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 Post subject: very concerned
PostPosted: Thu Nov 10, 2011 8:53 am 
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Hi everyone. I am new here and I found this forum as I was desperately researching suboxone strips. Long story short my 22 yr old brother has been a opiate addict since he was 16. He started with pain pills and then recently was arrested for possession of heroin paraphernalia. We had no idea he was shooting up, my mom and I found out the hard way. Here's the short part of the situation (skipping the detox/rehab fiasco)...He's on 8mg suboxone a day. He cuts the strip in half, where he takes 4mg in the morning and 4mg at night. He has the understanding that he needs to stay clean in order to live in this house and suboxone works best for him. Well yesterday after something "not being right with him" I searched his room and I found heroin wrappers, which confused me because he would be wasting his money doing it while taking the suboxone and we got the "academy award" for excuses. So after I had him take his night time dose in front of me, where he did but right after he went to the bathroom to brush his teeth. This morning he did the same. Tonight I gave it to him and he cut the strip in half and put both halves back in the package stuck together and pretended he took it...when i checked the package i noticed both pieces stuck together and had him take it, while i sat there til it was dissolved. Problem is he went right to the bathroom and brushed his teeth. This is drawing red flags all over.....my question is "Is there any way once its dissolved under his tongue can he brush it out?" It might sound like a stupid question but my mom and i are desperate and really concerned for him. I understand that it has a really bad taste and i could understand the need to get rid of it but I'm wondering if he is doing this to remove the suboxone....please help


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PostPosted: Thu Nov 10, 2011 9:33 am 
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Yes, brushing his teeth immediately after letting the strip dissolve (assuming he's letting it dissolve at all!) will affect the amount of suboxone that he gets in his system. There's always some sub left on the oral mucosa that will continue to absorb after the strip or tablet has dissolved. This is why we aren't supposed to eat or drink anything for 10-15 minutes afterward.

It does sound like to me that he's stopped taking his suboxone as directed and is using heroin again. Unfortunately, addicts cannot be forced into remission, but rather they must WANT to change their life.

I'm so sorry this is happening to all of you. I know how difficult my addiction was on my family, so I can only imagine how difficult this is on you and your family.

Maybe it's time for your family to sit down and have a talk with him. You never know, it's possible that he'll open up and be honest. I'd say at least give him that opportunity. After trying that, I'd reassess from there, depending on that outcome.

I wish you the best. Please let us know how it turns out. And remember to take care of YOU during all of this. Maybe even check out Alanon or some other such group.

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PostPosted: Thu Nov 10, 2011 10:53 am 
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It was kinda painful for me to read this post, and no fault on your part Dani. I did many similar things to your younger brother in my early 20's. I can understand the want to make sure he takes all his dose. If this is something you want to keep doing, you can't take responsibility for the times it doesn't work. Ultimately you're powerless over his choices. But loved ones can, in my experience, make it harder for a person to keep using.

Try and delay him having the opportunity to scrub / spit out his dose. Every extra minute he has his Subox in his mouth is less effect he will get from any heroin he's planning to use. When I was doing this, if a pharmacist decided to supervise my dose for 5 minutes, I couldn't run, because I'd get booted off the program. Every minute I had to sit there was like $20 worth of my hit down the drain. Eventually, after a few minutes of being supervised, I knew using later would be a complete waste. Sometimes I'd then concede defeat and have my whole dose, other times I'd spit it out late and use later anyway, and end up disappointed. Importantly, if your brother absorbs a decent amount of his Suboxone, the chance of overdose on heroin is reduced.

If your brother uses while on Suboxone, it isn't any failure on anyone's part, not his and certainly not yours. In my experience, using heroin on Suboxone can turn a person off using. When a person's is taking their Suboxone and is using, the effect of heroin is blocked significantly. The whole process of getting money, scoring, the ritual of using, is all robbed of the reward. If an addict keeps doing this, and wasting money, and wasting time... they may stop associating heroin with feeling good, rather seeing it for what it is - just a waste. In theory, this can break the circuit of heroin use.

