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Subutex - conflicting messages from doc
  1. #1
    marilynj55 is offline Junior Member
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    Default Subutex - conflicting messages from doc

    First time my doc prescribed Subutex (not Suboxone) a few months ago, he told me I'd have to wait till I was in withdrawal before starting. Then it was kind of like he slipped up one day when he asked if I'd used any opiates, and when I said no, of course not, I didn't want to get sick, he said bupe was different, that I would NOT get sick with it.

    I slipped up -- got off Subutex then like an addict idiot started using methadone shortly thereafter. So went back to the doc. He gave me the script yesterday (I used 50 mg yesterday of methadone) and he told me to wait a couple of days before starting the Sub or I could go into precipitated withdrawal.

    Now I don't know whether to believe him or not.

    My bottom-line question: DO you have to wait a few days or until in w/drawal before starting buprenorphine?

    Thank you..

  2. #2
    Robert_325 is offline Retired
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    Marilyn .... you need to not do that again. And two days off 50mg of methadone isn't going to cut it! You'll need to probably wait a good three days to get the methadone out of your system and then be re-inducted. You have to be careful doing this or you'll go into precipitated w/d, which is worse than any other w/d. I'll induct you if you want but you'll need to score a 26 on the COWS worksheet again before we start, and that is after the methadone is out of your system. I won't make you sick, never have and won't do it. You can't use a calendar to do this you have to use that COWS worksheet whether it's 2 days or 4 days. When you score a 26 or higher you're ready to begin. Not before that time though. God bless.
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  3. #3
    Robert_325 is offline Retired
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    I think your dr is full of it! I've had too much personal success here working with people on subs. There are too many people still clean and still on this forum that got clean in a couple months and others that it took a year. Everyone is a little different. I'll put my experience here up against any flake sub dr that makes stupid statements. There ARE some good sub drs but there is NO "magic number". Magic doesn't exist!! He is an idiot. Not to sound so judgemental but drs like this upset me with passing out info that came out of nowhere reputable. God bless.
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  4. #4
    marilynj55 is offline Junior Member
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    Quote Originally Posted by Robert_325 View Post
    I think your dr is full of it! I've had too much personal success here working with people on subs. There are too many people still clean and still on this forum that got clean in a couple months and others that it took a year. Everyone is a little different. I'll put my experience here up against any flake sub dr that makes stupid statements. There ARE some good sub drs but there is NO "magic number". Magic doesn't exist!! He is an idiot. Not to sound so judgemental but drs like this upset me with passing out info that came out of nowhere reputable. God bless.
    How long do you think I should stay on the Sub, then?

    Also, since COWS won't apply since I don't think I am out-and-out addicted, how many days should I wait?

    Thanks.

  5. #5
    sookie3 is offline Member
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    Quote Originally Posted by marilynj55 View Post
    First time my doc prescribed Subutex (not Suboxone) a few months ago, he told me I'd have to wait till I was in withdrawal before starting. Then it was kind of like he slipped up one day when he asked if I'd used any opiates, and when I said no, of course not, I didn't want to get sick, he said bupe was different, that I would NOT get sick with it.

    I slipped up -- got off Subutex then like an addict idiot started using methadone shortly thereafter. So went back to the doc. He gave me the script yesterday (I used 50 mg yesterday of methadone) and he told me to wait a couple of days before starting the Sub or I could go into precipitated withdrawal.

    Now I don't know whether to believe him or not.

    My bottom-line question: DO you have to wait a few days or until in w/drawal before starting buprenorphine?

    Thank you..
    He's got no clue..... Wait till your cows score is right. Speaking from experience here I went from 20mg of methadone to 8mg of Suboxone 24hrs later because the doc said it would be ok...It wasn't unbearable for me but I definitely should have waited another day or so. I was in precip withdrawals for about 4 days before I began to settle. So I agree on waiting because if you don't there's not much you can do once that Subs in there. And you are on 50mg thats more than twice what I was on.. Good luck...Sookie
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  6. #6
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    Quote Originally Posted by marilynj55 View Post
    How long do you think I should stay on the Sub, then?

    Also, since COWS won't apply since I don't think I am out-and-out addicted, how many days should I wait?

