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 Post subject: Very Confused
PostPosted: Sat Dec 10, 2011 10:00 pm 
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I am new here and and would appreciate any input I have been taking subs off and on for over several years, I am addicted to painkillers. Currently I have been seeing a Dr. at a clinic around eight months. In the past I was given 4 milligrams of subs a day. In the beginning of this program I was started on 8 until just recently it was increased to 12. My second appt. I brought up that maybe my dose should be increased and the Dr. became very upset and said no, that I should be tapering my dose not increasing it. It was difficult for me not to run short of pills. She also said I should start considering tapering off and would always remind me how they take a long time during tapering and how doing so makes a huge difference. Now I'm told as of January I will have to come in once a week for subs and be drug tested and be tapered off faster than usual. For what reasons would a Dr. have to take me off subs and at a faster rate especially when my dose was just increased?


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PostPosted: Sat Dec 10, 2011 11:34 pm 
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sharr wrote:
I am new here and and would appreciate any input I have been taking subs off and on for over several years, I am addicted to painkillers. Currently I have been seeing a Dr. at a clinic around eight months. In the past I was given 4 milligrams of subs a day. In the beginning of this program I was started on 8 until just recently it was increased to 12. My second appt. I brought up that maybe my dose should be increased and the Dr. became very upset and said no, that I should be tapering my dose not increasing it. It was difficult for me not to run short of pills. She also said I should start considering tapering off and would always remind me how they take a long time during tapering and how doing so makes a huge difference. Now I'm told as of January I will have to come in once a week for subs and be drug tested and be tapered off faster than usual. For what reasons would a Dr. have to take me off subs and at a faster rate especially when my dose was just increased?


DEAR SHARR: These doctors...they can be idiots!! I had a doctor like that my first go around. She was all for me being on sub...started me 16 then down to 8...in about a year she became different...wanted me off the subs..said they were ruining my colon and bla bla..They were saving my life as I had a 29 yr. addiction to hydros...She gave me my last months supply and told me to taper off!!! I found another doctor..huge difference..dosed me in the office which the other doc did not..and I am on 16 mo now for 6 mo..they would like me to reduce down to 8 ,,but slowly..even gave me subutex which is much cheaper..I don't know why she would just give you 4 mg. a day...did she start you out on 4mg???...that is too low to start out with...8 to 12 is a good dose. Eight months is not near long enough in my opinion. It takes us as long as it takes us. We have to learn how to live as normal people while we are on sub an not thinking about painkillers. If i had to stop now, i know I would go right back out there to that hell of addiction! Maybe your doctor needs your space so she can see a new patient. They can only have 100 at a time on sub. I would try to talk to her and convince her that you need this med. and this dose. Remind her that it is saving your life ( if the subs help you like they do me)..If you read other posts on this forum everyone is different...some people have been on it for years..others want to get off sooner. If you read Dr. Junig's take on this he believes you should stay on sub until you have learned how to live without the non addictive behavior..maybe you could read some of his ideas on the subject. They sure don't agree with your doctor. I am not a doctor..and I don't know everything.. all this is just my opinion..but it sounds like you need a new doctor. Good luck to you and try not to let your doctor or anyone else push you back into addicton.....Judy


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PostPosted: Sun Dec 11, 2011 1:24 am 
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I would almost have to agree that it seems as if the dr may just want your space. I think addiction treatment is just big business like any other. It costs an arm and a leg to even get treated in the first place. About two weeks after I started suboxone I got a nasty letter from the dr telling me that if I ever failed to report a medication to them again I would be dropped from the program. The medication that the dr was refering to was an antibiotic that I had finished 3 days before my sub apointment to clear up a fungal infection on my back. Why would I report that in my first appointment if it was no longer even an issue because I had taken all of them. If they had actually looked then they would have seen that it was a ten day supply and my sub appointment was 13 days later. That really pissed me off. Here I was trying to get clean and I got nailed for an antibiotic. I dont know why drs do what they do. Yout dr should listen to you because only you know your body. You will know when it is time to taper on your own. If you need a higher does then so be it. The bad thing for you is that if she only writes so much and you take more then you are going to run out of it too soon and eventually face withdrawls until you are eligible to get more. That shoudnt be an issue because like I said if you need more then so be it. Have you ever tried alternating your doses? What I mean by that is see if you can get away with taking less than you are prescribed a day. If you feel like you need more in a couple of days or whatever then you will have the extra to use because you took smaller doses than prescribed. I used to do that. I could get away with 4 mg per day for about a week. Then after a week I would feel it in my body that I needed some more so I would take 8 mg. I would take 8 for a couple of days and then drop back down to 4mg. It worked for me and it helped make it last longer plus gave me some cushioning for thr days when I needed more. I hope you get your issues resolved with your doc. If not try to find a new one if possible.


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PostPosted: Sun Dec 11, 2011 2:20 am 
The bottom line is that individual medical professionals have individual views on how and how long suboxone should be prescribed. I would suggest talking to your doctor about his insistence that you taper off of Suboxone on his time schedule and let him know how you feel about it, your views, and your thoughts/feelings. I hear all the time that Dr's are greedy, money hungry, etc and want the "extra slot" afforded to them by dropping patients....I think that's bullshit, personally, as keeping stable long-term patients generates almost identical income as picking up new patients would. Looking for a new Dr if you simply aren't happy is also an option, when you do you should ask what the Dr's typical practice is regarding tapering timelines, if you want long-term to indefinite maintenance, ask the Dr what his/her views are about it UP FRONT to see how they might mesh with your ideas, that way you've lessened the likelihood of surprises down the road.

