Page 1 of 4 123 ... LastLast
Results 1 to 30 of 95
Like Tree11Likes
Need Advice
  1. #1
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default Need Advice

    Robert and Melinda:

    I posted the other night fessing up that after an absolute nightmare of suboxone withdrawal 2 years ago I ended up back on Hydros taking 6- 10's a day for the last 6 months after a toothache that I just could not handle. I am in the process of being accepted into a suboxone program. I believe I will be inducted on Monday the 27th.They will use film. I will be out of Hydro's in the next couple of days without an idea of how to get more. I may just have to go cold turkey but I am running a business and can't see myself being able to handle it. I thought about going to the Dr. and asking him to help me with meds to get through a cold turkey. Would he be allowed to prescribe something to sleep and anti-anxiety meds to get me detoxed legally? And...if I go through with the Sub program I need to get advice on speaking with that Dr. so I do not get anymore than I need. From what I hear about this Dr. he is really good. You have to be willing to stay at the place for 4-6 hours while being inducted and the nurse told me he does use 2mg increments. I saw on another post that Robert is sick. I absolutely hate to hear that. I pray for both of you everyday because of all the support you gave me first time round. I am so ashamed of this happening again. I had been doing soooo well and of coarse, Donna can't accept nice and better things happening to her. I have to put a boot through it. Melinda, can you pleases speak to Robert on my behalf and get some answers for me? You are both doing God's work in the most incredible way. I thank you from the bottom of my heart, on behalf of addicts everywhere. Thanks again.

  2. #2
    Catrina is offline Advanced Member
    Join Date
    Jan 2010
    Posts
    1,311

    Default

    Hi DD,

    First of all, I would venture to say that most, if not all of us, have relapsed either intentionally or unintentionally, and probably more than once before we got it right. For me, hopefully I have it right this time, 16 months clean time.

    I can't address your sub treatment having only the knowledge that I have gotten here reading others posts. However, regarding your dilemma of how to get thru until the 27th when you meet with your sub doctor I do have some advice. Go see your regular doctor! Tell him exactly what's going on with you. In most cases, they are NOT the bad guys. It's the shame and difficulty in saying the words out loud that have gotten ourselves in this mess that makes us reluctant to ask for their help. I was in a similar spot. I wasn't headed to a sub doctor but I'd made up my mind to get clean. I thought I wanted to taper. While it didn't work for me and I ended up going cold turkey, I did go to my doctor and spilled my guts. Surprise, surprise. He didn't judge me. He was compassionate and tried to help me in anyway I wanted to get clean. The bonus was that once I was clean, that door was shut. No more calling to whine about my back pain, or migraine or whatever issue of the day was in order to get a script. Now, I know that if I need a doctor I may as well just call and say I need to see him.

    Call your doctor. Tell him you have an appt at the end of the month and ask him for a script to get your through. You said that you have enough for a few more days and probably that means that you should have had enough for alot longer. Well, if you tell your doctor the whole story it's not going to come as a surprise to him that you're about to run out of pills before you should. My bet is that he'll help you in whatever manner you want him to, either to prescribe things to make detox more comfortable or to give you another script to get you to the end of the month.

    Just another thought. You mentioned asking your doc for meds to help your detox more comfortable. If you go that route and manage to detox, then why bother with subs? After all I've read, I'd only go that route if you're not able to detox any other way. Again, none of my business and the bottom line is to just get clean however you decide to do it. Others with sub experience I'm sure will have better advice in that department than me.

    Good luck. You're taking the first steps. Keep us posted here and lots of folks will come out of the woodwork to give you support no matter how you decide to do this. Melinda, Robert, Henry or a host of others will be along soon to address your sub therapy.

    Peace,

    Cat
    bipolar4life likes this.

