short distance, finally marathon. I obsessed over my running with the same energy I put into getting drugs. Still have the journals that describe my daily runs. While I got healthy, I stayed within the group of behaviors that made me a substance addict. Even ran with injuries. You know, behaving the same and expecting a different outcome?

I finally broke down in my late 30s and needed the attention of an orthopedist and several surgeries and opiates. Opiates...and I thought I loved COCAINE!!! The difference was opiates were and are so damn easy to get. My embrace of daily usage began in the fall of 2001 and I saw the light in late March, 2005 and was induced. I have used Suboxone since that time, starting with 16 mg. My first doctor encouraged tapering and I, the king of the people-pleasers, agreed to what I now know was an overly-aggressive approach. It wasn't working and, thankfully, an insightful nurse assisting the MD got the treatment turned around. My MD retired and referred me to another MD who is a great guy, pretty easy to talk to. And very committed to tapering me off Suboxone. I was at 12mg. when I started with him 2 years ago and stayed there for about 9 months. He introduced the taper as something I "owed myself to try."

It has been a struggle. I am rx'ed 4 mg right now. I don't want to be there. Most days, I need more than 4 mg. Like 8 mg. I was so very comfortable at 12 mg. I am having the hardest time communicating this. The doc is not the bad guy here. I am a life-long addict who has been a poor self-advocate in this area. My wife has often asked me what benefit there would be to stopping Sub. She asks if I'd stop taking insulin if I were a diabetic. I have no good answer for that. I just know that it's not working right now.

I see the doc in 8 days and currently have 7 2mg. pills remaining. Obviously, I am not able to successfully manage 4 mg daily. Short-acting pain meds are still dangled in front of me all the time (I have to remind doctors and staff to review the note about narcotics I have had placed in my file). I had an emergency root canal a week ago & the dentist was pushing me to take a vicodin script (he'd even give me a refill!!) as I was getting on a plane the next morning and would be out of state for a week. My continuing ortho injuries would make it very easy to get my specialist to write me an rx. I have legitimate conditions, but, as I look back to a year or so ago, at 12 mg. none of this bothered me then. I wouldn't consider accepting an offered vicodin script. I didn't WANT it! I was finally settled after 35+ years in the substance abuse 'research' industry. Now, I am asking myself how do I get what I think I need?

Thanks for listening.

OBXboy


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PostPosted: Tue Jul 20, 2010 5:41 pm 
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Hi Obxboy. Even though you've been registered and lurking here for awhile, I'd still like to welcome you. I'm glad you posted. Thanks for sharing your story. Isn't it funny how no matter how unique we are, we addicts seem to have so much in common?

Before I go on, please know that the following opinion is non-medical and essentially unprofessional - just the opinion of an informed recovering addict on an online forum. Since you have struggled with addiction your entire adult life and have done well on suboxone, it sounds to me like you'd be a great candidate for long-term maintenance. I agree with your wife, a diabetic wouldn't stop their insulin, thereby placing their life at risk. And that is what SOME of us would be doing if we need long-term treatment and only get it for the short-term. Addiction kills, but I don't have to tell you that.

In addition to your lifelong addiction, it sounds like you also have chronic pain issues that need to be addressed. And like me, you can't ever go back to full agonists to treat your chronic pain, am I right? In my opinion, that just makes you an even better candidate for long-term treatment than you already were. If you taper off sub, what would you do to treat your pain? Would your active addiction behaviors not resurface if you turned to pain meds again? They way I see it you would be in danger of relapse, maybe more so than others.

These are the things I would be telling my doctor, if I were you. Your doctor won't know the reasons you want or need to be a lifer if you don't make it clear (maybe you already have?). But keep in mind there's always the chance that your current doctor simply doesn't agree with lifelong bupe treatment and you may have to find a new doctor who can appropriately address your personalized needs. Maybe on your next appointment it's time to have a long talk with your doctor?

Again, welcome to the forum. I hope you stay in sight and keep posting. You're an excellent writer and it was a pleasure to read your post.

HAT

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


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PostPosted: Tue Jul 20, 2010 8:49 pm 
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Hi Oxyboy -

You have already gotten a great response from Hatmaker; I agree with everything she said.

