[desert rat]

Forgive me, but this may be lengthy...
First, Robert_325, I have to commend you for your attentiveness, compassion, empathy & apparent expertise re Suboxone,etc w/d. It appears you have been able to help many who otherwise, I fear, would be lost.
Secondly, I am coming to you for some assistance. Perhaps ironically, I am a physician (see disclaimer below). Against my inclinations, I was referred to a pain clinic & started on opiods over 5yrs ago for what I have now realized was medication-induced intractable HA (I had previously had multiple cranial surgeries). I was placed on high doses of every class of opiods over that time. Not only did I fail to obtain adequate pain control, but the side-effects were worse than the pain, & my quality of life deteriorated even further. It was as if I were in constant w/d - sweats, chills, anxiety, extreme mood swings. (I'll omit the difficulties that interviened w/ the healthcare profession.) I finally insisted that I be taken off all opiods & was started on Suboxone,@ home induction, & told to take whatever dose it took to 'stay commfortable' re w/d up to 32mg.
It seemed to take 32 mg/d, although I don't think it was a'good' induction. After apx 4-6 wks, I titrated down (my initiative) to 24mg/d. I finally confronted my doc re: if his plan was to use subox as replacement tx or if he was going to help me get off opiods as I had originally requested. He confessed it was the former. I again req that he help me get off opiods. His plan was to decr from the current 16mg by 1mg/wk & he said it would take 4 mos. He rx'd clonidine, bentyl, baclofen, & klonopin for w/d sxs. Unfortunately, the side effects continued, & were intolerable! I couldn't fathom 4mos of this, so I requested to completely d/c subox. I was admitted essentially for sedation for the 1st 3 days, basically slept & had no problem. I was d/c'd w/ the advice that I had had a 'mild w/d'! (although I was warned that it would take 3-12mos to recover fully). (due to size limits, I'll continue this in a separate post)

[Robert_325]

desert rat ... I am appalled at the way you describe your treatment thus far. I have to get to the post office to get some things out in today's mail but will be back shortly. Looking forward to hearing the rest of your story.

I will be happy to share whatever I am able to when you complete sharing your story. I have actually worked with several others in the medical profession. As you know, none of us are exempt from developing dependency problems , not even drs. I look forward to talking with you again shortly. God bless.

[desert rat]

(cont)12/20 was last dose of Subox. After that, true w/d sxs began. Sweats, chills, abd cramps-was quite sedated w/ clonidine. Bentyl controlled abd sxs. There were 1 or 2 days that I could fxn for a few hrs-almost seemed like some coincidental med combo
PM of d11 was good. D12 began what seemed true hell...anxiety, severe leg & back pain. Prev mentioned drugs didn't help, nor did aleve, tylenol, exercise, stretching, whirlpool, epsom salts, BioFreeze.etc
After 3d,went to ER. Toradol offered no relief. Given Ultram & flexeril on dischg. Ultram did help w/leg & back pain, which has recurred intermittently. Yest was day 24 since last subox dose (16mg/d). Fxning has been virtually impossible due to on-going heebie-jeebies & anxiety. Klonopin, max Clonidine, flexeril not much help except to make me weak & tired. Ambien has helped w/sleep until waking in panics @3am. Have been following posts, & as much as the internet has been faulted for giving bad advice, they have been a source of validation, info & reassurance-esp when my 'addiction specialist' from a world-renowned luxury treatment center said I was 'somatatizing'. (I'm not rich-I pay him $100/30mins thru his ancillary practice). Fortunately, I also had sneezing & some other involuntary w/d sxs that, along w/ the validation from this site, kept me from feeling totally abandoned &/or hopeless.
Finally to my question-
based on need to fxn & sheer desperation (& no resp from my doc), I took a 'sliver' of Subox (est 0.5-1mg) yest 1pm. What a difference-was able to go for a walk & do household chores until the sxs recurred around 6 hrs later (told doc&asked for advice-still no resp). Today, woke pretty ok-should've gotten right up & out for walk, but sat around & the heebie jeebies/anxiety started. Took 0.5mg (sliver) @ 1pm today & am doing ok (need to get stuff done but wanted to do post)
***Question for Robert, musicman, others
1) is this relapse?
2) what would you rec re dosing to finish off w/d, yet stil fxn? (have enough subox)...
God bless you & thanks!

