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PostPosted: Sun Sep 27, 2015 7:01 pm 
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Okay, I didn't mean to sound so dramatic in the title. I'm just afraid of the coming week, when I won't have any bupe (until my next appointment) and I feel like it will help to write each day (or multiple times a day, maybe) about what's going on. I appreciate any and all comments (and support, he adds hopefully), though this will be mostly personal thoughts and situations, so it might not be too interesting.

So anyway, I was dealing with some stressful stuff, and somehow got the idea that if I took extra Subs, I'd feel better about it all. Actually, I think it was more that I have very little confidence in my ability to handle these kinds of things (I lack "life skills" in general and I can't deal with people), and I had the thought to use Subs as a shield. "If I'm on Subs, I'm Competent Crossfinger, who can do anything!" It's true to the extent that Subs have given me my life back, but taking 8-16mg extra in a day did literally nothing except waste Suboxone, as far as I can tell.

The upshot is that I ran out of Suboxone five days before my next appointment and refill. I went even more overboard than that would indicate, because for the past five days or so I've been stretching out my supply. I don't understand how I didn't leave myself enough to get to my appointment, but... well, I'm stupid, I suppose. So last night I had been without Subs for almost three days, and I felt so incredibly awful that I caved and took the final 4mg I'd been saving. I wish I'd just suffered, now.

Now I've got a whole mess of worries. I think I'd be able to take it if it were just withdrawal -- maybe -- but worse, I don't know if I'll still test positive for bupe when I take the drug screen. Then what will happen? I'm incredibly terrified, from the bottom of my soul, of losing my script. I can't afford starting over with another doctor. For this reason, I don't want to tell him that I messed up and misused my script. It's the first time it's happened, not that that's much of an excuse.

I'm thinking of taking high loses of loperamide to ameliorate the withdrawal, but I'm also worried that will make me test positive for opiates. Dr J (I think; user "suboxdoc") tells me he doesn't think this will be the case, though, so that's been a load off my mind.

But even so, there's the worry of not testing positive for bupe, and also a question of how long my new insurance will take with the prior authorization thing. My old insurance took a day. I've heard horror stories about it taking up to three weeks, though. I think what I'll end up doing is just paying cash. I wonder if I can take a receipt up and get money back when the authorization goes through... I've heard of that. I'm also thinking I'll buy nine pills or so with cash, and then buy the rest when insurance kicks in. I don't know if that's allowed, either.

I'm just so worried. I'm worried about making the drive to and from my appointment while withdrawing (it's a very long drive), and I'm worried about the drug test, and I'm worried about the insurance. I can't believe I got myself into this situation. I swear that if I lose my script through this stupidity, I'll just fucking end it all.

No, I won't. But I am feeling pretty crazy about it. If I had just saved back half a fucking pill more...

(I know some might say that this could be a good time to kick the Subs, but I just don't have any desire to. The situation is complicated, but I'll just say that I know I'm not ready.)

Well, thanks for reading, if you did. Advice is greatly appreciated, as are any comments at all. I'll probably come back and complain when I'm withdrawing, if I'm able to concentrate enough to type. God, this isn't gonna be fun. I hope the loperamide deals with the restless legs at least. I wonder if I can convince my doctor's staff to squeeze me in early. They never have before, but if I tell them it's really important...


Last edited by crossfinger on Sun Sep 27, 2015 8:48 pm, edited 3 times in total.

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PostPosted: Sun Sep 27, 2015 8:20 pm 
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Hi, I'm Queenie, I don't know exactly what to say but I can tell you of my experience.

When I started on Suboxone, all was going fine. Then out of nowhere, my doctor says he is retiring and he has to refer me to another doctor. I was fine with that. The only problem was that the new dr. was supposed to call me on a certain day and I'm waiting & waiting & no call. I was so afraid of withdrawal. I started popping subs and I had run out. it was when I joined this group that I learned that taking more subs does nothing. Finally the dr. calls & tells me to see her in 3 days. I panicked. but I said nothing. I went through 3 days and I felt fine. I got to the dr. just in time, I guess, and I got the rx. I filled it that afternoon. I learned my lesson and never went over my dose again.
I wish you luck and I hope things turn out right for you. I will keep you in my thoughts and pray all turns out well for you. You can read my story here under queenie1959. There is a post where I was a wreck when all this was happening.