I noticed that you said your current doctor introduced the idea of tapering as something you "owed to yourself to try." I can see the reason in your doctor's thinking here - many of us need to be pushed at times to try something, maybe because we are afraid, or stuck in a rut, or for whatever reason. We might be convinced that something is not right for us, but how can we know it's true if we don't give it a shot?

But then you go on to say:

Quote:
I see the doc in 8 days and currently have 7 2mg. pills remaining. Obviously, I am not able to successfully manage 4 mg daily. Short-acting pain meds are still dangled in front of me all the time (I have to remind doctors and staff to review the note about narcotics I have had placed in my file). I had an emergency root canal a week ago & the dentist was pushing me to take a vicodin script (he'd even give me a refill!!) as I was getting on a plane the next morning and would be out of state for a week. My continuing ortho injuries would make it very easy to get my specialist to write me an rx. I have legitimate conditions, but, as I look back to a year or so ago, at 12 mg. none of this bothered me then. I wouldn't consider accepting an offered vicodin script. I didn't WANT it! I was finally settled after 35+ years in the substance abuse 'research' industry. Now, I am asking myself how do I get what I think I need?


And what I hear you saying here is that you HAVE tried. In fact, you have succeeded in your taper to some extent, reducing your dose from 12 to 8 to 4mgs. The thing is that now that you have lowered your dose, you can clearly see that this approach is not working for you at this time. You are struggling with managing your symptoms, you don't feel as comfortable or secure in your remission/recovery, and you see that it is more difficult for you to resist offers of pain meds.

The only way for you to get what you think you need at this point is to be honest with your doctor about what you are experiencing. If it is difficult for you to communicate your needs to your doc (which is totally common for many people, not just addicts), I would suggest writing down your points and observations and bringing them with you to the office visit. If you think your doctor will try to convince you to continue your taper, you could also try anticipating his arguments and figuring out how to best respond to them before you go to the appointment so you will feel prepared and confident.

You seem to have pretty good insight into what the problem is, and it seems to me that any reasonable doctor would have to agree with you. Tell him how difficult this has been and how much you value the stability & recovery that you've found on Suboxone. Be open to his suggestions as well - maybe he will be ok with you staying at 8mgs, maybe he will want to you to expand your recovery program beyond just taking Sub (if that is all you're doing right now). If you have other ways that you work on your recovery, you can let him know about that too - that you are working hard at this but it's just not working.

I have been in situations with doctors many times where I felt like I was somehow disappointing the doctor if his recommended treatment just wasn't working out for me, and I know how hard it is to speak up for yourself when that involves contradicting what the doc has told you. But learning to advocate for ourselves and learning how to get our needs met in healthy ways is a really important part of recovery - and it looks like you have a great opportunity to do that here.

I really hope things work out for you & that you come back and let us know how it went.

_________________
You can't stop the waves, but you can learn to surf.

-Jack Kornfield


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 Post subject:
PostPosted: Tue Jul 20, 2010 10:37 pm 
Oxyboy - you spelled it out so well in your post. How about just printing it out and giving it to the doc to read. I think your story shows that you did give tapering a try, and it's not going to work for you (at least not now). Hopefully the doc will understand your position. Good luck.
Lilly


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PostPosted: Sun Jul 25, 2010 12:00 am 
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Thanks for the feedback, everyone. I saw my therapist the day after posting and his comments are reflected in your own. Lilly, I was thinking about doing exactly what you suggest in giving the doc a printout of my comments. My therapist suggests a somewhat scaled-down version given verbally. I am going to try that. I do not anticipate a problem. I called the doc's office on Friday. He was not there, so I spoke to the nurse who works with his Sub patients. I told her what was going on and that I would run out of meds well before I could see him when he returned this coming Wednesday. She listened and warmly agreednto call in a 7 day 'bridge' Rx, at my current dosage, to get me to mid-week. As I am not out of meds, I will be fine.

Ideally, I'd like to be maintained at 8 mg. I hope he agrees. We get on very well, me and the doc. But, as stated in my first post, he is the MD who replaced my initial Sub doc. He took my records and began treating me without hearing my story from me. I think I need to stress the life-long nature of my condition. Abstinence is not the best choice for me. With the right dose of Suboxone, a major issue of my life no longer rules my life. I need things to stay that way.

Thanks again!


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