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PostPosted: Fri Sep 09, 2011 1:27 pm 
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Ok, this message is going to bel long but please bare with me. I really do need some advice here. I'm running out of options and this is seemingly looking like my last one.

I have been on Suboxone since March of 2010. Over one year. Over that course of time, I started at 24mg a day and now currently stuck at 8mg a day. I see a psychatrist for my suboxone once a month. The problem is, I've been relapsing on heroin frequently over the past 3 months. The suboxone just isn't keeping me away from heroin anymore. When I first got on suboxone, I stayed clean from all opiates for about 8 months. Then I started relapsing. One time one month, and then another time a couple months later. Well now, I'm relapsing on heroin or should I say USING once a week. It's like, every since I found out I could divert my medication(my psychatrist knows, I tell him everything) and still get high on full agonists, basically cheating the system, I started abusing heroin again.

Here's how it works for me. During the week, I take my 8mg once a day. 4mg in the morning, 4mg at night. It's just what works best for me. The day before I get paid, I purposefully skip my suboxone dose, wake up the next morning and go straight to the ATM and my dealer to get heroin. I use for that entire day, and then start my suboxone again the next morning. This is a vicious cycle and it's doing me absolutely NO harm. I am absolutely against raising my suboxone dose though. I've been on this drug for over a year, I already know it's going to be hell getting off. I've been on 8mg for quite a few months with no desire to go lower. I can't go lower knowing I've been relapsing! But at the same time, I just don't want to go higher and take that step backwards. This is why I'm beginning to wonder if Methadone is what I need.

The reasons I am worried about switching to methadone is that I really do not want to feel so medicated that I am a zombie the entire day. I want to be able to function. I don't want to be nodding out, but I want to feel content/good and not have ANY desire to go use a street drug. So that's the negatives to the situation. Maybe that's just a stigma, and that you can actually function perfectly fine on methadone. I don't mind feeling a little bit of a buzz, that's ok with me. Hell, to this day I still get a buzz from suboxone for the first 2 hours after I take it. Crazy huh? I think I'm 1 in 10000 in that department. I know my girlfriend is against methadone because her sister's boyfriend took it, and all he did was sit around, eat, play video games all day, and wasn't really productive. Well maybe he was on a higher dose than what I would need to be held comfortably? That's what I tried to explain to her anyway.

The reason I am attracted to methadone is that it gives me ZERO room for diversion. I am forced into going to the clinic every day, and taking my medication in front of a nurse so I can't "skip" it in anyway in order to go and get high. I truly feel like that alone would put a stop to my relapses, and they are getting more frequent. It originally started with me using one day every month or so, then once every two weeks, now once a week and it's stopped there. So I guess that's a good thing. I haven't allowed it to get to multiple days in a row or anything like that. I don't mind driving to a clinic every morning if it means I'll never have the desire to go buy heroin again, or put a needle in my arm.

Here's my problem though...I really don't know how to go about starting it. There is ONE methadone clinic in my area, and they have an "unofficial" waiting list. The city is known for a lot of heroin users so I guess I can understand, but I don't have time to sit around and wait to be put on a list. The next closest clinics are down in New York City, which is a 2 hour drive away. I can't make a 4 hour round trip every day just to take my medication, not with the economy the way it is, gas prices, and what have you...so here is what I was wondering, and maybe someone can shed some light on this.

My psychiatrist that I'm currently seeing is an incredible man. He's always understanding of my relapses, and always tries to help me in any way he can. He is the very first psychiatrist I've seen for suboxone(I've went through 4 doctors now over this drug) that will prescribe me a benzo for my severe anxiety. None of the other doctors would prescribe me a benzo due to the abuse potential, because they figured "Hey, if he was addicted to opiates, that automatically means he'll get hooked on benzos too!" How wrong they were. I do not have the desire to take my benzo(klonopin 1mg/twice daily max) unless I absolutely need it. In fact I usually have extras that I bring to him at the next visit that he disposes of. I think that's a big reason as to why he trusts me as much as he does. I want to bring up methadone to him. He knows about my relapses, and I'm going to tell him they're getting worse and it's causing a lot of havoc within my family, and in my relationship. I've already lost the girl of my dreams once. I got her back, and I can't afford to lose her again. I plan on bringing my mother with me, who supports me switching to methadone as long as it keeps me away from heroin or other illegal narcotics. Can my psychiatrist prescribe me Methadone for PAIN purposes and stop writing me the suboxone scripts? If my mother verifies to him that she will be in charge of holding my medication and giving it to me once every morning as directed as to prevent any kind of abuse, would this be possible? I know he can prescribe pain medication as he told me if I ever need an operation, to let him know ahead of time and he will write me the proper strength narcotic(due to tolerance buildup from suboxone). So would he be able to write me methadone? He already knows I don't abuse my prescriptions, or take too much and I've been seeing him for almost 7 months now. I know he can't write methadone to me for addiction reasons as only clinics are allowed to do that, but for pain seeing as how he's an M.D.. I can't see why not. I think with my mother being present, and my history of being honest/and not abusing my meds he may be willing to be on board with it. So that's what I'm wondering.