[Robert_325]

What a mess! I am blown away that a dr would agree to placing another dr on 32mg per day of suboxone. Obviously there is no honor between drs. I know this isn't funny at all but this is one of the most obvious examples of suboxone being used improperly I've seen to date. I just can't hardly imagine this being between drs.

I "sort of " agree with the philosophy that induction should be completed with whatever amount of suboxone required to stabilize the patient (within reason). But NEVER in my life have I seen anyone require 32mg to stabilize. I had a lady this morning stabilize on 4mg at induction as an example. It normally takes between 6mg-8mg to stabilize, occasionally a little more or a little less. But that is all.

The suggestions that musicman and I make are based on the process that I basically developed for myself when I personally detoxed using subutex. I was previously taking thirty 30mg roxicodones plus 25-30 lorcets, lethal amounts of benzos and soma daily and I stabilized at 12mg, then reduced to 8mg after three days. And I had abused opiates since the late 1960s. If I stabilized at the dose I did I just can't imagine someone else being any worse off than I was and requiring so much more medication. So forgive me as I am not judging but with all due respect taking 32mg of suboxone is insane. It's just not necessary. And then to remain on that dose for up to six weeks before titrating down to even 24mg???? I've never even heard of anyone being RXd suboxone in those amounts for so long except for an RN who came through here some time ago. She had previously been prescribed 40mg. I had her down to 8mg in less than two weeks. To top all this off the dr was planning on keeping you at that dose on a maintenance program if I understand correctly? I don't even know how to respond to a dr giving that type of advice especially to a fellow dr. It's no wonder you felt like hell while you were doing this. The medication was most likely making you sick with side effects.

According you your post the final dose of suboxone you took was on December 20, 2008 @ 16mg. At this point all the clonidine, flexeril, ultram, ambien, klonopin, etc are irrelevant. None of that matters now. Except I will add however that with a RX for klonopin on top of 32mg suboxone you are fortunate that you didn't experience respiratory depression. Don't drs use a PDR or something prior to handing out medications that pose such a high risk for adverse drug interactions?

I would not be the least bit concerned about a relapse at this point. You NEVER should have stopped taking the suboxone while at 16mg per day titrating down from months of use starting with six weeks at 32mg. That was a certain disaster the second your detox began from the suboxone. You just don't jump off suboxone at 16mg, especially not after being on it for months at the kind of doses you were taking. You have been in horrid buprenorphine w/d since 12/20. It's obvious with your physical response to the small doses of suboxone you've recently taken.

I don't know if you will like my suggestion or not, but I can tell you what I would do if I was in your place. You need to be re-inducted at a small dose the correct way, stabilized again, and titrated down properly. I want you to understand why I am saying the things I am saying and what I am basing these statements on. Go to the following link and read the process that I developed for myself. This is what has worked for countless numbers of people on this forum.

http://www.drugs.com/forum/featured-...apy-50887.html

I would imagine that you could be inducted at a micro-dose basically. I am not saying that you would start out like someone taking suboxone for the first time. But you need to be re-stabilized and then we can reduce your dose properly (according to the taper schedule on the aformetioned link). Unless you are stabilized you might as well just finish this cold turkey and be miserable. Why do that? You have all this suboxone left over, might as well get yourself out of w/d and get on with your life. I will help you if you want me to. But I would insist on doing it per the "suboxone/subutex therapy" post that you will find at the above link. Let me know if you wish to proceed as I have suggested. God bless.

[musicman48]

Dr,I just wanted to say something quickly and I will be gone.I have a friend that I met thru NA, that was in the same cond that you are in.He stopped his sub therapy CT at 8mg bid.He was miserable needless to say.After being off sub for 19 days I talked him in to being re-inducted at 2mg bid.This was enough for him.He was titrated down using Roberts taper plan "that I also used"and is now on his 5th day wo sub.He is doing much better .When I say much better , he is still having sleep issues,restlessness,etc but in much better shape than he was prior.I think Robert's suggestion of "starting over" is a great idea in your case.If my friend was here he would say the same thing.Good luck and God bless.