Stay strong,
Queenie


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PostPosted: Mon Sep 28, 2015 9:59 am 
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Hello Cross,
Ive read your posts and im really sorry about the shortage of meds.Many go though it. I did in the begining of treatment although not to the point of what your up against.

Witch leads me to this. If you zero in on feeling bad, you Will feel bad. You worries will bring you down more than not having a daily dose. You can get lope, sure it may help you. Even pick up a restless leg med too. But Cross you will have 3 days of mostly no wd. The halflife Buprenorphine will see to that. You ve taken so much bupe that can carry you.
Thinking about how horrible it all will be can't be a positive thing.

I feel bad for you, I do. Try to stop this worring by taking a little action. Id call the new Ins company and tell them or ask them how your claim is going to go. They may tell you everything is a go. If not, you tell them what your going to need on friday..It can't hurt man. You ll feel better just by trying.

I do not know your Dr. Sub docs are all different it seems. There are rules to follow in every sub program. Take a look at your contract, im guessing you signed one. Look it over. If there isnt one, then how does this dr treat people? Is he fair? Most of them are. Can't you just tell him the truth??? What is wroug with that?

We are all addicts , we do make mistakes sometimes. But does it make sence to take away the med as a punishment for being truthful?
I understand your fears. Ive had them too. But after nearly 5 years my dr and I understand each other. How is your give and take with your dr? If you can tell him why you over took your sub then he may be able help and understand you better imo..

I don't believe this would be a good time to kick sub or anything right now. You said your not ready. Seems like your not. Bupe is saving your life now.
If you talk to your doc about all of this there will be nothing more to worry about. UA won't matter either.
These are just suggestions Cross, im no dr or expert, but I do want you to make it though this. You need your bupe.

With Buprenorphine being a partial agonist you may be ok. . I personally know four people over the years that have gone though what you are and they made it . You can do this.!!

The UA, i can't help you there. Just what kind will they do? Cup or will it be sent off to lab work? It is the Nor Buprenorphine that gets measured. Chances are it ll show up ..

Stick with us here Cross, please keep posting..



Razor...


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PostPosted: Mon Sep 28, 2015 1:43 pm 
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Hey Cross,

First of all, don't beat urself up over this, we're addicts and we all make mistakes and I'm pretty sure the majority of us have taken extra sub at one point or another. It's ok to make a mistake, just make sure u definitely learn from this one. I know ur scared, I'd be scared in ur situation too. So is today ur first day with no dose? Like razor said, u will be ok physically for around 3 days, mentally will probably be challenging for ya. But u can get through this I promise. I know it's easier said than done but u can.

I don't know what to tell ur Dr, because ur levels will most likely be off unless u get an earlier appointment. Most of the time it's best to just be honest, but I'd hate to tell ya that if ur doctor isn't understanding and u get in trouble. But there won't be much of choice if he sees that ur levels are way off. But, if it were me, I'd just tell him the absolute truth and hope he/she is understanding like they should be. I also don't think ur ready to jump off yet, just because u over took ur meds doesn't mean u should just say to heck with it and stop completely.

This is definitely a bump in the road for ya, but u will get through this. I don't have any advice about insurance and what u should do there cause I have none myself lol. But please keep us updated and let us know how ur doing. This forum is the best place for support!!

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PostPosted: Mon Sep 28, 2015 7:39 pm 
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Right now, I have a patient who is in your situation. If you are her, let me know! She ran out ten days early (for a month script), and I am asking her to take one per day of the 7 she has left, and then contact me in seven days. This is her first month-- and I want her to learn a couple things-- first that there are actual limits that must be followed, and second that the the extra doses were, in fact, completely wasted. This is a very common situation. And on one hand I need to show her some consequences, to reach the part of her mind that is able to place those limits.

