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Unread 03-25-2008, 01:11 PM   #1
pamela
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Default Throwing up help!!!!

For those of you that haven'y read my recent post, my son started sub yesterday and is sicker today, after 32mh yesterday over the course of the day and never getting rid of his hot and cold chills. No sleep with ambien and now I just gave him 8mg to start and he is throwing up like mad. I don't know what else to do, he is so sick I never expected this and I feel like I lied to him when I said sub would work. My husband just went to get some altoids because I think the taste is part of the problem. At this point I am wondering if I should call the doctor, could it be to much sub, could it be he needs subutex, do you think its just the taste? We are far away from home and I am getting scared what if this continues, what will I do. Oh and I think he threw up the 8mg of sub he had just started melting, should we wait or start again?
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Unread 03-25-2008, 01:15 PM   #2
Pearl
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Hi pamela. I don't want to give you the wrong information. I'm sure someone with more knowledge will be along soon. I just want you to know you are not alone and Bupe. treatment DOES work. You didn't lie to your son. You are an incredible support and Mom. He's very lucky to have you. Take care of yourselves!

Elizabeth;}
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Unread 03-25-2008, 01:16 PM   #3
Mike
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Yes call the doctor. It could be too much sub, or too little sub, or sub at the wrong time. Check his pupils with yours. If they are very small, he doesn't need more sub, if they are very large he is still in withdrawal and needs more sub. What was his COWS score when he took the first dose?
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Unread 03-25-2008, 01:26 PM   #4
pamela
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Mike his cows was 10 so he insisted that was enough and he was jumping out of his skin, he was scared and full of anxiety I couldn't get him to wait another second and now I am the one thats scared. This is all new to me and no he is right I can't begin to know what he is feeling or going through I just want this to work so badly and you have all given me so much hope. But I can't help sitting here wondering about all the what -ifs. I can't look at his pupils right now I am not sure if he is sleeping or just lieing with his eyes closed but I am afraid to go into the room because all he keeps telling me is he can't do this he is so sick and he wants to get on a plane and fly home and get drugs or methadone which he says makes him feel normal. Peal thank you, this is the hardest thing I have ever done in my life. Than you all for your support. As soon as I see his eyes I will determine if he needs more or less and call the doctor.
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Unread 03-25-2008, 01:29 PM   #5
So.Cal.
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did he switch from methadone to sub??
TT
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Unread 03-25-2008, 01:29 PM   #6
Mike
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Once he's stable I think he will like it better than methadone. If he is relaxed, that's a good sign, but the pupils will tell the story.
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Unread 03-25-2008, 01:35 PM   #7
pamela
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Yes,So.Cal he had come off methadone but just 4 days from between 20 to 60 the last day 10 and than a 96 hour wait. He has used methadone for short periods in between heroin use and thats what he wanted to go on but I was against methadone because I saw the potential for abusing it(which he was doing) so I told him about sub and took him to the doctor and here we are. In a mess!
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Unread 03-25-2008, 01:43 PM   #8
pollie
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when I first went on sub I switched from meth to sub and the 1st day I took even a 2mg I was in full withdrawal as my dr. neglected to tell me to wait 2-3 days after I took my last dose of meth. It took me a good 3-4 weeks to feel normal on sub like everyone else was feeling due to the meth still leaving my body. I think 32mg a day is very high of a start dose and it may be making him sick. Please call your dr. and find out if your son was on meth for a while before starting sub. Sub is suppose to start a low doses to higher one not the opposite. I wish you luck and you are a loving mom.
also, some people do much better on meth than they do on sub and visa versa.
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Unread 03-25-2008, 01:45 PM   #9
Mike
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That clears up a lot, he probably still had some meth in him and went into Precipitated withdrawal. Usually when people feel as he does when switching from meth it isn't because they took too much sub, but not enough. The pupils will tell the story. Also do another COWS score and see where he is now next chance you get. Look mostly for objective things pupils, sweat, yawning, goosebumps, heart rate. Sometimes doctors need to go above 32mgs on the first day with some methadone transfers. He will only get better from here on out.
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Unread 03-25-2008, 01:48 PM   #10
Mike
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pollie, I think you would have felt better sooner had you taken 32mgs. the pain you went through those 2 weeks was the sub building up in your body. You could have reduced that time with higher doses. This is from the PW sheet.

"The goal of induction is to safely
suppress opioid withdrawal as rapidly as
possible with adequate doses of Buprenorphine.
Failure to do so may cause patients to use
opioids or other medications to alleviate opioid
withdrawal symptoms or may lead to early
treatment dropout. To achieve this, some
physicians have found they may need to dose
as high as 32 mgs. the first day with some
methadone to Buprenorphine transfers"
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Unread 03-25-2008, 02:13 PM   #11
pamela
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Mike I will do what you say as soon as he wakes up, I will redo the COWS and see where hes at and than determine what to do. I think you guys know more than his doctor who gave us minimal information.If he is able to rest that can only be a good sign. This is just very hard to watch, as a mom usually you can always fix it when it comes to your kids.I feel helpless. Thank you all
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Unread 03-25-2008, 02:34 PM   #12
Mike
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It is great news that he is sleeping. If he was still in withdrawal he couldn't. It's also important he doesn't take any other medications to self medicate, especially Xanax or other antianxiety meds.

