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 Post subject: Oh no, what did i do?
PostPosted: Fri Nov 20, 2009 6:37 pm 
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Ok, my 2 week wait for my 1st appointment is up tomorrow. So of course it came time to get off the pills and make sure I am going thru withdrawals. Well I made an appointment with a doc from the doc locating tool on suboxones website. Just assumed they new why I was calling so I never told the lady on the phone , I figured this is what she does....... SO, today, 1 day before my appointment I thought it was weird that the lady who answered the phone never mentioned opiates OR suboxone at all. I called the lady and asked how long I should not take opiates. She said, honey if you need to take your meds before you come see the psychiatrist by all means do so. I said I'm opiate dependent and need suboxone help. She said Oh, let me call the dr. and call you back. She called back and said "don't take any meds in the morning or you could get severe withdrawals". My appointment is at 8pm. I'm afraid I just found a bad fit and just needed to vent a little.


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 Post subject: just wanna say....
PostPosted: Fri Nov 20, 2009 9:38 pm 
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Hello, I am new to this site, but love it. I have been on suboxone for 5 months today, clean of anything else. Suboxone was a complete life saver/changer for me and continues to be, with everyday on it increasing benefits from my not using/abusing full agoinists, and I will personally recommend bupe to anyone trying to kick the habit and cannot do so one their own as I could not no matter how many times and hard as I tried.

Anyways.........I did have a very bad experience with a dr. that was all bout the mooola (money). He was a phsyc that took the 8 hour course to treat addiction with suboxone but only for more income and not to help. He is a phsychiatrist (possibly a good one, I doubt it tho) and shoud stick to that. HE WAS NOT very helpful with any questions just, take this see me in so and so weeks. I changed dr.'s, found one that knows his stuff, addiction medicine for 30 years etc......my advice and is only my opinion is to find a different dr. before you get ducked like i did at first....

but you will want to be in moderate withdrawls before taking suboxone (heroin, immediate release pain killers I think 18-24 hours is best at least where as oxycontin, avinza, transdermal patches, methadone etc, with long half lifes and what knot it is best to not be using for at least 72 hours, but the safe mark is after you been having withdrawals for sometime and are at a moderate level, past mild but not too far along. Either way if you are "farther along" in w/d than a moderate state all suboxone will do is make you feel even better. GOOD LUCK!!

Bill


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 Post subject: thanks
PostPosted: Fri Nov 20, 2009 10:15 pm 
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Bill, thanks for the response. Yeah, they don't sound very educated on this drug or the treatment that should come with it. I am sooo desperate right now tho, I think too desperate to wait another day or week to find a new doc. I think what i'll do is go to this guy in the morning and at least get started (I am dying). As I have mentioned I already waited two weeks for this appointment.

We'll see what happens I guess. Thanks Bill.


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PostPosted: Fri Nov 20, 2009 10:37 pm 
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I hear that....do what you gotta do. I know when it came down to it for me I could not wait another day, actually another hour........and not because I couldn't get any agoinists but because i needed my life back. I did goto the 1st dr for 8 or 10 weeks, but should have gotten outta there by week 2. I hope this dr does help you but if not and you need to change go for it, dont let some quack tell you and lead you to ways that will not actually help you recover but make them able to buy another 40 foot yacht or something... or support their own oxy habbit but to actualy help you get better. There are doctors out there that do want to help out there trust me, you just may need to search a lil bit for 'em..... BEST OF LUCK


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PostPosted: Fri Nov 20, 2009 10:51 pm 
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BigRed wrote:
I hear that....do what you gotta do. I know when it came down to it for me I could not wait another day, actually another hour........and not because I couldn't get any agoinists but because i needed my life back. I did goto the 1st dr for 8 or 10 weeks, but should have gotten outta there by week 2. I hope this dr does help you but if not and you need to change go for it, dont let some quack tell you and lead you to ways that will not actually help you recover but make them able to buy another 40 foot yacht or something... or support their own oxy habbit but to actualy help you get better. There are doctors out there that do want to help out there trust me, you just may need to search a lil bit for 'em..... BEST OF LUCK


Thanks BigRed, 10hours to go til appointment or disappointment..........lol.