But on the other hand, I do NOT want her to be in serious withdrawal, and DON'T want her to use agonists. If she fails in this challenge, I will probably bail her out (now, I'm hoping she ISN'T reading this!). But I know that most people will do fine on 8 mg per day--- and this challenge usually teaches people that fact.

The whole thing is a bit patronizing. But with addiction, it is as if there are three people in any interaction with the patient; the doc, the person who is sick of using, and the little kid who needs things NOW, no matter the consequences. I have to do something to get the desperate person to take charge-- and this is the way I've learned to deal with these situations.

I'm hoping that the writer has a doc with similar attitudes-- and if she is honest, things will work out. But unfortunately I know it doesn't work that way-- and there are docs who actually kick people out of treatment, just because they struggled. SHAME on them.

Be aware that there is a variety of buprenorphine products, ranging in cost from less than $3 per dose to three times that amount. Plain buprenorphine is the cheapest, and it does the exact same thing as the others. But many docs think people routinely inject buprenorphine. Those docs are idiots-- but they are not interested in changing their opinions.

Bottom line-- you can get by on far less than you think. Keep busy. Divide what you have left and keep each dose in your mouth as long as possible. You'll make it!


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PostPosted: Mon Sep 28, 2015 8:28 pm 
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A heartfelt thank you to everyone who has replied! I really appreciate it. Looking forward to logging on and reading replies has actually been a big comfort, and there are more (and longer) than I had dared hope for.

@suboxdoc:
Quote:
Right now, I have a patient who is in your situation. If you are her, let me know! She ran out ten days early (for a month script), and I am asking her to take one per day of the 7 she has left, and then contact me in seven days. This is her first month-- and I want her to learn a couple things-- first that there are actual limits that must be followed, and second that the the extra doses were, in fact, completely wasted. This is a very common situation. And on one hand I need to show her some consequences, to reach the part of her mind that is able to place those limits.

[...]

The whole thing is a bit patronizing. But with addiction, it is as if there are three people in any interaction with the patient; the doc, the person who is sick of using, and the little kid who needs things NOW, no matter the consequences. I have to do something to get the desperate person to take charge-- and this is the way I've learned to deal with these situations.

[...]

Bottom line-- you can get by on far less than you think. Keep busy. Divide what you have left and keep each dose in your mouth as long as possible. You'll make it!

Thanks a lot for the reply! That's not me, but it is a very similar situation, so I hope my doctor is as compassionate (and informed) as you are, heh. I'm kind of glad it's a common situation -- hopefully that means that my doctor has seen it before and won't be enraged or something!

You're absolutely right in that "three people" analogy: I don't understand how I managed to run out like this, when it is a situation that is clearly coming and clearly preventable. It's not like I didn't know how many I had left or couldn't count the days until a refill, and yet I did it anyway. Boggles the mind. I think I've learned a lesson, though! I managed to get an earlier appointment with my doc, but I'm pretty sure I won't be able to pick up the script any earlier than 28 days from the last one.

Still, as you say, I'll make it! Thanks again for the kind words and the helpful information.

By the way -- regarding dosages: I perceived no difference between taking 24mg of bupe and taking 8mg; and I thought I read somewhere (here?) that the ceiling dose isn't 24-32mg as is sometimes stated, but is in fact 4mg. Can you shed any light on the situation? Is it 4mg if assuming 100% bioavailability, or was that info just wrong? It seems like I did perceive a difference between 4mg and 8mg, and I can't imagine making 8mg pills if 4mg is the max (but if we're talking incomplete absorption or the like it would make sense, I guess).

@queenie1959:
Quote:
I learned my lesson and never went over my dose again.
I wish you luck and I hope things turn out right for you. I will keep you in my thoughts and pray all turns out well for you. You can read my story here under queenie1959. There is a post where I was a wreck when all this was happening.

Yup, I've learned my lesson as well (I hope). Thanks for the thoughts and prayers; I also enjoyed reading about your previous experiences. Well, maybe "enjoyed" is a bad word for it, since I'm sorry you had to go through so much! But it made me feel like I could handle this, since I'm not the first person to deal with withdrawal and "prescription anxiety", and even have an easier time of it than some.

