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 Post subject: what to do
PostPosted: Tue Aug 23, 2011 9:05 pm 
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about 2 months ago i was on 12mg of suboxone tablets and doing good. I went to my doctor app and he told me he wanted me to go down to 8mg, going down 2mg at a time. so when i was there i had him give me the film at the same time he lowerd my dose. that month i noticed i was not doing as good as i was, so i thought it maybe cause he lowerd my dose. I went to my next app. and told him how i was doing and how i was feeling, he said to just try to adjust and try to go down to 8mg a day. so now am at 8mg and still on the film and having more cravings. so am not sure if it is the dose or maybe i need to go back to the pills and try that at 8mg a day. so has anyone had better luck wit the pills or do yall thank it could be that he is lowering my dose to much?


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PostPosted: Wed Aug 24, 2011 12:12 am 
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At 8mg, you should be above the ceiling for Suboxone and you shouldn't really be having any cravings, although the ceiling varies from individual to individual.

If it were me, I'd go back to the pills and see what happens. Maybe the films just don't agree with you? If you're still having cravings on the 8mg pill, you should let your doctor know this.....the reason you're taking Suboxone is to kill the cravings.

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 Post subject: yup
PostPosted: Wed Aug 24, 2011 7:58 am 
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Romeo wrote:
At 8mg, you should be above the ceiling for Suboxone and you shouldn't really be having any cravings, although the ceiling varies from individual to individual.

If it were me, I'd go back to the pills and see what happens. Maybe the films just don't agree with you? If you're still having cravings on the 8mg pill, you should let your doctor know this.....the reason you're taking Suboxone is to kill the cravings.


[b]agreed[/b] :!:


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PostPosted: Wed Aug 24, 2011 8:15 am 
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First I want to say I moved this thread from the Methadone category into the Dosing category.

Now I want to clarify something about the ceiling and individualized dosing when it comes to cravings and why I disagree with Romeo. 8 mg is definitely comfortably above the ceiling so your receptors should be saturated and STAYING that way. But that does NOT mean that your cravings will be controlled. The ceiling has nothing to do with the amount that will control one's cravings. That is what makes each person's dosing individualized. You might be fine with regard to cravings at 12 mg but start to have cravings at 8 mg, whereas someone else might need 16 mg to control their cravings. Same ceiling, different dosing needed to extinguish their cravings. Again, THIS is what individualized dosing is all about. I hope that makes sense.

Some people do experience issues when switching from the pills to the films, so that could be contributing to your issues. But in my opinion, the most important thing here is that you're back to having cravings and that puts you at risk of relapse. I would report those cravings to your doctor ASAP. Being on too low a dose while on sub maintenance so that you have cravings defeats the entire purpose of even being on suboxone. Hopefully your doctor will get that!

Let us know what your doc does/says this time!

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 Post subject: What to do
PostPosted: Wed Aug 24, 2011 7:07 pm 
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Thanks everyone for all the advice so some peolpe do have more luck wit the pills than the film?


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PostPosted: Wed Aug 24, 2011 7:44 pm 
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Ok, Hat, now I'm going to respectfully disagree with you. The ceiling is not the level at which the your receptors are saturated. The ceiling is the level at which you reach a "steady state", where because of the long half life, you are able to build up enough in your system that you shouldn't "feel" your dose. Below the ceiling (at doses from under 1mg to under 4mg) study subjects reported feeling a dose/response correlation. In other words, a higher dose=more effect. But above 4mg or so the "effect" doesn't seem to change.
Now as far as saturation... I was going through a period of intense cravings a while back and my doc put me up to 16mg/day. He said at 16mg 98% of the receptors are occupied, so they are effectively saturated. He said you can get 100% saturation at doses above 16mg, but it becomes a question of whether there is a benefit to covering that last 2% by going up to 24 or 32mg. I think that is why they are now recommending that the max dose be reduced to 16mg (although I haven't heard anything about that lately).
Anyway, all of that was a long winded way of saying that I DO agree that you might want to increase your dose, at least until the cravings are under control. IMO the films deliver the dose more efficiently and therefore are "stronger" although I didn't really feel any difference myself. Other people feel that the exact opposite is true. So in the pill vs. film debate I think you have to go with what works for you. Hopefully your new doc will cooperate.
Good luck,
Lilly


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PostPosted: Wed Aug 24, 2011 8:18 pm 
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What you're saying, Lilly, about feeling the dose under the ceiling is true. I never said it wasn't, but what I said about another aspect of the ceiling effect - saturating or "hitting" the receptors applies as well. I tried to explain it the way I understand Dr. Junig's explanation of it. One of his quotes is below (sometimes he said "hits" sometimes he says "saturates"). I'm not surprised that two different doctors say two different things about saturation points. But I really don't think we're even disagreeing, at most we're presenting two disagreeing doctors.

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PostSat Dec 25, 2010 5:15 pm

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"There is a difference between the dose required to HIT the ceiling level, and the dose needed to STAY above the ceiling level until the next dose. 4 mg will saturate most of the receptors but it takes a higher dose to keep them saturated for 12 - 24 hrs!

See my videos for more on the ceiling effect- link at addictionremission.com."


