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 Post subject: 8 mg too much?
PostPosted: Thu Oct 28, 2010 11:19 am 
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I was recently put back on Suboxone after a 6-month relapse back into Oxycontin and heroin addiction. The doctor prescribed me 16 mg/day (one 8 mg strip of film twice per day), but considering how expensive Suboxone is, its relative potency, and its long half-life, I am beginning to think I need much less than this.

During my relapse, when I could not find Oxycontin or heroin, I would sometimes purchase Suboxone off the street to hold me over. During these periods, as little as 1-2 mg was all I needed to remove withdrawal symptoms for up to 36 hours. I feel like taking 16 mg a day is doing nothing except creating an even bigger physical dependence on opiates, and setting myself up for a painful taper.

Also, since the half-life of buprenorphine is about 36 hours, I don't see why it is necessary to take a dose twice per day. Say I took 4 mg of Suboxone. 24 hours later, I would still have more than 2 mg on my system. So what is the purpose of twice-daily dosing? Is it just to maintain a certain plasma concentration of buprenorphine? Because personally I don't begin feeling uncomfortable until about 48 hours after missing a dose of Suboxone.

I need to stretch the Suboxone out as much as possible, but it is also important that I have enough in my system that I do not get any cravings or experience any withdrawal symptoms.

Does anyone else have experience trying to stretch out their Suboxone? Is it realistic that I would be able to take 2 mg just once per day without any problems? Why is it that doctors prescribe such enormous doses when smaller ones seem to do the job just fine?

I'd love to hear some of your experiences or thoughts on this matter.


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PostPosted: Thu Oct 28, 2010 11:41 am 
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It sounds like you have done your homework and frankly I would not argue with anything that you have said. Many, many people have found that they don't need anywhere near 16 mg/day for Suboxone to be effective. Best practices also suggest that Suboxone be dosed only once per day - not twice. If you are able to achieve the desired results (no cravings, no withdrawal, etc.) at 4 mg/day, by all means, that is what you should do. As time goes by more and more providers are figuring out that these high doses of Suboxone are not necessary. Again, current best practices state that 16mg is the maximum that should be prescribed. Like you, many "heavy duty" addicts have found that much lower doses work just as well. Plus, with the cost of Suboxone, being able to reduce your monthly cost by 75% can be huge.

It appears that you are new to the forum here. It's good to have you here. I would be actually interested in hearing about your relapse. Had you been on Suboxone in the past? When I ask that, I mean, "officially" - as in were you in Suboxone treatment with a physician - not purchasing on the street. If so, we don't often hear about people who stop Suboxone and then relapse. If that is what happened in your case, your story would be very valuable. Even if that is not the case, any story of relapse is very useful in trying to avoid the same thing happening to any of us in the future. Hopefully you'll tell us your story.


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PostPosted: Thu Oct 28, 2010 12:29 pm 
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I have quite a bit of experience with Suboxone, both prescribed and off the streets. I first got addicted to Vicodin and OxyContin 5 years ago while I was a student in California. Once it got the point where I was taking 200-300 mg of hydrocodone or oxycodone daily I decided to seek treatment for my addiction. Eventually I came back to the east coast and was put on Suboxone for the first time. I was prescribed 24 mg a day but unfortunately my doctor also prescribed my benzos which turned into a problem of its own.

Since I was abusing the benzos, and still abusing cocaine, I really didn't make any progress recovering from my addiction. After two years on Suboxone, I lost my health insurance and at the same time my provider lost his medical license because he was writing his Suboxone patients prescriptions for Roxicodone and benzos. I was forced into detox because I was in danger of having a grand mal seizure from combined Suboxone and Valium withdrawals. However after I got out I did little in the way of working on my recovery, and within a few months I had graduating to intravenous use of Heroin and OxyContin.

After a few months of that, I checked into an inpatient rehab program, and then into a sober house. I managed to stay clean for about a year. This last spring I relapsed in a very bad way and now I am facing some very serious drug charges and almost got kicked out of school, so I am determined to kick this habit for good before it completely ruins my life. It has already caused so much pain to my family and friends, and destroyed so many of my hopes and dreams that I just can't do it anymore.

So a couple weeks ago I found a provider who put me back on Suboxone. I am also seeing a substance abuse counselor and a psychologist. I have insurance but unfortunately my doctor only takes cash and my prescription benefits only cover $750 worth of medication in a year. At 16 mg a day this is less than 2 months worth of Suboxone, so I really need to make sure I stretch this out so I can properly taper off.

To be honest I really wish I could just stay on the Suboxone indefinitely. It is a miracle drug for me, I have experienced absolutely no cravings at all since I started, and have even stopped smoking marijuana. My focus has returned and I can finally get back to my academics and repairing the damage I have done to myself financially and legally.