    Thanks.
    COWS is a withdrawal scale not an addiction scale so it does apply. As soon as you score a 26 or higher you are in enough withdrawal to successfully be inducted on Subs and not be thrown into precipitated wd. Listen to Robert (and do your part) and you will be clean in no time! Good luck and God Bless.
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  7. #7
    marilynj55 is offline Junior Member
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    Quote Originally Posted by Dunwithitall View Post
    COWS is a withdrawal scale not an addiction scale so it does apply. As soon as you score a 26 or higher you are in enough withdrawal to successfully be inducted on Subs and not be thrown into precipitated wd. Listen to Robert (and do your part) and you will be clean in no time! Good luck and God Bless.
    Maybe my brain is drug-addled at this point (well, that too) but that makes no sense to me. If I am not addicted per se I will not go into physical withdrawal; therefore the scale will have no meaning for me. I just have to pick a time that is far enough away from my last dose and start the Subutex. Probably tomorrow at around noon. I've been at around 20 mg., averaged out, over the last 16 days and without anything over the last 72 hours. That's got to be good enough to go. Otherwise I wait forever.

    I'm taking the Subutex more as a statement to myself (the taper) that I am done with this drug stuff, I have truly bottomed out, and if I, after the taper, pick up methadone or any other opiate ever again, I am doomed.

    MJ

  8. #8
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    Quote Originally Posted by marilynj55 View Post
    Maybe my brain is drug-addled at this point (well, that too) but that makes no sense to me. If I am not addicted per se I will not go into physical withdrawal; therefore the scale will have no meaning for me. I just have to pick a time that is far enough away from my last dose and start the Subutex. Probably tomorrow at around noon. I've been at around 20 mg., averaged out, over the last 16 days and without anything over the last 72 hours. That's got to be good enough to go. Otherwise I wait forever.

    I'm taking the Subutex more as a statement to myself (the taper) that I am done with this drug stuff, I have truly bottomed out, and if I, after the taper, pick up methadone or any other opiate ever again, I am doomed.

    MJ
    I guess I'm confused. If your not going to have any physical withdrawal then why go on the Subutex? I must have misunderstood something.
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  9. #9
    marilynj55 is offline Junior Member
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    Quote Originally Posted by Dunwithitall View Post
    I guess I'm confused. If your not going to have any physical withdrawal then why go on the Subutex? I must have misunderstood something.
    I am afraid if I don't, I will be too tempted to keep on going and going and going with the methadone. Also, I don't actually KNOW if I'm going to be sick or not. I've certainly taken enough over the last few months for that to be a possibility. I'm doing it as a precautionary measure and also, as I said, as a statement to myself, "I AM DONE WITH THIS," never again. I can't stand the expense nor the stigma nor the low self-esteem, always wanting to die. I'm so sick of it, and the shame.

    MJ

  10. #10
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    Quote Originally Posted by marilynj55 View Post
    I am afraid if I don't, I will be too tempted to keep on going and going and going with the methadone. Also, I don't actually KNOW if I'm going to be sick or not. I've certainly taken enough over the last few months for that to be a possibility. I'm doing it as a precautionary measure and also, as I said, as a statement to myself, "I AM DONE WITH THIS," never again. I can't stand the expense nor the stigma nor the low self-esteem, always wanting to die. I'm so sick of it, and the shame.

    MJ
    My guess would be then if you have been taking Methadone for months that you will have physical withdrawal so in that case, like Robert said, you need to wait until you are a 26 on the COWS. It's your decision, but I have suffered precipitated wd's and they SUCK! Good luck.
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  11. #11
    marilynj55 is offline Junior Member
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    Quote Originally Posted by Dunwithitall View Post
    My guess would be then if you have been taking Methadone for months that you will have physical withdrawal so in that case, like Robert said, you need to wait until you are a 26 on the COWS. It's your decision, but I have suffered precipitated wd's and they SUCK! Good luck.
    I HAD been taking it for months, got off October, November, December, then slipped up again Dec. 14 or so, at the rate, averaged out, of about 20 mg. a day. So that is why I am unsure if I will have to go through w/drawal or not and what is making it difficult to determine a 26. I don't think I'm gonna go to a 26.

    Besides, I think Subutex is different. I know Robert feels differently, but I don't think the precipitated w/drawal problem is as great as with Suboxone. I will have waited four full days.

    I dunno. I could be wrong and I hope I'm not.