  3. #3
    Anonymous Guest

    Default

    Hi Donna
    My heart breaks for you !!! we talk about you a lot saying what a bad ASS you were...but you know what, things happen !!! I was a year clean and had to have a hysterectomy and they mest up so I was on pain pills for a couple months and did a taper off subs...so you know it happens to all of us...
    I will let Robert know.. he was coming to life a little last night...
    but I know he will want to talk to you himself...
    I dont think he got to sleep to early last night so it could be a couple hours before he gets up...
    but know worries we will get you thru this...
    talk to you soon, Melinda

  4. #4
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default Holding tight

    Thanks to you both for responding. I know how powerful this forum is and no matter what I will survive this huge hiccup and it won't kill me (well kind of) so I'll be better and stronger for it. Doesn't mean that I ever want to do this again. I knew after my first tablet that I had made a way bad decision...tooth killing me or not...but addict (I LOVE everything I like) that I am I just justified the hell out of it.
    There was just a very good multi-part article done in the local paper here about the complexity of this problem for addicts, providers, and the authorities...a multi-faceted nightmare. That is what prompted me to get back on the wagon and fix this BEFORE it was extremely OUT OF CONTROL. I am always in pain with my back and my legs and sciatica. I really could rightfully use these drugs probably for the rest of my life but WHAT A HASSLE. I want off, I want a non medicated life of humility and joy. Thanks again.

  5. #5
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Quote Originally Posted by ddosher View Post
    Thanks to you both for responding. I know how powerful this forum is and no matter what I will survive this huge hiccup and it won't kill me (well kind of) so I'll be better and stronger for it. Doesn't mean that I ever want to do this again. I knew after my first tablet that I had made a way bad decision...tooth killing me or not...but addict (I LOVE everything I like) that I am I just justified the hell out of it.
    There was just a very good multi-part article done in the local paper here about the complexity of this problem for addicts, providers, and the authorities...a multi-faceted nightmare. That is what prompted me to get back on the wagon and fix this BEFORE it was extremely OUT OF CONTROL. I am always in pain with my back and my legs and sciatica. I really could rightfully use these drugs probably for the rest of my life but WHAT A HASSLE. I want off, I want a non medicated life of humility and joy. Thanks again.




    Hi Donna ..... I have been in bed for almost a week with BAD flu. I'm starting to come around again but this is my first day out of bed. This flu has sucked badly! Felt like death this last week.

    But I wanted to tell you that I would NOT go back on subs again if I were you. You haven't used that much again for that long. I would taper down a little and then STOP COLD TURKEY and go see your regular dr. Be totally honest as he is not there to judge you but to help you.

    The dr can prescribe clonidine, a small dose of a benzo like klonopin for ten days or so, even ambien for sleep won't hurt. You'll be clean in a week and won't have to repeat the sub route again. I pray you listen to me. You'll be fine working after about three days with these meds.

    For what my opinion is worth to you that would be a MAJOR mistake to start out on subs again. I couldn't be anymore serious! Hope that helps. God bless.
    Last edited by Robert_325; 04-17-2011 at 02:35 PM.
    disabledleo likes this.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  6. #6
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default

    Hi Robert:

    Sorry it took so long to respond. I was so sorry to hear that you were so sick. I hope you continue to feel better. Flu or "flu like sypmtoms" are the worst and when you are in it, it looks like it will never end.

    First of all, I do want you to know that I have an open mind. I would never not consider carefully your advice. I know that you do know what you are talking about and I also know that you are aware of the hell I went through getting off the subs. I want to give you more information about my situation so that you can see why I think that subs would be the "best" coarse of action for me right now.

    OK...I am almost out of hydros. I have a two day supply and I cannot get another script for those until the 1st of May. My use has escalated to 8-9 a day in these last couple of weeks due mostly to anxiety, unable to sleep...basic freaking out. I am in a bad bad depression state. I see no hope for me or anything I am involved with or touch. I am not on any meds at this time for that condition. I know how severe the depression can deepen when I go off the opiads. I don't think I could survive it, I really don't. The program I am getting into is run through Catholic Charities. I have been there 3 times now and I can be inducted on the 27th. There is a womans group that I will have to attend on Wednesdays while in this program and I honestly believe that I need this support and help to help myself. I need to get heatlhier and start excercising and eating right and I don't believe by going cold turkey that these things will occur. I believe that for the short term I want to use the subs will allow me to get some of these other things into place before I start experiencing any extreme withdrawal effects. I am a rat on a wheel right now. Every day is get up, get ready, go to the store and stay there from 10:00am to 8:00pm ever night but Sunday I get off at 6:00pm. It is not much of a life except I do believe I am building something that I will eventually be able to get other help and be ok. It takes time.