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PostPosted: Thu Oct 28, 2010 5:13 pm 
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Thank you for being willing to tell us more of your story. You clearly have been through the ringer here - as many others have been. While you are only one person and one example, I can assure you that you are in very good company. The percentage of people who relapse when they come off of Suboxone is astronomical. When below the age of 30 it is even higher. In my view, it is exactly why anyone attempting to stop Suboxone has to be extremely cautious and have a very solid recovery plan in place. For the great majority, it just simply makes more sense to stay on Suboxone. For you, it really does seem like you may need to find a way to do Suboxone long term. Yeah, the cost may be great but look at the alternative. In the end, which will cost you more - being on Suboxone or not being on Subuxone. All told, it would seem that already it has cost you more (all told) than you ever would have paid for Sub over the past year. Am I right?

Perhaps you can get results down at 2mg? Perhaps you can do 6 for a while, then 4 and then down to 2 for the long-term. It sounds like you have some time to think about it. For me, I have just put it into my monthly budget right up there with food and shelter. I am fortunately in a financial position that insurance or not I'll be okay staying on it. But even if money were tight, I personally would give up eating out, vacations, fancy clothing, and much else in favor of buying Suboxone. Yeah, it is not where near as much fun but at the end of the day it's the right decision - at least it is for me. I actually do hope to attempt to taper and stop at some point. I started Suboxone one year ago and was just about 100% certain that I'd stop Sub at some point. I'm getting close to 50/50 at this point - and it's not the withdrawals that scare me. It's the long-term depression and sleep issues - the Post Acute Withdrawal (PAWS) - and fear of relapse that concern me. My life is pretty darn good at this point. Do I really want to risk that?


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PostPosted: Thu Oct 28, 2010 7:03 pm 
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WELCOME TCH2299 :D

It really sounds like you know your shit and know how suboxone can save our lives! I agree its really shity that its so damn expensive!! I have to pay for my doctor visits but not for my meds, thank God! I will give you a few sites that might be able to help with some of the costs!

Have you tried needy meds? Heres the link for that:

http://www.needymeds.org/drug_list.t...&name=Suboxone


There is also a PRINT OUT FOR A $75/MONTH SAVINGS CARD HERE

http://forheretohelpprogramsavings.com/ ... ?cid=hthpf


Have you tried calling the Heretohelp program. They can help you find a sub doctor. They did me. They will help you and make the calls while you hold. Here is the phone # 866-973-HERE .

Also heres another link to find a different doctor who may use your insurance

https://www.naabt.org/patient_doctor/patient_login.cfm

I hope you continue to do well, Keep up the good work :D :!:


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PostPosted: Fri Oct 29, 2010 1:47 pm 
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Thanks for all that information. I checked out the needmeds website but unfortunately since I have insurance I do not qualify for that program. I consider myself lucky that insurance will pay for a couple month's worth of medication anyways. By the time I have used up my prescription benefits, I plan to be down to 2-4 mg a day anyways.

donh, you are correct in saying that the cost of relapsing multiple times has far surpassed what it would have cost me to continue Suboxone maintenance. This latest relapse has cost me somewhere in the range of $35,000 including lawyer fees, emergency room visits, ambulance rides, detox, and of course drugs. Not to mention the pain it caused my family, girlfriend, and close friends.

At this point I am certainly willing to make sacrifices in other areas of my life in order to be able to afford Suboxone. My recovery is more important than anything else right now and the Suboxone is a key ingredient in my recovery right now. Since I am a university student I am lucky to have free access to PhD psychologists through the school's student health program, and free relapse-prevention groups on campus as well. I plan to take advantage of every resource available to me at this point.

I'm glad to have found a community of people in a similar situation that are serious about their recovery. I think having support from people who have first-hand experience with addiction is very important.

For those of you who have been on Suboxone for a long time, are you able to maintain at doses around 2 mg without any significant discomfort? What is a typical daily dose for someone who has been on Suboxone for a year?


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PostPosted: Fri Oct 29, 2010 2:04 pm 
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tch2296 wrote:
For those of you who have been on Suboxone for a long time, are you able to maintain at doses around 2 mg without any significant discomfort? What is a typical daily dose for someone who has been on Suboxone for a year?


I was able to wean all the way down to 1mg per day, but I was unable to stay there. I started having a lot of depression symptoms and cravings. I'm not trying to scare you or anything. So, I shot back up to 4mg, then back up to 8mg to stabilize again. I am now trying to taper down to 4mg, where I will probably remain indefinitely. I have heard of people being able to take 2mg of suboxone and do quite well at that dose, though.

Keep in mind, I'm 46 years old and have been heavily abusing opiates since the age of 14. I believe that is a contributing factor to MY specific situation.


