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PostPosted: Mon Oct 28, 2013 11:23 am 
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Hello,

I am starting this post for my husband, T, in hopes to give him a place to go when he needs support. T has been on Suboxone for almost 4 years now, after years of Vicodin and cocaine use. About 6 months ago, he was put on the generic form of the pill, in which he feels did not have the same quality as the real Suboxone. I am wondering if there is a difference when trying to taper off this generic stuff, as opposed to the actual Suboxone brand. He takes it twice daily, once in the morning and once at night. I thought that dose was quite high for someone who's been on it for 4 years

Anyways, as I've been reading, it seems that he needs to start with taking 25% off his 8 mg dosages in steps, until he gets to 4 mg. Then the real work will start when he will try to get down below 4 mg. Then he should take off 10% of his dosages in due time until he is done. T has already told me is that this generic pill is very hard to split/cut. We are wondering how to split the dosage... Should we get a scale to weigh each pill, crush it, and administer a percentage of the original weight? Or will that ruin the integrity of the "medicine"? It's the only way I can think of right now.

Additionally, I want to mention that the 4 years he's been on Suboxone, I actually thought he was 100% off any and all drugs. T had reached rock bottom 4 years ago, lost his job, and almost myself and his one daughter at the time. He decided to go to rehab, where I thought he had detoxed. But instead of being completely honest, he decided to continue on with Suboxone for the next 4 years. Never abusing it or getting high, but maintaining a dependence so he could be free of all other drugs. I never knew he was on anything, and he hid it from me, which he sad was a mental obstacle every day- a guilt-factor. He has made accomplishments in the 4 years, getting a job as a manager and excelling at it. Providing for our family, taking care of our kids, and allowing me to be a stay at home mother for our 2 daughters.

But now that I know, he wants off it. He's said that he's wanted to tell me so many times, but couldn't find the courage. He doesn't want to take this drug the rest of his life.

He is mostly afraid of depression after getting off it. And i think that has to do with the many years he has psychologically and physiologically depended on a drug to get him through each day.

We are looking into finding a Naturopath to help with possibly facilitating this taper, to help cotnrol mood and physical discomforts.

If anyone would chime in about our situation, we would appreciate it. Looking to hear if our "plan" is a good one

Thanks,

L & T


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PostPosted: Mon Oct 28, 2013 11:58 am 
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Welcome!!

You sound like a very dedicated wife, and supportive. I can say that having you support your husband is going to be the BIGGEST thing for him. Coming off of any drug is no picnic. Suboxone is one of the hardest because it helps us to gain control of our lives, and coming off can be quite the obstacle for our minds.

I'd like to start by telling you that I hope you're not too hard on him about this. Getting on Suboxone was the smartest thing that your husband could do. Suboxone alters your mind in a way that helps you to regain your life, and the people in it. 99% of us here on this forum would not be clean, upstanding human beings without it. It, like you said, does not get us high. It just helps us get back on track. If he hadn't started on it, there's a good chance that he wouldn't have been able to accomplish all of the wonderful things that you mentioned.

Now, I've never taken that high of a dosage from Suboxone. But there are MANY here that have, so keep checking back. He will need to be upfront with his Suboxone doctor, and the best thing he could do is give them to you to give to him as needed. Once you both figure out the right dosage for each time in his taper. It's important that you listen to him, though. Tapering is supposed to help ease the withdrawals. So if he is feeling like he's just not able to live his life, he may need to slow down & go back up a little. This could be a struggle, but in the end it is very worth it.

You are correct in your %'s. coming off slowly & steadily is going to not only help him with the physical withdrawal, but that depression and anxiety later on as well.

You're a great wife, keep up the amazing support & you and your husband will be just fine! Us addicts are very strong when it comes down to it.


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PostPosted: Mon Oct 28, 2013 4:02 pm 
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Yes, the general rule of thumb for tapering is 25% reductions until 4mg (or so), then 10% reductions. Most of us have found that being flexible with your taper is a good thing. He may be able to reduce by 25% and after a week or two, be stable again, but the next reduction of 25% may be too much. He may stabilize at his new lower dose in as short as a week, other reductions may take longer.

Tapering will gradually remove the drug from his system and it is, by far, the best way to avoid harsh wd symptoms. Tapering can also be a good indicator of if he's ready to be off Suboxone. If he can't put together a taper and work it, he may not be ready to get off Suboxone.

As far as getting to lower doses without having to cut a pill, he could try the liquid taper method. We've had members here dissolve a pill into water which is in a baby syringe. A syringe you'd use to squirt liquid oral medication into a baby's mouth. Squirting the entire contents of the syringe would be 8mg, half would be 4mg, 1/4 would be 2mg, etc.

He could also ask his doctor about the 2mg pills once he's low enough.