  12. #12
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    Quote Originally Posted by marilynj55 View Post
    I HAD been taking it for months, got off October, November, December, then slipped up again Dec. 14 or so, at the rate, averaged out, of about 20 mg. a day. So that is why I am unsure if I will have to go through w/drawal or not and what is making it difficult to determine a 26. I don't think I'm gonna go to a 26.

    Besides, I think Subutex is different. I know Robert feels differently, but I don't think the precipitated w/drawal problem is as great as with Suboxone. I will have waited four full days.

    I dunno. I could be wrong and I hope I'm not.
    oh yes you are SOOOO WRONG... subutex and suboxone have the same stuff, buprenorphine... its that bupe that puts you into prec wd. not the naloxone in the suboxone...
    i too went from methadone to subs, too early, and beleive me you wont have such a ho hum attitude if you go into them... yes they do suck... 2 days worth of horrendous suffering..

    your choice. but dont come asking for advice and then say, i think subutex is different... it isnt. you need to go to 26 or you WILL GO INTO PREC WD...
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  13. #13
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    AND IF you are not ''addcicted per se''' your words.... why the hell are you needing an opiate replacement.... yes your brain does sound drug addled right now...
    have you actually read anything anyone has said to you here...?

    do you think these people just make this stuff up for you to argue about...??

    come on....

    also, if you can go 4 full days, i dont see why you dont continue.... you will only get addicted to subs.. what dose do you plan on starting on..?
    it needs to be as low as possible... i bet your doctor said here take 8mg or 16mg. no worries.... and thats gonna lead you to be addicted to subs...

    ok marilyn, ive read some of your earlier posts. yes you are addicted. yes it sounds like you want to just dabble with subs, and take more than necessary... you need to decide if you want to do this right, and succeed. or continue to do it YOUR WAY. which is obviously not working for you....

    your choice
    Last edited by Anonymous; 01-12-2012 at 06:36 PM.

  14. #14
    Robert_325 is offline Retired
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    marilyn .... bottom line is that if you aren't addicted and don't hit a 26 on the COWS worksheet you have no business on subs. It WON'T keep you clean, you have to do that. It's just a tool to get clean. And I will not have any part of putting you into precipitated w/d.

    Do what you like but I can't tell you what to do if you don't follow what I've told you and all the others have reiterated. God bless.
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  15. #15
    marilynj55 is offline Junior Member
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    Quote Originally Posted by cheekysod View Post
    AND IF you are not ''addcicted per se''' your words.... why the hell are you needing an opiate replacement.... yes your brain does sound drug addled right now...
    have you actually read anything anyone has said to you here...?

    do you think these people just make this stuff up for you to argue about...??

    come on....

    also, if you can go 4 full days, i dont see why you dont continue.... you will only get addicted to subs.. what dose do you plan on starting on..?
    it needs to be as low as possible... i bet your doctor said here take 8mg or 16mg. no worries.... and thats gonna lead you to be addicted to subs...

    ok marilyn, ive read some of your earlier posts. yes you are addicted. yes it sounds like you want to just dabble with subs, and take more than necessary... you need to decide if you want to do this right, and succeed. or continue to do it YOUR WAY. which is obviously not working for you....

    your choice
    If you only knew how conflicted I am right now. I do not have a ho-hum attitude. I am grapping with the devil himself and I know it. I don't know HOW to mark the end of my methadone-taking without following through on this now-looking-stupid plan I've come up with. I feel if I don't do this taper, though it may only be a few days, and staying a couple of days with each increment, that I will continue with methadone.

    My mind has taken over here and I don't seem able to pull back. I've had this stupid f******** bottle of pills looking at me all f******** week long, reminding me what a loser I am and then I realized I was so looking forward to taking them! Now what to do! I seem unable to pull back. All I seem to do is cry and think about what a loser I am, and how when I want to take methadone, that impulse just takes me over and pulls me out the door. I just feel I need something to stop me for a while, but now I realize I've gone down the wrong path once again and don't know how to stop this merry-go-round without completing this stupid idea I came up with.

    Well, it wasn't stupid when I came up with it. i honestly thought I was going to go into withdrawal. Now I've got this buildup of DESIRE for these little suckers, even if it's only one or two.

    I just feel like dying right now, I feel so hopeless.

    This is as honest as I can be. Everyone can advise me not to do it, but I think my mind crossed the line on Monday when I was in that stupid dr's office and I have a history of being terrible at pulling my mind back when I've laid plans, particularly drug plans.