There are a lot of opinions on the web, so i wouldn't take any as fact (even mine) but try and find credible supporting documentation that concurs. The NAABT PW sheet is a good one and has references. It's the one with the COWS on the back: http://www.naabt.org/documents/NAABT_PrecipWD.pdf also the Suboxone dosing guide: http://www.naabt.org/documents/NAABT_PrecipWD.pdf
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Unread 03-25-2008, 02:55 PM   #13
pamela
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Well he wasn't sleeping just trying to rest. I checked his pupils and they were big so we tryed more sub. First a rinse with hot water, than 1/2 a pill with an altoid on top of his tongue. He kept gaging but he didnt throw up till it was almost completely melted. There was a little residue in the tissue he spit in. We will wait a little while and try another half, but this will take all day if he needs 32 again. If he starts to feel better at some point before the 32 do we stop or does he need to take the full dose again because at this point we really still don't know what he needs to feel OK. I put a call into the doctors service but no call back yet.
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Unread 03-25-2008, 03:19 PM   #14
Mike
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As soon as he feels ok that will be enough., Give at least 30 minutes between doses. At the right dose his pupils should constrict, and the other withdrawal symptoms should disappear.

Does he understand that bupe is an opioid that just partially sets off the receptors, and his induction is getting enough of it in him so he can feel enough opioid effect to stop the withdrawal and feel normal?

It will only get better from here. Soon he will notice he isn't craving opioids, the pains in his legs and stomach will disappear, and he will begin to feel normal.
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Unread 03-25-2008, 03:36 PM   #15
pollie
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Mike you may be right as my dr. treated me with a transfer of meth to sub when sub was still pretty new. But the 1st day was horrific I tell you even a 2mg pill brought me to bad stomach cramps, sweats, cramps. etc...But I only waited 24 hrs. as my dr. told me to do that. Then weeks later he put me on the 8mg pills and told me to swallow them and nothing about sublingual aspect of sub but maybe he didnt know better. The pharmacist is the one person who told me how to take it right. Then before I knew it I was on 3-8mg pills a day and it saved my life and I want mom to know that. I'm not sure how old your son is but god bless you for being there for him. If he was on a clinic and then went off and bought it on the streets it may have been he used it in between the herion to stop himself from being sick. I was on a meth clinic 2x and did it sucessfully but we are all different. It takes time to be on any opioid (meth or sub) to get our minds in the right place and keep us clean. I am an adult with children and I was there and sub has kept me clean almost 5 yrs.
eventually it will work for him and hopefully he will continue it and go to meetings for extra supports if he thinks he needs it.
Being a mom is hard enough and we do anything to save our children and addiction is so rampid right now and I praise you for everything you are doing and the love you have for your son I am the same way!!
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Unread 03-25-2008, 03:39 PM   #16
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Pam,
I tried to send you an email but it did not show it when I clicked email. I would like to speak to you some more.
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Unread 03-25-2008, 03:44 PM   #17
Mike
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polliw, that happened to a friend of mine. The 2mgs was just enough to kick the methadone off his receptors but not enough to stimulate them, so he had withdrawal. It wasn't until he was able to take a lot more bupe that he felt better. It was hard to convince him because the way he saw it, "if 2mgs makes me feel this bad, more would make me feel worse" he finally took more and felt ok. It took 48mgs that first day for him, then only 16/day after that.
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Unread 03-25-2008, 04:00 PM   #18
Smith
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Hi Pamela

Fist I would like to say, Mike is right, you should not take anyone opinion as the absolute truth or there experience as the same as yours, and certainly not over the advice of a good doctor. In the end you need to make your own decisions. I'm just relating my experience and what I have read. With that said here is my take on it.

I also had a problem with nausea, it lasted the whole day after starting bupe. In your sons case I think it would of help to start with subutex, but if you don't have that you will have to work with what you have. They are right if he is still showing signs of WD, like dilated pupils then it is a matter of not havening enough bupe, not to much bupe. If he is having a problem like me with throwing up, it was a combination of things both the taste and just the WD's. The one thing you need to look out for, is that if he is spiting it out to soon, then he is not absorbing a full dose. So make sure he is keeping it under his tongue long enough, and not spiting out undissolved bupe. I would try to keep it under his tongue as long as possible and not less than 15 minutes, I would shoot for 30 minutes. If some is coming out undissolved, you may need to give him more to make up for it. Because of the celling on bupe it will not do any harm to go above 32 mg a day, if you have it available, until you get to outrageousness doses. If it took 32 mg yesterday it will probably take 32 mg today. If he feels better, and does not have craving you can stop increasing the dose. It takes an hour or two to get the full effect of a bupe dose. Once he's stabilized for a day or so you can start to come down with the dose. It may take him longer to get comfortable because of the methadone. My wife and I did not sleep for two or three days. I remember holding the subutex and my mouth with my hand to keep from throwing it up. It was a terrible experience, but you only have to go through it once.