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PostPosted: Sat Nov 21, 2009 12:52 pm 
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msummers1020 wrote:
BigRed wrote:
I hear that....do what you gotta do. I know when it came down to it for me I could not wait another day, actually another hour........and not because I couldn't get any agoinists but because i needed my life back. I did goto the 1st dr for 8 or 10 weeks, but should have gotten outta there by week 2. I hope this dr does help you but if not and you need to change go for it, dont let some quack tell you and lead you to ways that will not actually help you recover but make them able to buy another 40 foot yacht or something... or support their own oxy habbit but to actualy help you get better. There are doctors out there that do want to help out there trust me, you just may need to search a lil bit for 'em..... BEST OF LUCK


Thanks BigRed, 10**hours to go til appointment or disappointment..........lol.


So, I went and saw the Dr. this morning. His secretary had me fill out some information about medical history, meds I'm taking etc..... After that he called me back. This is exactly how it went down. I told him I was excited about the program and getting started. He said yes it is a brave step your taking and we'll discuss that at your visit. He then asked me what I new about suboxone and I told him I heard its great, less addicting than methadone and works good. He said yeah,that's all true. He asked me what I was taking and how I was taking it. I told him about 20 percocet 10mg's a day orally and snorting. I then tryed to tell him some of the other things I've taken but he stopped me and said just tell me about the percocets right now. So that was that. He said ok, so like 200mg of oxycodone. I told him I've done alot of research on thr web and that most peole are on 16mgs a day. He said I would not get that much and that suboxone has a ceiling effect around 12mgs. He said he even prescribes the worst heroin users no more than 16mgs a day. He wrote me a script for 14 8mg subs and said I will see you in two weeks. I was with him for 5 to 7 minutes. His secretary said my next visit will be 15min. I go in at 8am and he has another appointment at 815.


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PostPosted: Sat Nov 21, 2009 1:10 pm 
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hey msummers as far as how many milligrams of Suboxone someone is prescribed is mainly because some have better absorbtion of the medication than others. I'm also on 8mgs and it's been great the key was for me to learn a good method of taking the medication there's a thread here on the site where Dr. Junig gives a quick run down on how he suggests his patients take the medication I'll try and find it but some of the more important points are to make sure you're allowing the Suboxone to dissolve without swallowing, I know it takes awhile to get used to but after I mastered it I really have fewer cravings. Also try and keep saliva to a minimum and after the tablet has dissolved spread the dissolved paste around all surfaces of your mouth as buprenorphine is absorbed through all mucos membranes so the larger surface area you cover inside your mouth the more medication is absorbed.

Anywho how are you doing so far? Did you manage to get through the induction ok? I hope everything went smoothly keep us updated on how you're doing.

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PostPosted: Sat Nov 21, 2009 3:28 pm 
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Matt2 wrote:
hey msummers as far as how many milligrams of Suboxone someone is prescribed is mainly because some have better absorbtion of the medication than others. I'm also on 8mgs and it's been great the key was for me to learn a good method of taking the medication there's a thread here on the site where Dr. Junig gives a quick run down on how he suggests his patients take the medication I'll try and find it but some of the more important points are to make sure you're allowing the Suboxone to dissolve without swallowing, I know it takes awhile to get used to but after I mastered it I really have fewer cravings. Also try and keep saliva to a minimum and after the tablet has dissolved spread the dissolved paste around all surfaces of your mouth as buprenorphine is absorbed through all mucos membranes so the larger surface area you cover inside your mouth the more medication is absorbed.

Anywho how are you doing so far? Did you manage to get through the induction ok? I hope everything went smoothly keep us updated on how you're doing.


thanks Matt, yeah I'll have to look up the method of taking the meds. I heard or read that some people refer to painting your gums with it or even keeping it in your mouth, the saliva that is, for 30min or one guy said even like 75min i think.

Anyway, I didn't really like how fast this guy pushed me in and out. But whatever, Im still grateful for the meds. After an hour of taking it I felt great, maybe even a little high but I hear that is normal for the first week or so. Anywho :D , I am feeling good and I am glad I made this step. It's time for me to sort out the mess I have made of my life and get back to good. As far as the induction, like I had posted I was on my own. He did not have subs to give me or maybe he did but he didn't give me one there. I thought that was a little odd. It was my understanding that you wanted to be with a doc when you take your first dose so they can monitor you for a couple different reasons. Who knows? This guy spent 5min. with me. So I can't help but think this is all about the money for him. Whatever.

