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PostPosted: Sat May 15, 2010 5:31 pm 
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This is gonna be long but I find it hard to tell my story without background, so whatever:

So last Summer I entered an outpatient detox program (suggested by my insurance company) that required going in every day for two weeks for evaluation and meds. I was coming off 2.5 mg/day of Suboxone and they didn't taper, they stopped you cold turkey. It was problematic because of the travel involved, but I tried for a couple days and generally, I was fine comfort-wise with the med setup they had for the symptoms (0.1mg Clonidine & 0.5mg Ativan together, which I only needed once or twice from the morning through mid-afternoon, 2 of each at a time later and generally given the freedom to take more if it didn't feel like enough), though I was very wiped out energy-wise. I believe they were generally giving out 10 pills of each for each day and the clinical director was surprised when I had to take it all, but the MD didn't seem to have a problem with/worries about it and that I was just more hypersensitive to the symptoms than their average patient and upped my max to...12 of each, I think.

The third day, I was beyond wiped out (even with the Ritalin they gave me to take when I woke up), and had someone come with me because I didn't think I could make it in otherwise. There was some discussion that maybe I wouldn't fit the program at the moment, but we'd see how the next day went, and they also gave me an extra Ritalin (which I hadn't taken in the middle of the day before) to take at that moment. I was pretty upset but had calmed down and things looked ok for the time being. As the Ritalin kicked in...boom, my breathing got labored and between that, the August heat, and the dry mouth from the sizable dose of Clonidine, I felt like I'd almost pass out. When I talked to the program director, he recommended I go back on the Sub for a couple months, and that I'd probably need a higher dose than I had been taking. It seemed to be agreed on that while we couldn't be sure, my theory on why things got so bad that day was probably accurate.

A few weeks later, I was suddenly getting headaches from the subs and not sure what to do. I felt that I needed to get off of it ASAP, and talked with my insurance case manager, who suggested I call the program's director for advice. He said that maybe, with the sense of urgency that I felt and the weather still being hot, that I find the inpatient program closest to their general style of medicating (in my area, the vast majority of detox programs, both inpatient and outpatient, use methadone tapers and not buprenorphine in some form and/or Clonidine, Ativan, etc). I was under the impression that if it got less urgent, I could go back to their program. I was able to control the headaches via a change in the herbal formula from my acupuncturist. The weather cooled off, I made an appointment, and felt I'd be good to go this time, since I'd just be tired and not dealing with extreme heat. I made a new eval appointment. This is where things got weird.

In the waiting room, the clinical director even saw I was there and acknowledged me when I thought they called me in because they called by first name and someone else with my name got called. They had someone do my intake. When it was time to see the clinical director, she and the program director bother claimed that they had told me they wouldn't take me back because an outpatient program wasn't right for me. They never, ever said this, and basically browbeat me for an hour as I argued over the ridiculousness of the whole situation:

- Why would I have come in?
- Why did they not call me when they saw I made an appointment?
- Why didn't they talk to me when they saw I was there?
- Why did they do the intake if they knew they were going to say no?
- Why were they convinced that we had agreed on this?
- Why did they refuse to admit that they had said that the afternoon Ritalin + heat + dryness = argh scenario was what likely happened? (I realized as I got home that this may have been a liability issue over the questionable of providing the extra Ritalin dose and instructions to take it immediately)

They also claimed there was some sort of official meeting over this (not made clear if it was that day or after my previous visits there).

