Starting out - suggestions and links

[NancyB]

Hi, thanks to Nan's suggestion here's a thread with a bunch of links and suggestions that may help when starting the process of taking Suboxone, or have already started taking the medication.

Thanks again, Nan, for all of your help in putting this together!

Nancy

Educate yourself on Suboxone and addiction. Some good places to start:
http://www.naabt.org/education.cfm
http://www.naabt.org/resource_kit/
http://www.hbo.com/addiction/thefilm...segment_6.html
http://www.hbo.com/addiction/underst...addiction.html

Learn the difference between tolerance, physical dependence and addiction:
http://www.naabt.org/faq_answers.cfm#15

Why you are not switching one addiction for another:
http://www.naabt.org/faq_answers.cfm#1

Five Mistakes People Make
http://www.addictionsurvivors.org/vb...ad.php?t=21140

Phases of treatment - medication is only a small part:
http://www.addictionsurvivors.org/vb...ad.php?t=23809

Common misconceptions about Buprenorphine treatment
http://www.addictionsurvivors.org/vb...ad.php?t=20261

Ways to find treatment:
http://www.addictionsurvivors.org/vb...ad.php?t=21259

Ways to save on treatment:
http://www.addictionsurvivors.org/vb...ad.php?t=26463

Suboxone is only indicated to stop withdrawals and cravings. Period. It's not a miracle drug that will instantly make your life better. That is up to you to do the work through therapy or other programs.

Before starting, read this pdf to understand why you need to be in mild-to-moderate withdrawals before taking Suboxone. Page 2 is the Clinical Opiate Withdrawal Scale (COWS) where you can gauge your withdrawals.
http://www.naabt.org/documents/NAABT_PrecipWD.pdf

How to take Suboxone:
http://suboxone.com/patients/about_s...XONE_film.aspx

• Don’t worry about the number of mg you are taking.
Everyone is different. The right dose for you is the lowest one that alleviates cravings and withdrawals.

• Unless you’re dosing for pain, once-a-day dosing is recommended. That eliminates the behavior of watching the clock, waiting to dose that was part of being in active addiction.

• If taking for pain also, many people find that they can take advantage of any analgesic properties by taking small (1 to 4mg) doses every 4 to 6 hours. Others find they receive no pain relief at all. It depends on the person and the type/severity of the pain.

• Some people find that taking Suboxone in the afternoon or later can disrupt their sleep. For those people, it’s best to take it once in the morning. Others find it makes them sleepy. For those, taking it at bedtime works well.

• Suboxone has a halflife of around 37 hours. Because of this, you may not notice a dose reduction for a couple/three days.
Increases are generally noticed right away. Most people feel some effect within a half hour of taking it, but full effect isn’t realized until up to 2 hours later.

• Stabilization can take a week. It’s best not to change your dose during this time.

• Keep a journal of when you take your Suboxone, how much you take and how you feel. That can help you and your physician in finding your optimal dose.

• Tips for taking Suboxone.
-No caffeine or nicotine for at least 30 minutes before taking your Suboxone – both may constrict the blood vessels that the medication is absorbed through.
-Right before taking it, rinse your mouth out with as warm water as possible – this may dilate the blood vessels for better absorption.

• If the taste is bothersome, try putting a mint or hard candy on the top of your tongue while the medication is underneath.

• Suboxone is a tool that needs to be utilized with other tools for the best treatment outcome. These tools include peer support – either live, like AA/NA/Smart etc. Or online in communities such as this one.

• In some cases, there may be conditions that surface that were masked by full agonists. Those can include, pain, anxiety, depression. Discuss these with your physician, or with anxiety/depression, think about going to therapy.

• There may be urges at the beginning of treatment. See if you can correlate them anything. Do they come at the time of day when you would be taking your former drug of choice (DOC)? Is it because of stress? Depression. Pinpointing why the cravings are happening is the first step in learning how to deal with them. If they are overwhelming, physical cravings, then speak with your doctor. You may need a dose adjustment.

[NancyB]

A couple more that came up in chat tonight:

Discount cards to help with the medication expense:
http://www.addictionsurvivors.org/vb...ad.php?t=12915

The manufacturer's free med program:
http://www.needymeds.org/drug_list.t...&name=Suboxone

A list of state drug & alcohol websites:
http://www.alcoholanswers.org/resour...ohol-links.cfm

Substance Abuse and Mental Health Services Administration (SAMHSA):
http://buprenorphine.samhsa.gov/

[NancyB]

The following are some suggestion for questions you might ask when preparing to start bupe treatment. Thanks to all who contributed.

Do you limit your treatment length?

Do you take insurance? If no, will you provide receipts I can submit to my carrier?

Are you an addiction specialist?

How often will I have appointments?

Do you have a 'program', if so, what does it consist of?

Do you follow the suggestions and trusted methods outlined in the TIP40, or do you just wing it?

Are you affiliated with any local pharmacies to stock Sub, so I don't have to drive all over or wait days for them to get it?

Recommend any counseling or therapy?

Will you treat me for anything else beside opiate addiction?

Will you recommend a "family doctor" that isn't a dealer?

If I should relapse, what is your procedure to re-start or am I out?

Will you listen to me if I feel that my dose is too much or not enough?

If you favor a short treatment as opposed to a longer maintenance and taper, will you stay with me until I'm ready to stop or will I have to seek another doctor to continue?

What lab tests are required? How much do they cost if there is no insurance coverage?

