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 Post subject: Too much?
PostPosted: Fri Aug 17, 2012 6:56 pm 
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Hello all!

Forgive me, I am positive that all of the questions that are about to come out of my mouth are likely already answered someplace else. If I had enough time to look at each post in this section, I wouldnt ask. I've got a 4 year old tugging on my dress as I am typing so I will try and make this quick. Thank you in advance for any thoughts, expertise or advice.

I am on day 2 of my subutex treatment. I am currently perscribed 8mg and told to take 1/4-1/2 a tablet 2-3 times daily. Trouble is, I am not sure if I am permitted to take more if I crave more. I wonder if I will get in trouble from my doctor. Or if I will find myself in a situation like I was when I was in pain management where I wasnt allowed to get another full script until after 30 days or so. Truthfully, I really know nothing, and my doctor wasnt very helpful.
I recently read something on the internet when I was trying to find out how much I should take that left me even more confused than when I started looking for answers. When asked "How much should I take?" it said this: " During the first few days, you may need to use as many as 3 to 4 of
the 8 mg pills to stabilize yourself and not have any cravings or withdrawal symptoms.
Start by spreading it out as ½ a pill
every 3 to 4 hours if needed. After that, however, most people settle into the 1 to 2 pills per day range, taking ½ at a time."
Does that mean 3-4 pills a day?! Or 3-4 pills in the span of your first few days starting treatment?
I am so confused I am about to be driven to tears. I am worried that I am taking too much today. And I started taking subutex to stop abusing opioids not to take too many of just another medication. ::sigh::
Note: so far today I have taken 2 and 1/2 8mg tablets.

Hopefully someone with half a brain (which I seem to be lacking at the moment) can figure this out for me.

THANKS! (now to go make a very hungry preschooler some dinner)


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PostPosted: Sat Aug 18, 2012 12:45 am 
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Welcome MsJ

sorry your having such a confusing time, getting started. thats kinda how it goes though.
sure seems like it happens to alot more than just you.

Anyways, I guess I have a few questions for you first!!

How are you FEELING???
are your withdrawl symptoms gone,for the most part???
i think its a rough transition to say the least, and although you may 'feel' like dosing, there really is no need to, if your on 16mg of suboxone. You really dont 'feel' any reward, for taking more. You can read all about the cieling levels, and saturation levels, here
http://suboxforum.com/viewtopic.php?t=1738

that should help a little.
And try to distract yourself, is the best advise I can give you. I took too much suboxone, the first few months of my treatment, and all I did was run out early. I really didnt 'feel' anything, except guilty for doing it.

I guess getting used to NOT being high, was the biggest hurdle, for me.

Im just guessing here, so if Im WAYYY off, Im sorry from the bottom of my heart!!!

heres a thread on it, too, where other members talk about feeling the same way
http://suboxforum.com/viewtopic.php?t=6746

So, really go off how you actually FEEL, not what your head is telling you.
for most people, 16mg is ample enough suboxone. when I first started, I was on 24mg. Im now on 16, but sometimes get by on just 8mg. I really feel no difference, expect when my back hurts and I feel the pain all the way down my legs. those are the days I take 20mg.
And thats 'ok' Im perscribed 24. Many people have said here, that its WAY too much, but for me, and being Rx'd for pain, Im fine with it. I know I can never take another opiate for pain control, at least nowhere in the near future.

Welcome to the forum, and suboxone treatment.
I wish you the best of luck, in all that you do :wink:

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PostPosted: Sat Aug 18, 2012 9:41 am 
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heya welcome! Many people find induction difficult. It's difficult to ease a person into Sub treatment, because induction is a pretty risky period for relapse and many doctors err on the side of caution with dosing - ie the docs I've had believe it's better to dose too high than too low for risk of relapse.

Anyway, first thing I'd advise is sticking to your doctors orders, just cos it's probably not wise to follow some stranger's advice on the internet over a doctor who has actually met you and knows more of your using history.

BUT if I were in your situation, I'd take whatever Sub I required to stave off both my physical withdrawals and cravings and urges to use other opioids. The main purpose of Suboxone is to manage a persons cravings - ie to have enough Sub in their brain throughout the day that a person doesn't need to obsess over using, and can get on with their lives.