@razor55:
Quote:
Thinking about how horrible it all will be can't be a positive thing.

I feel bad for you, I do. Try to stop this worring by taking a little action. Id call the new Ins company and tell them or ask them how your claim is going to go. They may tell you everything is a go. If not, you tell them what your going to need on friday..It can't hurt man. You ll feel better just by trying.

I do not know your Dr. Sub docs are all different it seems. There are rules to follow in every sub program. Take a look at your contract, im guessing you signed one. Look it over. If there isnt one, then how does this dr treat people? Is he fair? Most of them are. Can't you just tell him the truth??? What is wroug with that?

[...]

The UA, i can't help you there. Just what kind will they do? Cup or will it be sent off to lab work? It is the Nor Buprenorphine that gets measured. Chances are it ll show up ..

Thanks for the advice and sympathy. You're right, worrying about it won't help, so I've been trying to keep my mind on other stuff. I called the insurance company, as suggested, and they faxed the doctor for prior authorization immediately, so hopefully that will give it a bit of a head start. They also said it will only take 72 hours or less if the doctor marks it "urgent", and I am assuming he knows to do this, since he did so with my previous insurance. I hope so, anyway. I should have asked him to do so, but I didn't have the gumption (I'm very shy and hate to make demands -- or requests -- of people). So I figure now I'll give it a day or two, and then call up and ask what the progress is... sound good?

The contract just says that breaking any of the terms "may" result in cessation of treatment. But I feel like I have something of a connection with the doctor and he's been very accommodating before, so I'm thinking of telling him the truth. (Like I've alluded to before, I don't really "get" people so it's possible that our connection is all in my head, heh, but I don't think so.) I definitely agree that we ought to be able to tell the truth without having so much on the line for minor errors, but I suppose we gotta work with what we got.

Re: UA, I go to a lab and then piss in a cup for the lab. No idea if that's good or bad for my purposes, but the good news is that I managed to get in tomorrow, so after tomorrow morning I'll be able to report back on how the appointment went, and hopefully taking 4mg on Saturday night will have been enough for the UA, heh.

@jennjenn:
Quote:
I don't know what to tell ur Dr, because ur levels will most likely be off unless u get an earlier appointment. Most of the time it's best to just be honest, but I'd hate to tell ya that if ur doctor isn't understanding and u get in trouble. But there won't be much of choice if he sees that ur levels are way off. But, if it were me, I'd just tell him the absolute truth and hope he/she is understanding like they should be. I also don't think ur ready to jump off yet, just because u over took ur meds doesn't mean u should just say to heck with it and stop completely.

As I've said above, thank you for the support! I think my doctor is the understanding sort, and I think he likes me on a personal level, so I have hope. I'm probably gonna tell him the truth and let the chips fall where they may. I'll definitely keep this updated so no one has to wonder, heh. It seems like the insurance bit is squared away, at least.


*********************

So, today I felt mostly okay. The anxiety over the situation has been pretty bad, but as I wrote above, I called the insurance company and got the prior authorization stuff started. I also managed to get an appointment for tomorrow with my doctor, which is a relief even though I won't be able to pick my meds up until the 1st at the earliest; at least this way I'll probably have bupe in the urine sample, heh.

So I guess now it's mostly a waiting game. Will update if I find anything else out. I'm worried about the bupe levels in my urine sample, and I'm worried that the doctor sent the prior authorization fax to my old insurance, but I'll call up the new insurance in a day or two and ask to check on the progress, I think. I hope Crossfinger's Doctor marked it "urgent"!


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PostPosted: Tue Sep 29, 2015 6:49 pm 
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My appointment went well. I told him most of the truth, and he was understanding. He gave me some stuff to read and recommended attending NA or another recovery program more often. He said some stuff along the lines of what Dr. J has said here, so that's really nice and encouraging.

I wasn't able to be completely truthful, though. I mean... seeing his reaction, I think I probably could have been, but I didn't feel like risking it at the time. So he doesn't know just how little Suboxone (0mg, to be exact) I have left, so there's not going to be a new script to get me in under the 28 day window. Still, that won't be too far away, so I think I can make it.