You did the right thing, just hang in there. It will start to get better. Remember it's going to be hard for a while. Has he shown any improvement at all. It will get better. My hart goes out to you and him, I remember how hard it was for me and my wife. People on small doses of opioids a day, can switch to bupe easy. Others like us, it can be a difficult experience.

I will also post on your other thread. hope everything starts to get better soon.

Smith
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Unread 03-25-2008, 04:03 PM   #19
pollie
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geeze....I was going according to my dr. and he said he was not switching patients from meth unless they were on 30mg or less and I was down to 20mg for like 4 months so a good candidate to switch and after he seen me suffering for about 2 weeks he said I think you need more cause you switched from the sub so after I was on 24mg a day and taking it properly under the tongue I felt better each day. But yes I was petrified that if I took another 2mg pill the 1st day I would be in for more hell to pay so I opted not to. I was like going into full wd's all over again from day 1 of sub introduction and then each day got easier.
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Unread 03-25-2008, 04:21 PM   #20
pamela
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OK we waited 30 min and no change so he took another 4mg so now he has only had 8mg today it takes a long time to get it in to him because of what he goes through to keep it in. He is resting and he did say he feels a tiny bit better he is at a seven with 10 being the worst! so he will need more but he has to wait so he doesn't get sick. Unfortunietly he knows it will make him feel better but he doesn't want to take it because he throws up so its a catch 22. My email is naildr356@aol.com feel free to email me. Thank you all, you have been a tremendous help.
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Unread 03-25-2008, 04:37 PM   #21
Smith
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Hi Pamela

I so glad he is starting to finally feel better. I think it is a good idea to break it up into 1/2's so it is more likely to absorb better. It should be all down hill form here.

If you want some great info, form the experts and you have time. I would check out TIP 40 ( http://www.naabt.org/links/TIP_40_PDF.pdf ) and the suboxone 2006 monograph ( http://www.suboxone.com/pdfs/IMsml.pdf). They give a very cautious dosing schedule, so I wouldn't worry about that to much, it's in case the patient only had a small tolerance to opioids. If you have a very large tolerance,like your son, I think the best approach is to get the level of bupe up to the comfortable range as soon as possible. Like the post Nancy gave in your other topic, and Mike pointed out. TIP 40 and the suboxone monograph are good for other information, so you can make informed decisions. Also the the prescribing in in the suboxone monograph often give way to short of waiting times form the last dose of other opioids and when you start bupe. That's why it's best to go by the COWS scale and not a set time frame, which I think you did.

Please keep us updated, I can't wait until he start to really feel better, unfortunately I have to go to work now, so won't be able to post much until tonight. Just hang in there.

Smith
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Unread 03-25-2008, 04:46 PM   #22
Mike
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Good, he'll probably need at least 16mg today. It will only get better. Although it doesn't taste good, once he's not in withdrawal he should be able to take it no problem. I actually began to like the taste. (it was the taste of freedom from addiction) Once he starts to see it working his anxiety will drop and that will have a big effect on how he feels. Once he knows his dose, he'll be able to take a full days worth all at once, and forget about it for the rest of the day.
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Unread 03-29-2008, 06:41 AM   #23
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if he is switchign form methadone to bupe he should be on subutex. that little bit of inert naloxone in suboxone could be the case. it affects each of us diff. i can't have suboxone it makes me ill as a hungover frat boy. not to mention it affects my prespective and other mental things., i was on 32mg of suboxone and went to subutex. i cut the dose in half in 1 yes thats ONE day.
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Unread 03-29-2008, 03:42 PM   #24
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Quote:
quote:Originally posted by mikells43

if he is switchign form methadone to bupe he should be on subutex. that little bit of inert naloxone in suboxone could be the case. it affects each of us diff. i can't have suboxone it makes me ill as a hungover frat boy. not to mention it affects my prespective and other mental things., i was on 32mg of suboxone and went to subutex. i cut the dose in half in 1 yes thats ONE day.
I think the dose decrease had more to do with the change in feeling than the switching medications. People on too high of a dose of either med feel better at lower doses. Your expectations probably played more of a role than you might think. Either way glad it was an improvement for you.
S-
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Unread 03-29-2008, 04:03 PM   #25
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Well he is no longer throwing up although he still uses the altoids. I have been posting his progress on another post under new induction, but I thought for those of you that don't realize its the same person he is doing so much better. He took 16 yesterday and was fine all day we will see what today brings.
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Unread 03-29-2008, 04:20 PM   #26
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pamela,

Sounds like he has stablized. That's fantastic, because once a person gets to that point, they see the value of Buprenorphine.

His energy will come back, however a little reality will set in that the opiates all help us escape from. Buprenorphine is not a medication that will allow one to escape from reality, for me, anyway.

His emotions might ride a rollercoaster for a while, but that's all part of stablizing. I'm glad he's doing much better.

Doug
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