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PostPosted: Tue Mar 31, 2015 7:32 pm 
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Hi Everyone,

I hope I'm not asking a stupid question, as I've searched for this issue and can't seem to find much information on it, but then again, this may be due to the fact that there just isn't an answer. If so, I'm sorry for asking a question that should be obvious. Here goes...

Since I've been tapering below 2mg, I've had unpredictable WDs lasting for 2-3 days at random intervals. I am currently weighing my dose (pills) with a mg scale, hoping that the accurate measurements would alleviate surprise or roller coaster WDs. However, I'm starting to wonder if either my scale isn't accurate or, perhaps there just isn't a reason for it and WDs just show up randomly.

For example, after a 10% drop, on days 2 or 3 (or both) I'll have slight WDs, but manageable. Then, usually about 6-7 days later, I'll get pretty bad WDs lasting for about 3-4 days. I'm sure you know the symptoms, bad anxiety, insomnia, aches, fogginess (which is usually there to some degree, but on these days it's much worse), chills, and no energy. I wish the WDs were "in my head" but alas, I really feel the physical symptoms and I know what good, WD-free days feel like.

I'm just confused because I hear most people say that during a taper, their WDs are fairly predictable if they are taking accurate doses. Usually on days 2, 3 or 4 (or all of those) post-drop, WDs show up for most people, but mine are showing up at random times. It's just frustrating because I'll be ready to reduce another 10%, then I can't because WDs show up on days 6, 7, 8 and sometimes 9 and 10 and last from 3-4 days, thus significantly prolonging the taper. (I'm really trying to be patient with the taper, as I know patience is key).

I hope I'm not asking a stupid question. Perhaps there is no answer and it's just the fact that my taper is finally catching up to me, albeit at random intervals? I just thought it wouldn't hurt to ask.

If I do find that this is not normal, I will surmise that, at lower doses, my scale just isn't accurate anymore and I'll have to try the liquid method for the rest of my taper. I just wasn't ready to start the liquid method yet, as I'm at 1.58 mg and I hear about most people starting the liquid method below 1mg.

I'm also really trying to be tough and get through the WD days without increasing my dose. I haven't taken any rescue doses or anything and I'm only reducing my dose after at least 4 days of stability at each dose. Typically I'll stay at a dose for a week before I drop, but I've had to stay at each dose for up to two weeks due to the WDs showing up on days 6,7,8,9, etc. It's just frustrating to have WDs show up randomly.

Sorry if I'm rambling. Thanks in advance for any responses. I really appreciate all of the support and knowledge of this forum and the amazing people who run it, who reply, and who are also working on recovery.

-Best,

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PostPosted: Tue Mar 31, 2015 11:38 pm 
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You can be pretty certain that the human body will act consistently--- which suggests to me that something else is causing the inconsistent symptoms.

When the brain concentration of buprenorphine drops below your tolerance level, you will start to experience withdrawal. When the brain concentration of buprenorphine is at or higher than your tolerance, you don't have withdrawal. That pattern is reliable, and the reasons for the symptoms are clear (decreased mu receptor activity causes a decrease in firing in certain brain networks, which in turn causes an increase in brain excitability, changes in blood flow, changes in bowel activity, changes in mood, etc).

But there are a couple things that might be causing your symptoms to come up in unpredictable ways. First, absorption of buprenorphine is highly variable. Average absorption of the film or tablet is about 25% of the dose--- but that percentage is affected by the amount of saliva in the mouth, the time that the drug is in the mouth, the circulation of the blood in mucous membranes (which is affected by mouth temperature, drugs with vasoconstrictive properties, hydration status, etc). You might be absorbing twice as much of a dose at some times compared to other times, depending on how consistent you can keep the dosing.

Second, beyond the simple physical symptoms of withdrawal, there is a huge learned component that is triggered by emotions, memories, and expectations. Many people experience withdrawal-- or at least symptoms that feel like withdrawal--- on relatively high doses of buprenorphine, if they start to expect withdrawal symptoms. I see many patients who complain of 'sweats' that seem to go away if they take even more buprenorphine (even if they are already taking 16 mg per day). But if those people can ignore the symptoms, they almost always go away after ten minutes or so, and eventually stop occurring.