I'm still really, really nervous about the whole thing, though. I usually get a text from Walgreens about my script, and I haven't got one, so I don't even know if it's been sent... and there's a chance, as mentioned above, that my doctor didn't mark the authorization fax "urgent" and/or sent the authorization to my old insurance. I wanted to call all three places (insurance company, doctor's office, Walgreens pharmacy) and check up on everything, but I made a pact with myself that I'd give it at least today before running around in a panic. 24 hours for time to work its magic, so to speak. I don't want to look desperate, after all, and who knows what anyone would be able to tell me after so little time?

So... that's where it is, I guess. Tomorrow morning you bet I'm gonna be on that phone.

I feel fine physically still, though. I attribute it to the loperamide -- it's been long enough that I should be feeling withdrawal, since I've already been basically off Suboxone for a week, with only a single 4mg dose for the past six days or so. I've been taking a high dose (~12mg) (of lope) in the morning and a high dose at night, and aside from some mild anticholinergic effects, I feel totally normal. I recommend anyone who fears withdrawal look around online for information about loperamide in that context; I won't recommend actually using it, because I don't want to be responsible for any problems (in mega-doses it is said to sometimes cause heart problems, and it can cause dependence with prolonged use like any opioid), but I'm so relieved to have this as a backup.

Seems that lope has a long half-life, too, so I might try skipping tonight's dose. Loperamide only works with peripheral opioid receptors, but it's actually working pretty well to combat the intense cravings I started to get (for any sort of opioid at all), which is interesting to me -- maybe peripheral opioid effects are very important in giving one that sense of need? But I'm still having a few mental cravings, although surprisingly dull ones.

I guess what I'm craving is actually just to have it all settled, rather than Suboxone itself, now that I think of it. I would feel fine waiting if I knew when it would be properly dealt with, but at the moment it could be that tomorrow I get the text from Walgreens and pick up my script on the next day or two, or it could be an endless hassle of "we don't know when it will be ready, sir" with the insurance company or doctor's office or Walgreens jerking me around until the 10th or 11th of October. I say 10th or 11th because I feel like 10 business days will be enough even in the worst case scenario, but by Wotan's left eye I hope that it's not that long. Knock on wood for me, please!


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PostPosted: Thu Oct 01, 2015 4:39 pm 
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Well, today has been a good day. The insurance has okay'd the script! I'm in the clear... as long as my UA turned out right, but I'm thinking it did or I'd know by now, right? Knocking on wood. I'll be able to get my script tomorrow, if they let me get it two days early (and I think that's allowed here). So today, I'm just distracting myself and letting the time go by, trying not to go crazy worrying about whether or not it will actually turn out alright!

I'd like to take this opportunity to reiterate: loperamide has saved my ass (and, in fact, my entire body, ha-ha). I tested out whether or not this was really the reason I wasn't feeling any withdrawal symptoms: I tried to skip a day, and by the next morning, I was sick as a dog. I took 8mg more, and in about an hour I was completely fine.

Online, you find stories of people taking up to 200mg of the stuff, or even more, in isolated cases; that's 100+ pills at once! That can't be good for you, and indeed one person has chronicled a story of loperamide dependence and how she caused serious damage to herself -- her heart, I think -- by taking regular, massive (I think 100-300mg!) doses of loperamide. So don't go crazy; it won't get you high, no matter how much you take. However, I read that up to 20-24mg in a day is sometimes given in hospitals, and the most common dosages, for withdrawal, are between 8 and 30mg/day. I have been taking ~20mg a day (~10mg morning, 10mg evening).

I'm thinking of making a thread about it, in fact. I know a lot of us are really scared of some situation causing us to go without our bupe, and now that I know how incredibly well loperamide works, my mind has been eased. (Incredibly well meaning: some say it takes away 95% of withdrawal, some say 50%, but the most common numbers given are 80-90%; for me, it was 99%.) I'm not a doctor, and I can't promise that it's safe to take even 10mg at once, but this is what I have read and experienced. Research it yourself if you are ever in a bind!


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