Sadly, addiction is more complicated than that. If someone wants to use, and they're blocked of their drug of choice, most turn to other types of drugs. To truly recover from addiction, he has to make a decision. And the first big milestone in this process, for me, was when I asked for help. I actually asked my family, which was weird. That was at 24 after 7 years on heroin. We're all different though, and it takes what it takes.


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PostPosted: Thu Nov 10, 2011 12:05 pm 
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He could be swallowing his dose which will basically render Suboxone useless. The Buprenorphine in Suboxone is absorbed much better through mucus membranes than by the stomach/intestines, that's why we take it sublingually.

If he's swallowing his dose, which would be very easy for him to do, then the heroin would have almost full effect on him.

Bottom line, when we addicts want to use our drug of choice, we're gonna find a way to do it. Your brother has to be the one who WANTS to stop the insanity and be willing to accept help.

Living with or loving an addict is an awful thing sometimes. We usually hurt the ones we love the most, all the while we hate what we are doing, but we can't stop. Addiction is an insidious disease and my heart goes out to you.

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PostPosted: Thu Nov 10, 2011 1:05 pm 
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You got some great advice as far as your brother is concerned and I don't really have anything to add to that.

I would like to stress Hat's suggestion to take care of and seek help for you and your mom. Addiction affects everyone in the family and there are things you can do to remain healthy and better understand addiction. I strongly suggest finding a local alanon meeting. Alanon is for family members of addicts and they will help you to better understand what your brother is going thru and help you to remain healthy thru this horrific thing called addiction.

Knowing that you and your mom are seeking help and info on addiction can also help your brother to see that you are fighting for him. This will make him feel less alone in his addiction and could help him to open up to you. Addicts a lot of the time feel alone and that there family just doesn't get it, him knowing you are doing everything in your power could inspire him to fight too. Everyone is right, ultimately he is the only one that can decide he is ready but this may help him in getting there. My heart goes out to you and your family and I hope he can get back on his sub and take it correctly.


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PostPosted: Thu Nov 10, 2011 3:18 pm 
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Thank you everyone for your replies. I'm sitting here crying from reading your responses and while I'm typing this. I'm just at lost for words right now. We spent all morning in court for his heroin paraphernalia charges just for court to be postponed til next month so he can bring in his "needle exchange card" so the charges will be dropped. At first his public defender told him he can enter a program (I can't remember the name of it) where he has to be drug tested for 6 months, while paying his fines otherwise it's jail time. Until his friend who was arrested with him showed up and things changed because he had the same card with him and his charges got dropped. We thought this was a way for him to be forced to be clean and "learn his lesson"...When we first learned of his addiction we did sit him down and talked to him. He sincerely wanted help, begged for help...My mom put thousands of dollars out for his treatment just for him to come home the first night and use...thats when we got him on the suboxone treatment. At first he was using it the right way, religiously...but then this past week was when he started being shady that's when I realized he wasn't taking it. Last night proved it. Today after coming home from court we had a argument about him getting clean again and staying clean. After reading your responses I told him he has to take it in front of me and no brushing his teeth for at least 15 minutes. He swore up and down that he wasn't using and argued the point that he had to wait. Well he took it and I know he swallowed it. I know there's nothing else we can do...he has to want to stay clean but we can no longer have this going on in our house...I also have a 14 yr old sister living here and he begs for her not to find out what's going on. My mom and I just don't know what else to do. Do we sit back and watch him continue to spiral down hill? Do we keep pushing him to be clean? We just don't know.