    So there you have it. I know I'm a loser. I just hope to God I can get out of this somehow rationally, even if it does involve taking a few of these. I know I'm playing with fire. I know. I know. I know.

  16. #16
    marilynj55 is offline Junior Member
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    Default cheekysod

    One more thing: You end by saying "Your choice," but isn't that the whole bloody problem? The LAST thing this feels like right now is a choice. It feels like a compulsion. It feels like possession. It feels like...BEING AN ADDICT. This is the whole root of the problem I have never been able to figure out.

    It feels like a choice when there is time under my belt clean, but right now, in the thick of it, it's running me and it feels like there is nothing I can do about it.

  17. #17
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    sooo you need to listen to the good advice you have been given here....

    make sure IF YOU ARE GOING TO USE SUBS.. start on .5mg increments.... yes point 5.... wait an hour, see if you feel ok. only then take some more... this is so you get stable on the lowest effective dose..

    an example, i started on 12mg. far far too much. after a couple of months i stayed on .5mg for months and months, it was my backstop. i had been using my methadone iv for years, and for me i needed a back up...

    if you are going to use subs,,,, make sure you LISTEN... dont take big amounts...

    and yes it is your choice..... getting clean that is...

    do you want to use subs as a tool to get clean... or do you want to dabble and see how much it takes to get high. i re read some of your older posts thats why i asked that....

    but you can do this if you want to.... we have all been in your shoes and sometimes it takes someone who has walked there before us to spell it out in black and white....

    you arent a loser,,,, but you need to listen, your way hasnt worked. robert offered to induct you here, but you seemed to fob him off with the subutex/suboxone issue... they are one and the same ok....

  18. #18
    marilynj55 is offline Junior Member
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    you arent a loser,,,, but you need to listen, your way hasnt worked. robert offered to induct you here, but you seemed to fob him off with the subutex/suboxone issue... they are one and the same ok....[/QUOTE]

    Yeah, I hear you on that. Henry and I had been working together before and I contacted him again this time. Robert, I neglected to tell you that and I apologize.

    I am getting so antsy to TAKE SOMETHING, just to get it started and let it be what it will be, which I hope and believe will be a taper the way it is suggested here. I just don't know when in the hell I can start (I'm beginning to sound like a broken record) since I probably will not be going into w/d.

    There is a buprenorphine clinic in our town that takes in addicts and after two days, just on their word that they are down to 30 mg. of methadone, start them out with bupe, not Suboxone, but bupe, and I've spoken to them a couple of times. Wish I were doing this under their supervision.

    If I start with .5 right now, it having been four plus days, it might be all right, yes?

  19. #19
    Robert_325 is offline Retired
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    Are you a 26 on the COWS worksheet?
    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.

  20. #20
    marilynj55 is offline Junior Member
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    Quote Originally Posted by Robert_325 View Post
    Are you a 26 on the COWS worksheet?
    My anxiety level and jumpiness is, but all the other stuff doesn't quite add up. It's around a 21. I am going to wait as long as I can to get to as close to a 26 considering my circumstances.
    Last edited by marilynj55; 01-12-2012 at 11:28 PM. Reason: additional