I got very upset because of the lack of options in the area (they offered to set me up with the one inpatient program they referred to, but I was hesitant to go there for reasons I won't go in to). When I talked to one of the counselors to get calmed down, she pretty much seemed to come as close to agreeing with me as she could without saying it for they're her bosses reasons. My insurance case manager agreed with me 100% and was absolutely puzzled by their behavior. I also made sure to warn him that I had a feeling they'd bill the insurance company even though they didn't actualthly provide any services beyond the re-evaluation and was concerned that they may have actually gone through with my appointment (which, as mentioned, they had no legitimate reason to when at the latest, they should've talked to me and cancelled it after seeing me on their schedule/in the waiting room) solely to bill a visit from the insurance company. The one time I ever had a mix-up like that before (somehow, after being referred to a certain ENT specialist because the local ENT wanted me to see one associated with a major hospital, nobody in his office pointed out that he was working in a cancer center and just doing work on problems secondary to cancer) the doctor apologized profusely, voided out the visit, handed back the co-pay check, and made sure not to bill the insurance company.

For the next few months I had no idea what to do. There was one doctor I found online who seemed like a good fit, but he didn't take insurance and financially, I couldn't afford it at the time. Well, about 2 months ago, I was able to afford to see him. His program was a taper over 6 weeks or so (visiting every 2 weeks with regular phonecalls) and in going down from the 6.5mg to 0.5mg (using less Clondine and Ativan, and then Clonidine and Clonipin, in most cases not taken together as well as switching to Subutex at one point), things went relatively ok. Friday was supposed to be the cold turkey day with no more Subutex. Things started bad because late Thurs night/early Friday morning was noticeably worse than it had been before...and that was hours before I would've taken the Subutex anyway. The meds didn't work at all, even the Donnatal (which the doctor said I could take even if my stomach felt ok, as I had noticed that the Phenobarbital did help with the symptoms at all). Generally it was all severe leg pain/restlessness, crawlies, and temperature issues. For hours I tried to manage. Aleve would help and then, for whatever reason, not last more than an hour or so. Siberian Ginseng from my acupuncturist would help randomly. Dr. said I could increase the Clonopin, first to 1.5 pills and then to 2, but because it was later in the day, that was taking one and then one instead of taking them together.

I ended up eventually taking the Sub because I got into a really bad headspace from the physical pain and felt I just needed to regroup and see how the new Clonopin dose would work taken at the proper schedule. Got through the night. Talked to my acupuncturist (who has worked in Methadone clinics) during the morning who even offered to come to my house to do those ear points that work wonderfully for withdrawal, and that we'd talk later to figure out what to do. Then things got worse again and I took the Subutex. Talked to my Dr. and we seemed to come to a better understanding, but he doesn't prescribe more than 6 Clonopin/day (discussion stemming from how symptom-wise, I was much better with that other program), so what we agreed on for now was that I stay on the Subutex for another day at least, drop the Clonopin back down to 1.5 pills since I'm back on the Sub, I'll switch from Trazodone to Seroquel for sleep (he only likes to use Seroquel very short term for weight gain reasons), and I'll figure out what'll happen acupuncture-wise, then talk to him tomorrow. He brought up the potential of staying on the .5mg Subutex for longer along with the Clonopin, but I desperate want to get off both and onto low-dose Naltrexone.

Ok, that was really long but it felt better to get all of that out.

So...any further suggestions as to what I can do to get through this? He thinks I am at least partially having a harder time than I should due to just generally having an overly sensitive nervous system (which I knew: Before I ever touched an opiate, I went to some specialists who, based on psych & neuro testing, came to the conclusion that I have a very low pain tolerence). I just want to be able to sleep through the night, not in enough pain that I'm driven to the point of throwing things, biting things, and screaming, while flashing back to my worst withdrawal ever, before I knew it was withdrawal (even LONGER story) and the mental space I was in then.


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PostPosted: Sat May 15, 2010 7:22 pm 
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A six week taper from 6mgs to zero is really fast. Obviously, .5mgs is too high of a dose for you to jump from, as evidenced by the severity of your w/d symptoms...even with all the comfort meds you're getting.

Maybe try tapering down even lower, like to .25mgs? I couldn't jump from .5 mgs, but I did it pretty painlessly from .2 mgs. All I needed were a few doses of clonidine and a couple nights of ambien. There are other people here who have done the same, some even tapered down to .12mgs and barely felt their withdrawal at all.