My girlfriend on the other hand, well... I'm just worried that if I start methadone and I appear overly medicated, she's not going to like it.. but on the other hand she absolutely hates the fact I'm relapsing! She doesn't even like it when I get a little groggy from taking my klonopin. Constantly looking at my pupils. It's hard for her to trust me even though she's in love with me after all the times I've lied about my drug use. I WANT to STOP relapsing for her and for my family., but I just don't see it happening remaining on suboxone. It used to do the trick, but that was before I started IV'ing drugs. I also goto outpatient groups once or twice a week and speak with people, but it hasn't stopped me from going out and getting what I wanted when I could.

Sorry for the very long post, but does anyone have any advice for me on how I could get on methadone relatively soon? I've kinda already made my mind up about this 95% of the way. I'd rather be on methadone for a while, then taper off and try suboxone again in the future after this phase has passed. I have a good therapist, I have a good group I goto, but it just hasn't helped and I know for a fact I'm a patient who needs medicated recovery to stay away from heroin. So my main question is, for someone a bit more knowledgeable. I just can't afford to wait for a clinic when it could be weeks or months before I get in. What if during that time I relapse again and this time I OD? *Knock on wood 1000 times*. I can't afford to take that chance!

Inpatient Rehab isn't the answer for me either. It has never helped me. I withdrawal like crazy, finally it subsides, I get out and start all over again. That's why I'm going to outpatient, so I can at least have the groups/therapy and still be on a medication to ATTEMPT to keep the cravings down and nullify any withdrawal symptoms.

Thanks so much.

Me.


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PostPosted: Fri Sep 09, 2011 9:54 pm 
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First and for most you will not be over medicated methadone clinics are no longer what they use to be, patients are no longer getting 250mg dose’s left and right the DRs that run the clinic are now trying to keep patients at low of dose as possible. Besides once you find your maintenance dose and are on it for a few days you will not feel any type of buzz or high that is one of the biggest lies about methadone! If you have a tolerance to opiates and take it properly your body will adjust and it will be like taking Advil the drug will have no effect on you after a while I am talking from personal experience. As of your GFs sister and her boy friend situation has no relation to you methadone is very individualized what it did to him does not mean that it will do that to you. But one thing I am going to let you know now it is different at every methadone clinic but at my clinic and more and more, they will not start dosing you it you are on a benzo because the drug interaction between the two are lethal most methadone overdoses are due to the mixture of benzos. I can’t tell you how many people I have heard at my clinic alone say they had to stop there benzos scripts to start dosing. And it will help you tremendously with structure like you want as in having to go the the clinic every day. For ex when we use we can dose as many times as we want a day but a clinic eliminates that which is great.

As of the clinic near you that is your best bet call once a week and ask if there is any update on openings which will show you want to be part of the program. Most methadone clinics say they have long waiting list to eliminate the addicts who are just looking for a quick fix till there next dose. I recall the clinic I am at said up to a year I got in after 3 months of calling every week. And I know you want to start methadone right now or asap but that is not how it works with a clinic you have wait for your turn. As of your DR you see now writing you methadone scripts I will be dead honest with you, unless you have true pain issues and injuries and once were a pain management patient it is a long shot. No matter how much your mom supports you or how persistent she is will not matter put it this way if you don’t have true pain you are basically asking your DR to break the law and risk his license just for you. And being that he is a PSYCH. Dr and all the sudden starts writing you scripts for methadone the DEA is going to look into that real quick which in turn he will than lose his DEA number to write controlled substances scripts to anyone and in most cases lose his license. So if you don’t have legit pain and injuries you will not be getting any scripts for methadone from him or any DR for that matter.