For your symptoms, I recommend trying to distract yourself at the first sign of symptoms. Try to get your mind completely off the topic for ten or fifteen minutes. You may find that the symptoms disappear, and only come back when the blood level of buprenorphine gets lower.

Good luck!


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PostPosted: Wed Apr 01, 2015 1:05 am 
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Thank you very much for your reply SubDoc! I really appreciate it. I will concentrate on my dosing these next few days to see if I am somehow affecting the absorption. I really try to make dosing as consistent as I can; ensure its under my tongue, let it melt for 15 minutes, no swallowing, waiting for 15 minutes to drink water after absorption. Etc. but perhaps I'm doing something incorrectly. Thank you for this!

Regarding the "wait ten minutes" method, it totally makes sense, but I put all of my focus on other things, meditate, don't think about it, try my hardest to convince myself it's "in my head," but sadly, none of these tactics work. I would love to use mind over matter and make them go away, but alas, they get worse as the night goes on. This lasts for 3-4 days.

I refuse to take more sub than my current dose and I know I'll just have to push through it. I just wish I could determine what I'm doing wrong so I could correct the situation. Perhaps there isn't a solution, but I will definitely focus on my dose process these next few days to see if there's a chance I'm not properly absorbing the sub.

THANK YOU, a thousand times! You've given me hope that there may be a solution to this and I'll be able to continue my taper.

Sincere regards,

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PostPosted: Wed Apr 01, 2015 11:41 am 
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BK you using pills or strips? Pills felt inconsistent for me in liquid. Strips did not. If you can get the strips somehow, use those if you can. Pills made the process a bit harder, but not insurmountable. You've got a good head on your shoulders, and have asked a lot of the right questions plus have provided support on here both to me, and a number of others. I'm rooting for ya and know you can do it!

Edit: i know my suggestion goes against what the subox doc has said, so take it with a grain of salt, but I tended to let the liquid absorb for close to 30 mins each time especially as I got lower in dose (below .3mg). I found this to help at least somewhat. It didn't change the fact that the doses lasted shorter and shorter throughout the day.

evolved.


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PostPosted: Wed Apr 01, 2015 7:54 pm 
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Hi ER,

Thank you so much for your reply and support! It's so uplifting when I feel so down and crappy.

Unfortunately, I only have access to the pills. I believe what you said about the strips; makes sense. Alas, I must make do with what I have and push through. But I really appreciate the info.

Thinking I will try the liquid method to see if my scale isn't accurate. I suppose it won't hurt to try, as these unpredictable WDs are really getting me down and I really want to see if I can at least try to expect when WDs may show up and plan accordingly.

I will also try your suggestion on keeping my dose in my mouth for longer. Hell, at this point, I'll try anything to see if I can have some consistency in how I feel.

Thank you a thousand times for the info and support. How are you doing? I bet you are feeling well! I hope so.

Best,

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PostPosted: Wed Apr 01, 2015 9:05 pm 
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Hey BK :)

Just wanted to tell ya that I have been following ur post and even though I'm not stopping my sub and don't have any experience in trying to stop yet, but I think ur very brave and wanted to cheer u on. Ur definitely in the right place for some great support.

Also, I agree that maybe some of ur issues have to do with maybe ur doses isn't coming out the same each time. Maybe that's causing some of ur problems. Also the absorbing on small doses I'm sure is pretty tricky, so maybe that's something going on. I'd keep ur medicine in as long as possible too just to be extra sure ur getting all the medicine. Basically, I don't know or understand why ur having these off timing withdrawals, but just wanted to tell ya how brave u are for sticking with it. I'm sure it's tough as heck, and I'm not sure I could do what ur doing, that shows how strong u are. Just wanted u to know, I'm rooting for ya and hope and wish u all the success in the world!!! Good luck BK :)

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PostPosted: Thu Apr 02, 2015 10:32 am 
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Bad kitty,
I don't know if this helps at all but once I got below 2mg, I never really felt that well. That's when the taper started getting difficult. Then at .5mg I started using the liquid method. I really wished I would've started that method sooner, it made a huge difference in how I felt. I think maybe it absorbed better at small doses that way.

You're doing great, hang in there. This is where the real work starts: below 2mg.

But in retrospect I think it has to suck so you'll know either way if you're really ready to discontinue your suboxone or if you're ready to commit to going back to a dose that makes you feel consistent and stay there for awhile.

