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PostPosted: Tue May 18, 2010 10:12 am 
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Sorry guys, but I need to clear this up. It's all oh so confusing... especially while trying to save money and having an R&B pamphlet for a Doc... HOW MUCH is ENOUGH? I mean, for everyone. Anyone with an opiate habit. Don't mind the past DOC habit, just plain watermark - how much Sub do you need to have in your system to stay at MINIMAL over-the-platau point?

From what I've read on this wonderful website, buprenorphine hits its lijmit when there's at least 2 mgs in your system. Which means - even if you've absorben only 1/3 of a 8 mg tab and swallowed/spit out the rest, you would still have enough to fully occupy your receptors. Right? So why oh why some are dosng 16, 24 and 32 migs a day? I understand the incentive for clever Docs - more frequent refillls, more office visits, more doctor fees. I get that. And besides, there's also a "psychological" effect of using a higher dose... but would you _really_ feel the difference when you're already aware you've hit your ceiling, so to speak? :) I just don't get it! Like today, for instance...
ok, long story short - inducted last tue, given 4X8=32 + took another 24 at home, mistake I know, but whatever - 56 migs. Another 24 on Wed, 16 on Thu, 8 on Fri, 4 on Sat, nothing Sun. Did the math using "quick half-life table" = according to the calculations, there was around 22 migs left in my system come Monday night. Waaaay over the top, right? But I WAS feeling wd symptomps! And to be sure it wasn't psychosomatic, I tested my pupils and their reaction to sudden exposure to light - dilated, and the reaction was slow, almost nonexistent. Which means the symptomps were _physical_. Well. maybe just some of it , but they were there. And of course, after learning that I dosed with another 4 migs and - surely - felt much better in minutes. Even my pupils returned to normal. THAT should NOT have happened with the ridiculous blood level I still had in my system!

So what do i make of this? I'm an ex computer programmer with a degree in finance for gods sake1 it's simple math and I'm confused like that cat without whiskers, "perpetually caught behind the refrigerator"/ (c) Philip Dick "/ )
So what should I do? Wait till my level gets down to at least 4 (calculating with simple math, no blood tests, approcximately of course) and then resume dosing 4 migs/day, or dose tonight and continue without reducing?

Thanks /in advance/ for your help :)


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PostPosted: Tue May 18, 2010 11:54 am 
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Hi mathAn,

I may not be the best person to try to answer you question, but I'll give you my thoughts on it. Although you want a clear answer as to when everyone's opiate receptors are saturated (the ceiling) I just don't think it's that simple. For one, we all have different metabolism rates and logic tells me that's a factor. Also, consider this: Recently a member of this forum posted about how s/he was tapering down to get to the lowest dosage possible, however at 6 or so mg s/he started having terrible cravings. But at the 8 mg dose, that person stabilized - even though some would consider 8 mg above the ceiling. My understanding is that when our receptors are saturated the physiological cravings disappear. This of course doesn't take into account what I call psychological cravings, which have nothing to do with the state of our receptors. Those psychological cravings can only be addressed as part of a larger, healthy, active recovery plan. Of course it is entirely possible that some people look to higher doses to deal with those non-physical carvings, if you will.

In the end, I just don't think there is one correct dosage that fits everyone.

As for doctors having some motivation to keep people at a higher dose, well, I don't see it that way. Most people - after the initial induction days - see their doctor once monthly, sometimes less. They pay the same thing for their doctor regardless of what dosage they are prescribed (be it cash or insurance copay). Take me for example. Because I also use bupe for pain control, I'm on a dose that some would consider "too high", yet I only see my doctor every three months. So I'm just not seeing how a doctor would profit from someone being on a higher dose.

I have no idea if any of this adds anything whatsoever to this discussion, but I thought I'd give it a try. I'm sure others will weigh in with their opinions.

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PostPosted: Tue May 18, 2010 3:52 pm 
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Hi There:

That would be me you are referring to with the dosing issues. At 1mg, I was MISERABLE. After a LONG taper from 16mg down to 1mg over a period of about 14 months. I have a 30+ year history of HEAVY opiate abuse, including many, many years of IV Heroin use. I'm sick as a dog with HepC as well.