[desert rat]

Thanks for the input, Robert & musicman. Perhaps I need to defend my most recent collegue as he was giving me a lot of leeway re: subox dose so that I could function for an important trip...so I had some control re: the dose, although I was not advised re: reasonable dose range (until meeting later w/another colleague for whom I have great respect). Anyway.....I am questioning the information physicians are being provided by the pharmaceuticals/FDA re: this (and other drugs), and I am coming to believe that this is the fundamental problem.
Re: my case....though still on a Catapress patch, today was much better (as I think I mentioned, I used another 0.5 subox)...no other supplimental meds (except Ambien, which I anticipate needing for several mos until my sleep centers 'reset').
I am afraid to udno all the 'gains' thus far...and think perhaps I will try the 'middle road' since I seem to be stabilizing. I'm going to try your 4-day rule, and try to stabilize on the 0.5mg x 4 d. Then???? Will probably be a woose, and try 0.25mg/d x 4 d. (vs. 0.5mg every other day), then go to 0.25mg every other day, then off. Given where I've been, I'm feeling pretty good now.
Please let me know if you see some significant problem w/ this plan. I really DO NOT want to go back up on the dose if I don't have to!!!!!
Despite his requests that I keep in contact (and I have done so), the doc is typically MIA. Kind of waiting to see how things go before I decide whether to sched f/u appt, perhaps at least to provide him w/ the benefit of our experiences .
Thanks again for your help.

[musicman48]

Originally Posted by desert rat

Thanks for the input, Robert & musicman. Perhaps I need to defend my most recent collegue as he was giving me a lot of leeway re: subox dose so that I could function for an important trip...so I had some control re: the dose, although I was not advised re: reasonable dose range (until meeting later w/another colleague for whom I have great respect). Anyway.....I am questioning the information physicians are being provided by the pharmaceuticals/FDA re: this (and other drugs), and I am coming to believe that this is the fundamental problem.
Re: my case....though still on a Catapress patch, today was much better (as I think I mentioned, I used another 0.5 subox)...no other supplimental meds (except Ambien, which I anticipate needing for several mos until my sleep centers 'reset').
I am afraid to udno all the 'gains' thus far...and think perhaps I will try the 'middle road' since I seem to be stabilizing. I'm going to try your 4-day rule, and try to stabilize on the 0.5mg x 4 d. Then???? Will probably be a woose, and try 0.25mg/d x 4 d. (vs. 0.5mg every other day), then go to 0.25mg every other day, then off. Given where I've been, I'm feeling pretty good now.
Please let me know if you see some significant problem w/ this plan. I really DO NOT want to go back up on the dose if I don't have to!!!!!
Despite his requests that I keep in contact (and I have done so), the doc is typically MIA. Kind of waiting to see how things go before I decide whether to sched f/u appt, perhaps at least to provide him w/ the benefit of our experiences .
Thanks again for your help.

Considering your history,you may want to consider tapering to .125...just a sliver.

[desert rat]

Ok, Robert.....maybe I need to listen. A bad night, even w/ Ambien, no sleep, restless, some sweats......
Day 27 from 16mg/d - 0mg/d, 2 days so far @ apx 1mg subox.
Am going to try induction, up to a max of 2 mg 2x/d x 4 d. as per you & musicman & see what happens. Am using 8/2 subox or 8mg subutex, but still have rx for 2/0.5mg subox that I'm thinking I should fill so we can microtitrate, despite the expense? How many do you think I will need?
Thanks for the help, again.