Sticking to a predetermined taper schedule always seemed like a bad idea to me. There are so many things that can effect your tapering process, it just seems better to be flexible and adjust your schedule accordingly.

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PostPosted: Sat May 15, 2010 7:31 pm 
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Hi Super Grover,

I'm sorry you're having such a hard time. I'm still on suboxone so I can't give you personal experience on tapering down and/or off. I can just relay what I've heard and read from others. That is, the best way to stop is to do a very slow, long taper (over months and dropping to very low doses). Like what DOAQ said. Many on here have used the liquefied taper method.

However, if for whatever reason you are determined to get off the subutex now, I've heard that a LOT of exercise really helps with withdrawals as well as vitamins. I'm hoping those people will weigh in with some of their specific experiences and recommendations.

One more thing I wanted to say - It almost sounds like you expect to have terrible withdrawals. I've found that such a perspective almost causes the situation to become worse. I don't know that that's true with you, but it's just something I wanted to throw out there.

Hang in there and keep us posted.

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PostPosted: Sat May 15, 2010 7:33 pm 
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Oh wow, what a story! Hi there! Well, Im very sorry I don't have any very good advice. I guess what i'm wondering is if you have health insurance (and it sounds like you have great health insurance) why you are so eager to get off the sub completely? I mean, you are at a pretty low dose, maybe you could stay on that for awhile until you find a program that you know will really work with you. I'm sorry if you answered this question in your post I got confused in some spots.

But, either way, just know that I will keep you in my thoughts and prayers and I really hope everything works out ok with you and your recovery. Please keep us posted. Best wishes.


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PostPosted: Sat May 15, 2010 9:04 pm 
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It isn't a 100% cut and dried taper schedule and it did go past 6 weeks. Been almost 8 now.

I will talk to my doctor about the idea of trying to cut the Subutex further. When I was on Suboxone, less than a 1/4 of a pill never seemed like it would work as an effective dose in any form. That could be different with the Subutex since it's not a combination drug (which is why my Dr. prefers it to Suboxone as the taper gets lower) and it's less crumbly than Suboxone. I'm talking with my doctor again tomorrow so I'll get his thoughts on that then. He had mentioned hearing of the liquefied taper at one point but I don't think he'd actually had any patients try it.

I have been neglecting my vitamins in all the chaos so I will try going back to that, too.

I tried to be pretty optimistic about the symptoms and on Thurs, the doctor seemed to think I'd do better than ended up doing, so I don't think it's necessarily my expectations skewing things.

Why I want to get off the Subutex ASAP is an even longer story that I'd rather not go into right now. The most simple version is that I had no energy and weird sleep before the taper and want to get on low-dose Naltrexone to get a vaguely normal endorphine system back.


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PostPosted: Sun May 16, 2010 11:07 pm 
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Even 8 weeks is way too quick. I was at 2 mg's damn near a year ago and am just now about off...you have to give your brain time to heal and get better on the lower doses or the paws will be terrible. You need to slow the taper way down if you really want to do it right.


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PostPosted: Mon May 17, 2010 1:44 am 
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Yeah, it took me 2 1/2 months to go from 1mg to nothing. And before that I was tapering for a long time to get down to 1mg.

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PostPosted: Thu Jul 22, 2010 11:06 pm 
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I ended up going to the one non-Methadone inpatient detox (Arms Acres, which I'm naming them to warn people) in the tri-state/NY metro area that I could find (there might be another, but they're terrible at returning phone calls so I can't get any information). It didn't work out well to say the least.