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PostPosted: Fri Oct 29, 2010 3:56 pm 
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I've been browsing through the dosing forum and reading up on what kinds of dosages have worked for other people.

For the last 10 days I have generally been taking 12-16 mg/day. I have had no cravings at all and it has helped a whole lot with my depression and anxiety. I generally feel motivated and am in a good mood all the time. I also haven't had any trouble falling asleep which is sort of unusual for me. So far the sexual side effects have been minimal. My libido isn't diminished at all and the only real issue so far is that it is difficult for me to achieve orgasm, although I think my girlfriend enjoys that particular side effect, haha.

I think I am going to see what happens at 8 mg/day and go from there. I will probably start keeping a log of how I feel day-to-day - whether I have any thoughts of using, whether I am depressed/anxious, and so on. If I feel like I need more after a few days I'll probably bump it up to 12 mg, but I feel like anything more than that is excessive, at least for me.

After that, I'll probably work my way down every couple of weeks until I find the smallest dose that keeps me symptom-free and without cravings. I really don't want to skimp on the dosage but cost is an issue since after a couple months the prescription benefits on my insurance will be used up.


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 Post subject: 2mg
PostPosted: Fri Oct 29, 2010 6:35 pm 
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2mg is pretty easy to taper down to.. I stayed there for 9 months, Just do it slow, Good luck, Mike


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PostPosted: Sat Oct 30, 2010 9:18 am 
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Mike is absolutely correct in that the best way to taper is to do so slowly. Dr. Junig recommends taking 10% off your dose every few weeks. Now, based on my own personal experience, that may be a little bit too slow at higher doses, say, over 8mg, but the lower you go, the more you need to heed this advice.

Today, I took my first 5mg dose in a while. I will remain at 5mg now until I see my doctor again in December. I may do another couple of months at that dose, then try jumping down to 4mg. I don't think I want to go any lower than that.


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 Post subject: same boat
PostPosted: Fri May 20, 2011 4:33 pm 
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I had the exact same question. My pain management doc who is now prescribing me suboxone started me at 16 mg/day and said I could even go up to 24 mg/day if need be. From what he knows, I had an addiction to hydrocodone, was being prescribed up to 8 per day at one point. From what I've read and talked to others about, 16-32 mg seems like a pretty insane amount to prescribe for a 40 mg per day vicodin addiction, am I right? In reality I was also taking some oxy as well, which I'm sure the doctor probably suspected, but still seems a bit out of whack. I'm also somewhat concerned about lack of info on long-term affects of suboxone as it's a pretty new medication. Does anyone have any info on this? I'm taking usually 8 mg per day and plan on tapering. One of my issues though is without any type of opiate in my system I seem to be in a horrible mood (taking SNRIs, which help a bit, but only if I'm also on the sub). So I have concerns about how I'm going to feel after tapering off the subs and if my mood issues won't cause me to relapse back into oxy/hyrdro. To me, it seems like doctors are going overboard on this drug. Why are they prescribing it in such hugh amounts?


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PostPosted: Sat May 21, 2011 12:01 am 
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I think I remember reading somewhere that the reason why the original dosing guidelines for Suboxone were so high had to do with the fact that the original studies were done on IV heroin addicts. As more information was gathered once physicians started prescribing Suboxone, Reckitt revised the dosing guidelines to 16mgs/day max unless it's being used to treat chronic pain.

The benefits of the higher dose are that it would allow the patient to maintain a constant blood-serum level (thus the patient wouldn't feel the effects of the drug wearing off between doses), at higher doses Suboxone provides a more effective & longer lasting blocking effect against other opiates so it discourages relapse, and the rationale behind the 32mg/day dose was every-other-day dosing.

For a lot of people 8mgs or even 4mgs is enough to supress cravings and withdrawal. Below 4mgs, you might find that you feel the medication wearing off between doses and experience cravings or withdrawal symptoms. I know this was the case for me, especially once I got below 2mgs a day. At that point I found I had to go back to dosing twice a day or I experienced difficulty sleeping and woke up feeling pretty crappy until I dosed.

I was also more aware of the fact that at a lower dose, if I really wanted to, I could probably get high on other opiates. So that's a consideration when deciding what your maint dose will be. At 16mgs or even 8mgs you probably can't get high without taking an extrordinary amount of drugs, but at lower doses there isn't enough bupe to occupy all of your opiate receptors so that benefit of being on Sub is reduced.

In my personal experience, the higher dose of Suboxone (I stabilized early in my treatment at 14mgs) was good for me...for a while. At that dose, I was freed from the up & down, crazy-ass rollercoaster of getting high, coming down, and going through withdrawal. I also felt really good at that dose - my moods were stable and I felt energetic. After a while though I started to feel that my dose was too high. As I got more of a grip on my life and settled into my recovery program I realized that I could probably lower my dose. I don't remember now exactly how fast I lowered, but I went to 8mgs for a while and then eventually stabilized at 4mgs for a significant length of time.