I know you don’t want to hear this but you are not going to be starting methadone real quick that just isn’t how it works for most people. But like I said if you are a pain management patient we are having a completely different conversation right now. The only way that you might be able to speed up the process is by starting a in patient methadone program which in turn they will prolly be able to get you into that clinic a lot sooner. For example I started the same day as this other guy I talked to in the waiting room he was on the waiting list for 1 day because he came from in patient I waited 3 months.

Hear is a link to my thread called “MY SWITCH” if you changed the tittled and poster it is the same assact thread and questions. And more of my quest of getting into a methadone clinic, my taper to start methadone, getting into a methadone clinic, my starting date/dose, updates and info on my increases and is updated weekly by me check it out it will def help I promise you.
http://suboxforum.com/viewtopic.php?t=4257

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PostPosted: Sat Sep 10, 2011 8:18 am 
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hellow sub845'. i know your not interested in bringing your sub dose up? like b-boy said you will probably have to wait.
and raising your dose to a much higher level will help stop your slipping, until you switch to methadone. b-boy is right on of what he's explaining to you. besides it will be a short time in bringing your sub dose up to a safer level. i had cravings too. i was on 12 to 16 and now 22mgs for well over a year,and it stopped my cravings all most. now i can deal with it better. and i
feel better on 22mg than 16' it totaly took away any possible problems with my fast metabolism.


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PostPosted: Sat Sep 10, 2011 12:13 pm 
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Hi, I know nothing about methadone and think if you will do better on it and want to try it then go ahead. I just want to address somethings in your post that do not make sense to me. The first is because of the ceiling effect of sub being around 4mg, raising your dose back to the level that stops your cravings will not make it harder to stop. Second, you say you want to switch because you will be forced to take your med infront of someone so you will not skip days to use. Then you go onto ask if you can get your phsyc. to prescribe methadone and you will have your mom hold them and give you one dose a day so you will be forced to take it correctly. Why not do that with your sub? Methadone to my understanding, does not block other opiates the way sub does., so even if you took it everyday you would still be able to get high. I mean no offense by this but because of the inconsistency in your post i wonder if thats what you want? You also say you don't mind a slight buzz. I fear your motivations are wrong and switching to methadone will only make it easier to continue down the path you are on.


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PostPosted: Sat Sep 10, 2011 3:21 pm 
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ok man- you said you didn't use at 24mg. great! now you are "stuck" at 8mg , whatever that means. lightbulb- raise your dose back and stop tricking the system and your mind. you are the only one your fooling. go to a meeting. i think you need a raise in dose, some meeting, stop diverting all yer subs, and go to some meetings(did i say that)- methadone is not the answer- addicts can be so dramatic and change a straitforward issue and try and make it so damn complicated. oh, and btw, no shrink is going to give an addict done


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 Post subject: oh yea,
PostPosted: Sat Sep 10, 2011 3:25 pm 
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this vicious cycle you speak of- in the 2nd paragraph of getting paid, skipping yer dose , shooting dope, is doing absolutely NO harm...that is the HARM! I barely read that buncha drivel you wrote after that


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PostPosted: Sat Sep 10, 2011 3:31 pm 
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and going back to 24mg and waste all that progress- why on earth would you want to do that, especially when yer making so much progress at 8 :idea: :?: make any sense- btw i only read the first three paragraphs and it spells out your main issue. i hope you derive something outa what im typing, im trying to make u think


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PostPosted: Sat Sep 10, 2011 9:57 pm 
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Stupid idea.

Unless you're on a blockade dose of methadone (100+mg), which is a very large dose, you'll be able to use more easily on methadone than suboxone, even without diverting your dose.

Why are you so against raising your Suboxone, yet happy to go on methadone? Methadone is much harder to get off, you'll feel more trapped on methadone. I'd rather be on 32mg Suboxone than an average dose of methadone personally. And I've been on methadone a couple of times.

Are you sure you don't just want to switch to methadone because it'll make you feel more high? I question your motives honestly.