Talk to you soon, thanks again!!!

Mike


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 Post subject: Matt
PostPosted: Sat Nov 21, 2009 3:35 pm 
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msummers1020 wrote:
Matt2 wrote:
hey msummers as far as how many milligrams of Suboxone someone is prescribed is mainly because some have better absorbtion of the medication than others. I'm also on 8mgs and it's been great the key was for me to learn a good method of taking the medication there's a thread here on the site where Dr. Junig gives a quick run down on how he suggests his patients take the medication I'll try and find it but some of the more important points are to make sure you're allowing the Suboxone to dissolve without swallowing, I know it takes awhile to get used to but after I mastered it I really have fewer cravings. Also try and keep saliva to a minimum and after the tablet has dissolved spread the dissolved paste around all surfaces of your mouth as buprenorphine is absorbed through all mucos membranes so the larger surface area you cover inside your mouth the more medication is absorbed.

Anywho how are you doing so far? Did you manage to get through the induction ok? I hope everything went smoothly keep us updated on how you're doing.


thanks Matt, yeah I'll have to look up the method of taking the meds. I heard or read that some people refer to painting your gums with it or even keeping it in your mouth, the saliva that is, for 30min or one guy said even like 75min i think.

Anyway, I didn't really like how fast this guy pushed me in and out. But whatever, Im still grateful for the meds. After an hour of taking it I felt great, maybe even a little high but I hear that is normal for the first week or so. Anywho :D , I am feeling good and I am glad I made this step. It's time for me to sort out the mess I have made of my life and get back to good. As far as the induction, like I had posted I was on my own. He did not have subs to give me or maybe he did but he didn't give me one there. I thought that was a little odd. It was my understanding that you wanted to be with a doc when you take your first dose so they can monitor you for a couple different reasons. Who knows? This guy spent 5min. with me. So I can't help but think this is all about the money for him. Whatever.

Talk to you soon, thanks again!!!

Mike


Oh, there were two things I forgot.

1) Matt, Im curious to know what your habit was before you were prescribed 8mg

2) Having a hard time finding that thread about most effective way to take suboxone.......if you can help me out that would be cool. Thanks dude.


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PostPosted: Sat Nov 21, 2009 4:25 pm 
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I'll try and find the thread I was up to around a few hundred milligrams of oxycodone IR and oxycontin a day and of course the days I couldn't find anything whatever else I could get my hands on morphine, hydromorphine, methadone didn't matter as long as I wasn't sick anymore. When I first started using it was hydrocodone and well you know how quickly things progress in opiate addiction. I do think it's important to note that as both my Dr. and Dr. Junig have said that the dose of Suboxone someone is on does not reflect how much the person was using (oxy, morphine, etc.) before.

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PostPosted: Sat Nov 21, 2009 4:28 pm 
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Here's a copy of what Dr. Junig said in the thread about dosing instructions:

I respect the answer in the prior post but disagree-- as a neurochemist I learned a great deal about the passage of llipophilic drugs through cell membranes, and there are much better ways to absorb buprenorphine than the 'under the tongue' method. The main reason the package insert says 'under the tongue' is because that is much easier to write, than what I am about to write. As for dosing, the technique I will describe does not affect the amount of absorption as much as it affects the speed of absorption; it still takes the same period of time to get into the bloodstream so I am NOT referring to getting a 'rush' or buzz (that is not possible with chronic use, as you all know), but rather it affects the time you have to walk around with something in your mouth. We all know that the minute you put it under your tongue, your wife is going to start a conversation or your phone is going to ring-- so it helps to make the time as short as possible.

Three things affect absorption: concentration (as that drives diffusion), surface area, and time. So the best absorption requires a very small amount of saliva, repeated painting of the solution over all mucous membranes (all surfaces in your mouth-- including cheeks, roof of mouth, tongue (both sides), gums, etc, and finally, you want ot keep it in your mouth for a good 10-15 minutes. While in solid form, the medication is of NO use to you; it cannot be absorbed until it is in solution, so I DO recommend crushing and dissolving the medication immediately, in a very small amount of saliva. Paint it all over for 15 minutes, then spit or swallow-- either one is fine. People who are sensitive to naloxone-- those who get headaches for an hour after dosing-- sometimes do better to spit out the naloxone, rather than swallowing it. I also recommend spitting it out if you have had a gastric bypass or any surgery that bypasses the proximal intestine, as if naloxone gets to the distal intestine it can be absorbed outside of the portal system and avoid breakdown by the liver. The result would be minor flashes of withdrawal for an hour or two after each dose of Suboxone-- not after Subutex.