Here's what I KNOW:

I could NOT stop using drugs no matter how hard I tried. And I ABSOLUTELY wanted to stop.
Suboxone allowed me to stop abusing prescription pills (oxycontin @ about 180mg per day)
While on the higher dosages, say, anything over 6mg, I was very stable.
The lower my dose got, even though the taper was quite slow, the stronger my urges to use oxy's again got.
Even on 4mg daily, I was having FREQUENT and strong urges to use oxy's
Moving back up to 8MG daily removed those urges completely

I can't explain it, and I have no science or data to back any of this up, but the fact is, on 8MG I feel FINE. I can function at work and in my personal life. I have no urges to use, I have no obsession, and I have minimal side effects, the main one being a good one: I sleep like a LOG every night.

As for "Ceiling Effects" with suboxone, I am pretty sure that is 32mg, but someone please correct me if I am wrong.


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PostPosted: Tue May 18, 2010 7:20 pm 
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I am really glad you posted this because it confuses the hell out of me too. Right now, I am on 8mg per day and some days 12mg for pain. I took 12mg (16 a couple days) for several days in a row. Probably about a week and a half. When I dropped back down to 8mg, the first couple of days were fine, but on the 4th day or so, in the evening, I didn't feel quite right. I ignored it assuming it was psychological. Woke up in the morning. I didn't sleep as well that night. I woke up and was just really having cravings. Couldn't wait to get to work to take my suboxone (usually I will try to go as long as I can without taking it). I had a funny taste in my mouth, was kind of sick to my stomach, my eyes were watering more than normal and I was yawning a bit. I thought it must be psychological but then I looked at my pupils and they were dilated. I then looked into the light to see what happened and just like someone else said, there was minimal, if any reaction. Now they weren't as large as when I am in full on withdrawal. But they were much larger than normal. As soon as I took my sub, they went back to normal and I felt fine.

So here I am, knowing that I should be way beyond the ceiling, and just thought.....maybe I didn't get full absorbtion the day prior. Maybe it is still all in my head. I think I felt fine until about the 4th day because of the half life. So I was above the ceiling after dropping back down to 8mg for a few days but then I lost it. I can also say that I in all honesty, feel my best when I am on 16mg per day. What the hell is that all about?

Anyways......can anyone explain this?

Cherie


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PostPosted: Tue May 18, 2010 11:15 pm 
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Ceiling effect refers to the amount of "opiate effect" you can get out of buprenorphine before it just plateaus. After that, more buperenrophine doesn't increase effects like pain relief, euphoria, and respiratory depression.

With full-agonist opiates, you can keep taking more and more of the drug to compensate for higher tolerance and you will keep getting the opiate effect you're seeking or you'll overdose. With buprenorphine, at lower doses it is a relatively strong opiate pain reliever, then the effect levels off and at higher doses it begins to act like an antagonist - blocking the receptor but not stimulating it.

The amount of Suboxone each person has to take in order to stay out of withdrawal and eliminate cravings is going to vary. Different addicts have different tolerance levels. A person who had a 10-vicodin-a-day habit is not going to need the same amount of Suboxone as someone who was IV'ing substantial amounts of heroin. Some people can't even use Suboxone because it's just not strong enough to compensate for their level of opiate tolerance. For example, someone switching from a high dose of methadone is just not going to get enough opiate-receptor stimulation from any amount of Suboxone.

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PostPosted: Wed May 19, 2010 7:06 am 
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Thanks SO much for that explanation, Diary. I know it helps me understand a bit better. Thanks for taking the time.

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PostPosted: Sat May 29, 2010 6:19 pm 
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Thank you all so much for answering.
I think I'm starting to understand a little... or maybe not... BTW, totally agree about metabolism and how different it is for different ppl. Mine is slow, by the way, really slow, following years and years of heavy smoking and near starvation. Maybe that's the reason I felt sick on a high dose - it just took longer to drop... still.. week 3 on suboxone, feeling nauseous and frequent hot/cold flashes, other than that doing OK I guess. Psychological cravings I just ignore, I mean I do have them and all, I just don't consider them a symptom, knowing very well they'll be there till the day i die. I've been a junkie since kindergarten, btw, just haven't had access to good drugs - but was sure as heck enjoying endorphine rushes and oxygen "highs" since childhood. I just dodn't know what it meant, cause I felt realy embarassed and screwed up and never talked to anybody about this. Or thought that it was perfectly natural and everyone was choking themselves occasionally till the point of passing out (not kidding) - otherwise how come I have discovered it all by myself, it's probably a normal thing that everyone does... yep... wish someone had noticed tho... maybe it wouldn't have hit me as hard, or at least hit me eralier in life, like all the normal teenagers :) Oh well, here I go rambling again...

