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PostPosted: Wed Feb 15, 2017 7:29 pm 
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Hi, I'm new to the S forum and don't really see any topics regarding my experience of Suboxone withdrawal after taking so much for so long. I was prescribed 64 mg per day. I took 8 tablets per day for the first 2-3 years and then switched to the film/strips when they became available and was prescribed 8 strips per day...staying at the same dosage of 64 mg per day for approx. another 3 years. It's been just over 4 years since I stopped taking suboxone. My experience and what I had to endure especially for the first 2 years was/has been a nightmare. I was wondering if anybody else had had a similar experience and if I was over prescribed?


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PostPosted: Wed Feb 15, 2017 7:48 pm 
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Welcome to the forum.Generally the highest doses we hear about is 32 daily. More common is 24 mg for a big habit to start, or perhaps 16mg.

Why were you given so much? What were your circumstances? What did your Dr. tell you? And why was your experience nightmarish?

YOu're so far over the ceiling effect that huge daily dose was likely not helping you anymore than say 16 or 24. But I'm not sure it was hurting you either. I know buprenorphine is an extremely safe drug and almost impossible to overdose on. But I'm not a doctor. So take that into consideration.

Thanks and best wishes,
Godfrey.


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PostPosted: Wed Feb 15, 2017 8:33 pm 
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mj,

Surely want to hear more from you as its very odd to hear of that high of a dose, not only initially but for so long. Headshaking really.

Agree w Godfrey's questions and comments. I guess one harm would be the hit to your pocket book. I would think lowering from 64mgs to ~8mg would go pretty well.

Ya, we'll need to hear more to be able understand. Thanks for posting and Welcome! Wishing you my best, P


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PostPosted: Thu Feb 16, 2017 10:53 am 
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Hi..thank you so much for replying. It's a long story as most are so I'll try to stay somewhat brief.
I've had a quite a few sports related injuries and surgeries through the years...both Knees, back, hip replacement and so on. So obviously, plenty of pain meds, of which I ended up having a never ending source/supply. The official reason was chronic back pain which was fairly significant and still is. The bigger picture was/ is that I'm an addict so obviously things progressively got worse and rock bottom was near. At the same time, I had become a father and knew things had to change. This is when I first heard of Suboxone and how wonderful it was...the miracle drug (before we knew what we know now). The problem was that I could not get an appointment w/ a Suboxone Dr because I hadn't done anything drastic due to my drug addiction. I was basically told... to get into a Suboxone program, I need to be sent by a judge, etc. Finally I found an inner city Dr that agreed to see me as he also knew that I would be paying in cash ( my insurance would not cover it at the time). The reason for all of these details is to explain why I was taking so much..64 mg/day. He said that it also helps w/ pain. Basically, my belief now is that he wanted to keep me as a patient because I was willing to pay in cash. Regardless, the fact is that I was taking 64 mg per day for many years and went through at least 2 years (if not more) of significant Soboxone withdrawal. The reason I'm reaching out is to share my experience and talk to anybody w/ a similar experience. I'd would really like to know and understand how the amount you take per day combined w/ how long you were taking Suboxone effects the level and duration of the withdrawal symptoms once you stop taking it.? Was my experience of having a high level of withdrawal symptoms for so long to be expected. Perhaps there is little information out there about this simply because my experience is so unusual? Any information or thoughts would be appreciated!!!


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PostPosted: Thu Feb 16, 2017 2:05 pm 
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Mjeff2 welcome.

Well I've never ever heard of anyone taking that much buprenorphine a day in my life. It's shocking really. I had to make sure I was reading this correctly, and when I saw ur doctor prescribed u that much, well shocked again is the word I keep going bk to. It still doesn't make sense that ur doctor was only doing that to keep u coming bk because he'd get paid regardless if he prescribed u 16mg or 64mg. So I have no idea what he was thinking. And I also have no idea how u paid for that much medication for years. How did u afford that?

I'm under the assumption that once ur over the ceiling level, ur withdrawal is the same at whatever amount. Meaning, if u stopped at 16mg or 64mg, ur withdrawal would be the same BUT, at 64mg, I could be wrong.

Over those yrs on this high dose, did u do any research funding this to be an extreme dose? Did u ask questions about why u needed 64mg?
I'm sorry for all the questions from us but u got to understand that most of us have never heard of one person being prescribed that high of a dose.


Honestly, I don't know why a pharmacist wouldn't question filling a dose that high. It's just a dose that I've never heard of before. I truly hope Dr Junig or docm2 can respond on this, that's who could shed more light on this for u. I doubt there's going to be many ppl with ur experience to share because 8 strips a day.... gosh that's a lot.

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PostPosted: Thu Feb 16, 2017 10:31 pm 
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Were you buying your medication from the doctor that gave him an incentive for prescribing so much?

I just really don't understand. Like Jenn says, we've never heard of anyone at such a high dose. There is no need for it that I can think of!