As for the concerns in the prior message, the exact level of buprenorphine in the bloodstream is not critical. In fact, most people will do fine on a wide range of doses, from 2 mg per day to 32 mg per day. The important thing, in my opinion, is to take enough that you remain over the 'ceiling' level for 24 hours after dosing, so that you can dose only once per day without having breakthrough withdrawal. Dosing more efficiently allows a person to reduce the amount of medication to get that effect, saving a great deal of money. One last thing-- do NOT rinse your mouth for at least 15 minutes after dosing, as some medication will be attached to the surface of your oral mucosa but not yet absorbed, and you don't want to wash it away.

The veins under the tongue are NOT critical to dosing; my complaint with sublingual dosing is that you end up with a small zone of super-saturated tissue around the tablet, and after that develops, little additional absorption will occur and the rest of the drug passes in the gutter along the sides of the tongue and down your throat. That's wasteful-- heck, what about those starving children in India who have NO Suboxone?


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PostPosted: Sat Nov 21, 2009 5:30 pm 
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msummer....i am sooo glad everything worked for you so far!! Your doc sounds identical to my first, but if you are getting the help you need then go for it and good luck either way......

And I still remember clearly what happened that 1st day. After med history and 1st payment, took piss test talked to doc for 5 mins, he was "sorry to tell me" that they have no suboxone/subutex in office for induction but if my first dose wasnt enough to take more as needed (upto 1 more making total 32mg) and call him for another appoint early for more subs if not enough to next reg appt. The way he determined my dose was not to listen to what i had been using or what got me to that point, just how much i used that day and day b4 (looking back, only to make sure i wouldnt go into precip w/d in his office prob...).

He was shocked of my "narcotic intake level" (as he so nicely put it) when i decided to tell him even without him asking my average regular dose of agoinists.... and wasnt quite sure for the dosage of bupe in my opinion. He DID want me to taper quickly and be sub free with in 2-3 months (thats at starting dose of 24mg per day for 1st 2 weeks because i never went past the perscribed 3 per day.....)

......after reading what others has mentioned, my 1st doc just wanted quick patient turn-a-round.....he did not support long term sub....he said if i was for long term then goto methadone clinic because i just wanted to trade one for another (drug) and he was about getting people clean.....those are words from his mouth.

If you need long term sub then you should have it, check into some other docs as I had to do....but if you feel that short term is what is good for you, then more power to ya! either way more power to ya and good luck!!! But... I know that it took me a decade to create my position today and will not take short term suboxone (short term anything for that matter) to fix and stabilize myself and all that has become because of my opiate (or opioid??) past.

As for the post from Matt2, I havent tried that method yet but have read about it a couple of times and would like to try since it makes sooo much sense. Thanks for the info! and dr. J!!


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PostPosted: Sat Nov 21, 2009 11:58 pm 
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Matt, thanks for your answers and the info from Dr. J . It DOES make alot of sense and I too will give it a whirl. Ya know, when Dr. J wrote "While in solid form, the medication is of NO use to you; it cannot be absorbed until it is in solution, so I DO recommend crushing and dissolving the medication immediately, in a very small amount of saliva." That made me wonder it you could mix the pix in a small amount, say like 1/16 cup of warm water and then basically rinse with that for 15min or so. Just a thought.......

Anyway, BigRed thanks to you too for you words of encouragement and information. Goodluck to both of you on you path of recovery and I will be in touch.

Im going to definitely make some phone calls on monday because I am not comfortable with the way this guy does business. He sounds very similar to YOUR first doctor BigRed. I have a feeling he has his eye on a 40ft yacht.......lol. We'll see what happens. I do know that I feel a hell of alot better already and can for the first time in a LOOOONG time see light at the end of the tunnel.

Peace

Mike


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