    So just hear my exact plan out and then lets have another conversation. Just remember Robert that I DO KNOW THE POWER OF THIS DRUG and I want to use it as SPARINGLY AND FOR AS SHORT A TIME AS ABSULTELY POSSIBLE. I have a friend that may be able to help me with some opiates to hold me over through till the 27th when I can be inducted with the subs.As I had indicated earlier, the nurse has told me that the Dr. inducts using 2mg doses. My appointment is at 1:30 and I have to arrive with withdrawal symptoms. I know how these Dr's. are and can be, so I need to have a plan up front on how to handle him and what to say so I do not get more than I need. Providing the induction goes as it should, then I would follow your tapering schedule and continue in the counseling program. I have an appointment with a nutritionist,I have an appointment with a dentist, and I have a plan to start walking in the park, or in the mall as soon as I can get a new pair of sneakers and a Ipod shuffle...

    This time I need a full support system to really change my life and bring myself back up from the shell of a person I fell like I am right now. I want this really bad and if you can think of another way please let me hear it. Like i said, I am all ears...i really am. If there is a way without the subs that is reasonable and I will be able to function and not be at risk I will do it. Thanks you Robert for listening. And melinda...thank you lovely wife for me too. Talk soon.

  7. #7
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Donna ...... You know that I am not opposed to using subs to get clean. But I don't want to see you end up in the same situation as before. Make sure you've thought this out good. Subs are just a tool, you have to do the work. Subs are no miracle drug, they are just a tool to help you get clean. You have to stay clean yourself.

    If you do this again with subs I would really suggest you get involved in NA seriously on a daily basis. You're always going to face potential temptations, that's our life, at least until we get a bunch of years clean. If you do this please follow the taper plan to the letter.

    This is your call. I don't have all the answers for sure. I will be there to help you whatever you decide to do. I simply suggest that if you're going to go the sub route that you do it the right way this time and don't jump off before you're ready. God bless.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  8. #8
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default

    Robert:
    I was clean for 1 1/2 years and did not actively seek getting back on meds. It was stupid and a huge mistake and yes I do need to do the work and get the help and support I need...this is why I want to be in this program. I need other recovering people around me and I need to get
    healthier. My REAL energy level sucks. I am not at a point where I have the luxury of time to do a serious withdrawal cold turkey. It is going to be hard enough to try to keep the intense schedule of appointments I'll have to keep to remain in the program. I have to work ALL THE TIME. I have noone else to help me. I cannot afford it.

    So I need for you to give me specific instructions as to how to induct under the Dr's care. I have a 1:30pm appointment on the 27th. How should I prepare other than to stop taking pills the day before? Should I tell him how I want to take the drug and in what mgs? After I begin, how long do you suspect I will have to continue until I can come off and how long does it usually take to taper? Thanks you so much for your help Robert.

  9. #9
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Quote Originally Posted by ddosher View Post
    Robert:
    I was clean for 1 1/2 years and did not actively seek getting back on meds. It was stupid and a huge mistake and yes I do need to do the work and get the help and support I need...this is why I want to be in this program. I need other recovering people around me and I need to get
    healthier. My REAL energy level sucks. I am not at a point where I have the luxury of time to do a serious withdrawal cold turkey. It is going to be hard enough to try to keep the intense schedule of appointments I'll have to keep to remain in the program. I have to work ALL THE TIME. I have noone else to help me. I cannot afford it.

    So I need for you to give me specific instructions as to how to induct under the Dr's care. I have a 1:30pm appointment on the 27th. How should I prepare other than to stop taking pills the day before? Should I tell him how I want to take the drug and in what mgs? After I begin, how long do you suspect I will have to continue until I can come off and how long does it usually take to taper? Thanks you so much for your help Robert.



    Donna....... I have copied and pasted the induction section of my sub therapy link. This is how I would do it with you if I was inducting you. I wish you could get the meds and let me do the induction. Guarantee I can induct you at half the dose the dr does it minimum.


    INDUCTION
    The induction is one of the most critical parts of sub therapy. If a person is not inducted properly they often experience ongoing physical and emotional problems throughout the entire sub therapy process. The standard method that many sub drs use of administering anywhere from 16mg to as high as 32mg or more during induction consistently proves to NOT be in the patient’s best interest. These doses inevitably lead to a patient with a physical dependency to the very medication that was supposed to help free them from their dependency.