That's just a reply on this thread: http://suboxforum.com/viewtopic.php?p=2 ... ght=#23067

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PostPosted: Wed Aug 24, 2011 9:39 pm 
Ladies, you have to remember this information is all subjective. There is no actual way of measuring the actual level of suboxone saturating the receptors at any given time. This would involve cracking the skull and I don't think that equates equally to humans in light of the monkey and mice trial stuff. I know disgusting......They can measure the blood levels of the active components of the suboxone and follow the half lives in a patient with a normally functioning liver.

The mg numbers are used as a representation of the majority of the patient's individuals response to the doses. Also taking in to account, how it is taken, bioavailability, metabolism, vascular volume, hormonal influence, liver metabolism, hydration, genetics......on and on, ad nauseum. There really is no proof that 98% of the receptors are saturated at 16mg. This is based on a general patient populations response.

I guess the bottom like is to aim for the dose that keeps an individual comfortable. This truly has to be a case by case treatment. The key seems to find the lowest dose that can be used to keep a patient comfortable. It really has to be individualized and so many never get this opportunity. That in itself is sad......


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PostPosted: Wed Aug 24, 2011 10:23 pm 
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They (Dr's.) can measure, and have measured, the amount of bup. attached to the receptors by using brain scans/images. It might be on SAMSHA's web site?


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PostPosted: Wed Aug 24, 2011 11:03 pm 
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Take away the ceiling and saturation aspect, you lowering 33% of your dose. That's going to have an impact on you but the cravings will pass. My doctor would never lowere me more than 20-25% when I was at a higher dose. When I started to get to the lower doses (under 8mg) he would try to keep it around 10%. That has always worked good for me and the rest of his patients. Ask him about 10mg for a month or two. The 10% drops have always worked for me.

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PostPosted: Thu Aug 25, 2011 10:53 am 
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To the OP- Although at 8mg/day, your receptors SHOULD be saturated........if you're still having cravings talk to your Doc AGAIN!
The whole point of being on Sub is to keep you out of withdrawl......AND to eliminate cravings. If you're still having cravings you're putting your recovery at risk! Please make sure you express this to your Sub Doc!

Fairrobin-As stated above, I agree with EVERYTHING you said! I understand that there have been studies regarding the ceiling level, and "best practice dosing guidelines".........BUT, EVERYONE IS DIFFERENT........different body chemistry, different severity of addiction, and also hafta take into account HOW MUCH ABSORPTION THEY'RE ACTUALLY GETTING..........hence, INDIVIDUALIZED DOSING!

I started out on a high dose of 32mg, over two yrs ago. My Sub doctor slowly reduced me over the past couple yrs to 14mg. I had been on 16mg for about a yr, when he finally reduced me to 14mg. I understand that my receptors SHOULD have been saturated, and most likely were.......BUT, I was still having cravings after that small reduction from 16-14mg.
Whenever I had my first appt with my new Sub doctor, and I explained this to him, he immediately raised me to 16mg. He said "Unless you're goal is to taper off, if you're stable on a particular dose on Sub maintainence, then there is no reason to lower your dosage. If you're having cravings, this totaly defeats the purpose of taking this medication".

BTW, It was SO NICE to find a new doctor whom has the same outlook on longterm Sub maintainance! Now I don't hafta get all anxious/nervous right before my next appt, like with my previous doctor. (Although my last Sub Doc tapered me very slowly, he said something different EVERYTIME I saw him, it made me a nervous wreck...wondering what my nxt appt would be like,)




Bottom Line........If the dose you're taking ISN'T addressing your cravings, please keep on your doctor to increase you. Addiction is a deadly disease! Having cravings day after day puts you at incredible risk for relapse.......AND we KNOW where that can lead!


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PostPosted: Thu Aug 25, 2011 11:47 am 
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Has anyone noticed that we're all basically saying the same thing? That dosing is individualized when it comes to cravings and if one is having them while on sub maintenance, their dose should be raised, otherwise it defeats the purpose of being on it. Period. No one is arguing that point.

If someone has a problem with what myself or Dr. Junig has said regarding the ceiling, I'd first suggest reading more of Dr. Junig's posts on the subject on his Suboxone TalkZone blog or any of his other blogs/sites. But as far as the direction of this thread, the way I see it, everyone here is saying the exact same thing and there really isn't even any disagreement when it comes to cravings.

Jameskenneth- There appears to be a consensus among us that if you drop too low and start to have cravings you may just have to go back up to the dose you were on when you had no cravings. Please do let us know how it goes with your doctor. And my apologies for the small diversion in your thread.

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 Post subject: What to do
PostPosted: Fri Aug 26, 2011 9:18 am 
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I just want to say thanks for all the help. I don't go to my doctor tell the 19 but I will let yall know what he does


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PostPosted: Fri Aug 26, 2011 4:21 pm 
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Hat-I aploogize if it seemed as though I was disagreeing with you...........I wasn't.

Looking back at my post, (and seeing how I typed some words in all caps).......it does kinda appear as though Im yelling.

Im Sorry for that.

I think I used the caps to express how I was feeling in regards to what Fairrobin stated.

Hat, I AGREE with everything you stated. I was just pleasantly surprised to read Fairrobin's post.......because her explanation is pretty much EXACTLY how I feel, and what I would've stated.......had I not read her post first.


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