Back to the drugs. Right now I'm sorta "stabilized" at 8 mgs once every 48 hours (I tried taking 4 mgs daily, but felt worse actually, I believe it's because of the poor bioavailability of the Sub, and the absorbtion rates are NOT linear, e.g. two doses of 4 mgs (half a tab) are NOT equal to the dose of 8mgs (full tab) that gets absorbed when taken sublingually. Just for you newbies out there - Sub is tricky that way :)

The other reason some ppl are still not feeling really OK even after 2-3 weeks on Suboxone, I think, has to do with our habit and the longer we have been using, the longer it takes for our system to normalize. Besides, for someone who has been high as a kite for the last 7 years, - what IS really normal? I don't even remember what it's like to be clean. But I'm sure even as a small child, i would sometimes wake up feeling tired, or depressed, or just plainly exhausted. I mean - how do you tell between your "normal" states and the side effects? I've always had poor appetite, so - am I supposed to feel nausea when I'm sober, or do I need some additional treatment? If only i could go back for a second and just compare experiences :)

What bothers me though, is that I still often feel flushed and sweaty, even tho I take showers twice a day and try to wear light and comfortable clothing. Even my Sub doc, when I came for my follow up yesterday, told me I was diaphoretic (?) and my blood pressure was a little too high. But he was OK with me not dosing daily but once every two days, and my new script was for only 15 tabs for the next month. Some clonidine for blood pressure, some Reglan for the stomach. And out the door. 5 minutes, 210$ (just for the folllow-up, not counting the prescription cost) later I'm still searching the Internet and feeling like I've been run over by a train, back and forth...

But, personally, I think at that point Sub has done everything it could for me. I just need to start eating and working out, so my brain re-learns how to make its own dopamine and other yummies, otherwise I'm stuck in this limbo forever, drugs or not. Lord give me strength :)


Anywayz, thanks again to everyone for replying, you made some good points, at least I know I'm not the only one (who knew being "special" sometimes is not fun, not fun at all :)) I'll keep posting in this thread in case I dig up some new info about dosing and ceiling effects, and another thing - with all the side effects and the confusion, sub IS a lifesaver.

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PostPosted: Sat May 29, 2010 10:56 pm 
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The hot flashes are a common side effect and should go away after a while.

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PostPosted: Mon Jun 07, 2010 4:50 pm 
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Well, there you have it. My dose was actually too low. For me and my tolerance, anyway.
And that's why it happened.

I was cleaning my house. Organizing kitchen drawers and cabinets, I discovered something I've not seen for years - my "beginner box". You know, this fancy metal or wooden boxes they show in drug-movies or drug-series, which addicts carry around with them, where they keep all their "works"? :) yup, exactly that. And joy oh joy, a pack of brand new 1cc syringes, with some super-emergency-secret-end-of-the-world stash (which every experienced junkie probably has) was recovered as well. I honestly didn't remember putting it there, it was so long ago! All that time, when I was stuck at home sick, sweating and sneazing, begging the phone to ring, - and did not remember having almost a gram of salvation sitting there right under my runny nose. Well, it was found, and it was dealt with as follows:

At first, I made a decision to get rid of it as quick as possible. to flush it down the toilet, so i won't be able to recover it later. And there I went, to the bathroom, having zero cravings and full of honest-to-god good intentions about the rest of my life. but the bathroom was occupied. Yup! Just another 5 minutes, I should have waited - but of course, the spiritual junkie that is my other half (err, more like my other 2/3 at this point) interpreted my boyfriend's natural need as a sign from... well, not God, of course, but one of His distant relatives. And I saved a half. Just a half, you know, how junkies loooove compromises. Makes it easier to nod off :)