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PostPosted: Mon Oct 28, 2013 7:20 pm 
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Consulting a naturopath is a great idea! Making sure your husband is in top condition is good way to help him get through withdrawal. My suboxone doctor often suggests an anti-depressant like Wellbutrin when his patients taper all the way off. Your husband's fear of depression is very valid and it's not just psychological. It will take his brain a while to be able to produce enough endorphins to replace what the suboxone was artificially producing. That is one reason that exercise often helps during withdrawal as well. It helps get the endorphins firing!

Your husband will not just have to deal with depression during withdrawal, there is also a possibility that he will be affected by PAWS, post acute withdrawal syndrome. It might be a good idea for you to research PAWS a bit to know what your husband may end up dealing with.

There are comfort medications that his sub doctor could prescribe to him. Clonidine is a blood pressure medication that is prescribed off-label for withdrawal symptoms. Xanax can be helpful for anxiety and sleeplessness that are both common during withdrawal. Immodium can help with stomach complaints.

I have a feeling that it is hard for you to get over the betrayal of trust from your husband not telling you that he was on suboxone for 4 years. I hope that the fact that he has proven himself the last 4 years with great behavior eases your mind. When he started suboxone, he probably didn't even know if it would work. I'm sure that he wanted to do well by you and he might not have been able to do that without sub. A lot of us use suboxone to stabilize and rebuild our lives and it looks like your husband has done the same. Please don't underestimate how hard addiction is to recover from.

Your husband has a lot going for him! A loving and supportive wife, two beautiful daughters and his whole life ahead of him! I'm sure your help means the world to him. Your plan sounds great! Just don't forget to be a little bit flexible. Some dose drops are easier than others.

Please encourage your husband to reach out on this forum! Sometimes it takes another addict to understand what you're going through. When he has a bad day (and he will), it helps to vent it out to others who have gone through the same thing. I wish you all the best!

Amy

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PostPosted: Tue Oct 29, 2013 2:30 pm 
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Hello again,

I wanted to mention that I will most likely be the one who will write or note progress. T isn't much of a typist.

My husband has read these responses and was very surprised, thankful, and appreciative of the responses you all made. It felt good to read something that was personal and for HIM. Because everything we have ever read online was always about someone else's situation/story. I too, am very happy to see that there are others who care and want to help us : ) You addressed some important facts of this process that we will both have to take note of. SO THANK YOU!

I've decided T needs a journal to keep track of progress and patterns.
Yesterday T only took one 8mg pill at noon, and then this morning he took an 8 mg. So instead of taking his 16 mg total per day, he wants to take 8 mg total per day. He says he feels fine and is really committed to getting off these, but is this too fast? T believes his mind is a big factor in all of this and that he can do it. But I explained to him about the half-life. Won't it catch up with him in a few days?

Ideally he would still like to take a dosage twice per day, meaning if he's on the 8 mg step, then he would want to take 4 mg in morning, and 4 mg at night. For his own sake, he thinks that it will be a mind over matter thing, and it would be better for his mind to believe he's taking it twice per day. Is that a smart approach, or should he work on just taking it once per day, all at once?

I am basically the researcher here, so I am going to look up the PAWS, as well as liquid tapering. My one primary question about that is... doesn't the medicine HAVE to dissolve under your tongue in order to work? If you syringe the subox/liquid into your mouth and swallow, does it still work?

We are still waiting to hear back from the Naturopath we called yesterday. She specializes in men's health, and detoxification to name a few.


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PostPosted: Tue Oct 29, 2013 2:44 pm 
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Taking Suboxone twice daily can be considered addict behavior, but it's not like taking his dose twice a day will ruin him, it just kinda reinforces those addict behaviors.

I hope you and he understand that his being on Suboxone didn't "heal" his addiction. Once he gets off Suboxone, his cravings for opiates will likely come back and he's really going to need to have some support in place to learn how to deal with life without drugs. Getting off Suboxone and staying off opiates altogether are two different animals.

Dropping his dose from 16mg to 8mg isn't necessarily too fast. Suboxone is an interesting medication in that it has a "ceiling" where once you take more than 8mg or so, you don't notice too, too much if you were to take more. Same thing in reverse. As far his receptors in his brain are concerned, 16mg is awfully close to 8mg because most all of them are occupied. (The ceiling is thought to be around 8mg.)

But, with that said, Suboxone wd symptoms don't usually kick in until a few days out. Suboxone has a mean half life of 37 hours, it's a long acting medication. If he still feels good after day 4 or so, he should be in the clear for his next dose reduction. Some people have good luck with a quick taper, some like to take it slow. As far as I'm concerned, there is no one right answer, he has to do what works for him.

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PostPosted: Tue Oct 29, 2013 3:09 pm 
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Romeo wrote:
Taking Suboxone twice daily can be considered addict behavior, but it's not like taking his dose twice a day will ruin him, it just kinda reinforces those addict behaviors.