I personally found that after awhile I got so stressed out trying to manage my taper, and I got so far inside my own head about how I was feeling...I just gave in and jumped. In no way am I advocating this for you or anyone else, just sharing my experience. Only you will know when you're ready.

Cheering you on, regardless of what you decide:)


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PostPosted: Thu Apr 02, 2015 7:05 pm 
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JJ and Fishy,

Thank you so so so much for the support! It really makes me want to push through when I read encouragement from you.

Fishy, I think you are totally right; the liquid method is the way to go. Going to try it this weekend, as I'm sure it will take me a bit of time to practice it.

The reason for trying liquid is due to these surprise WDs. I've gone over all of the potential factors that could be affecting me and I've surmised that it has to be the fact that my scale just isnt accurate at these lower doses. I just can't believe that it could be anything else, as I've really been concentrating on my dosing procedure and ensuring I wait 30 minutes (suggested by ER), wait another 15 before drinking water or anything, etc.

So, hopefully I'll report back in a week or so that these sucky, suuuucky surprise WDs have been alleviated once I switch to the liquid method. I hope!!!

Again, thanks to both of you and ER for the awesome support and suggestions. I appreciate it to the thousandth degree! Your support is so beneficial in me keeping up the strength to continue this taper!

I hope you are well. Fishy, sounds like you are through the rough part; it will only improve from here on and I bet that is a wonderful feeling! I'm so amazed by your toughness and strength. It's also really helpful to read your progress. Keep up the good work girl.

Best wishes to all of you!

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PostPosted: Sat Apr 04, 2015 4:12 pm 
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Well, just thought I'd post about the current status of my struggle to ensure consistent dosing and thus hopefully diminish the unpredictable WDs I've been experiencing in my taper below 2mg.

It seems as though my situation is somewhat unique in the fact that, no matter how hard I try, I can't seem to avoid surprise WDs. So, this is why I'm updating this thread, just in case someone else finds himself/herself in this situation. If I do figure out a way to alleviate this problem, I hope it will help someone else. Plus, I suppose that the more information we have, the better, eh?

I decided to switch to the liquid method at this point in my taper, as I've assessed all factors that could be creating WDs on days 6,7,8,9,10,etc. after a 10% drop. I've maintained consistent dosing practices: keeping dose in mouth for 20-30 minutes, do not eat or drink for 15 min post dosing, etc. Therefore, I have decided that the only factor is likely inconsistent dose measurements due to the fact that I'm using a mg scale to weigh each pill dose and there is really no way to assess whether the scale is accurate other than calibrating it, which I've done many times.

Liquid solution: I mixed an 8mg pill of sub with 8ml of warm water in a clear plastic bottle. Waited 30 minutes and stirred the solution with a wire stir mechanism I crafted from jewelry wire. Wow, as ER has said, the pills obviously do NOT completely dissolve; there is a definite film at the bottom of the container. As ER said, not sure if this film is filler, sub, etc. I mixed up the solution before drawing up 1.6 mgs in a 1ml syringe (two doses of 1mg and then .6mg). Made sure to draw from the bottom of the mixture, hoping that it will at least draw somewhat consistent amounts of sub. I then administer the solution into little plastic vials that hold up to 2ml, in hopes that: 1) I can measure somewhat accurate doses due to the film at the bottom and 2) I will be able to assess how much of the film is mixed with each dose, as the film settles at the bottom once the dose sits for a bit and 3) I will be able to transport each dose if necessary, as I travel for work, spend the night at boyfriend's house often, etc. Just for information purposes, I am not able to use sub strips.

Even though I stir the solution before drawing 1ml + .6ml (equaling my current dose of 1.6 mg), once each dose settles in the vial, there are inconsistent amounts of film at the bottom. Each vial has a different amount of film. The first three vials have more film than the rest, displaying that each dose is likely inconsistent, unless by some miracle, the film is only filler and thus may not affect the actual dose of sub. I am storing the vials in the fridge in hopes that cold storage will prevent the solution from becoming stale or contaminated.