Long story short - first hit was just to "get rid of the demons", e.g. to realize once again that Bupe will block these mean little opiate posers and kick them off my receptors Bekham style. It didn't happen. Maybe because my dose was too low for my level of tolerance. Or maybe the actual Bupe dose that I was getting from half a 8mg pill was less than 2 mgs, "below the ceiling" - I still don't know. But somehow, after only 4 hours of my last Bupe dose I got high from a fraction of what I used to do, and of course spent remainder of the night - and the next three days - chasing that high, and feeling super for about, hmm... 1 to 2 minutes after the hit. And then all the annoying side effects, all the aches and pains, all the edema and other bullsh!t that my poor betrayed Sub was tending to so caringly, so gently, that I had not even noticed - returned. Talking about "don't know what you've got till its gone". But I just couldn't stop. it wasn't about how I felt anymore, it was a pure and irrational desire to use again and again, no matter how lousy I felt moments afterwards. I'm lucky i've run out so fast, and - horror, the horror! - for a couple of hours I've even struggled with my conscience about asking my boyfriend to call our dealer again... only that stopped me. I did not have access to this much money, and I didn't have her pager no# with me. And to provoke a guy who's been basically white-knuckling thru all the pain and trauma, recovering from a surgery, a near-death experience and a PTSD all at once on a ridiculously low dose of methadone - well, even my inner junkie could not stoop that low. Besides, I had more than 2 weeks worth of sub pills to bail me out! So I shot the last remaining cotton and destroyed all the works. I decided to go to sleep, wake up in moderade w/d and then basically repeat the induction procedure, but stop at 16 mgs this time, since doing more would only make things worse, as I have learned.

But the distant relative had other plans for me. I think, on other hand, it _was_, in fact, someone in the God vicinity :) Suddenly I came down with chills and fever, usually this happened before, when i had an infection, but my lymph nodes were ok, just teeth-shattering chills, debilitating muscle cramps and headaches that seemed to last for hours. and when I finally fell asleep... I woke up an hour later with numb tingling hands, shortness of breath and chest pains in my left side. Excactly the way I felt the day before they put me on a ventilator in the ER year ago, when I spent 1 month in a coma and another 4 in an ICU. It was like someone was actually _reminding_ me of the things that would undoubtedly follow should I ever dare to try this crap again. I could see His index finger moving left to right, doing "uh-uh-uh!"
And thus the wayward daughter returned...

I was in mild withdrawal when I dosed, and I expected all the unpleasantries that I went trough on induction - e.g. 3 days of semi-misery, fatigue and muscle cramps. But after 20 minutes I was fine! More than fine. Teh all-forgiving pink tab not only took me back, but made my painful injection woo-woos disappear. Not even a headache! After one pill. I almost teared up, honestly, I'm used to getting harsh punishments for every little thing that I did wrong, - ans here I am, day three, feeling healthy and energetic, and still waiting for that delayed retribution, that may never come... :) well, as long as I'm being a good girl of course...

So, here's things I managed to learn besides the "lesson" :) - first, my stable dose is probably higher than 4, I'll start with 8 and if i'm comfortable enough, will get down to 6, but there I'll stop at least for some time, until I start coping with my cravings and not just ignoring them "cuz drugs just won't work". That was a nice catch, too. Second, Sub is even tricker that I though. i mean, we have all abused different kinds of opiates, yet our addiction stories are amazingly similar, - but then, show me 2 people who have had the exact same reaction to the Sub! i think it takes more studying of brain chemistry, what receptors are affected by what drugs exactly, and how the Bupe works on them, etc. And third - don't try to taper off too early! Subox dependency is much less dangerous and life consuming, than opiate addiction, even "low-dose" opiate addiction - cuz in the long run, there's 99% your opiate tolerance will grow anyway, but with Sub you can stay on the lowest effective dose for years (at least 4-5) without experiencing much discomfort, both physically, emotionally and even financially, especially when you get your life in order and acquire a solid health insurance. But until you work out your issues, that does should be more "effective" and less "lower", if you get my drigt. Just flood the crap out of your receptors with Bupe if you're not sure. Better be safe than sorry, IMO.

Of course, all this was just parts of my personal experience, and if someone is actually capable to finish reading this post - I hope he can find some valid points for him-herself. Relapse is not the end of the world. You're not a strong-willed person, otherwise you wouldn't be an addict in the first place. I honestly don't know how long this "warning from above" is going to have its hold on me, but... one day at a time, right? :)

well, be good y'all :) see you later (I hope)

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PostPosted: Sun May 08, 2011 4:06 am 
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On 8, I'm fine. On 4, I'm sick. So I'm not sure what ceiling effect we're talking about... but it's not 4 mg's for me at least. I'm betting the 8mg tablets and films are 8 mg's for a reason.


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