    The purpose of the induction is simply to stabilize the patient ending their w/d symptoms. We find this happens most effectively when the patient is inducted in dosing increments where the patient stabilizes at the lowest effective dose. We suggest using 1mg - 2mg dosing increments dispensed at least one hour apart.(Using 1mg or 2mg increments is determined by the patient’s using history.)This allows the patient enough time to ensure they are receiving maximum benefit from the medication prior to taking each additional increment while stabilizing. We seldom find it necessary to induct ANYONE at more than 8mg. We have people who have inducted at less than 2mg and we are typically successful with inductions totaling 3-6mg. The people who do best historically are those who begin this therapy at the lowest effective dose. This can only be achieved with an induction process administering minimal amounts of medication at each increment.

    The induction process should last for a period of 4-5 days. The first day is when the patient is initially stabilized. On the second day the induction dose is split into two equal doses as this will help with making tapering easier later in the process. At the end of either three or four days we find that the dose used to stabilize the patient can be reduced by 25% on the following day and this becomes the lowest effective dose. So doing all of this takes 4-5 days depending on the individual. This is where the patient’s dose remains until they begin to taper down the dose.

    Allowing 4-5 days provides ample time to adjust the induction dose as may be required to maintain the stability of the patient. Those patients who don’t stabilize properly have problems throughout their therapy. That is always the case. The amount used to stabilize doesn’t seem to be as important as the process by which the induction is done up to a point as previously mentioned.

    It’s imperative the patient be in a state of moderately severe to severe w/d at the time of induction. Otherwise it’s likely the patient will experience precipitated w/d. In short they end up deathly sick. The time required to reach severe w/d after stopping different drugs ( pills vs methadone vs street drugs) varies some but the ABSOLUTE best guide is the COWS worksheet which most drs use some form of anyway. COWS (clinical opioid withdrawal scale) Go to http://www.drugs.com/resources/opioi...wal-record.pdf for the worksheet. If you make sure you’re at a 26 or above accumulatively on the worksheet then you will normally do well with induction if the aforementioned dosing procedure is adhered to. The score of 26 on the COWS worksheet is a minimum. This is a non-negotiable factor that not all drs follow hence they administer large doses of medication attempting to cover up the precipitated w/d.


    Donna I hope this help but again I wish that I could induct you myself. Give yourself plenty of time in w/d so you don't go into precipitated w/d. God bless.
    Last edited by Robert_325; 04-18-2011 at 05:47 PM.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  10. #10
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default

    Robert:

    Noone wishes more than me that you could be the one doing the initial induction. However, I plan on giving the Dr. this induction plan and telling him that I do not want to be on Suboxone any longer than absolutley necessary and to that end I want to take as little as I need the first time. I have talked with someone that knows the Dr. well and I have been told that he will listen.
    So, I am going to suggest starting me with 1mg and waiting a full hour. I am already weaning off the loratabs and I will be in big time withdrawal when I go there. Next Wed (1 week) after I am inducted I will come home and post what has occurred so that we can figure out how to proceed. If you want me to reinduct because things are not right i will do it. I want to be off these things as quick as possible. I want to follow you to a t. Period. Not any less not any more. Exactly what you say. Thank you so much Robert.

  11. #11
    disabledleo is offline Member
    Join Date
    Oct 2007
    Posts
    373

    Default I have to say its nice

    Robert Its soo nice to read your posts again & I must have soaked up a good bit of your knowledge because after reading first post my thoughts were EXACTLY what your first post read.. I hope you are feeling better & you have had my prayers & you were on my mind EVERYDAY since you've been laid up.
    Melinda told me you both are on facebook but I do not know enough info to find you both. Pass on to Melinda I'm the 1 in Richmond Va. & my picture is with both my angels on each arm. Have her find me & request friendship & make sure to leave a note who she is so I understand.
    See you both have made a huge impact on my life & I thank you for my entire family & friends for bringing me back....

  12. #12
    Anonymous Guest

    Default

    Quote Originally Posted by disabledleo View Post
    Robert Its soo nice to read your posts again & I must have soaked up a good bit of your knowledge because after reading first post my thoughts were EXACTLY what your first post read.. I hope you are feeling better & you have had my prayers & you were on my mind EVERYDAY since you've been laid up.
    Melinda told me you both are on facebook but I do not know enough info to find you both. Pass on to Melinda I'm the 1 in Richmond Va. & my picture is with both my angels on each arm. Have her find me & request friendship & make sure to leave a note who she is so I understand.
    See you both have made a huge impact on my life & I thank you for my entire family & friends for bringing me back....
    see if you can find me under Melindaw49@yahoo.com I cant seem to pull you up