[desert rat]

Robert or Musicman - today is day 3 of my re-microinduction....Have been taking apx 1mg 2 times a day. Going fairly well. Took your advice re taking sobox dose near bedtime (10p). Last night woke 'on schedule' @ 3am w/ pretty bad sweats...worse than the night before. Enough so that I had to take a 'sliver' of subox. Then I took my usual 1mg @ 7am. Have noticed yest & this am, if I don't eat something before I get moving, I get pretty nauseated. Resolves if I eat.
Anyway, today seems a little more symptomatic re: w/d sxs.
Am I doing ok re: the micro-induction?? Am I too low on the dose? Should I plan on titrating down after day 4 (tomorrow)? I am going to go ahead & get 5 tabs of the 2/0.5mg sub's to help do the lower doses.
I appreciate your help. Robert, thought I heard you had dental work done...hope you're feeling better. MM-please forgive me if it seemed I was 'dissing' you....not my intent. You both have your hands full doing all you're doing to help everyone-too much for one. I trust both of you & happy to take suggestions for either. I can't tell you how much I appreciate your help after all I've been thru. 10 yrs of being disabled when I probably didn't need to be, all because of misdiagnosis (although I do have facial neuropathy from screwed up sinus surgery, its controlled w/ low dose neurontin. The really intractable facial pain that no one could figure out (so they just kept piling more drugs on (incl narcs)) appears to have been caused by SSRI's. Now, no narcs(soon)>no mood swings/deression >no ssri's>no headache = getting my life back! Priceless. Hopefully, I can get back to being a doc, a runner, a woodworker, etc soon. Thanks again for helping me get off the suboxone...I don't know what I would have done if I hadn't found you guys!!!!!
Anyway, let me know what your thoughts are re the microinduction & next step for taper if you get a chance. ThanksJ

[Robert_325]

This is why we do this by having the patient communicate and follow our instructions on a daily basis. Because people want to try this and try that and it doesn't work right for them. Then they come back asking what to do when they still have symptoms and all they had to do was follow EVERYTHING that we said to do in the first place and it would have worked just fine.

You need to be totally stabilized. You should be having NO w/d symptoms whatsoever in the middle of the night or any other time. (There is no reason why you should be taking a sliver until you are in the tapering process.) You stay at the stabilizing dose for four days with no w/d symptoms. You are still having symptoms so that means you don't titrate anyplace until you have four days with NO symptoms as we have said repeatedly. These past days even don't count as you are still not stabilized. If you titrate down now before having the four good days this will continue.

With all due respect, Musicman and I both suggested that you re-induct and get stabilized and you chose not to do that. You chose to pick 2mg as the right dose, I didn't tell you to induct at 2mg. Now you're still having w/d symptoms and asking if you should titrate down again. What would you say to a patient who you gave instructions to but they chose to do it their way instead and then their choices didn't work? God bless.

[desert rat]

Robert, my apologies for whatever misunderstanding...I've been trying to contact you or musicman for direction the past 48 hrs, but I guess my posts weren't getting thru.
I have been trying to find what dose to use for the microinduction....I thought 1mg 2x/d could work...forgive me for being gunshy and not wanting to start at too high a dose, but I'm a little bit in a catch-22 as I am restarting a med that the prescribing physician thinks I have detoxed off of (and I am under the microscope legally more than the average person as I need to keep things on the up & up re: my medical licensure).
I have NOT begun to taper....I DO understand the need to stabilize...and I do understand the need for 'compliance'! I think you were a little quick to come down pretty hard at my attempts. Perhaps you thought I understood something that I apparently missed. I am doing my best, and I am not quite clear why you are so pi$$$ed off. Again, my apologies for whatever I did or didn't do.
I also have not known (all along) if the 3am (and other time) sweats were from w/d or a side effect of the Sub, as they have been an ongoing issue at all doses and w/ most of the opiods I've been on. And, I've not mentioned it b/c not I (nor any physicians I've worked with) are not sure if or how much of a factor it is, but I also have clinical adrenal insufficiency which may be affecting my response to the opiods, but no one seems to know (and there really isn't much research on it, so its just been a big ??? in all of this).
So, let's try this again....I've tried 1mg 2x/d for the past 3 d....
Today, given your input and previous suggestion, I took 2mg (take 1mg, wait 1 hr, take a 2nd mg)....I am somewhat nauseated and just not feeling that hot, and sweating. Not edgy, if anything, a little sedated...
So, is this my induction dose??? I DO understand stabilizing at least 4 d. before starting to taper.

