[Robert_325]

We have become over-run with questions from people requesting help in this area. Musicman and I have been tracking the following information for some time. I first used the following sub process on myself during my own personal opiate detox with subutex and musicman followed using the same principles with suboxone. There have been many success stories since. Musicman and I both use the same math formulas for giving advice based on our combined experiences.

We are sharing our experiences with what has worked repeatedly on this forum. We are not drs and recommend seeking advice from the professional of your choice in all matters that concern you.

Sub therapy is becoming the gold standard for treating opiate addiction. The main problem we see is most standard forms of sub treatment consists of a standard one-size-fits-all method for treating patients. Everyone receives the same treatment and it doesn’t work best that way. All too often a high dose is used initially as drug companies are recommending a high enough dose that will work for the most troublesome patients being used on everyone. This results in horror stories for too many patients. Most patients need very little medication for it to be the most effective.

Patients do best when treated symptomatically. Drs are being advised by drug manufacturers to RX way too much medication for whatever reasons according to the success we’ve experienced sharing among ourselves. There are always some exceptions as with any medication, but the exceptions are few and far between. When over-medicated so many of these patients under drs’ care come here as basket cases from taking too much sub.

Please review this post before asking questions about sub therapy. Many of the most commonly asked questions are addressed here for your convenience. Personal attention is then recommended at the point where the suggestions offered here cease to apply to you.

INDUCTION

This is one of the most important parts of sub therapy. If a person is not inducted properly they most always experience ongoing problems. The standard method of administering 8mg followed by an additional 8mg and so on until we often see patients being inducted with amounts as high as 32mg and more consistently proves to NOT be in the patient’s best interest.

The purpose of induction is quite simply to stabilize the patient. But we find the induction most effective when the patient is inducted at the lowest dose possible. We suggest using 2mg dosing increments dispensed at least one hour apart. This allows the patient plenty of time to make sure they are receiving maximum benefit from the medication with each additional dose. We seldom find it necessary to induct ANYONE at any more than 8mg. We have people who have inducted at 4mg – 6mg and done very well.

The people who do best historically are those who begin this therapy at the lowest effective dose. This can only be determined by a slow induction process administering minimal amounts of medication at each dosing. There are instances where higher doses are required but we still find it in the patient’s best interest to always follow the aforementioned process. 2mg drug increases administered at least an hour apart is the best way in which to determine the most effective induction amount required.

We have found things work best when the induction process lasts for a period of three 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 three days we find that the dose used to stabilize the patient can be reduced by 25% and this becomes the lowest effective dose. So doing all of this takes three days. For example if you are inducted at 8mg then after three days you should be fine reducing your dose to 6mg. This is where the patient remains until they begin to taper down their respective doses.

Allowing three 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 true 100% of the time. The amount used to stabilize doesn’t seem to be as important as the process by which the induction is done.

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 can get very sick. The time required after stopping different drugs (most RX pills vs methadone vs street drugs) varies some but the best guide is the COWS worksheet which most drs use some form of anyway. COWS (clinical opioid withdrawal scale) Go to www.suboxone.com/pdfs/OWR.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. The score of 26 is a minimum. This is very important as precipitated w/d is not fun.

It’s suggested that you go to the Need To Talk forum and check the thread titled Glad To Be Here as this is a recent induction done exactly as recommended above. More recent examples will follow. All communications are there to read on this thread. It just shows how simple this process is if done correctly. The final induction was at 6mg in this particular example.

USING SUB TO GET PAST THE OPIATE DETOX

Most of us are pretty strong believers in 12 step recovery. Even those who don’t participate in NA, AA, or whatever usually rely on church, family, or a combination of all the above for a solid system of support. Most addicts will agree it’s almost impossible to do this on our own and stay clean forever.

We agree with the medical community that a solid recovery program is nearly imperative with sub therapy as once the sub therapy ends you are on your own. Sub is an opiate. That’s why it’s called opiate replacement therapy. So when we stop the sub our long term chances are so much increased if we are involved in a quality program of recovery whatever that program might be for you.

It takes only a matter of a couple weeks, a little longer with methadone, but the point being it only takes a short time and the original opiate detox is past. We are no longer in real need of a medication used to get us past the detox. So this is where we begin to taper down.

There are ongoing arguments regarding how long one should remain on sub that are based on our using history. The success we have seen to date shows best results are overwhelmingly on the side of using sub short term. We have started to taper in as little as a week and hardly ever over three weeks following induction. People are being inducted and tapering down to nothing in a matter of 4-6 weeks average. There are no horror stories to date from anyone using sub therapy on our forum or at least none from those who use it the way we have suggested.

None of this means that some people won’t do well using sub as a maintenance medication. We just haven’t had that experience here yet. Possibly after the medication is used for a longer period of time we will see something different. Sub really hasn’t been used long term by enough people to make any statements based on any facts yet.

TAPERING

We are only going to address tapers from the induction process through reaching 4mg. Once you reach 4mg the thing that has made us successful is dealing with each person individually and according to their individual symptoms. If you have difficulty at 6mg rather than 4mg then get with us individually at that point. You may do just fine on your own all the way to 0mg following this taper plan. It’s quite obvious that we are all different to an extent.

The problems we see most often with traditional sub drs’ treatment programs are that they are very expensive and they are all the same just about regarding method. Initially the patient is RXd a high amount of medication (as much as 16-32mg are seen often) when NO ONE here ever required over 12mg in an induction (as of 12/18/08). Most are 8mg or less.

We begin tapering down until we get to the 4mg level and then we try to work individually with members. It’s quite basic reducing to 4mg. That can be accomplished by a formula. But getting to 0mg is more difficult especially for those who come to this site having been on sub elsewhere for a long time or some other type or circumstance.

Some people taper right down to zero with the standard tapering formula. That is if you will reduce by 25% of the total daily dose and maintain that dose for a period of four full days while experiencing no w/d symptoms it’s safe to reduce again by another 25% and expect the same results. If you experience any w/d symptoms during the four day period you can take .5mg sliver and the w/d symptoms usually dissipate immediately. If you require slivers to remain stable at any level you should start over the next day trying to put four days together again.

The reason for sometimes feeling w/d symptoms is the long half life of buprenorphine, the main drug that is in sub. To be very simple it can take days before we experience the w/d symptoms from sub. So this is why we wait for four days to allow for the half life. When we make it four days without symptoms we should be fine reducing again.

It’s not uncommon to have some minor side effects from sub as with almost any medication. There can be some depression, sleep problems, anxiety. So we suggest not taking the sub close to bedtime, get some mild to moderate exercise depending on your condition, there are things to do that will help lots of things. But stick with the same principles all the way down as far as you are comfortable. We are here to help at that point.

Robert_325