  13. #13
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Quote Originally Posted by ddosher View Post
    Robert:

    Noone wishes more than me that you could be the one doing the initial induction. However, I plan on giving the Dr. this induction plan and telling him that I do not want to be on Suboxone any longer than absolutley necessary and to that end I want to take as little as I need the first time. I have talked with someone that knows the Dr. well and I have been told that he will listen.
    So, I am going to suggest starting me with 1mg and waiting a full hour. I am already weaning off the loratabs and I will be in big time withdrawal when I go there. Next Wed (1 week) after I am inducted I will come home and post what has occurred so that we can figure out how to proceed. If you want me to reinduct because things are not right i will do it. I want to be off these things as quick as possible. I want to follow you to a t. Period. Not any less not any more. Exactly what you say. Thank you so much Robert.



    You got it Donna. Let me know when you get back from induction and we'll decide together what is best moving forward. I'll help you all the way through this time. God bless.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  14. #14
    Mikki111 is offline Junior Member
    Join Date
    Apr 2011
    Location
    On an Island
    Posts
    36

    Default Thank You So Much!

    Hello Robert and Donna,
    I have been following your posts for over nine months, I have made copies (run out of ink, twice) and continued to read and re-read your wonderful, thoughtful, compassionate and knowledgeable advice. I have taken all the advice you have offered so freely and without judgement and my apt to begin the suboxone is May 3rd. I believed I did everything right I found a great Doc, got lots of great feedback from their other patients in the program. I will get to the "problem" I need help with in a minute.
    My story is no different than all of our stories, I will not fill theses pages with my medical background. I will tell you where I am today briefly and how I got here. I had three surgeries 1995,1996 and 2000. I went on Fentany in 1998 l started at 50 went to 100 then 150 then 200 until 2009 My Primary Doc and I have been lowering the doses for the past 2+ years I am now on 50mcg. This is the dose of the patch I will remove on May 1st. My journey has not been easy but it has always included a patch stuck on my chest! and I am done, or will be May 3rd.
    Now, the problem I really need your help with.
    The Sub. Doctor today has told me I will be starting on a suboxone 16mg pill!!To start!This is the dose he will be starting me on in the office the first day, the first dose!!!! I almost fell over when he said it. I told and showed him everything you both have said about starting low and if needed moving up during the day slowly. Well he went on and on about the fentanyl in my system and how long it has been there and I don't even know what else he said because all I could think about was getting home to ask you both what to do. I have met with this Doc six times over the past three months and the dosage never came up. Please let me know what I need to do. I have some time as I can continue on the 50 mcg fentanyl.
    I really need your help. Please help me...
    Could this be right? for my situation? Oh I have so many questions, but I will wait to hear from you.
    Thank you so much for being here day after day. You are Blessings!

  15. #15
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Mikki111....... I don't care what he said 16mg is a CROCK!!! I guarantee you that I can induct you on no more than 6mg, probably less. I've inducted tons of people coming off fentanyl. Granted fentanyl is bad news but 16mg is the "sub dr standard dose for everyone". THAT IS A FACT!!!

    I would ask for your meds and tell him you'll induct yourself. Tell him you'll come back the second day and if you aren't totally stable on about a third of what he wants you to take you'll do anything he says. Then we can do it here and I'll induct you myself the right way.

    I'll bet you I've inducted as any or more people that the goofy sub dr has. I know how to do this and he can't say in advance exactly what dose you need. That is total BS, DON'T DO IT is my advice.

    If you have no other option, you can stop the subs after he inducts you for a day or two, then I'll re-induct you and he'll freak out totally when you go back to see him on a tiny dose proving what I'm saying is right. Let me know. God bless.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  16. #16
    Mikki111 is offline Junior Member
    Join Date
    Apr 2011
    Location
    On an Island
    Posts
    36

    Default

    Thank you so much Robert for such a quick response!
    You are awesome...
    I am going to make another apt. with him before I start the
    suboxone and will bring all of your posts with me. If he is not
    willing to go lower than 16mg then I will take your advice, leave the
    apt with my meds and we will do it together.
    I don't understand how to re-induct, does that mean I would have to
    go back on fentanyl and back into w/d and start sub again?
    I am sorry I just want to understand what I need to do.
    Do you think the 6mg is acceptable to start? I want to be confident
    in a dose you think is good to ask him to start with.
    I am being totally honest with you Robert when I said I never heard
    another word he said after he said 16! You have never wavered
    Ever about starting low, always low, the lower the better.
    Thank you again so much
    I would not have taken this route nine months ago without your advice
    to the many people I have watched get through this with you.
    and the constant to it, you never waiver and it works, I have watched
    for months and now I will join the others you have so graciously helped.
    Please just let me know what I need to demand he start me at. and
    the please explain the re-induct to me.
    Thank you so much...