I've found that with Suboxone there's this "ideal" level - the level of Sub that isn't high enough to feel stoned, but isn't low enough to experience urges. It's interesting that for me, I only feel urges to use when the level of Sub in my body is low like later in the day. The using thoughts are a symptom of not having enough Sub in my body, of my body wanting to "top up" with other opioids.

The other thing. I wouldn't advise taking more than the maximum your doc has prescribed, simply cos if you do you'll run out, and you'll be in a risky situation. And with a new doctor it doesn't look that good asking for an early refill straight up.

In a nutshell, if I was in your situation I'd do thus - raise the dose carefully if I'm experiencing cravings. Lower the dose a little if I'm feeling stoned / buzzed out on bupe. But I wouldn't raise it over the max level prescribed else you may run out.


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PostPosted: Sat Aug 18, 2012 11:21 am 
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Thanks everyone for the reply!

Amber: As far as how I feel, err, fine I suppose...
(ugh that sounded pretty ungrateful) I'm glad however that I am not some sort of goosefleshed sobbing mess sitting in the corner of some dark room.
The thing is, I am still having cravings. I dont know why, but perhaps it is just a mental thing. I am used to being able to take my drug of choice whenever I wanted to. (sometimes that ended up being darn near every hour when I had enough Kratom)
I'll try and give you the short version of what my day was like yesterday. I woke up and had breakfast then shortly after took 1/2 of the 8mg pill. It ended up being a good morning, I got a lot done around the house. 3 1/2 hours later I took the other half and I felt great for a while. When I went to take my evening dose, it was as if I had taken nothing at all. Stupid me, I took another 1/4 after about a hour. Only to end up feeling like I was running in circles.

I am assuming everything I am experiencing is mental. But some small part of me is wondering at this exact moment, " Should I of taken a 1/2 instead of 1/4?".

So I guess because I didnt know any better I am likely going to get in trouble with my doctor for taking too much on the first day and the second day. I am guessing that filling a subutex script is the same as filling a pain medication script? If you took too much of a thirty day supply and it left you unable to have any meds for the last few days of the month, you cant fill it early? Am I right in assuming that?

I guess that may be the reason why my doctor only gave me enough for 3 weeks, just in case perhaps he could help? I just dont see him being the kind of person to be angry with me. ::sigh::

TJ: I am still obsessing. But not because I am sweating bullets from withdraw. I dont know what to make of it.

My script says, "Take 1/4- 1/2 two-three times daily" Perhaps I should take 1/2 in the morning and then quarters for the the rest of the day. So that means that at max I can take 1 and 1/2 pills in a given 24 hours. Would I get in trouble if I did indeed use that much every day? Could I span it out in more "doses" as long as I didnt exceed the 1 and 1/2 pill range?

My god this is confusing. I wish I could fold up my doctor and put him in my pocket.


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PostPosted: Sat Aug 18, 2012 11:37 am 
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Its wierd that you dont have exact instructions, but probably becuase your doctor wanted to leave you 'room' to see where you need to be.

If you do in fact end up taking more, I would just call the dr. office and explain that. That way they will know you need a refill earlier than expected. obviously its not one of these dr's with EXACT instructions, so really you should be just fine in doing that.
when I first started, and ran a few days short (with a two wk script) my doctor did refill it early. but its a good idea not to wait until your OUT, then 'back pedal' telling them what's happened.

So, I would say take what you feel you need to. If you get could your dosing to twice a day and eventualy once, that'd be great. But thats after your 'over' the rough patch of first inducting.
its only day three after all right?

so theres my advice, call the doc's office and at least leave a message that your ending up taking "X" amt daily, which will not leave you enough to get to your scheduled refill date. (just my opinion, worked for me)

Any other questions, just ask :wink:

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PostPosted: Sat Aug 18, 2012 11:40 am 
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Also, I'd really like to post the link where I saw this "dosing information" that I posted earlier in bold. When you go to Google and type in, "How much Subutex to take?" its like the 2nd or 3rd link to show up. It's misleading.

