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Unread 04-30-2006, 03:12 AM   #1
Suture
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To any newcomer,
Don’t let people scare you into not taking a lifesaving medication for as long as you need it. Studies are clear, longer treatments are more successful than shorter ones.1,2 Of course, if you can accomplish abstinence with less medication in a shorter time, all the better, or if you can do it without medication assistance, better yet…most people cannot. Most overdose deaths occur during a relapse just after a period of abstinence. Discontinuing an effective treatment for no reason other than rumor and in defiance of the scientific evidence is placing yourself in a life risking situation. Ignoring science and deciding what medications we should take and for how long is how many of us got into trouble in the first place. Please learn about the treatment so the facts will help guide you and find a doctor who cares for your wellbeing that you won’t have to second guess.

1.http://www.naabt.org/documents/JAMAsummary.pdf
2.http://www.drugabuse.gov/NIDA_notes/...uccessful.html

When prescribed appropriately (to people significantly physically dependent on opioids) buprenorphine has been shown to NOT increase your tolerance, that means you don’t need more as time goes on, that means you are NOT becoming more physically dependent on it, that means it is not physically harder to discontinue whether you are on it 3 years or 3 months.

Some people on this board were administered buprenorphine inappropriately; their level of physical dependence did not warrant a full maintenance dose and hence became more dependent than they originally were. Although bupe has shown a milder withdrawal syndrome than other opioids it would appear significant to anyone who has not experienced a true full opioid agonist withdrawal syndrome.

Suboxone maintenance is for people who without it would relapse and put their life at risk. If relapse can be avoided through 12 step, or counseling sub maintenance is not necessary. For those of us who have tried the alternatives and were unsuccessful Sub has become a lifesaver and I for one will welcome any withdrawal I go through when I taper because I know I, like some of my friends, would be dead had I not found Suboxone and a good doctor.




<center>[u]Common misconceptions:</u></center>

You don’t feel any effect from buprenorphine:

Buprenorphine was deigned to give a limited opioid effect. The intensity of this effect varies from person to person, based on genetic makeup of the brain. Bupe was made this way to keep people in treatment. Before Bupe Naltrexone, an opioid blocker, was another treatment. It worked well and blocked virtually all opioids but the cravings were still there and any lingering withdrawal remained. This made for poor compliance and a high relapse rate. Bupe with enough agonist effect to stop cravings and withdrawal helps people stay in treatment long enough develop the tools they need to transition to a permanent addiction free life.

There is no withdrawal from bupe:

I don’t know where this one started because ALL of the literature and ALL of the studies show that there is indeed withdrawal. They also show that the withdrawal symptoms observed are mild in comparison to withdrawal from a full agonist. If a person has not experienced withdrawal from a full agonist it would be impossible for them to compare the two. Furthermore milder” is a very subjective term what’s mild for one person might be severe to some more sensitive.

Bupe post acute withdrawal lasts longer than other opioids and is more severe:

There are few studies as to long-term post bupe treatment. Partly because there is little reason to study it. All of the science points to a milder withdrawal profile and suggests that any long-term post treatment withdrawal would also be milder. It clearly states in the literature that due to the slow disassociation rate of bupe the acute withdrawal will come on slower and last longer, but be milder”. So why then do some people think the science is wrong? Here’s why, The brain is changed by addiction to full agonist opioids. It can take many months for the brain to return to a pre-addiction status. During this period symptoms of fatigue, cravings, hypersensitivity to pain will be experienced, and has been experienced long before bupe was invented. If someone with these brain changes took buprenorphine for say 30 days and tapered off they would still feel the effects of the changes to the brain caused by the original addiction, but many blame these symptoms on the bupe. In reality they would have them whether they took the bupe or not. When administered properly people do not become more physically dependent on bupe, they may not be less dependent either. So regardless of how long they are on it the changes to the brain are still there. It is thought that a slow gradual taper will allow the brain to slowly adapt to life without an opioid supplement.