-Travis


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 Post subject: Same Doctor
PostPosted: Sun Dec 11, 2011 2:18 pm 
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Mine is the same way. This is my second Sub doctor because I moved to a different state. He was the only one who would take my insurance and their is no one else who doesn't charge "cash only".

He is a good and caring doctor but was quite surprised when I told him how long I've been on Sub. He said he expects all his patients to be tapered off in six months. So now I'm going to have to talk to him about that.

My reasoning is because I now live in Las Vegas where there is a rampant drug abuse problem. He is probably trying to do the most good with so many people asking for help. The patient cap doesn't help any either.

My first visit I didn't have a problem getting off Sub. That was my intention anyway before I moved. But now I have cancer and will be needing pain meds and don't trust myself with them. This last surgery it got out of hand for two days before I went back onto my Sub again. Who knows what the future holds. I am going to have to learn to take them as prescribed. But it isn't all my fault. Sub raises tolerance and it took a week for them to even start to work. This next time I'm going to bring in the paper Dr. Junig wrote about surgery and pain relief and see if it'll help.

Try to have a good talk with him and be honest about the fear of getting off when you're not ready. He surely doesn't want you to relapse, does he? That's what he is doing by forcing you off.

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PostPosted: Sun Dec 11, 2011 2:42 pm 
travispnorton wrote:
The bottom line is that individual medical professionals have individual views on how and how long suboxone should be prescribed. I would suggest talking to your doctor about his insistence that you taper off of Suboxone on his time schedule and let him know how you feel about it, your views, and your thoughts/feelings. I hear all the time that Dr's are greedy, money hungry, etc and want the "extra slot" afforded to them by dropping patients....I think that's bullshit, personally, as keeping stable long-term patients generates almost identical income as picking up new patients would. Looking for a new Dr if you simply aren't happy is also an option, when you do you should ask what the Dr's typical practice is regarding tapering timelines, if you want long-term to indefinite maintenance, ask the Dr what his/her views are about it UP FRONT to see how they might mesh with your ideas, that way you've lessened the likelihood of surprises down the road.

-Travis


GREAT POST....!!!

What's often not considered is that providers are as varied in their thoughts and practices as their patients.
There is no "one size fits all."

Just because a provider doesn't agree with YOUR plan or tailor their practice of medicine the way YOU think they should doesn't make them "idiotic," uncaring, uncompassionate, stupid, etc. This just means that its not a good fit. That provider's practice style doesn't mesh with your expectations and that you should probably continue searching for a provider that is on the same page as you. Neither is "right or wrong"... just don't match.

Personally... I'd rather keep the same patients indefinately than get new ones. This would mean that they are all stable and "know the ropes" and less suprises for me. Problem would be that this would also mean that none of them successfully tapered off and lived drug free. To some providers... that would be considered a treatment failure.

So in our practice.... we attempt (not force) tapers at regular intervals (3mo, 9mo, 18mo) and I document the results in the EMR. Patients know this from the beginning... and we have found that it can serve as a indicator to the "outside observers" that we aren't simply "handing out drugs to addicts" and that even WE have hope for progression towards a drug free lifestyle for the patients. As far as we are concerned... if you come in on 16mgs... and at yr 2 is down to 8/4/2 mgs... then you are getting significantly better...

Again.... providers are as varied in their thoughts and practices as their patients.


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 Post subject:
PostPosted: Sun Dec 11, 2011 4:40 pm 
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Thank you for the helpful feed back. The obvious choice for me is to look for another Dr. This program is covered by medicaid. The main reason I am so freaked out by her doing this is because I know I can't afford to pay a private Dr. In the past I was tapered off 4 mgs and thought that was hell, which was my own fault for not doing it the correct way. One appt. she tells me to be prepared to go off subs then the next appt. she increases my dose and tells me as long as the program is around, not to worry. I keep wondering that for her to do this I must have done something wrong. What a mess! Thanks again for all the help...........Sharr


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 Post subject:
PostPosted: Wed Dec 14, 2011 2:21 am 
sharr wrote:
Thank you for the helpful feed back. The obvious choice for me is to look for another Dr. This program is covered by medicaid. The main reason I am so freaked out by her doing this is because I know I can't afford to pay a private Dr. In the past I was tapered off 4 mgs and thought that was hell, which was my own fault for not doing it the correct way. One appt. she tells me to be prepared to go off subs then the next appt. she increases my dose and tells me as long as the program is around, not to worry. I keep wondering that for her to do this I must have done something wrong. What a mess! Thanks again for all the help...........Sharr


Seems to me that a doctor who DOESN'T care is the one that is going to give you whatever it is you say you want.

If you wanted an increase in oxycodone and the doctor said no, would you go out and find a new doc? That is kind of how I see it. 12 mg is a pretty large dose, unless you had a monster IV habit. Maybe the doctor knows what he/she is talking about.

Or maybe (s)he really is just money hungry. Idk.


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Fond Du Lac Psychiatry
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