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 Post subject: MMT vs. BMT
PostPosted: Sun Sep 11, 2011 6:11 pm 
I first want to say that I’m very sorry you’re struggling. You may not like what I have to say, but I hope you can respect where I am coming from. I am not against methadone in any way, in fact I am a huge advocate of its use for certain populations but I would not recommend that you get on methadone and here’s why:

I was on Suboxone in 2001 for about one year before I, like you, began relapsing. I was also an IV heroin addict at the time. I decided that Methadone may have been the right answer for me at the time as well and switched to methadone for about three years. The first year I was on methadone maintenance through a clinic in Minneapolis I was a ‘model patient’ and because of this within about a year I received the ability to get a months worth of take-home doses at a time. I will grant you that, yes, during that first few months when I had to go to the clinic to get my methadone and dose in front of a nurse daily it did ‘keep me honest,’ motivated and on track; I didn’t relapse once. But inevitably one gets to the point where they are getting take-home doses and have to be responsible for taking the medication themselves. In fact, all methadone clinics I am aware of are closed Sundays; so right off the bat EVERYONE gets 1 take home dose weekly. It sounds like part of your current justification for switching to Methadone is that you will have more motivation to HAVE to take your replacement medication but that simply is not true. As I said, Sunday doses are take-homes so you could easily skip that, use it to double-dose on Saturdays or as you have stated you are already doing with Suboxone, divert it to get money for your DOC. Also, no one is forcing you to go to the clinic when you are on methadone, you simply could skip going to the clinic if you wanted to not take methadone.

It sounds to me like you want to make the switch to methadone for less than noble reasons i.e. getting ‘a little buzz.’ Methadone is an opioid and does cause euphoria to an extent, though also obviously tolerance limits this after a period of time so it is typical for methadone maintenance clients to first play the ‘I’m having cravings or it’s not lasting me 24 hours game’ to have their dose increased, which is fairly easy to get in my experience. This will work to a point but obviously not indefinitely so what many people end up doing, myself included, is adding benzodiazepines, Soma or alcohol to methadone to potentate its euphoric effects. For me, this led to a vicious cycle and the ‘cure’ eventually became the disease all over again. I do have to say that I was never in my life more unfunctionally intoxicated than I was for my last year or so on Methadone when I began abusing valium, soma and klonopin with my doses.

My personal experience with MMT was almost ten years ago, and I realize some things are different in the world of MMT these days, but I get the impression that you are looking for a medication to completely stop your addictive/relapsing behaviors and that simply is not going to happen as medication is a large part of the recovery for us maintenance patients, but not the whole picture by any means. Some people go to therapy, some people go to NA/AA meetings, some people don’t but I think everyone who is having success in recovery will agree that they are doing SOMETHING other than just taking methadone or buprenorphine to stay clean.

As for getting a psychiatrist to RX methadone for ‘pain management’ to get around having to go to a maintenance clinic, I would say that it’s HIGHLY unlikely to happen as well as an overall bad idea, probably worse for you than going to a maintenance clinic. Obviously an MD can RX methadone for pain but I would say that in your case it would make no sense and wouldn’t then have any of the ‘benefits’ you are looking for in switching i.e. having to dose in front of someone.

Again, I REALLY feel for you at this time mostly because I’ve been where you are, but I think you are trying to get someone to say ‘yeah go for it! Get on Methadone, it will change your life for the better!’ Someone likely has already said that to you! …I haven’t read the responses yet...I’m not going to say that, though, I am going to say that if you have already had a positive experience with a higher dose of Suboxone, I don’t understand your aversion to getting back there and at least trying it out before getting yourself chained to methadone maintenance. One can go from Suboxone to Methadone with no problems, but to go the other way can get difficult. Methadone maintenance will always be there, but I would not try it until you have already exhausted all other options, especially the obvious option of getting back to a dose of Suboxone that is productive for you.

-Travis


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PostPosted: Sun Sep 11, 2011 10:01 pm 
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Hi Travis, I have never been or plan on going on Methadone but wanted to say that was a very well written informative response. I really hope the op reads this and takes what you are saying seriously as I think you have given him very good advice.


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PostPosted: Mon Sep 12, 2011 4:03 pm 
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Guys, I promise you the reason for wanting to switch to Methadone wasn't because I wanted to experience a full agonist opiate. I don't want to feel medicated. When I wrote my post, I was very emotional, from the relapsing, and other stuff but I've stabalized over the past week or so and so far SO good. I'm going to a new support group now. The sole reason I had thought about methadone maintenance was because I was unsure of how good it's blockade effect was in comparison. I don't know very much about methadone and that is why I asked here. I thank you for your replys, and criticism. Good or bad. It's all valuable.