Shorter treatments are better:

Short term treatments are better only if they work. Of course if someone can remain addiction free without ANY medication that’s preferable. However many cannot. If they can do it with a 7 day or 30 day medical assisted withdrawal, that’s great too. The fact is that most of the people that attempt these methods relapse. For the ones that don’t fantastic, for the others a longer term treatment is necessary and preferable to repeat short term failure. The studies are clear longer term, treatments have a much higher success rate than shorter ones. Does mean everyone should do long term treatment? Of course not, it’s an individual thing, if short term is unsuccessful then longer term is a wise progression and preferable to relapse.


Finally let’s put all of this into context:

The serious condition of opioid addiction should not be underestimated. Treatment is often a life or death decision. If non-medical treatments have been unsuccessful, then medical treatment should be considered. Comfort of post treatment withdrawal should play little role in the decision to administer a lifesaving treatment.



I’ll close with this one thought. Please learn as many facts as you can so you can better determine what your unique personal experience will be, and what treatment and treatment duration is best for you. There is plenty of information on this site and links to many more sites to help you learn the truth. Best of luck.
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Unread 04-30-2006, 03:29 AM   #2
Brett
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Great Idea Suture!!! Hopefully all visitors will see this topic and read it first. It only takes one bad apple to spoil the whole bunch. This is not a place for anti-sub people to post. This wonderful idea by Suter Should be a topic where newbees can recieve the encouragement they need and deserve. Suboxone is a wonderful medication that has saved many lives, including mine.
TIM,,NANCY I hope you will delete any negative posts on this topic.
Again great idea sut. Talk about ticky s

Brett
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Unread 04-30-2006, 03:34 AM   #3
TIM
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Good idea,
Also if you are new to the site be sure to read this topic if you have not already: http://naabt.org/forum/topic.asp?TOPIC_ID=169
Welcome!
Tim
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Unread 04-30-2006, 03:34 AM   #4
opiatedeficient
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GREAT topic, Suture.

Bottom line is that the best treatment is whatever works best for the individual. If that involves withdrawal and support groups, that's fine. If that involves a short-term course of suboxone that's fine. If that involves longer-term suboxone with the intent to discontinue use after a certain period of time, that's fine. If that involves life-long suboxone, that's fine too.

The good news is that there ARE options now, whereas not too long ago there weren't. I would encourage any newcomer to read a lot of literature about the different methods of treatment and recovery, ask a lot of questions, and to be an advocate for themselves in ascertaining what they need and not being afraid to ask for it.
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Unread 04-30-2006, 03:59 AM   #5
elbowguts
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Quote:
quote:Originally posted by Suture


When prescribed appropriately (to people significantly physically dependent on opioids) buprenorphine has been shown to NOT increase your tolerance, that means you don't need more as time goes on, that means you are NOT becoming more physically dependent on it, that means it is not physically harder to discontinue whether you are on it 3 years or 3 months.

1.http://www.naabt.org/documents/JAMAsummary.pdf
2.http://www.drugabuse.gov/NIDA_notes/...uccessful.html
Neither of those references support the claim made above.

Quote:
quote:
Although bupe has shown a milder withdrawal syndrome than other opioids it would appear significant to anyone who has not experienced a true full opioid agonist withdrawal syndrome.
So now anyone who complains that they experienced significant withdrawal symptoms from buprenorphine is just inexperienced with what "real" withdrawal is like? Since you're speaking as an authority, suture, can I ask how long your bupe withdrawal symptoms lasted?

As I have reported elsewhere on this board, my experience with bupe withdrawal is that the acute symptoms were indeed milder than what I experienced in previous withdrawals from "full opiod agonists". However, the post-acute symptoms dragged on for much longer than I experienced with full agonists. It was as if the typical fourth day of hydro withdrawal dragged on for at least a month and a half.

Bupe is a good choice for many people. But you don't do them any favors by misleading them about the implications of that choice.