After a year or so, I started contemplating tapering off of Sub completely and I lowered my dose again. I got down to 2mgs and stayed there for quite a while, 6-7 months I think, and then it took me another 4 months to go from 2mgs to 0. All together I spent almost 2 years on Sub. So to answer your question, yes, I found it was possible to maintain on 2mgs a day.

I hope this info helps and feel free to ask me anything. I've been off of Sub for 21 months now and I'm doing great. I think your plan to get to a lower dose seems sound - just pay attention to how you are feeling physically and mentally as you cut your dose. And I think it's wonderful that you are utilizing all the support systems available to you. I couldn't have made it this far without support and a strong, multi-disiplinary plan for my recovery. The best thing about Sub (in my opinion) is that it gives you the gift of time and stability to figure out how to take care of yourself. Good luck!

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PostPosted: Sat May 21, 2011 12:13 am 
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One of my issues though is without any type of opiate in my system I seem to be in a horrible mood (taking SNRIs, which help a bit, but only if I'm also on the sub). So I have concerns about how I'm going to feel after tapering off the subs and if my mood issues won't cause me to relapse back into oxy/hyrdro.


Oh man, I feel for you. I have dealt with depression and generally being in shit mood for over 20 years. When I first found opiates I was like HOLY CRAP, this must be what it's like to not be depressed! I fell in love. Opiates are great antidepressants...too bad about that tolerance thing. And once your tolerance is too high, they don't work anymore and you're left feeling even worse than before.

Suboxone also worked great as an antidepressant for me. So well that I went off of my antidepressant meds while I was on Sub and did just fine. I thought that I would stay on Sub forever since it addressed my depression so well, and I was worried that my depression would come back if I tapered off as well.

Fortunately, my counselor had other ideas. Talking with her made me realize that depression is a HUGE relapse trigger for me, and part of my recovery program was to find my triggers and develop ways to address them. So I spent the 2 years I was on Suboxone learning tools to manage my depression (and also my chronic pain). I learned how to take good care of myself and worked on making doing so a habit. I strengthened my meditation practice, started exercising and eating better, wrote about stuff, learned how to set boundaries, etc. What worked for me might not be what works for you - but part of recovery is learning about yourself and figuring this crap out.

To make a long story shorter, the final outcome was that I was able to taper off of Sub and I was ok. I managed my depression without medication for quite a while, even through my dad's death and a bunch of other stressful shit. What finally got me was SAD this winter and though I did a bit of backsliding I went back on medication (Wellbutrin) and I'm feeling a lot better now. I didn't turn back to opiates and I didn't let things get totally out of control, so that's a win in my book. And I'm ok with being on antidepressants, I've made my peace with it. In fact, I'm pretty blown away that I made it as long as I did without them. Just goes to show that healing is possible.

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 Post subject: Re: 8 mg too much?
PostPosted: Tue Sep 15, 2015 9:01 pm 
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I realize this is an old thread but I thought it worth replying to as it popped up on first page of a Google search on maintaining proper levels. The reason you might need 16mg is because you only actually absorb about 40-50% of the dosage into your system. Therefore a 16mg daily dose is really about 7-8mg in your system. There is a ceiling limit to the amount in your system that will work before any extra is a waste, I think it's around 8mg but not 100% certain offhand. Since subs have a half life of around 3 days it is normal to start with a larger dosage during induction to get enough into your system to get you up to the ceiling level and keep you there, but after a few days typically you could lower down to one 8mg dose (or two 4mg dose) to maintain that ceiling effect. So long as you take regularly without missing a day you will be at a stable level where any more is a waste. You stay there for a while on that dose, like a few months, then you can start trying to lower your daily dose by 1mg every 2 months until you finally taper off completely. That is an ideal long term maintenance taper plan in my opinion. If you stay taking 16mg a day after your induction you will just be making the eventual taper much longer and more difficult than it needs to be, while gaining little to no difference in how effective the medication is acting on your body. That has been how I understand it and I'm sure that you can put yourself on a tougher journey by taking subs in massively high doses abusing them or whatnot, but if you are using them as prescribed the above method I described should work for even the most heaviest of opiate users. But ultimately follow your doctor's instructions on dosage. And be honest with what you are taking so they can formulate a dosage plan that gives you a real chance to taper off eventually. It may take a year, 2 years, 5 years, or longer.. but it can be done. And if you can't taper off that's not the end of the world as the goal is to avoid using illegal alternatives and being able to have a proper quality of life without the constant rat race, so to each their own. Good luck and godspeed.


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