  17. #17
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default W

    I can't or wouldn't tell anyone the exact dose they should induct at because everyone is different. It's the induction process that is important. This comes from the sub therapy post in Featured Drugs that we've used here for years successfully.....

    INDUCTION

    The induction is one of the most critical parts of sub therapy. If a person is not inducted properly they often experience ongoing physical and emotional problems throughout the entire sub therapy process. The standard method that many sub drs use of administering anywhere from 16mg to as high as 32mg or more during induction consistently proves to NOT be in the patient’s best interest. These doses inevitably lead to a patient with a physical dependency to the very medication that was supposed to help free them from their dependency.

    The purpose of the induction is simply to stabilize the patient ending their w/d symptoms. We find this happens most effectively when the patient is inducted in dosing increments where the patient stabilizes at the lowest effective dose. We suggest using 1mg - 2mg dosing increments dispensed at least one hour apart.(Using 1mg or 2mg increments is determined by the patient’s using history.)This allows the patient enough time to ensure they are receiving maximum benefit from the medication prior to taking each additional increment while stabilizing. We seldom find it necessary to induct ANYONE at more than 8mg. We have people who have inducted at less than 2mg and we are typically successful with inductions totaling 3-6mg. The people who do best historically are those who begin this therapy at the lowest effective dose. This can only be achieved with an induction process administering minimal amounts of medication at each increment.

    The induction process should last for a period of 4-5 days. The first day is when the patient is initially stabilized. On the second day the induction dose is split into two equal doses as this will help with making tapering easier later in the process. At the end of either three or four days we find that the dose used to stabilize the patient can be reduced by 25% on the following day and this becomes the lowest effective dose. So doing all of this takes 4-5 days depending on the individual. This is where the patient’s dose remains until they begin to taper down the dose.

    Allowing 4-5 days provides ample time to adjust the induction dose as may be required to maintain the stability of the patient. Those patients who don’t stabilize properly have problems throughout their therapy. That is always the case. The amount used to stabilize doesn’t seem to be as important as the process by which the induction is done up to a point as previously mentioned.

    It’s imperative the patient be in a state of moderately severe to severe w/d at the time of induction. Otherwise it’s likely the patient will experience precipitated w/d. In short they end up deathly sick. The time required to reach severe w/d after stopping different drugs ( pills vs methadone vs street drugs) varies some but the ABSOLUTE best guide is the COWS worksheet which most drs use some form of anyway. COWS (clinical opioid withdrawal scale) Go to http://www.drugs.com/resources/opioi...wal-record.pdf for the worksheet. If you make sure you’re at a 26 or above accumulatively on the worksheet then you will normally do well with induction if the aforementioned dosing procedure is adhered to. The score of 26 on the COWS worksheet is a minimum. This is a non-negotiable factor that not all drs follow hence they administer large doses of medication attempting to cover up the precipitated w/d.

    ------------------------------------------------------

    I start people at 1mg - 2mg and they wait at least an hour before taking any more. It takes that long for small amounts of sub to work to its full effect. I have inducted several people at a little over 1mg. I would NEVER consider giving ANYONE 16mg at a time. That is pure insanity or lack of knowledge. Hope that helps.

    And if I re-induct someone you simply stop the subs and wait until you go into w/d again and score at least a 26 score on the COWS worksheet. Then I would induct you again properly. It's not that bad considering you would likely be on a dose of 3-4mg instead of 16mg and able to do this process successfully. God bless.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  18. #18
    Mikki111 is offline Junior Member
    Join Date
    Apr 2011
    Location
    On an Island
    Posts
    36

    Default

    Thank you again! I will keep you posted the date I start is May 3rd
    I will check in with you the day before and we will do this together!
    Again, thank you so much
    ~We know what we are - But know not what we may be

  19. #19
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default

    Hi Robert:

    I am going to be inducted this afternoon. I will be armed with all my information for the Dr. and I am praying hard that this goes the way it should. I do think it will. I have read the induction info you posted for me and i get it. I am seriously hoping for a very light induction amount, and I will do my best to HONESTLY assess how I feel after my first amount. I'm sure that can be tricky. I am taking my copy of COWS. I will post as soon as I can. Thank you so much Robert.