I find particularly onerous this contention that those of us who complain about how truly crappy it was to withdraw from bupe only think that because we never experienced true withdrawal. That's ludicrous and only serves to discredit you.

-- Guts
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Unread 04-30-2006, 04:30 AM   #6
Suture
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Newcomers,
Don’t get sucked into arguments of opinion. Learn the facts yourself so people with selfish needs to validate their experiences don’t perpetuate misinformation. A good place to start is the TIP-40. It is a referenced clinical guide and explains very thoroughly the pharmacology and the clinical use of buprenorphine. On page 20:…The preponderance of research evidence and clinical experience, however, indicates that opioid maintenance treatments have a much higher likelihood of long -term success than do any forms of withdrawal treatment…”

"Patients were able to terminate buprenoprhine treatment more comfortably than methadone treatment because of buprenorphine’s milder withdrawal effects." Practical Considerations for the Clinical use of Buprenorphine.Science & Practice Perspectives. August 2004. Page 4, column 1 http://www.drugabuse.gov/PDF/Perspec...-Practical.pdf (paragraph 2.)

"…it produces less stimulation and physical dependence than full agonist medications,…" Opening the Door to Mainstream Medical Treatment of Drug Addiction.Glen R. Hanson, Ph.D., D.D.S., NIDA Acting Director, NIDA Research Findings, Column 2, paragraph 3 Volume 17, Number 5. January 2003. http://www.nida.nih.gov/PDF/NNCollections/NNHeroin.pdf

"…the withdrawal syndrome upon discontinuation of buprenorphine is, at worst, mild to moderate and often can be managed without administering narcotics." Advocacy News from ASAM: Buprenorphine Legislation Hailed as Treatment Breakthrough (patient resources.)

"Buprenorphine is considered to have less risk for causing psychological and or physical dependence than the drugs in Schedule II such as morphine, oxycodone, fentanyl, or methadone." Subutex and Suboxone Approved to Treat Opiate Depedence. FDA Talk Paper. October 8, 2002.
http://www.fda.gov/bbs/topics/ANSWER.../ANS01165.html (paragraph 4.)

"This medication is different from methadone in that it offers less risk of addiction and can be dispensed in the privacy of a doctor's office." http://www.oxycontin-help.com/web_li...n%20Treatment/ (Treatment/paragraph 5.)

"…buprenorphine is much easier and better tolerated than the withdrawal experienced with opioid agonists. Although buprenorphine could be tapered in 3-4 days…"Outpatient Buprenorphine Treatment for Opioid Addiction. John E. Franklin, MD, MSc(paragraph 1.)

"However, degree of physical dependence is less than that produced by full agonist opioids. This means withdrawal syndrome should be less severe for buprenorphine."Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence A Curriculum for Physicians. January 2001, by Eric C. Strain, MD, Editor and Jeanne G. Trumble, MSW, Project Director. Development of the curriculum was supported by the: Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration US Department of Health and Human Services. http://www.buprenorphine.samhsa.gov/...Curriculum.pdf (pages 3-44.)
Withdrawal is subjective what is very difficult for one person might be a breeze for another, some people are just more sensitive. Learn the facts and do what's best for you. Wishing you success with your recovery.
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Unread 04-30-2006, 05:06 PM   #7
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Newcomers,
One thing I’ve noticed over and over, the people who have been treated appropriately with bupe, like myself, mostly report positive experiences and are happy and grateful that they have their lives back. The people who were treated inappropriately or had unrealistic expectation had bad experiences and are angry. There is another trend, the people who have taken the time to educate themselves before treatment have a much better time with it. None of the Suboxone studies show 100% anything, that means there is always someone happy with the treatment and others unhappy. Why the unhappy people feel the need to augue with the people who were successful is beyond me. OK if it didn’t work for you, go to methadone, or rapid detox, or back to your DOC if bupe is so bad.