The first night went ok enough with a little bit of Clonidine and the Valium they used to taper me off the Klonopin my Sub doc had been giving me. The next morning was terrible, and when they explained that they didn't give more than 0.1mg of Clonidine 4x/day (and having been taking a total of 0.3mg/day recently) along with knowing that they were lowering the benzos, I knew it wouldn't work out and decided to leave. They suggested I try the Ultram (which I had asked not to be given) first. The outpatient place had mentioned this when they recommended Arms (which they said was otherwise "like them but inpatient), and said to turn it down. When I mentioned it to my doctor, he said the same thing, and that it could make things worse. The Arms staff said it was a standard part of their opiate protocol and that they'd never heard of anyone having problems with it. Knowing that I didn't have many options, I called my doctor from Arms. He said that it should be ok...but as I found out later, he expected them to taper it.

The rest of the week went fine. I get home, call my doctor to check in. His reaction was that they really screwed me over, and to see him the next day, because I was going to get bad withdrawal because they didn't taper. He explained that while Ultram isn't an opiate, my brain sees it as one, and that the potency was way above what I had been getting with the Subutex. He said I would get bad withdrawal (which is why I went inpatient in the first place), and I did. It was so bad that I was worried about my mental state, called my doctor, and he told me to take a small amount of Suboxone and go over the rest with him when I saw him the next day, which I did.

Right now I'm on 1.5mg of Subutex (0.5mg 3x/day) and 0.2mg of Clonidine at bedtime. Going by my more recent and some older experiences, my doctor seems pretty sure that my brain is a lot more sensitive to opiates and withdrawal than the average person, so he thinks I should just stay where I'm at if I can't find the right place (between NY being methadone-heavy and having Medicaid, that doesn't look great). From talking to the insurance case manager, he thinks that the previous inpatient program should let me back in, but even if they did, do I wanna go there? He gave me the name of 2 outpatient and 1 inpatient places to call (the inpatient is part of the same hospital as one of the outpatient, and is the one bad at returning calls), but he's not sure that they would cover another inpatient yet even if it was the right one for me. Outpatient I know I would be best waiting until the fall when the weather cools off to be able to do a once a day for two weeks program with the commuting involved. Even then, assuming that it's close to the other programs med-wise, will I be functional enough in terms of energy to do it?

So what the hell do I do? I'm trying to stay positive and at least look at the inpatient experience as a place where I made some friends and got off the Klonopin (though I probably didn't need inpatient for the latter at the dose I was on for the amount of time I was on it), but I'm incredibly frustrated and want off the Subutex.


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PostPosted: Fri Jul 23, 2010 1:11 am 
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Holy crap, Super Grover, you've surely been put through the wringer. I'm sorry you've had to suffer so much, seemingly needlessly.

This is my advice to you - do the liquid taper method. Decrease your Subutex dose by 10% like every 2 weeks or so. With that small of a reduction, you should be able to handle whatever withdrawal symptoms you encounter - especially since you have access to clonidine.

It takes a long time and can be a pain in the ass, but doing it slow and steady is (in my opinion) totally worth it.

Believe me, I am in no way a person with a high pain tolerance. I have fibromyalgia and I am super-sensitive to all kinds of things. My nervous system gets easily overloaded, I am prone to migraines and anxiety, and there are times when I'm so pain-sensitive that I can barely stand for my little daughter to hug me. I am not tough - and yet I made it through my taper with only a few days of clonidine here and there and at the end I took ambien a couple of times. My energy was generally ok and I never missed work - a job where I stand for 8-10 hours and have to interact with customers.

I really don't see the need to overload your already-sensitive system with a complicated cocktail of taper medications - especially since it isn't working for you. You might not be able to get off the Subutex as quickly as you'd like, but I think you'll be more comfortable this way and you stand a better chance of actually making it through the withdrawal process.

By the way - I've heard that Ultram withdrawal is especially awful because it not only acts on your opiate receptors but also messes with your seretonin as well, so it's like withdrawing from both an opiate and an SSRI at the same time.