[Robert_325]

Originally Posted by desert rat

Robert, my apologies for whatever misunderstanding...I've been trying to contact you or musicman for direction the past 48 hrs, but I guess my posts weren't getting thru.
I have been trying to find what dose to use for the microinduction....I thought 1mg 2x/d could work...forgive me for being gunshy and not wanting to start at too high a dose, but I'm a little bit in a catch-22 as I am restarting a med that the prescribing physician thinks I have detoxed off of (and I am under the microscope legally more than the average person as I need to keep things on the up & up re: my medical licensure).
I have NOT begun to taper....I DO understand the need to stabilize...and I do understand the need for 'compliance'! I think you were a little quick to come down pretty hard at my attempts. Perhaps you thought I understood something that I apparently missed. I am doing my best, and I am not quite clear why you are so pi$$$ed off. Again, my apologies for whatever I did or didn't do.
I also have not known (all along) if the 3am (and other time) sweats were from w/d or a side effect of the Sub, as they have been an ongoing issue at all doses and w/ most of the opiods I've been on. And, I've not mentioned it b/c not I (nor any physicians I've worked with) are not sure if or how much of a factor it is, but I also have clinical adrenal insufficiency which may be affecting my response to the opiods, but no one seems to know (and there really isn't much research on it, so its just been a big ??? in all of this).
So, let's try this again....I've tried 1mg 2x/d for the past 3 d....
Today, given your input and previous suggestion, I took 2mg (take 1mg, wait 1 hr, take a 2nd mg)....I am somewhat nauseated and just not feeling that hot, and sweating. Not edgy, if anything, a little sedated...
So, is this my induction dose??? I DO understand stabilizing at least 4 d. before starting to taper.

I'm not pi$$ed at all Dr. I'm really not, please don't think that. I just wanted to make a point so you would understand my frustration. I realistically answer 20-30 posts per day, 24/7, plus the countless emails I receive and I do this on a voluntary basis. That is okay as this is a ministry for me. I get paid in my own ways being blessed. I'm not asking for pity just cooperation. I know that God has led me to do this, to help others who are suffering by using my experience to change their lives. He wouldn't have saved me from the life I previously led if not to share His message and recovery with others. I just wanted you to see my side of this with the analogy I used of how you would feel if a patient didn't follow your specific suggestions but wanted you to straighten out what they had done wrong. I know now that you've got to be able to see where I'm coming from. I don't turn down anyone who wants help. I just require that they go along with me or else I'm wasting my precious time.

I don't know about the adrenal condition that you mention. That is something I don't have knowledge about. You will have to trust your judgement on whether my suggestions are causing you additional physical symptoms along with these other problems. I can't comment much on that condition as it's beyond the realm of my knowledge. But when you stabilize with suboxone you should feel better than you've felt since being a teenager. You should not be experiencing night sweats, chills, etc. Those are not symptoms of the proper suboxone dose. Those are w/d symptoms which mean you have not stabilized properly. You have been in serious w/d all this time while not using the suboxone and since starting back again you've never totally stabilized yourself. You've just taken little bits and pieces and it has never had a chance to work for you as it should. It's my opinion that you continue taking the doses an hour apart until you feel perfect as you should. At that point you will be stabilized. I seriously doubt that you will stabilize at less than 4mg. I would say there is a chance that 3mg might do it, but based on YOUR symptoms I doubt that it will.

If you stabilize at 4mg you would only stay at that dose for three days as I suggest at the following link. (see INDUCTION)

http://www.drugs.com/forum/featured-...apy-50887.html

On the fourth day at 4mg you would reduce (as mentioned at the aforementioned link) by 25% to 3mg. But getting stabilized is imperative if you are going to do this successfully. If you don't stabilize (regardless what the dose is) you will NEVER have a peaceful day while finishing this process.

You would stay at 3mg (as your case is different than most) for maybe a week, then I would have you begin titrating down in 25% increments (with each four day period of having NO w/d symptoms) until you reach .5mg per day. This is how it works for everyone. At that time I would have you skip one day entirely, then take .5mg. Then skip two days, take .5mg. Skip three days and take .5mg. Then you are ready to jump off. I doubt you would have any noticeable symptoms whatsoever following that schedule.