The thing with me is, I have a very, very fast metabolism. So fast that it's literally impossible for me to gain weight like a normal person does. Because of this, I really think it is impacting the blocking effect of the buprenorphine. I think the bupe is leaving my system at a faster rate because of it. It's definitely not the 36 hour half life it should be. See, with my last little relapse cycle, I was using heroin once a week. One day I would just completely stay high for the majority of the day, and then jump right back on my suboxone the following day. Let's say the day I used was Tuesday of each week. From wednesday to sunday I would take my 8mg dose as directed. On monday, the day before I intended on using, I would take 4mg. So by tuesday morning, I should still have PLENTY of buprenorphine left in my system to block the majority of all opiates correct? Well, like I said, it's not that way for me. Because I can go out on tuesday and score, and feel the drug very, very strongly and without having to use more than I usually did back in my pre-suboxone days. That's whats causing me all this trouble. And will upping my dose of buprenorphine really prevent that? It shouldn't because of the ceiling effect.

The reason I was intrigued by methadone maintenance in comparison to buprenorphine maintenance is because it actually seems more strict. I had thought Methadone had blockade effects regardless of dose due to it's half life, and it didn't need to reach a certain dose in order to do so. Being as I have the suboxone at hand, I can choose when to take it, if I feel I need to take it, etc. With methadone, that's not the case. I wouldn't have a chance to skip a day and then let the desire to use fill my brain until I eventually score. I would be forced into going to the clinic every day to take my dose. That is the MAIN reason I have considered switching, and I plan on talking to my therapist and counselor about it. And seeing what they suggest. Again, like I said...I am not wanting to switch to methadone because I want to feel "high" legally due to it being a full agonist. I'm aware that there is a honeymoon phase with methadone as there is with buprenorphine, and after a while, you level out and don't achieve any kind of "buzz". I am interested in it because I want to stop relapsing, and whatever it takes to help me do that, I would be willing to try. Besides inpatient rehab, because I'm not a believer of it. I'm just not. I did an inpatient thing for 14 days, a quick detox if you will. It was early on in my addiction to oxycodone. By day 10 I was feeling normal again, with still minor symptoms and by my discharge date I was feeling pretty normal. It took me 2 weeks to go out and be full blown addicted again using every day. I'm a strong believer of drug replacement maintenance, whether it be methadone or suboxone, and you know...when the time is right and my mind and body tells me it is, I'll get off it. But I'm not rushing myself.

In closing, I really believe there is more to this once a week relapse episode I've had going on for about a month now. I think it's really a pure mental thing for me. My aunt has developed cancer in her brain, and I lost a 3 year relationship. It simply went to hell. It's just an awkward time though because the two of us love each other very much, we're still close as friends, and we still see each other, and are intimate with one another...we just don't want to be in a "relationship" because we're afraid it's too soon. I think because this time of my life has been so stressful, I'm back to using the old addict "reward system" for using that one day each week. I think some part of me is justifying it without me actually knowing it? It's hard to explain, so I hope you guys will understand. I don't want to relapse. I don't want to even think about heroin, or the latest opiate I've used, OPANA. I was clean for over a year without relapse, but this period isn't the first time I've relapsed either. It's just the first time it's been a scheduled/consistent thing. I had relapsed twice before this. Each time was about 3 months apart, and then I stayed clean up until about 1.5 months ago. So that is where I am right now, and I thank you all for the replies.

Latest on me is,

I am dosing my suboxone every day as I should. I took my full dose today, and I'm going to wake up tomorrow without thinking and put a strip under my tongue before I allow my mind to enter "it's reward day" mode. I am going to a new support group, am receiving outside support from family and friends, as well as my therapist and counselor. I'm hoping I'm gonna put this behind me. Not proud of it what so ever, but it's been a learning experience, and I guess it'll make me stronger in my recovery in the days/months/years ahead.

My next visit to my suboxone prescribing psychiatrist is the 1st of next month. I am going to explain to him that I have been relapsing again, and I will mention everything to him that I have mentioned here, and why I am intrigued about methadone. I will also talk about going back up in dosage with the suboxone but the reason I don't see much point to that is currently, when I am taking my 8mg dose(4mg/am 4mg/pm) I am not craving at that time, so upping my dose won't change anything. I'll still be hitting the ceiling during the week, and I'd still be able to get high that one day each week if I wanted to. So upping the dose of buprenorphine theoretically wouldn't help. Because I can still skip that day if I want. Where as I felt having to goto the clinic and taking it each day(methadone)(or getting removed from the program) would like travis said, keep me more motivated to stay "honest" so to speak. But the take-home doses is a good point, and something I'd have to deal with eventually.