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PostPosted: Fri Jul 23, 2010 1:51 am 
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Hi SGrover, I'm not sure I have any advice but I just wanted to say I'm sorry to hear what a hard time you're having. It sounds like you do have some things on your side though, don't you? like--a good insurance case manager, plus it sounds like you have a good relationship with your doctor too. I'm interested in hearing more of your story too, if you every want to share more. Personally I have not had much luck with rehab programs. I dont' mean to discourage you or anyone else from seeking help though, and of course everyone is different too, what works for one doesn't necessarily work for all. The thing about being given ultram without being fully informed about it does sound difficult. You seem to feel very urgent still about wanting off the subutex. Of course I dont' know your entire story but I do know that a person can start to feel pretty desperate when going through all this type of stuff--detoxing and dealing with insurance issues at the same time is a hard enough combination if you ask me. Actually, one or the other is hard enough. I remember though, people telling me to be patient when I was feeling desperate and urgent and I guess it's just hard that sometimes being patient is the only thing you CAN do. Detoxing seems like it really can make time drag. But I wonder if the best thing for you wouldnt' be to slow down a bit more, stick with your doctor if you can, and try to taper down farther on your own, with your doctor to check in with as you go? I say this partly because when I read your first post it reminded me some of the Intensive Outpatient Treatment program I tried when I first got on sub. Everyone says expectations can make a big difference in how you feel, (about WD for instance, that if you expect it to be bad maybe it's worse) and I really believe that can be true, but honestly, I was looking forward to that IOT program but was nothing but disappointed, it was like I wasnt' treated as an individual at all there, just expected to attend the expensive program every evening. Now a case can be made that I didnt' give it much of a chance. Maybe I wasnt' patient enough...Anyway, after what you said in your first post, about how you went back to the first outpatient program, for your appointment and then they did your intake and then proceeded to argue and argue with you about why they didnt' want to accept you...AFTER they had made that appointment with you AND did an intake too...well, I dont think I would want to go back there if I were you...on the other hand, if you think the program there basically was right for you and it was just...well, a mix-up, then maybe it would be the right thing for you....I dont' know, just if it was me I dont' think I'd consider it. Anyway, I have also tried a daytreatment program in the past which just didnt' work out for me either and other than that once spent 5 days hospitalized on a dual-diagnoses ward...which that one actually helped me some and I wanted to stay longer or get transferred to a different inpatient situation but no one on the hospital side thought that was an option so I tried the outpatient program they referred me to but didnt' last long there. Anyway, I wish I knew how to help you, but like I said I do wonder if you can consider slowing your taper down more and just sticking with the doctor you have now? I hear your sense of urgency though, can you tell us more of what's going on and why you think you need to get off subutex a.s.a.p. now? I know it's been longer than you hoped and all, but is it actually about some side effects you get from sub or something else that really makes you feel you need to be off it? For me, I'm just trying to stablize ON sub for now....Ultimately I'd like to get off it too, adn right now in particular the cost is really a big hardship for me, but I dont' think I should think a lot about discontinuing my sub right now, despite the money problem. And personally, at this point, I feel pretty wary of rehabs and programs overall. Like I said, reading your first post really took me back. I remember an all day hassle just trying to get a clear answer on whether my insurance would cover the IOT program and never getting a straight answer, meanwhile being periodically rudely pressured and scoffed at by one of the staff at the rehab and then when I finally started the program, it was just so disappointing, I'm sorry, but it really did nothing for me nothing at all except contribute to my fatigue and depression and cause me stress about my work and needing to get off work early enough to be on time to the program. Now it sounds like maybe you've had better experiences with programs than I have, in some ways at least, but personally, I don't know if I'd ever consider a program again, whatever my circumstances. Meanwhile, for you, I know you may be extra-sensitive, but still, you are now on a pretty low dose of the subutex, and although i dont' know all your concerns about it, well, some people recently have told me to try to think about what's going well and what I'm doing RIGHT, and I'm just wondering if that might help you a bit too, it HAS helped me, to think about my main objectives, and look at my improvement, instead of fully focusing on the parts of my situation that I'm upset and anxious about. And....anxiety is killer, is the thing. But....anxiety can be WORSE than the reality that we are anxious about. Anway, I'm glad you posted again and I hope you will keep us posted on what's going on and I wish you luck. Ok-- try to take good care of yourself as you can and post again soon, I'll be checking for it.