I hope you and he understand that his being on Suboxone didn't "heal" his addiction. Once he gets off Suboxone, his cravings for opiates will likely come back and he's really going to need to have some support in place to learn how to deal with life without drugs. Getting off Suboxone and staying off opiates altogether are two different animals.

Dropping his dose from 16mg to 8mg isn't necessarily too fast. Suboxone is an interesting medication in that it has a "ceiling" where once you take more than 8mg or so, you don't notice too, too much if you were to take more. Same thing in reverse. As far his receptors in his brain are concerned, 16mg is awfully close to 8mg because most all of them are occupied. (The ceiling is thought to be around 8mg.)

But, with that said, Suboxone wd symptoms don't usually kick in until a few days out. Suboxone has a mean half life of 37 hours, it's a long acting medication. If he still feels good after day 4 or so, he should be in the clear for his next dose reduction. Some people have good luck with a quick taper, some like to take it slow. As far as I'm concerned, there is no one right answer, he has to do what works for him.


Romeo,

Thanks for that quick reply. I feel like I should be paying you! Awesome info. T's doctor is not helpful with this in the slightest.

T wants to know what "feeling fine" is considered? Is any type of WD symptom during this time an indicator that he tapered too fast? Or should he expect do be mildly uncomfortable at times? He's afraid of restless legs at night. During the day he said he can manage restless legs because he walks at work a lot. But RL at night would make it hard to sleep.


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PostPosted: Tue Oct 29, 2013 3:18 pm 
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T wants to know what feeling fine is, eh? Well, that's a loaded question if I've ever seen one!! :wink:

To an addict, feeling fine is being higher than Jackson Browne. LOL. But that's not what we're shooting for here. Feeling fine basically means he can live with his symptoms. If he gets RLS going from 16mg to 8mg, then he should go back to 12mg.

You most certainly don't have to pay me, but if you really wanted to, you could send me some yummy McDonalds food!!! I swore off McDonalds a few days ago to drop a bit of weight, but this living life without yummy McDonalds food is driving me INSANE!!!! GAH!!! :lol:

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PostPosted: Tue Oct 29, 2013 3:28 pm 
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To answer your question about sub placement in the mouth: any mucosal membrane will do. The reason they want you to put it under your tongue is because there are a couple of blood vessels there for quick transport. :) Some people let it dissolve under their tongue. Some people move the strip of sub around their mouth, kind of "painting" the inside of the mouth with the dissolving strip. The reasoning behind that is that the more area you spread the sub around, the more and faster the absorption.

Our Romes is a treasure whether he has a McDonalds muffin-top or not! Lol!

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PostPosted: Tue Oct 29, 2013 4:58 pm 
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(If only Romeo knew that most mc donald's items are made with the same ingredient used to make rubber yoga mats.)

FamilyGuy - Romeo brings up valid points but I wanted to add that I took my sub dose twice daily for almost the entire time I was on it. In the beginning I felt like my suboxone dose wasn't holding me through the entire day/ night. I would have a bit of trouble sleeping, etc.. So my Doc suggested I split dose. By doing this, I realized that I didn't need nearly as much sub as I had been given and held steady at a much more realistic dose. 8mgs seems like a good dose and does well for a lot of people. I'm not surprised at all that he's good with 8 rather than 16. The thing with split dosing is to be weary of feeling like you need to add an extra dose on crappy days, etc.

Good luck-


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PostPosted: Mon Nov 04, 2013 9:52 am 
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Romeo,

I used to eat McDonald's once in a blue moon- and now I eat it... never. After watching "Food Inc." I've changed my eating habits. I highly recommend the film. It's almost like a diet within itself. You won't need the self-discipline to stop eating fast-food, because your mind will be forever affected by what's revealed in that movie!

Anyways, back to business, T is on his 6th day of taking 6 mg/twice per day, down from the original 8 mg. We decided to just hack the 25% off in order to play it safe. I have been able to successfully chop each pill. He has been writing his dosages and symptoms in a daily journal. And to my knowledge so far there hasn't been any awful WD symptoms. We have talked about him switching over to the film as time goes on, or asking his Doc to give him the 2 mg pills.

In a couple of days I suspect we will cut down again.

T is expecting a phone consultation call from the Naturopath this evening.


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PostPosted: Mon Nov 04, 2013 1:13 pm 
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I've seen that show, all it did was make me crave McDonalds even more!!! WHAT IS WRONG WITH ME? (Amy, Tiny and all you other smartasses, try to resist the impulse to answer that question for me!! :lol: )

So, T did a 25% dose reduction 6 days ago and he hasn't had any bad wd symptoms? That's awesome!! That's a really good indicator that he may tolerate his reductions very well. Tell T I said, "way to go!!" Tell him I think he should treat you to a nice Big Mac and fries tonight, too. :)

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PostPosted: Mon Nov 04, 2013 2:19 pm 
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Hahahahahahaha. Trying to contain my laughter. It isn't working.

Way to go, T!! (:


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