I know you're reading this thinking I don't understand addiction because I have to experience it first hand...but no one knows that I used to have an addiction, with cocaine being my drug of choice. I know first hand what he is going through. The difference is I didn't have the family support that he has because I didn't let my family know....I was really good at hiding it. I didn't have therapy or suboxone....just a rock bottom wake up call. I understand the "need" to have the drugs everyday, every minute, every second of the day. It just hurts so much because I once felt the same struggles that he is now going through and I want him clean before it's too late. It hurts knowing that because he has the support of family and friends and has suboxone for treatment but is turning it all down, We just lost our father January of this year, we don't want to lose him as well.


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PostPosted: Thu Nov 10, 2011 4:05 pm 
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I wonder if Methadone might be a better treatment option for him?? Most Suboxone users say they don't really "feel" their dose and it seems like he really still wants to feel that opiate high. I've never taken Methadone, I really don't know that much about it, other than it's used to treat opiate addiction too. We have a few members on this site who are familiar with Methadone, hopefully some of them will pop in and offer their thoughts or suggestions on Methadone.

It's so very hard to compare one persons addiction to anothers, danie71. I understand that you were able to halt your drug use after you hit your bottom, but your brothers addiction is more than likely significantly different than yours and apparently he hasn't hit his bottom yet?

Addiction, as with many things in life, comes in different flavors and different strengths.

I was able to kick cocaine years and years ago without too much difficulty, but it took me FOREVER to get off of opiates. Opiates had a grip on me that I honestly thought I would never be able to push past.

Have you considered sharing with your brother the fact that you're a recovering addict?? He might open up to you a bit more about what's going on and why and you might be able to help him a bit more?

I'm so sorry that you and your family are having to go through this. My prayers are with you and your family.

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PostPosted: Fri Nov 11, 2011 2:04 am 
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Thank you Romeo. I have a few friends who were on methadone and the withdrawal symptoms and addiction to that is just not something we (as in myself, brother, mom, and also his consular) will consider. Methadone is so scary. I mean I know it works for some addicts but to others it can do more harm than good. We know he has it in him to kick this with suboxone and support, just trying to find his "will" again is the hard part. Today was a tough day and we are going to give him a day to gather his thoughts and have that talk again. I am very hesitant to tell him about my past addiction, but if all else fails I will as a very last resort. Its scary because I do want him to know that I can in fact relate to him but on the other hand I'm afraid its something he can hold over my head and run to my family about down the road and the last person I want to know about my past addiction is my 14 yr old sister, who looks up to me; it kills her to see my brother go through this and it kills my mom and I to see her worried for him as well. It is to this day a struggle with the fear that if someone put it in front of me I don't know if I would have it in me to say NO.
I understand that everyone is different with their addictions. He has not hit his rock bottom yet. We thought he was very close when he was arrested...but now we seem to think differently. My rock bottom was almost suicide. I don't want to go into details but I remember the pain I was in, the anger, hurt, depression, guilt, trouble, thoughts, actions etc...and I think that's why I am so afraid for my brother. Its been 8 years since I've been sober and I am so hoping that my brother will one day be able to say the same. Thank you for your prayers.


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PostPosted: Fri Nov 11, 2011 11:30 am 
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I know it can be scary to tell someone about your addiction, but I think you could really help your brother by telling him. Right now he most likely feels alone and that none of you understand what he is going thru. He probably also feels like the family failure and to know that you went thru addiction and came out on the other side could help him to see it is possible and could help motivate him. If he felt he had someone to talk to and support him that understands what he's going thru it could really help him to open up to you and lean on you so to speak. Our minds play crazy tricks on us addicts and most likely he feels very alone. If it were me I would swallow the fear of my family finding out and fight this with everything I have because opiate addiction is deadly. I am sorry if I am being to blunt but I feel that telling him could help save him.