Is there a charge for in-office urine toxicology testing?

How long does it take for the doctor to return calls?

Is there a notification to patients and a procedure in place for when the doctor will be unavailable? Eg., is there someone to take calls at those times?

Is confidentiality assured? How? Who may see my private information?

Will I receive treatment/medication on the first visit?

Is the cost of medication received in the office an additional charge?

Do I need to provide a urine specimen in order to be treated? What about urine specimens for subsequent visits?

What are the reasons the doctor might discharge me from Sub treatment?

Is the induction in your office? And if so, then here are more questions directed towards that:

If beginning my treatment at home, what can I expect from my initial dose and how should I expect to feel in the first few days?

How long should I wait before taking my first dose of Sub.

What is the procedure for starting, how much Suboxone and when?

Will you be available by phone if I have a problem or question?

We hope these help.

Thanks.
Nancy

[valvenis]

WOW! This post really informed me on this type of drug and is really helpful for me. this information really makes me feel stronger at being able to beat this addiction. Because I have been really concerned on how to fight the thoughts in my head about going back to roxycotin, but by pin pointing what causes those urges and finding something else, positive, to reduce those cravings and thoughts.

[shortydoowop]

If you are experiencing back pain, is it ok to motrin or something for that?

[NancyB]

Originally Posted by shortydoowop

If you are experiencing back pain, is it ok to motrin or something for that?

Hi shortydoowop, yes, motrin and most over-the-counter medications are safe to take with Suboxone. If you ever have any worries, you can always give the pharmacy a call, and they should be able to help you also.

Welcome!

Nancy

[manohealing]

I've never seen this, but this should be the first thing people see, especially the questions for doctors.

[lahopeful]

These are all very helpful and informative questions to ask. Thank you for your contributions.

[nan]

Since this has so much necessary information I am going to bump it up again!

nan

[SubGirl007]

About the suggested questions to ask your bupe doc, that could almost make sticky note status, jmho! I wish I had seen this before I went to Dr. Sado – he would have failed the test miserably. Speaking from experience, these are the kinds of things that can make or break one's subx experience.

~ ~ ~
FWIW Nancy, I still haven't seen a bill from this guy yet. Maybe he got caught up in the coding part, there probably isn't a code for smoking cessation.

[NancyB]

Hi SubGirl007, I think you may be right! "Now, where is that code for smoking cessation??" hahaha!

Nancy

[Leo]

shortydoowop - What a brilliant username

[501_bluez]

...especially Nancy´s post that has the questions to ask a potential sub doctor.

Thanks!

[AuntieM]

Hi All,
For the part of coding of the medical claim (ICD9) there is a code for everything. Mine starts with tobacco addiction and also opiate dependance. They have codes for everything. I work for one of the top 5 insurance companies. I once saw a medical claim coded, food, unprocessed in anus...

[SubGirl007]

Hi Auntie M! Thanks for your comment. Here's the glitch: I made the appt for an annual and for Subutex medical maintenance. However, he hijacked the whole appt and immediately started lecturing me about smoking, prescribed Chantix and Subutex, no annual was done except that he took my blood pressure (and I ALWAYS have perfect 120/80 BP) It was not on my agenda to quit smoking, although thanks Doc for putting the bug in my ear. ;-)

After I started w the Chantix, I began to have a bad reaction to either the Chantix or the combination of the two. I was also very skeptical about the Roxy generic, as I had started w Hi-Tech and that was wonderful. He never believed the generic story. He was very insensitive and not at all sympathetic to my discomfort when I consulted w him several times on the phone. He treated me very much like I was drug-seeking, he sounded very accusative if anything as if I was just drug-seeking. (For what? To take more subutex? That would be weird, now that I understand how Subutex works!)

Then I came back for a follow-up appt as per his request, still no annual was performed – it was a follow-up for the Chantix management, and to make me do a pee test for the Subutex. (more accusations) Yet, he suggested Suboxone film (which I am using now) but never actually prescribed it, just asked me to come back in two weeks, still suffering because he didn't buy my Roxy generic issue.

So I started calling him the Sadodoctor since he was so unsympathetic to my discomfort. Lol.

I have to check w my insurance to verify this, but I don't believe he's billed me..still, and this was back in August. So Nancy and I started wondering just how Sadodoctor would code this; again, bc smoking cessation was not what I went to see him for and I never got the annual. But I did get a script for Subutex.

Your information is helpful and interesting, but I am starting to think that if indeed Sadodoctor hasn't yet put the claim through insurance, it's bc he couldn't figure out how to code it. I feel it would be unethical to bill me since I never wholly got what I went to see him for, but it's a tough question bc he did prescribe the Subutex.

Funny about the food in anus claim. How was it coded? I wonder what the story behind that was.. omg.

L .

p.s. I now have a new and overly sympathetic P-doc

[PainKillerPrincess]

Interesting about the doc that didn't bill you out and what the reasoning may be. I work in the medical field and manage a doctors office and handle all billing. There is a icd-10 code for everything.(perhaps it was icd 9 if prior to October2015). This includes smoking cessation- however the icd10 billing codes must match the patients diagnosis codes and subsequent doctor notes.. This could be where he got into a sticky situation as it is also documented what prescriptions were given. So perhaps he was trying to make it present as if it were an appt for smoking, but didn't have all the codes and notes to back it up. Regardless it sounds like he was a jerk so glad you found a new sympathetic doc! Was this doctor a specific suboxone doctor?