But then again, that's my fault for listening to google instead of my instructions on my bottle. I just wish I could recall what he said when I asked him what I should do when I take a bit more than what's written on the bottle. All I remember is him saying " Just come see me."
I don't know if he said that so he could yell at me for being stupid, or if he would want to change my dose.


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PostPosted: Sat Aug 18, 2012 11:50 am 
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Your very early in your treatment, so I really dont think he's gonna yell at you!! but I know its a justified concern, with us addicts :roll:

Believe me, I was scared of my doctor in the begining, too. But now we get along really well.
Please just call, so they can schedule you for an appt, if thats what you need, or just okay your refill for earlier. I think we may have been typing reply's at the same time, above, LOL

Anyways, try not to stress out, I think you may have flexible doctor, since the instructions on the bottle, seem flexible.
Let us know how it goes, and post here whenever you need to.

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hold it together, when everyone would understand if you fell apart
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PostPosted: Sat Aug 18, 2012 12:32 pm 
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Awesome advice. I am going to call his office on monday and explain the situation. I'll have to find my spine, as in the past, I would of rather delt with a few days of WD vs saying that I took too many. I hated the lecture. No doctor could of made me feel any more guilty than I already did for being a addict.

Perhaps this is a silly question, but with most pain medications, when someone takes them for a long period of time, you tend to build a tollerance. Is subutex like that?

Also, it seemed that no matter what kind of opioid medication I was on, in my experience, the first dose I took always had little effect on me. For example, when I was perscribed pain medication, I would always have to take a 1/2 pill more in the morning for my first dose to notice any effect at all. When I was using Kratom I had to take my first dose and then take another 45 minutes later to notice anything at all. Has anyone ever experienced this too? I am wondering if that is why I feel no different at the moment. I took 1/4 a 8mg pill over a hour ago and I feel exactly the same as I did when I woke up. Perhaps it's all mental? I tend to over analize things anyway.

So far for me though, (even though it is still day 3) I havent experienced such awful side effects. Only a awful migraine on day 1&2. I hope day 3 wont hold the same side effects. And my throat is terribly sore. But that could be from anything.

Thanks guys!!


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PostPosted: Sat Aug 18, 2012 5:43 pm 
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Im gonna post you some more links, and if you read about how the buprenorphine actually works, how it stacks in your system, and floods your receptors, then you will understand why you dont 'feel' anything when you take it.

And yes, i think calling the doctor is an absolutely excellent idea. Like I said, I doubt he'll be mad at you, since he wasnt that strict with his instructions.


http://www.naabt.org/collateral/How_Bupe_Works.pdf


THIS I JUST COPIED/PASTED, from the link I gave earlier. but I really think if you read it, you should understand why you aren't feeling a 'reward' other than maybe a mental one.


A question was asked about the last post that warrants top billing:

“Buprenorphine acts similar to opioid agonists in lower doses, with the same addictive potential as oxycodone or heroin. In higher doses—doses above 8 mg or 8000 micrograms per day—the ‘ceiling effect’ eliminates interest and cravings for the drug.”


Ceiling Effect

I’m not sure I followed this. Can you explain more? What would you think about someone who is taking 1-2mg of Suboxone twice a day without a prescription, and says they want to stay on that dose once they find a prescriber? Are they better off on 8mg or more per day, or would it be ok for a prescriber to keep them at the lower dose? Is the answer the same if they hope to taper off the medication completely within a year (they don’t feel able to do this on their own right now, but hope to be able to when some life circumstances change). Thanks!

This gets a bit complicated, but I’ll do my best. A couple background issues; buprenorphine has a ‘ceiling’ to its effect, meaning that beyond a certain dose, increases in dose do not cause greater opioid effect. That is the mechanism for how buprenorphine blocks cravings.

If the blood level of buprenorphine is ABOVE that ceiling, the opioid receptors are maximally, 100% stimulated. If the person takes more buprenorphine, and the blood level increases, the opioid receptors don’t feel the increase, as they cannot be stimulated more than 100%. But more importantly: when the person takes less, and the blood level of buprenorphine goes DOWN, the receptors also sense nothing– as long as the level stays above the ‘ceiling’ level.

Read the above paragraph, and think on it until you grasp it– as it explains buprenorphine and Suboxone. If you understand that paragraph, you will know more about Suboxone than most doctors!