  20. #20
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Quote Originally Posted by ddosher View Post
    Hi Robert:

    I am going to be inducted this afternoon. I will be armed with all my information for the Dr. and I am praying hard that this goes the way it should. I do think it will. I have read the induction info you posted for me and i get it. I am seriously hoping for a very light induction amount, and I will do my best to HONESTLY assess how I feel after my first amount. I'm sure that can be tricky. I am taking my copy of COWS. I will post as soon as I can. Thank you so much Robert.




    Keep me posted. You should NOT need very much and be sure to wait a MINIMUM of an hour between each 1mg dose. You could take 2mg the first dose but no more than 1mg after that. You can even use .5mg doses to be sure you're at a small induction dose. God bless.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  21. #21
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default

    OK Good News....all the information that they gave me to begin the progam must have ben outdated and the Dr. no longer inducts in the office, which is wonderful because now I can do it with Roberts help. I am not yet ready according to the COWS sheet. The Dr. gave me a script for 8mg film ( I haven't opened one yet but it says 8mg/2mg) so I am assuming they are already cut into 2mg. So Robert I need to know how you want me to proceed. I am actaully thinking of trying to make it through the night into the morning before I start, but I don't know if I'll be able to handle it. I have a lot of work I'm doing and I cannot afford to lose a lot of sleep. I didn't get a lot last night. Just so you know, the Dr. prescribed for me to take 4mg. once a day. Please tell me what to start at and then how to determine from the COWS and the way I feel how much to take subsequent..in what increments? .25 or .50. I am a picture framer remember and I have some beautiful sharp blades that should handle that film nicely. Waiting to hear from u. Thanks.
    Last edited by ddosher; 04-27-2011 at 04:13 PM.

  22. #22
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Quote Originally Posted by ddosher View Post
    OK Good News....all the information that they gave me to begin the progam must have ben outdated and the Dr. no longer inducts in the office, which is wonderful because now I can do it with Roberts help. I am not yet ready according to the COWS sheet. The Dr. gave me a script for 8mg film ( I haven't opened one yet but it says 8mg/2mg) so I am assuming they are already cut into 2mg. So Robert I need to know how you want me to proceed. I am actaully thinking of trying to make it through the night into the morning before I start, but I don't know if I'll be able to handle it. I have a lot of work I'm doing and I cannot afford to lose a lot of sleep. I didn't get a lot last night. Just so you know, the Dr. prescribed for me to take 4mg. once a day. Please tell me what to start at and then how to determine from the COWS and the way I feel how much to take subsequent..in what increments? .25 or .50. I am a picture framer remember and I have some beautiful sharp blades that should handle that film nicely. Waiting to hear from u. Thanks.



    Donna ..... That is awesome news! This is going to work SOOO much better than the last time when you jumped at what .... wasn't it 8mg? At any rate the 8/2 strips are 8mg of suboxone. They have 8mg of buprenorphine and 2mg of naloxone. So that is fine. They charge almost as much for 2mg doses as they do for 8mg so glad you got 8mg to work with.

    I wish you would score yourself on the COWS worksheet and tell me what you score. That would give me a pretty good idea of where you stand. When did you last take opiates? With that info and your current COWS score I can give you a fairly accurate estimate of when you need to begin.

    We will start with a 1mg dose and wait an hour when we do this. Then we will add only .5mg doses beyond that. I'm hoping we can induct you at less than 3mg for sure, maybe even 2mg or less. I'll wait to hear back from you with your current COWS score.

    I am excited for you. We are going to knock this out for good for you this time! God bless.
    Ggeo likes this.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  23. #23
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default

    Sorry for delay...I'm here in the mall...I'm alone and have been fairly busy with customers and questions since I last posted...except of course for the fairly good gash I gave to my left index finger knuckle...probably should be stitched...but I did a nice job of just piecing it back together and hoping for the best. OK I last used yesterday at about 10:00pm...before I went to bed. I used 1/2 of a morphine pill I got from a good friend. I was out of hydros and she kicked in to get me thru until induction. I do not have any more though so next step is subs. I'm only scoring 10 right now on COWS probably because the morphine is somewhat stronger than the hydros...but I only had 8 of those to get me through.
    Last edited by ddosher; 04-27-2011 at 06:50 PM.