  21. #21
    HenryNCBA is offline Advanced Member
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    Marilyn,
    We talked quite a bit these past couple days. Right now you are saying you are at a 21. The other day when you wrote to me you said you were "a about a 23 and ready to bit someones head off". You took 50mg of methadone just this past Monday and yesterday you wanted to know if it was okay to take subutex which I advised against stating you need to get that methadone out of your system first. I also said when you were asking about jumping off the methadone what level and I said under 30 mg and the lower the better. We discussed this and you sent me that write up by the NDIC that stated that incorrect statement about subs, methadone, snorting and getting high and such where I warned that if someone were to follow that write up thinking that taking a combination of methadone and subs (bupe) that it will enhance each other and essentially make for a better high is so incorrect it isn't funny and whom ever wrote that should be given the combination so we can all see what happens to that moron and laugh while they suffer. As I mentioned methadone and subs do not mix period. I also stated what happens and what it takes to get into P/W and combining the two is REALLY asking for trouble.
    Your doctor is out for money and you are his/her paycheck. We have nothing to gain by giving you the wrong information. We want to see you clean and free of all this. I know the addiction has it's talons in you. It is obvious and it shows. Nothing to be ashamed of and you are not a loser. The addiction is doing the talking here and when you asked if I thought you were addicted or not I said the easiest way to find out is to stop everything and take nothing and see what happens. If you have no cravings and no w/d symptoms then that is great. Just the fact that you are in debate and at war with yourself is clearly evident that you are still addicted deeply. As for the methadone that you feel you are not addicted to I say you are. If you were not then none of this would be going on.
    We are all trying to help you Marilyn. We want to see you succeed. Robert has offered to reinduct you. I did it the last time and you got clean. You made it but the pull of the drugs was too strong and one of the things that mad it bad for you was the availability and having them lying around is too great a temptation. Once an addict always an addict and everything must be wiped clean so there will be no temptation or the temptation needs to be minimized meaning not having anything around and no access to it.
    If you go into P/W as I mentioned it is going to be pure hell and trust me on this that anything bad you have gone through in the past will seem like a walk in the park. You don't want to go there.
    Robert said it is your choice. That is because it is. He nor anyone else can control you and the only one that can is you. Aside from checking in to a rehab and staying there you need to put your foot down and go for it.
    Remember a statement I made which you felt I wasn't being very nice on months ago where I said "you are not ready"? This is what I meant. I am not trying to beat you down or make you look bad. I am saying this because I care and I want you to succeed. Sometimes a person needs a wake up call. We can be nice or hard about it either way but until that individual commits to themselves that this is it and they are going to do it period it will only continue to go round and round. This is addiction.
    I said it privately and I will say it here also that it is not a good idea to crash course through this. The program was put forth a certain way for a reason and isn't just data that was just made up and posted for the heck of it. It was produced with countless hours, study, research, observations, and you name it so it is the best thing out there and I have looked far and wide and this works!
    I agreed to help you again yet you are here asking for help also. I can't do both. It is also not wise to have too many people helping at the same time as things will become very confusing.
    If you wish to do it here we can do that. Either way is fine with me or if you wish Robert's help or anyone else I will step aside and still be here to cheer you on. This is not about us but rather about you.
    I hope that you are not taking the subs yet. You still have the methadone trace elements in your system. This is another reason that score of 26 needs to be met because that will tell you that you are ready. If you are not feeling any W/D then I agree with Robert that it is not a good thing to be taking subs if you don't need it.
    We will talk more later. Think about all this before you do anything okay? I want this to work for you and be rid of all this.

    Henry

  22. #22
    marilynj55 is offline Junior Member
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    Henry, I wasn't aware it wasn't cool to "do both," that is ask for feedback here and be working with you also. I will email you privately but, no, I do want to work with you and yes, I am ready. If I keep doing this I am going to die, either through suicide or overdose. I want better for myself and there is still time.

    I am at a 26 now, though, no doubt, and one thing I noticed missing from the COWS worksheet (or maybe I didn't see it?) is insomnia. I've hit the part of w/drawal where I am looking ahead to countless days of sleeplessness unless I handle this. So I'm going to let it get a little bit worse and then begin with .5.

    Anyway, I'll email you. Thanks.

  23. #23
    marilynj55 is offline Junior Member
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    Default successfully inducted

    After much blood, sweat and indecision, I finally inducted yesterday at 4. I feel so relieved.

    Another thing: I went to an NA meeting last night and discovered they have a Step workbook. I always wondered what people meant about "working the steps," and now I have something to sink my teeth into, actually writing about it and thinking about it in a logical way and getting some of this stuff out! I am very excited.

    The meeting itself was a little too canned for my taste, but I think I'm going to stick with it, for now, anyway, because the meeting before that touched me so deeply I cried through the whole thing. This whole notion of fellowship is so foreign to me and Other People, oh, my God, I don't really do Other People. And activities like skating and bowling and stuff, I got excited listening to it, because I do nothing, or have done nothing except get high and work. Now I can actually start building a life.

    I feel sad about the horrible state the world is in, and that is kind of a hangup of mine right now: Why bother building anything if the world is going to erupt into chaos or whatever in the next year anyhow? But the daily inner message is to keep going as if all is normal, so that's what I plan to do.

    Thank you all for being there for me. I can feel a change taking place, a readiness.

    Whew. What a ride!

    MJ
    Last edited by ddcmod; 01-14-2012 at 03:32 PM.

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