I understand the unique situation you find yourself in concerning licensure and the prescribing dr. But please understand that those are situations beyond my control. I can only share what works with you. There is nothing I can do about these other matters. If you will follow the suggestions I just made I would be very surprised if you have problems. If you do then post back to me and I can then deal with that specific problem when and if it happens. I only ask that you adhere to what I ask you to do for this to work. Hope that makes more sense. God bless.

[sonjabrake43]

It has now been 3 wks since my last vicodin (norco) I normally would take between 4 to 7 a day but sometimes I am sure I got out of hand and used more which made me feel even worse ..especially the next day got to the point to where I would wake up and need one to function and then sort of half them throughout the day ....in the end I wasnt even getting a high from these pills just took to basically feel normal...addicted on and off but mostly on for last couple of yrs and have gone through so much money and so many lies just to keep up with my addiction ...in the end just became more depressed then when I started abusing ....pretty sure this is why..I get bored so easily and get the blahs probably have dysthimia with some social anxiety and out of all the many ad I have been on the pill that worked for me most of course was the ********py vicodin...ughhhhh thought at first all was under control and have gone cold turkey a couple of times before but this last time I seriously wanted to sleep and never wake up..still feeling pretty depressed with very low motivation just kind of running on auto pilot...nothing makes me happy anymore and am so scared that I will never be ok...3 weeks!!!!! when does this go away...I probably need to be on some sort of antidepressant but hate hate the side affects of most of these drugs although I guess nothing could be as bad as this If anyone has experience like me please let me know how you did it....am 43 and have two girls in college and takes everything I can do now to help them when they need me which makes me sick inside....why did I do this to myself..thank gawddddd I did not have to work through all of this cause I would have been fired by now for not showing up for work...my husband is a wonderful man and we have been together for many yrs and he does know about my little demon but I dont think he quite understands it all especially the depression sorry for rambling on just found this forum and was hoping someone out there c ould help me and give me some imput on what to do and when things might go back to some kind of normalcy for me..I walk around like a zombie half the day and the other half I want to sleep ...do what I have to do to get throught the day and the bare minimum to say the least....

sick of being sick...blehhhhhhhhh

[Cats Meow]

Hi Sonja, you should start your own thread. I'm sure we can help you, are you only experiencing depression? You should be out of W/D's, and don't be alarmed that you're not 100% yet, but you should be around 80% (if you truly haven't taken anything), it does take 2-3 months to get to 95%, and a few more back to 100%, but at 80 you should be functioning excellently. Are you taking ANYTHING else? Besides depression what else are you feeling physically? Without knowing anything else, the very best thing you can do is vigorous exercise, any exercise will help you tremendously, this is the key to getting back to 100% as fast as possible, next I suggest you start taking good quality vitamins, even double the intake, energy drinks should help you a lot too, thirdly, start feeding your mind, read, do puzzles, tax your brain, the more the better. Don't start on A/D's yet, they mostly don't help anyway, try these things and you will see improvement, I guarantee it.

If you have a reply, and want more help, please start your own thread. You're going to be okay, but it's going to take a little work on your part, but you can do it and it's not hard.
Cats

[Robert_325]

sonjabrake ... what type of physical activity are you getting? Sounds like you're just laying around being depressed. Not judging you, just pointing out that is the worst thing you can possibly do at this point. Some moderate exercise will help with your overall well-being and you will feel better as it will help with your endorphine production. We lose that while using opiates. Regardless of how badly you don't want to exercise try going for walks at least. You should begin to feel better soon if you will get out and do something. God bless.

[melinda7.5]

Hi sonjabrake

After I got thru my w/d.I started walking on the treadmill I was not in very good shape after taking all of the drugs I took, and I was smoking back then too !!!, But I started out at 2 min a day and went up a min a day. I was really surprised how fast I got my energy back. It will also give you the well being feeling. You have come so far....Just push yourself to start any kind of exercise it will help you so much...
You will be out running a marathon in no time...
Good luck, let us know how you are doing...

Melinda