I took the first dose of liquid solution this morning. It's definitely challenging to keep the liquid under my tongue, so I attempt to keep it under my tongue and in the forefront of my mouth, in hopes that this approach will assist in absorption (I've read people's accounts of how they are still able to achieve absorption while keeping sub in the forefront of their mouths). I'm sure the fact that I'm still on a high dose for the liquid method is a factor in the challenge of keeping liquid under my tongue, so I try to just keep the liquid under my tongue/in the forefront of my mouth for 20 minutes, hoping for adequate absorption. After 20 + minutes, I swish the solution around in my mouth for 1-2 minutes, aiming for the gums, cheeks, etc. before I eventually swallow it. By this time, I have a rather large amount of liquid and saliva in my mouth. Yeezazs, it's like orange-tasting mouthwash. Ha.

Anyway, I will report if the liquid solution works, or if I am still experiencing random WDs at inconsistent intervals. I've read a lot about how people who are tapering experience WDs on days 2-4, instead of random days 6, 7, 8, 9, 10, and so on, as I've experienced throughout the last month or so since dropping below 2mg.

Just to be clear, I can handle 2-4 days of 10% drop withdrawals, which involve slight body aches, anxiety, fatigue, brain fog, insomnia, etc. The reason I'm attempting to alleviate "WDs" is not because I can't handle 2-4 days of slight withdrawals. It's because, when I experience unexpected WDs after 6 + days of a 10% reduction, the WDs are rather debilitating, as in I can't just "push through it" or "convince myself it's all in my head." The withdrawals are so bad I can hardly function. I honestly know what slight withdrawals feel like (and what withdrawal-free days feel like) and I can always push through them, perform at work, interact with others, etc. The withdrawals I've been experiencing this past month feel like full-on agonist withdrawals and completely debilitate me; they don't compare to withdrawals that can be summarized into a few days of not feeling well. I have definitely experienced those withdrawals during my taper and although they suck, they don't make me want to curl into a ball and stay in bed for days at a time. I'm not self validating here, but honestly, I'm tough enough make it through 2-4 days of slight WDs.

If I find that I still experience WDs at inconsistent intervals after trying the liquid method, I will surmise that, for some reason, my body experiences unpredictable WDs. If that's the case, well...I guess I'll just have to deal with it.

Of course, I am not saying that everyone needs to quit sub treatment. I have the utmost respect for anyone in sub treatment; whether you continue to use it for months, years or the rest of your life. I honestly think that sub has been the key in keeping me away from opiates/my recovery. I'm just one of those people who wants to learn to live without taking anything, even though I completely support anyone who needs to continue taking sub and I see nothing wrong with needing to take medication every day, I'm just at the point in my life where I want to finish sub treatment. I think that lifelong sub treatment is utterly beneficial; it's highly individual and long-term sub maintenance helps so many people. IMO, there is absolutely nothing wrong with staying on sub if it helps you live a happy life free from active addiction.

That's about it. I'm sorry if this is a long, rambling post. I just thought it wouldn't hurt to display my findings, just in case it may help someone else. I'll report again whether this method has helped me.

Peace and love,

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PostPosted: Sun Apr 05, 2015 12:05 pm 
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Bad kitty,
Sounds like you're doing everything right! Can't wait to see how this works out for you. I'm hoping this is the ticket!! Great idea with the little vials. I had thought of that when I was tapering, and ordered these little vials from amazon. Unfortunately they didn't arrive until I was like 6 days past my jump and they weren't of use to me anymore. So I tossed them, just to not have anything around that made me think of subs or drugs or any of that.

I'll be following your progress and cheering you on!!


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PostPosted: Sun Apr 05, 2015 1:39 pm 
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Hey bad kitty,
So you are using water and not a solvent? Just wondering.
Also, won't residue of the medicine stay stuck on the sides of the vials, thus needing more liquid after you extract the solution from the vial to get the rest of the medicine? Could be one reason for inaccuracy. Just my opinion kitty.
Just asking because I am getting ready to go below 2mgs myself.


Last edited by happyg1961 on Mon Apr 06, 2015 10:40 pm, edited 2 times in total.

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PostPosted: Sun Apr 05, 2015 4:53 pm 
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Hi Fishy,

Thank you so much for the support! I really appreciate it. I am really hoping the liquid method will make this taper more bearable. I don't expect it to be easy, just somewhat manageable. Lol. I know what you meant about feeling like crap most of the time.

