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 Post subject: Way to much saliva
PostPosted: Tue Feb 21, 2017 10:44 pm 
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Ok so I have posted here a few times with subutex problems well I'm sure it has come down to this. I salivate way to much and my meds wash away and I get no relief. Some days 4mg hold me all day and some days 2 8mg pills works for about a hour and then nothing. Now most of the time my mouth fills with saliva in about 7 min and the days it takes longer which are not very often I get alot better absorbtion. What can I do about saliva. I have tried the pill between the cheek and gum and gives massive headaches so that's out maybe it's something in the pill but that has never worked for me and I have tried multiple times.


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 Post subject: Re: Way to much saliva
PostPosted: Tue Feb 21, 2017 11:26 pm 
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I can't know what you are feeling, but it is hard to imagine how 2 of the 8 mg pills could 'work for an hour and then nothing'-- mainly because it takes an hour for the drug to get absorbed. When I did more in-office inductions, patients would describe slight relief at 45 minutes, and after 90 minutes they would finally feel better. Buprenorphine has a long half-life, so it is hard to imagine how 16 mg would be metabolized that fast.

Understand that I've written a lot, maybe too much, about getting proper absorption. But when I talk about maximizing absorption I'm thinking of poor souls who ran short, or who were forced to taper prematurely, who are trying to get by on small doses. Even with lots of saliva, 16 mg of buprenorphine SHOULD keep you covered.

The only way to know for certain would be to ask your doc to order labs, and check your blood level of buprenorphine after 24 hours. If it is low, you need to figure out why it leaves so fast (or never gets absorbed). Maybe it is the saliva-- but if it is truly 'gone' after 24 hours, I suspect something else must be going on. Maybe you happen to metabolize it very quickly.

If blood levels are high, then you need to keep an open mind to the idea that you are focusing on symptoms caused by memories of withdrawal-- not true withdrawal triggered by low blood levels of buprenorphine. It is common for people to think they are in withdrawal-- even though when I examine them they have dry skin and very small pupils. I believe that all of those withdrawal experiences are part of our memory banks, ready to be replayed when all of the cues are in place!


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 Post subject: Re: Way to much saliva
PostPosted: Wed Feb 22, 2017 9:37 am 
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Quote:
Understand that I've written a lot, maybe too much,


Never too much Doc. Keep 'em coming! Can't tell you how much we all appreciate your
informative posts.

G.


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 Post subject: Re: Way to much saliva
PostPosted: Wed Feb 22, 2017 10:42 am 
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I would suggest getting those labs done like Dr. Junig has suggested. It's hard to understand when you write that you don't feel it after an hour-because you aren't supposed to feel anything. Do you mean after an hour you are in withdrawal?? Stomach issues, sweats, sore-those kinds of things?? Can you please explain the feeling you have after taking the 4mgs(on the days that it is enough)? When you are taking the 4mgs, are you snorting it or you are taking all meds orally? Sorry for all of the questions, I'm just trying to get a little more detail. I know you have been having problems for months, it must be so frustrating!!
When I take my medication, as soon as I put it under my tongue, my whole mouth fills up with saliva. I just put my tongue up to the roof of my mouth and swallow so I get the relief of swallowing but I'm not getting rid of anything(saliva or medication) in my mouth.


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 Post subject: Re: Way to much saliva
PostPosted: Wed Feb 22, 2017 1:06 pm 
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I get what you may be saying Dr..
I rarely talk about this in group any louger to newbies. It can have a negitive to it by providing
extra s that tbe newcomer can use as a diversion that isn't part of recovery. Not to put words in your mouth doc, but ive seen it happen .
In low dose.s it seems to be a must for bio ability.
All true information on bupe are why we read here. Thanks Doc..


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 Post subject: Re: Way to much saliva
PostPosted: Wed Feb 22, 2017 6:07 pm 
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I seem to have the least salvia and get the best absorption first thing in the morning. I brush my teeth to stimulate my gum area before hand now that I am down to 1mg in the morning and 1 mg in the evening, but when I was on 8 and 12 mg and up, I could just wake up, pop a Suboxone strip under my tongue and go back to sleep. I do realize your on the pills but that doesn't seem to make THAT much difference. Good luck and I sure hope your not asking this to try to get more of the meds in your system than you are sub post to. That is pointless...


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 Post subject: Re: Way to much saliva
PostPosted: Thu Feb 23, 2017 3:52 pm 
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Ok I guess an hour was a little over board. I can feel it start to kick in after an hour and then it goes away and I start withdrawing again. I would do labs if I could afford it. I found on this site where a person used warm salt water to keep the saliva at bay i tried it and I got a lot better result. The meds didn't wear off after a couple hours and I felt pretty good for most of the day. Like I said the days I don't have alot of saliva it works great. Also I don't think I'm holding it in my mouth for long enough. And I found the more in withdrawl I am the better it works so maybe my mind is playing tricks on me.


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 Post subject: Re: Way to much saliva
PostPosted: Thu Feb 23, 2017 6:58 pm 
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I've also found that even though I have a bunch of saliva in my mouth if I keep the saliva in there for at least 20 minutes I get some better results


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 Post subject: Re: Way to much saliva
PostPosted: Thu Feb 23, 2017 10:56 pm 
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WTHECK,

I can sympathize with your problem, as I had that issue early in treatment. May I ask how long you've been on maintenance and your prescribed dose?

I've learned a few tricks for better absorption over the years. But, let me say this first. In the times where you feel like it's "not working", what symptoms are you experiencing? Please be open to the possibility that you may be experiencing psychological withdrawal instead of physical.....which sucks just the same, but is completely different. I ask because you mentioned the medication working better when you're in withdrawal.

This is a very unique medication with a long half life. If you're taking a dose over the ceiling each day, you shouldn't "feel" anything when you take your dose because your blood levels are stable and your receptors are occupied by the bupe. When you're truly experiencing physical withdrawal symptoms and you dose, you then feel relief from withdrawal....which in turn makes it seem like you "feel" the medication.

Now, just because we feel better physically dosent mean we as addicts can't still feel awful mentally or psychologically....(which is still a very real feelin). Early in treatment when I felt like my dose "wasn't working" I'd take more. I quickly realized that did nothing other than make me run short. You see, once you're receptors are completely occupied, there's no benefit from taking more. That's the beauty of this lifesaver!

I've also had many times where it just took longer for my dose to absorb. If you're patient and keep your dose for at least 45 min....you're bound to absorb the medication. You can even swalllow slightly if your mouth becomes too full. Once you swallow it all or spit out, DO NOT eat or drink for at least 30 min. There's still medication under your tounge. Try pressing your tounge down behind your back teeth after you've finished dosing and you'll see what I mean.

Here are some things I do for better absorption:

- Brush & use mouthwash beforehand
- Hold Sub in mouth for at least 45min if possible
- Avoid eating/drinking for at least 30min after you're finished dosing
- Keep head tilted slightly down until Sub is melted
- Once Sub is melted, rub your tounge around behind your teeth and on the inside of cheeks
- After Sub is melted, swish around like you would mouthwash

These are just some helpful tips. These things really come in handy when you're reducing too.
Please make sure you have a realistic idea about what this medication does & dosent do. I think you'll find that when you're doing the really tough self work....conquering the demons which caused you to use in the first place, your Sub will "work" significantly better.


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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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