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 Post subject: I would be honest
PostPosted: Fri Nov 11, 2011 12:42 pm 
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I totally agree with Breezy here. You would be helping your brother and also getting this out of the closet for yourself. You said your not sure if you could say No to this day if it were offered. I believe your still not completely free from this addiction either. I was once a heavy cocaine and crack user and I can tell you I WOULD RUN!!!!! if I even knew it was anywhere around me.
I believe this is something you and your family can use to really make some huge step in recovery with honesty. You know if your honest you may find out someone else is holding on to some "serect" to "PROTECT THE FAMILY". I think honest,coming out is the best thing you could do for your family. I would tell my mom first and as a family I would tell my brother. Your little sister of course does not need to know but if she does find out that does not mean she would not still look up to you. It would show her that people make bad chocies and they can overcome them.
I totally understand about the protect the family name but God knows I was the black sheep of the family. I have learned that my family looks up to me I've always been honest and straight up with them.They know I can be trusted.No bullshit when it comes to me I have made horrible decisions in my life but I never forgot the things my parents thought me.
Your brother will respect you for loving him enough that you can be striaght up with him and then it is up to him to want to change.You did it alone and you know how he feels and you can make some HUGE diffence to him right now.
I would not want you to have some regret by not being true to yourself and your brother.
Praying for you and your family. You know in your heart what you need to do and I just say do what feels RIGHT!!! Only you know your family this is IMO.

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PostPosted: Wed Nov 30, 2011 2:39 am 
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Brushing your teeth won't affect the absorption. If he truly keeps the sub under his tongue for the 10 minutes then brushing after won't reverse what has already dissolved. If he is swallowing without saying so then he won't be getting the right amount of med. After 10 minutes under the tongue, your body has absorbed all it will absorb. Some people (myself included) like to keep it under the tongue until your left with nothing but pure saliva. But after the 10 minutes or until the whole pill is dissolved, your body has already absorbed all it will. The reason why we dissolve under the tongue is we have capillaries under the tongue and the drug gets absorbed into these capillaries which lead the drug to your blood system. So brushing your teeth wouldn't change what's already in your blood. Although I was told by my doctor to not drink for 20 mins after. But this is due to allowing any piece that's undissolved under the tongue to fully be dissolved. Drinking would wash away the last piece. As far as using subs and using heroin and being confused to why he can still get high off the heroin has to due with the binding of the drug to the opiate receptor. Buprenorphine has a very high affinity to the opiate receptor. But if you take a high dose of another competing drug such as heroin and you take a high enough dose, you can displace the sub from the opiate receptor and allow the heroin or other drug to take it's place and your high! But this back and forth game of taking subs then taking enough drugs to get high and back to subs is really bad on the body and is a cheat to rehab. Subs are not intended to be used to get you through a rough patch until you can score. They are intended to get you through withdrawals, through your emotional rehab and allow you time to get a plan together on how you will remain drug free. Hope this helps and I hope your brother gets the help he needs and ACCEPTS it.


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PostPosted: Wed Nov 30, 2011 8:53 am 
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I know you're reading this thinking I don't understand addiction because I have to experience it first hand...


That couldn't be further from the truth. Family members often know more about the realities of addiction than those who are in it. Often we're the last ones to see how bad we get.

There are lots of options on the table, but at the moment it seems he's not coming to the table. Methadone, Suboxone, rehab, NA, counsellor, SMART. They're all there for him. But really, as you know, a person has to "want" recovery to get recovery.

I was on methadone when I still wanted to use, and I used on methadone nearly every day. Just like with Suboxone, there are ways to use on the methadone program.

Where methadone & Suboxone are useful in people who still use, is that they minimise the chance of heroin overdose ... and those on the program are less likely to resort to crime to get their drugs, as they have the methadone to fall back on when they can't afford to use. Methadone shouldn't be considered scary. There are a lot of misconceptions about methadone treatment, even among people on Suboxone. The difference between buprenorphine and methadone is not as profound as people think.

Just to put the risk of overdose in perspective. For every year of use, there's a 1% chance of fatal overdose. If they use for 10 years, the probability increases to 10%. It's high I know. But keep in mind that half the people who keep smoking die from a smoking related illness. Also, the vast majority of people who overdose mix the heroin with other depressants, mainly alcohol or benzos & heroin. It's important to make sure your brother is aware of that, and is careful. By making him aware of risk factors, it helps his chances of making it through to the point of recovery.