Happy: yes, I'm using water. Not sure what kind of solvent would work well? If you have any ideas, I'm all ears, for sure. I've read about people using drops of ethanol in their solutions, but haven't found enough info on it.

Yes, there is still a film of medicine in the vials after I dose. This morning and yesterday, I administered the vial under my tongue and then put a few drops of water back into the vial, then dumped that in my mouth as well. Hoping this won't dilute the solution too much/will assist in getting most of my dose into my mouth hole. Ha.

It's definitely more challenging to keep the liquid in my mouth rather than dissolving a pill. I'm just hoping it will work and allow me to continue my taper.

So far, so good on the liquid method. No WDs yesterday, hoping they won't appear tonight as well. In fact, yesterday was my first WD free day after five days of pretty debilitating WDs. I'm hoping this is not due to the fact that my dose has somehow increased from the liquid method. Hope hope hope.

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PostPosted: Wed Apr 08, 2015 8:40 pm 
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Basically - the strips I found to absorb evenly, while the pills (generics) didn't and had quite a lot of sediment in the syringe. It's possible what you're experiencing is the same, except with the strips.

My theory is this: When you dose, if it's settling at the bottom, if you dose vertically (with the syringe somewhat tilted up at least) you're probably getting more than you expected.

I hope the process has gotten easier for you BK, chances are you're getting close to the end of your taper and you're almost done! Don't worry!


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PostPosted: Wed Apr 08, 2015 8:55 pm 
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Bad kitty meow! How are you doing!? Haven't heard from u in a few days just checking in, know that I've been thinking about ya!! Hope all is well. ER is right... You're getting close and everything is going to be OK!!


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PostPosted: Thu Apr 09, 2015 8:23 pm 
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Hi ER and Fishy,

Ah, thank you so much for the info and most of all, the support! Seriously, your posts really mean a LOT to me.

The liquid method has proved to be successful thus far. Score! I have not had the awful unpredictable WDs since Saturday, when I started liquid. In fact, I reduced to 1.5 yesterday and haven't felt any withdrawl symptoms yet, although I'm sure they are to come since this is only day two.

But at least I'm feeling stable now. Yeez, those hard core WDs were awful. I'm sure I have a long way to go, but I'm hoping my symptoms will at least be manageable with each drop. I don't think I'll get through this without WDs, no way, but if I can have at least manageable symptoms that allow me to push through without wanting to stay in bed, I will be able to continue my taper.

Oh for sure ER, the film at the bottom of each dose is prevalent. I'm shaking up each dose as you suggested, in hopes that I'll be getting at least somewhat consistent doses. So far, so good.

Thanks again for your support and for the invaluable information! Without it, this would be soooo much more difficult.

I hope you are both doing well. ER, I bet you are feeling really well. I really hope so! Fishy, it sounds like you are so close to feeling 100%! Best to both of you and thank you a thousand times for the support!!!

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PostPosted: Thu Apr 09, 2015 11:25 pm 
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Bad kitty this is fantastic to hear that you are stable and doing well in continuing your liquid taper. Makes me extremely happy! Congratulations on taking the next step, you'll be there before you know it, and my guess is that whatever you're going to feel when you jump will probably not be any worse than the weird random WD you have been forced to deal with in the past. What if it really is smooth from here on in for you?? Wouldn't that be wonderful?! Take your time with each drop lower. You will get there when you get there.

Nice job high fives!!! This is exactly what I was hoping to hear from you! Keep us updated, you got this girl!!


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PostPosted: Fri Apr 10, 2015 1:27 am 
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Hey BK! I'm glad your transition to the liquid method has gone well so far. I hope that any withdrawals you feel are not too bad. Keep us updated!

Amy

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PostPosted: Fri Apr 10, 2015 4:01 pm 
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Meeeeooow!

Fishy and Amy, thanks for the kind words and support. As Fishy said, the liquid method seems to be the way to go once you reach below 2mg. I'm still not sure if the unpredictable WDs were from inaccurate doses or the fact that I may not have been absorbing the pills at these lower doses. Either way, I'm hoping the liquid method will allow me to somewhat predict when WDs will show up after each drop, thus making my taper more manageable.

Thanks again for the support Amy, Fishy and ER! You all rock. Kitty purrrrrrs. :)

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