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PostPosted: Tue Aug 10, 2010 10:56 pm 
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Trying the Clonidine patch (Catapres TTS-1) and it seems like I'm functioning a little better on it in terms of between-dose WDs so it may be a step in the right direction. Dr. said that we might step it up to the TTS-2 patch and then we'll see how things go.

Also, my case manager said that he talked to the guy who runs the inpatient place I tried and they agreed to take me back (and from how not forthcoming he was about how he changed the guy's mind, I get the feeling he forced his hand), but, as I said, I feel weird about going there.

Anyone know of any good directories of detox programs, both in and outpatient?

Also, does anyone think that any good could come from talking to someone at Arms Acres (either one of the counselors or the doctor) about what happened?


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PostPosted: Fri Aug 13, 2010 5:27 pm 
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Now the case manager is saying he thinks it might be possible to get the outpatient place to work on a treatment plan w/ Arms Acres. I'm going to talk to him again on Tuesday after he gets a better idea of when exactly they'll be more likely to approve an inpatient stay again.


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PostPosted: Sun Nov 07, 2010 1:09 am 
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Looks like this will happen as they've actually done it before. Evaluation went fine. Gonna check back in when I get over my sinus infection (don't wanna do it while I'm on antibioitcs and feeling crappy for other reasons) and then I should be good to go!


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PostPosted: Sun Nov 07, 2010 4:16 am 
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Sorry to bring things backwards. I realise how old this original post is. Back to your original question. Did you write that you were taking 12 (.1mg's a day of Clonidine?). That's 1.2mg's!! NO WONDER you were tired. I took it for methadone w/drawals and NEVER got above taking 0.2mg's, 3x's/day, (0.6mg's total), which was considered a lot, and I was tired all day long the whole time on it. I also have a friend who was given the 0.3mg pill (strongest) for sleep, who splits it up into 3pcs for the whole day cause 0.3mg's was way too much for him to take at once. I sure hope you get your BP checked at LEAST once a week? Talk about being over-medicated to the MAX. Sure hope that was a type-o, cuz if not, I'd be at CVS every morning getting my BP checked.


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PostPosted: Sun Nov 07, 2010 9:02 am 
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Diary of a Quitter wrote:

Sticking to a predetermined taper schedule always seemed like a bad idea to me. There are so many things that can effect your tapering process, it just seems better to be flexible and adjust your schedule accordingly.


I could not agree more with this.


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PostPosted: Sun Nov 07, 2010 3:57 pm 
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quadracersteve wrote:
Sorry to bring things backwards. I realise how old this original post is. Back to your original question. Did you write that you were taking 12 (.1mg's a day of Clonidine?). That's 1.2mg's!! NO WONDER you were tired. I took it for methadone w/drawals and NEVER got above taking 0.2mg's, 3x's/day, (0.6mg's total), which was considered a lot, and I was tired all day long the whole time on it. I also have a friend who was given the 0.3mg pill (strongest) for sleep, who splits it up into 3pcs for the whole day cause 0.3mg's was way too much for him to take at once. I sure hope you get your BP checked at LEAST once a week? Talk about being over-medicated to the MAX. Sure hope that was a type-o, cuz if not, I'd be at CVS every morning getting my BP checked.

That was only in the outpatient program that I couldn't finish (and presumably when I go back inpatient soon), where I was going every day and they check everyone's BP (and obviously, inpatient my BP will be checked constantly). When not part of a detox program, the most I'd take would be 0.3-0.4mg/day.

I've been told that for whatever reason, my brain is wired in a way that gives me much worse pain from withdrawal than the norm, and the doctor in the outpatient program didn't seem worried about it at all. Without the commute, it wouldn't have been too bad, though, so I should be fine inpatient.


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