  24. #24
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Quote Originally Posted by ddosher View Post
    Sorry for delay...I'm here in the mall...I'm alone and have been fairly busy with customers and questions since I last posted...except of course for the fairly good gash I gave to my left index finger knuckle...probably should be stitched...but I did a nice job of just piecing it back together and hoping for the best. OK I last used yesterday at about 10:00pm...before I went to bed. I used 1/2 of a morphine pill I got from a good friend. I was out of hydros and she kicked in to get me thru until induction. I do not have any more though so next step is subs. I'm only scoring 10 right now on COWS probably because the morphine is somewhat stronger than the hydros...but I only had 8 of those to get me through.




    Donna ...... I don't recall your time zone. I'm CST in Texas. You could POSSIBLY be ready later on tonight, if not tomorrow for sure. You still have a little ways to go being only a 10 score, but some people have symptoms that kick in pretty fast once they begin.

    Let me know what time zone you're in so I'll know if it's early or late where you are. Then we'll plan on talking later tonight and deciding whether we need to wait until morning or if you'll be ready later tonight. Will look for your reply at your first convenience. God bless.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  25. #25
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default

    I'm in New York and it is 8:48pm. And boy were you right...I am up to 20 already.

  26. #26
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Quote Originally Posted by ddosher View Post
    I'm in New York and it is 8:48pm. And boy were you right...I am up to 20 already.



    Just as I anticipated.

    I would bet you're ready in another hour or thereabouts. It's only 8:00 here and there is no reason for you to suffer through the whole night. I will be happy to stick this out with you and get you stable tonight.

    I'll watch the forum for your reply. I expect that you'll be up to a 26 in an hour or so like I said. Then you'll get a great night's rest and be ready to go in the morning feeling great. Just let me know when you are ready.

    This is going to be SOOO much better for you than when we first talked a couple years ago. I'm excited for you. God bless.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  27. #27
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default

    OK Robert...I am ready. How do you want me to do this...How much and should I just eyeball this film and slice off what you tell me as you tell me? I have to say once again Robert...thank God for you.

  28. #28
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Quote Originally Posted by ddosher View Post
    OK Robert...I am ready. How do you want me to do this...How much and should I just eyeball this film and slice off what you tell me as you tell me? I have to say once again Robert...thank God for you.



    We are going to do this in very small increments. It may take us a couple hours or so but you will be the winner in this deal ending up on a very low dose and doing a short run on subs this time that ends pleasantly and without all the pain and sufferering like your last time.

    Measure the total film strip length and that will be 8mg. I want to you to take 1mg or 1/8 of the total film strip. Use a razor is the best thing. If you need more in an hour we will be cutting back to .5mg. So write down the length of the 1mg piece as you'll be cutting only half ot that for the next dose. Remembering the length of that 1mg will enable you to easily cut a piece that is only .25mg if we need it. So write it down how long that 1mg piece is in length, put it up under your tongue and give it a good hour. Then post back to me in an hour how you feel.

    I hope to be able to see you at less than 3mg max, maybe closer to 2mg or less when we finish tonight. I'll watch for your reply in an hour. Let's knock this out! God bless.
    Last edited by Robert_325; 04-27-2011 at 10:08 PM.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

  29. #29
    ddosher is offline Member
    Join Date
    Mar 2009
    Posts
    164

    Default

    OK for the record the strip is 7/16". I took 1 mg and am ready to take another .50. Do feel better but am still charting about 18 on the COWS.

  30. #30
    Robert_325 is offline Retired
    Join Date
    Jul 2007
    Location
    Texas
    Posts
    16,689

    Default

    Quote Originally Posted by ddosher View Post
    OK for the record the strip is 7/16". I took 1 mg and am ready to take another .50. Do feel better but am still charting about 18 on the COWS.


    Thanks for that info. I actually didn't know how long the strips were. I have never used them as they are new. I learn something new I can use every day.

    It's fine to take another .5mg. Let me know how you're doing in an hour,. The fact that you feel some better with only 1mg is a great sign. Talk soon.
    I am not a dr. My statements are based on years of experience and related education. Consult with the professional of your choice regarding matters of concern.

Page 1 of 4 123 ... LastLast

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22