Below that ceiling level, the opioid effect from buprenorphine varies directly with dose—just as with oxycodone, hydrocodone, heroin, etc. Medications that have effects that increase with dose are called ‘agonists’. Buprenorphine is a ‘partial agonist;’ it acts like an agonist up to point, the ceiling effect, beyond which increases in blood level have no greater effect.

The level of this ‘ceiling’ varies from one person to the next, depending on efficiency of absorption (on average, only a third of a dose is absorbed from under the tongue), body size, liver function, differences in regional blood flow, and the presence of other medications that affect buprenorphine metabolism. In order for buprenorphine to have the unique, craving-blocking effects, the blood level of buprenorphine must stay above the ceiling level, for the reasons described above.

Lower levels (blood levels of buprenorphine below the ceiling level) still have SOME effects on cravings. Buprenorphine has a long half-life, an that alone reduces the desire to take more—especially if the medication is taken more than once per day– since the blood level drops very little between doses. For agonists or for buprenorphine below the ceiling level, drop in blood level equals drop in opioid effect, equals sense of things wearing off, equals cravings.

But the classic method for treating with Suboxone, as described in the certification course, is for it to be given at a high enough dose to stay above the ceiling level… and dosed only ONCE per day. If the blood level stays above the ceiling level, once-per-day dosing covers cravings completely. Yes, people still want to take more, especially initially, but that desire is not driven by chemical effects; the desire is instead based on psychological factors, like habit, or from being accustomed to feeling better after a dose, and getting a placebo ‘lift’ from taking a second dose.

A person can eliminate that second dose fairly easily, providing that the morning dose is high enough, i.e. usually 8-16 mg. To eliminate the second dose, the person should distract him/herself as soon as the thought about taking the second dose comes to mind. Immediately, do anything else—the dishes, call a friend, wrestle with the dogs… and the thought will pass. If the person does the distraction method for a few days, the need to take the second dose will go away—a psychological process called ‘extinguishment.’

Dosing every other day, and even every third day, has been studied; people cannot tell the difference, if the dose is raised enough to keep the blood level above the ‘ceiling’ (providing the person is given a placebo that tastes the same).

As for as the writer’s friend… I’m not a fan of any illicit use, but I am aware of the shortage of physicians. When the person has a physician, in my opinion the person should be prescribed a dose that allows for once per day dosing. Realize that buprenorphine wears off VERY slowly; it takes over three days for half of a dose to leave the body! So that ‘need’ to take more is almost always entirely learned or ‘conditioned.’ The medication does not wear off in that short period of time.

Even if the person has withdrawal symptoms, the sensations are almost surely imagined. How to tell? Use the distraction method, and note that a couple hours later, when the person remembers that the dose was skipped, note that the withdrawal went away. That doesn’t happen with ‘real’ withdrawal!

The sense of withdrawal that drives the second dose is simply a memory; a conditioned response that the body has that triggers the person to take more opioid. We become conditioned by drug use, just like the salivating dogs from science books! In the case of opioids, whenever we feel down, we think that an opioid will lift us up, as it has hundreds of times before. And even if what is taken is not a real opioid, the mind ‘feels’ a boost, just from expecting what has always happened in the past.

As for tapering, I look at many factors in order to recommend, or not recommend, stopping buprenorphine—things like age, presence/absence of using friends or contacts, physical health, mood, support network, personal motivation to stop buprenorphine, ability or lack thereof to dose once per day, consistently, number of relapses and personal ‘recovery’ plan, etc.

Realize that EVERYONE looks forward to a day when life circumstances will change for the better—but most of the time, life becomes more, not less challenging. Yes, it is nice to have a reliable job… but it is much more stressful being the sole breadwinner for a family with children, than working to pay for one’s self! Marriages settle down in some ways over time, but they also lose the intense infatuation that can gloss over personal differences.

As I have often written, it is VERY hard to stop opioids. It is a little easier to stop buprenorphine; I am convinced of that fact because I have seen opioid addicts taper off buprenorphine, but I know of no opioid addict who tapered off an agonist. But SOME people cannot taper of ANY opioids—including buprenorphine. I do not consider those people ‘addicted’ to buprenorphine, because they lack the constant obsession for opioids that is so destructive to the mind of an active addict. But they ARE physically dependent on buprenorphine— a fair trade, in my opinion, for a life of chaos, broken relationships, legal problems, and death.