Just please, if you're going to read any of my post, understand one thing... I am not interested in methadone because I want to catch a buzz legally. That really is against my point. I am only interested in it because it's something that has worked for many people(just like buprenorphine), and maybe it could work for me. And going to the clinic each day and taking my dose under close supervision might be what keeps me from finding a way to go out and use my DOC. It may not though either. I just want you all to know that. I'm not trying to find a way to beat the system to stay high legally. I want something that is going to stop the pattern I've started. Maybe it'll be my new support groups. Or maybe it'll be me having an epiphany. Or maybe I'll just wake up one day and say to myself "I'm an idiot, no more of that". Or maybe it could be methadone. I'm just weighing all my options folks.

I'm not looking for anyone to say "Yes, go for it!" or "Methadone will work for you!" or "It'll work better for you than suboxone!" that's not what my post is about. I'm looking for opinions(valid ones), stories, experiences. Anything that relates to my situation. Thanks all.


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PostPosted: Mon Sep 12, 2011 5:05 pm 
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Thanks for the update. I hear what you're saying. It sounds like you really do want to make some changes, and that's great. That attitude will help you work your way though this.

I just wanted to stress that increasing your dose should give you a better blockade. Now before I say anything further, understand I'm not a doctor or any other medical professional. Anyway, in addition to the solid footing you'll gain by being comfortably above the ceiling all the time (I don't think you're getting that now, especially since you're breaking your dose up), you'll also have the stacking effect. But I do think you'll need to bump up your dose and try not to break it up. With lower doses, per Dr. Junig, the half life simply isn't that long. And if you do have that fast metabolism you mentioned, then it's adding to the problem. In other words, you're taking 4 mg and it's simply not lasting. And it's my opinion that it's not occupying your receptors and KEEPING them that way.

Take care of yourself.

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PostPosted: Mon Sep 12, 2011 5:44 pm 
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Hey Subox845,

I had a couple of thoughts for you. The first one has to do with what IndigoChild said to you, I think you are way overcomplicating things here. It seems that us addicts have a way of taking something as simple as 2+2=4 and making it more like 2+2=23,456......and we justify 2+2=23,456. You were on a higher dose of Suboxone, it was working for you, you dropped your dose, then started relapsing. My first advice to you is to get you dose back up, you're not quite ready for a lower dose yet. There's no shame whatsoever in upping your dose.

You mentioned how you're worried about eventually coming off of Suboxone. From what I've heard, Methadone is much harder to taper/quit than Suboxone. You were on a high dose of Suboxone and got down to 8mg. How hard was it for you to get to 8mg?? I'm gonna guess that if you were on Methadone at comparably high doses, trying to drop to a comparitively low dose of Methadone would have been much harder?

Another thought, I'm an addict who just went through a brief relapse. My relapses start LONG before I ever use. Using the drug is just the last component of the relapse. If you don't use the tools that recovery is teaching you to discover the trigger for the relapse, then recovery is useless. I see where you go to group, you see a psychiatrist......I attend NA quite often, the thing of it is, I was just going through the motions. I wasn't really doing much about my recovery on my own time. I would go to NA, hear the beautiful stories of people being clean, how they did it and leave feeling all warm and fuzzy inside, then everything they said about how they got clean would magically disappear from my memory once I got to my car. Being in recovery and going to groups is more than just showing up, you've got to put in the work. You may be working like a madman at recovery, I don't know, I just know that my relapses are because I'm a lazy SOB who didn't want to put the work in. All I did was go through the motions and I reaped what I sowed.

I applaud you for coming here and opening up to us, I know how difficult that can be, then to get peppered with rather personal questions can be too much for some of us, but you came back and I think that says a lot about you.

Addiction is an insidious disease. It will lie to you so YOU don't even know the truth about what you're doing. This is why a support group who will tell you the truth, not what you WANT to hear, is so critical to recovery.