It's really really difficult danie. You and your mother have already poured so much into your brother. It's really really hard, but there's gotta be a point where you decide to step back and let him fight his own demons. You can always step back in when your brother shows more willingness to help himself. That's exactly what my family did. Supported me when I tried to support myself.


Last edited by tearj3rker on Wed Nov 30, 2011 9:38 am, edited 1 time in total.

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PostPosted: Wed Nov 30, 2011 9:24 am 
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Oxy-Ed wrote:
Brushing your teeth won't affect the absorption. If he truly keeps the sub under his tongue for the 10 minutes then brushing after won't reverse what has already dissolved. If he is swallowing without saying so then he won't be getting the right amount of med. After 10 minutes under the tongue, your body has absorbed all it will absorb. Some people (myself included) like to keep it under the tongue until your left with nothing but pure saliva. But after the 10 minutes or until the whole pill is dissolved, your body has already absorbed all it will. The reason why we dissolve under the tongue is we have capillaries under the tongue and the drug gets absorbed into these capillaries which lead the drug to your blood system. So brushing your teeth wouldn't change what's already in your blood.


Actually, after the tablet or film dissolves, there IS leftover medication on the mucous membranes that can still absorb. So yes, drinking, eating, and brushing teeth right away will remove some more of the medication that can still get into one's system. (BTW, all this info is from Dr. Junig - who's pretty much considered a suboxone expert). Also, there's nothing special about the area under the tongue. ANY of the mucous membranes in the mouth can absorb the medication in the tablet or the film. Do a search for Dr. Junig's "maximum absorption" method on his Suboxone TalkZone blog (there's a link at the top of this page) and it will explain much of this.

Just wanted to clarify.

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PostPosted: Fri Dec 09, 2011 8:09 am 
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hatmaker510 wrote:
Oxy-Ed wrote:
Brushing your teeth won't affect the absorption. If he truly keeps the sub under his tongue for the 10 minutes then brushing after won't reverse what has already dissolved. If he is swallowing without saying so then he won't be getting the right amount of med. After 10 minutes under the tongue, your body has absorbed all it will absorb. Some people (myself included) like to keep it under the tongue until your left with nothing but pure saliva. But after the 10 minutes or until the whole pill is dissolved, your body has already absorbed all it will. The reason why we dissolve under the tongue is we have capillaries under the tongue and the drug gets absorbed into these capillaries which lead the drug to your blood system. So brushing your teeth wouldn't change what's already in your blood.


Actually, after the tablet or film dissolves, there IS leftover medication on the mucous membranes that can still absorb. So yes, drinking, eating, and brushing teeth right away will remove some more of the medication that can still get into one's system. (BTW, all this info is from Dr. Junig - who's pretty much considered a suboxone expert). Also, there's nothing special about the area under the tongue. ANY of the mucous membranes in the mouth can absorb the medication in the tablet or the film. Do a search for Dr. Junig's "maximum absorption" method on his Suboxone TalkZone blog (there's a link at the top of this page) and it will explain much of this.



I never said that brushing your teeth wouldn't cause some of the med to not be absorbed in the system. I said that after a certain amount of time, the amount of drug that entered the system has finished and brushing your teeth after this timeframe won't "undue" what's already absorbed. It's in your blood stream by then and brushing your teeth won't affect it. Yes, like I mentioned in my previous post, there is some bits that are left unabsorbed under the toungue that could be absorbed and wouldn't if you brushed or drank something. But the majority of drug that you will absorb will occur in the first 10-15 minutes. As far as the vascularture is concerned, under the toungue is a highly vascular area. Yes you could put the sub behind your bottom lip too but try it and see how long it takes to absorb. It takes a VERY long time because there is less vascular area to absorb.
Just wanted to clarify.


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