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hold it together, when everyone would understand if you fell apart
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PostPosted: Sat Aug 18, 2012 7:06 pm 
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Reading all of that makes me wonder though... How does one try and figure out their ceiling level? I'd hate to think that if I just took one dose in the morning that anything else that is taken after that is a waste and nothing more than my "itch needing to be scratched".


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PostPosted: Sat Aug 18, 2012 9:36 pm 
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You can figure out where your 'ceiling' is by dosing just once in the day, and if your in w/d before your 24 hour mark, then you dont have enough in your bloodstream.
thats my take on it anyways. Everyone has a different opinion on it, becuz its ALL very confusing, and every single person's body is differnt, that we know for sure!!!

For ME,
I take 8mg, as soon as I wake up, then go to work, and sometime in the afternoon, my back starts hurting usually. From standing in the spraybooth all day, on the concrete floor. So I take another 8mg. Sometimes its 2pm, sometimes its 5pm.
I do feel SOME relief of my pain/stifness. My doctor told me that suboxone's effect for 'pain management' lasts roughly 4-6 hours depending on the person.
I guess thats why he 'perscribes' me 24mg/day. like I said before though, I hardly ever take that much. Maybe once a week. Unless Im doing something horrific (for me) at work like unloading 24 prehung doors by myself, then yea, Im gonna end up taking 24 that day.
Now, Ive tried distracting myself when I really hurt like that, and I always try tylenol first. I take Ibprofen every morning as well. Since Im always stiff when I wake up.

So, thats how it works for me. I never feel anything 'mental' like a lift or anything like that. I just feel a little pain relief, which does usually help my attitude.
I think you can experiment. And I dont know of many people that actually do the once daily dosing in the begining. ive asked my doctor about it, he doesnt seem all that concerned, and maybe its the pain thing too.

I hope I helped :wink:

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PostPosted: Sun Aug 19, 2012 12:03 am 
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Ceiling level varies from person to person, but for most people a dose of 8-12mg a day is enough to have them over the "ceiling" for 24 hours - ie a whole day. Now there are some people who metabolise Sub quickly. It's recommended for these people to dose multiple times a day - ie instead of having 12 mg in one hit, have 4 mg 3x a day kinda thing.

THEN there's the people for whom, even dosed at the ceiling level, their cravings are not diminished enough to keep them from wanting to top-up with other opioids. It's these people who perhaps methadone may be a better option.

Also, I don't believe that Sub is intended to remove cravings entirely. All it really needs to do is diminish cravings to the point where a person can control their urges, to "have the upper hand". Most people on Sub still get urges to use from time to time. All's important is that Sub gives them a degree of control, of ability to say "no I don't have to use" and to stick to their resolve.

As for your dose splitting - 1/4 - 1/2 two to three times daily. I'd suggest you take the same amount each time you split. At one stage I was dosing 8mg morning and 4mg evening. Having my dose split unevenly over the 24 hours led to uneven levels through the day, and I ended up getting midl withdrawals when i woke up. Ideally we want the most consistent levels over 24 hours. Try 4mg / 4mg / 4mg every 6-8 hours and see how that goes?


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PostPosted: Mon Aug 20, 2012 2:51 pm 
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@TeeJay:
For the past 2 days, I havent reached a ceiling. I am not sure if that is something that I should strive for...?

The past two days have been both good and bad.
Good in the fact that when I took my subutex, every single time, it had the desired effect and left me to normal thoughts. I was relaxed enough to watch a movie with my husband and son. (something that I havent done in YEARS)
I am feeling kinda hopeless about the dose though. Usually around 4-5 hours after my last dose, I find that I am in too much pain to stand long enough to get a sink of dishes done. I really dont know what to do or what to say to my doctor. He told me that if anything comes up to go in and see him.

I started on all of this so I could be free from a life of mindless addiction. But I am starting to wonder if that means that I am not going to be able to live a normal,minimally painful life.