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PostPosted: Mon Sep 12, 2011 5:45 pm 
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Just to clear things up methadone clinics are open on sundays! Great post Travis

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PostPosted: Mon Sep 12, 2011 6:41 pm 
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Subox845 wrote:

The thing with me is, I have a very, very fast metabolism. So fast that it's literally impossible for me to gain weight like a normal person does. Because of this, I really think it is impacting the blocking effect of the buprenorphine. I think the bupe is leaving my system at a faster rate because of it. It's definitely not the 36 hour half life it should be. See, with my last little relapse cycle, I was using heroin once a week. One day I would just completely stay high for the majority of the day, and then jump right back on my suboxone the following day. Let's say the day I used was Tuesday of each week. From wednesday to sunday I would take my 8mg dose as directed. On monday, the day before I intended on using, I would take 4mg. So by tuesday morning, I should still have PLENTY of buprenorphine left in my system to block the majority of all opiates correct? Well, like I said, it's not that way for me. Because I can go out on tuesday and score, and feel the drug very, very strongly and without having to use more than I usually did back in my pre-suboxone days. That's whats causing me all this trouble. And will upping my dose of buprenorphine really prevent that? It shouldn't because of the ceiling effect.


Man, this is not too abnormal. I am considered to be an "ultra-rapid metaboliser" myself. Normally I metabolise things faster than the average person. There are certain medications which then speed up my metabolism heaps more - certain anti-convulsants / anti-depressants. There have been times I was on those medications where I could have 8mg Suboxone in the early morning, then get goose-bumps / withdrawals by mid afternoon and have a shot of heroin at 6pm and feel it FINE. There was a point earlier in the year where I was also relapsing a fair bit, but because my metabolism was SO fast, it escalated to a point where I was using close to every day. I'd have my 8mg in the morning, use in the evening, then have my subox again the next morning. Ridiculous.

I'm a bit more understanding if your position now because I too was starting to wonder if methadone might be my answer. The only difference b/w you and I though was I've been on methadone before, and know that it isn't the answer.

This is how I rectified the fast metabolism thing. I was on two medications at the time - an anti-convulsant / mood stabiliser, and an anti-depressant. Firstly, I went off my SSRI anti-depressant. This made the problem a lot better, but still not 100%. I then switched anti-convulsants to one that isn't metabolised by the liver. After that my metabolism of Subox was near enough to normal. Finally, I started dosing twice daily. 8mg morning, 4mg evening. Nowadays I'm held pretty much fine. I'm back on an anti-depressant as well, but it doesn't seem to mess with my metabolism of Subox now I'm not on that anti-convulsant.

It sounds to me like you just have a rapid metabolism. Talk to your doctor about this, and experiment with twice-daily dosing if you haven't already. Also in my country, people that are considered ultra-rapid metabolisers can get special clearance to get doses over 32mg prescribed, as some people metabolise Subox so quickly that they need doses so high to hold them over 24 hours. They now have genetic tests to figure out if people are rapid metabolisers.

I'm also a tall, fairly skinny guy, who struggles to put on decent weight even with massive gym sessions and carb / protein heavy diets. Oh well. Better than the other way I spose.

Also, grapefruit juice is a potent inhibitor of the enzyme that metabolises Suboxone. So if you can bear the taste, it will likely make the Subox hold you longer. Otherwise, Earl-grey tea does as well to a lesser extent.


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PostPosted: Tue Sep 13, 2011 11:58 am 
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I too am glad that you came back and explained more, I can see now that you want to stop the relapsing and like Hat think that upping your dose will help. You said you were doing good on a higher dose before. Just because the ceiling is around 4mg does not mean you would not benefit from a higher dose. If you are metabolizing the sub faster then a higher dose would put more sub in your system and it would take you longer to metabolize. If you are taking 4mg twice a day then you are most likely dropping below the ceiling.

Also if you are worried you will skip a dose why not give your sub to your mom like you suggested doing with the methadone, then she can watch you take it and you could not be tempted to skip days. I only suggest this because you suggested this for methadone and do not see why you could not apply it to sub as well. Of course I am not a Dr. either and these are only my opinions based on my personal experience.

I really hope you can get this all straightened out and find a dose that holds you, you said above that you are not having cravings on your current dose so why up it? I think you know that is not true, if you were not having cravings then you would not be using. I applaud you for coming back and explaining yourself and hope you continue to post here, we are all rooting for you and are here anytime, even if it's just to bullshit and get your mind off using.


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