"This is when I first heard of Suboxone and how wonderful it was...the miracle drug (before we knew what we know now)." What is it exactly that we know now? To me, suboxone has been like a miracle and has improved my life 180 %.

Amy

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PostPosted: Fri Feb 17, 2017 12:34 am 
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Exactly, Amy-- I noticed that as well. 'What we know now' is that tens of thousands of lives have been lost because of the patient cap. 'What we know now' is that all of those people arguing that 'this is a new drug' were speaking nonsense (we actually have always know that, since buprenorphine has been around for almost 40 years!).

To answer the question, though-- I remember reading in a book chapter about buprenorphine, years ago, that high doses of buprenorphine increase mu-receptor antagonism. I wish I remembered the source... it isn't in Goodman and Gilman (the classic pharmacology text used in med schools), so I just don't know where I read it, or how much to believe it. I just remember that doses that were 'conceivable' but high-- maybe 32 mg per day or more-- were said to REDUCE mu-receptor activation. I remember sharing that idea with patients years ago, that if we raised the dose TOO high, it could start to INCREASE withdrawal symptoms. At some point I quit saying that, as I became uncertain over the reference.

But even without that concept, there is no uncertainty over the limitation on buprenorphine's effects beyond a dose of 16-24 mg. And since from all we know, ALL of the effects of buprenorphine are through the mu receptor, I see no known mechanism for greater or longer withdrawal symptoms caused by doses above 16-24 mg.

We just finished a long thread with someone who 'knew' his body, and had strong beliefs in his own reality-- and when the science disagreed, he claimed that all of the science was wrong. But we humans are far more alike than we are different. In fact, our genetics are very similar to the genetics of mice or frogs too! Opioid receptors are the same in all humans, and the same in many other species-- so there is a high degree of predictability over how buprenorphine works in EVERY person.

Maybe the high dose of buprenorphine had an effect on your thoughts, making it harder to let the drug go. Or maybe you just happen to have very bad withdrawal-- or maybe you happened to enter a depressive episode that lasted for months after withdrawal ended. Maybe PAWS-- whatever that might be-- caused your symptoms. But from what we know, our bodies can't tell the difference between 16 mg vs 64 mg of buprenorphine. If someone knows of a theory or finding that suggests otherwise, feel free to share it-- not a 'feeling', because people have feelings that support pretty-much everything-- but some type of objective finding.


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PostPosted: Fri Feb 17, 2017 8:42 am 
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There are so many strange stories out there, and so much misunderstanding, including
from some physicians. I had an appointment yesterday with my doctor....an addiction psychiatrist he claims... who honest and true claims bupe is a "full agonist," and that larger doses are more frequently used for pain. When I politely pressed him a bit on the last item he merely shrugged and said, well I don't know anything about smaller doses being more normally used for pain and left it at that. I don't understand the lack of professional pride that implies, or his appalling lack of curiosity concerning a subject he's supposed to be an expert on.

Just one trouble with that is I started rejecting everything he said out of hand, and was certain he was wrong when he said I should be getting some pain relief. I've since learned that some people do get some relief on the kind of maintenance doses we talk about here.

mjeff, you sound like an intelligent sincere guy and I sympathize with you. You've been treated badly by your physician. You're also operating on some faulty assumptions. Understand that most people do very well on buprenorphine. It's really an amazing drug which allows addicts like me to live a sane, sober life unbothered by the terrible cravings that would in virtually all cases cause a relapse. I don't even have a desire to drink (I'm also an alcoholic). Suddenly something's that's defined me as a person....my lifelong lust for drugs and alcohol...has changed. In some important ways, I'm no longer the same man.

It's been over 3 months for me now and it's still hard to believe.

I wish you the best. My suggestion is that you hang around the forum, and do a lot of reading. Also continue participating. I promise you'll come to a much better understanding of what bupe does and doesn't do, and how it very likely has and and has not affected you.


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PostPosted: Fri Feb 17, 2017 12:30 pm 
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Godfrey, I enjoyed a chuckle w your first sentence coming right after Dr J's response and at first thought you were referring to his post. ha. I know you weren't hence the chuckle. ha

I'm not going to post the link bc its incorrect but just read a 27 page 2014 multi study suboxone, pain, anesthesiology review. It said while there is a respiratory and tolerance ceiling, there is no analgesia ceiling, therefore higher suboxone doses do work for better pain control and encouraged more suboxone to cover increasing pain... What??? Also said a Dr increasing a pt from 8/2 to 32/8 for more pain relief should also be aware that 6 mgs more naloxone will get in too so beware of PWs also occurring. Say what??? also incorrect bc we know little naloxone gets absorbed orally and what does is quickly taken care of by the liver. Seems like there is alot of incorrect info that Drs and we all read...

Mjeff, How were you able to get in an 8mg strip 8 X's/day. I would not have been able to work and present at meetings or eat or live my life - wo real interruptions. Best, P


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