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PostPosted: Mon Aug 20, 2012 11:41 pm 
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Dont worry, it should get better!!!

for me, when I first started, I had lots of pain, mostly in my back, and I thought the SAME THING. I was thinking, if this is gonna be my New 'normal' Ill NEVER make it!!!!!

but honestly, I think it was my body screaming for opiates. I mean, thats what our brains get used to, after all.

FOR ME, my back pain/everything subsided at about two weeks. I still feel SOME pain, on a daily basis, but nothing like my 'transition' period. It really did suck. You can try some ibprofen or heat packs, anything, whatever works, do it.

Just try and push thru this 'adjustment' phase. and nowadays, for me, taking a dose twice a day, DOES relieve my pain.

Ive heard many other people here on the forum say the same thing, too. about the 'transition' phase. for some it lasted a lil longet than two weeks, for some not quite as long as two weeks.

Hopefully,,, you feel better soon.
Just try and think about all the damage we did, and what your body is getting used to going 'without' now. of course it's gonna send every brain signal for pain that it can, to try and get it's 'reward'

Hang in there, I think your doing just fine :wink:

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hold it together, when everyone would understand if you fell apart
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PostPosted: Fri Aug 31, 2012 3:28 pm 
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Just wondering:
I'm seeming to have a fair amount of trouble being able to get my dose to melt under my tongue. Its usually taking about 20-30 minutes on average. What can I do? I'm already breaking my (half) 4mg tablet into half (2 2mg tablets then) . It still takes just as long. I'm thinking that the effectiveness of the dose is greatly depleted by the time it is currently taking to dissolve.

Also, after it dissolves and you have a pinch of "grains" floating around in your mouth, are you suppose to not swallow that for a while?


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PostPosted: Sat Sep 01, 2012 12:21 am 
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You're on brand Subutex? I've found Subutex takes a bit longer to dissolve than Suboxone. But there are some ways to speed up that process.

If you can, break up your tablets into 4 or 5 lil "chunks" before you stick em under your tongue. When I used to have Subutex dispensed to me from the methadone clinic, by law they had to do this to prevent people spitting it out and injecting it. But in the end I much preferred them broken into chunks. They'd do it by getting a pill crusher, then only twisting it a lil bit just enough to break it up into a few big pieces. It'd help it dissolve faster, and help me absorb more because I wouldn't have a mouth full of saliva by the time it fully dissolved.

I'd also suggest you read Dr. J's "maximum absorbtion" blog post, where he talks about how to get the most out of your dose. Basically after you stick ur chunks under your tongue, wait until they dissolve then you "paint" the concentrated lil pool of Subsaliva (aka subliva) around your cheeks, gums, roof of your mouth .. all over.

Also, I know the pharmacists and docs say wait 15 minutes or so til it dissolves. But most people I know keep it in their mouth a good 30 mins at least.

Good luck!


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PostPosted: Sat Sep 01, 2012 12:43 am 
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Omfg, subliva :P

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PostPosted: Mon Sep 03, 2012 9:54 am 
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Joined: Fri Aug 17, 2012 6:35 pm
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TeeJay wrote:
You're on brand Subutex? I've found Subutex takes a bit longer to dissolve than Suboxone. But there are some ways to speed up that process.

If you can, break up your tablets into 4 or 5 lil "chunks" before you stick em under your tongue. When I used to have Subutex dispensed to me from the methadone clinic, by law they had to do this to prevent people spitting it out and injecting it. But in the end I much preferred them broken into chunks. They'd do it by getting a pill crusher, then only twisting it a lil bit just enough to break it up into a few big pieces. It'd help it dissolve faster, and help me absorb more because I wouldn't have a mouth full of saliva by the time it fully dissolved.

I'd also suggest you read Dr. J's "maximum absorbtion" blog post, where he talks about how to get the most out of your dose. Basically after you stick ur chunks under your tongue, wait until they dissolve then you "paint" the concentrated lil pool of Subsaliva (aka subliva) around your cheeks, gums, roof of your mouth .. all over.

Also, I know the pharmacists and docs say wait 15 minutes or so til it dissolves. But most people I know keep it in their mouth a good 30 mins at least.

Good luck!



Is there anyway you could post that link for me when you get a second TeeJay?


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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