I have been off bupe for over a year now after being on it for 3 years. I did a long taper and had mild withdrawal at the end. Mild in comparison to a heroin detox which is very subjective. I had trouble sleeping for a couple of weeks, aches and pains, some depression and cravings, everyday got better and after a month I was fine. Never missed a day of work. In comparison when I quit heroin I was curled up in the fetal position puking on myself, crying, cramps, and wishing I was dead…big difference certainly mild in comparison. I really can’t compare 30 days out for each because I could never make it that long with H because the long term withdrawal symptoms were so intense.

Guts complained people are misinformed about the intensity of the withdrawal,
Quote:
quote:Originally posted by elbowguts

"*Should* be less severe..." That's reassuring.
The science is meant to be educational NOT reassuring. If he knew that he might have been better prepared for his treatment or sought another.

Newcomers, please educate yourselves!! You need to determine what is right for YOU! Personal accounts are interesting but they don’t tell you what is likely to happen to YOU, there are just too many variables. This will be a better board if we ignore rude people who’s only interest is to disrupt.
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Unread 04-30-2006, 06:06 PM   #8
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newcommers,
Like any treatment this treatment is not for everyone. To avoid becoming one of the angry people who come to this board to attack the people who have successfully rebuilt their lives with effective buprenorphine treatment and want to spread awareness of this treatment, please learn as much as you can about it. Learn the good and the bad, read the science and listen to the individual experiences, but weigh them accordingly. Then discuss it with a knowledgeable healthcare provider.

Addiction is complicated and although science has come a long way there are still things that are not understood. There are many variables to consider, drug of choice, dose, length of addiction, brain chemistry, triggers, environment, genetic predisposition, coexisting mental illness, coexisting physical problems, and many other factors will all affect your individual treatment.


Here’s a great article. It’s somewhat technical but explains the processes of addiction and will give you an idea of what science knows and doesn’t know about addiction:

http://archives.drugabuse.gov/PDF/Pe...s-Neurobio.pdf

Often addiction treatment is a life saving decision, get the facts and don’t let anger or rumor influence a decision that could not only save your life, but restore the quality of life that has been missing for so long. I wish all of you the same success with your recovery that I had whatever path you take.
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Unread 04-30-2006, 10:50 PM   #9
Suture
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Newcommers,
Here’s a reprint of something I wrote a while back. It is representative of the type of advice people give here. I hope you will see the non-bias content and the emphasis on education. Had some of the unhappy people who complain about this board took this advice they may not have had such a bad expirience. I hope some of you find it helpful.

Answer to Is Less More”

The correct dose, as stated in the dosing guide, "..is the lowest dose that reduces cravings, eliminates withdrawal and prevents the patients from continuing other opioid drug use..."

That said the correct dose for an individual could be &lt;1mg/day or &gt;32mgs./day. Everyone is different. Not only do they have different brain make up, but two people with exactly the same addiction history may require different doses. There are many unknown factors that contribute to what the correct dose is for an individual.

The dose may change over time, up or down. A patient that needed 16mgs./day for the first month of treatment may only require 10mgs. a month later. Since people do not develop further tolerance to buprenorphine the dose will not continue to go up in response to taking it longer.

Because of the ceiling effect there are diminishing returns on doses above the ceiling which is thought to be 12-16mgs for most people (but could be more or less for others) so doses above 32mgs have little added effect for most. Patients who still have cravings and withdrawal at 32mgs/day may not be appropriate patients for buprenorphine because it cannot deliver enough agonist effect for them. This has been the case in some heavy long term heroin and methadone users.

Besides the typical side effects, constipation, headache, insomnia,loss or gain of energy, there appears to be little consequence to favoring dosing on the high side. Inadequate dosing however, may not suppress cravings and could prompt a relapse, a potentially life risking event.

The progress of the psychosocial treatment accompanying therapy should be considered before changing dose. Patients that need to make many changes and adjustments in their lives may benefit from a stable dose, so they can work on the other aspects of their addiction treatment without the stress and distraction of changing dose.

The correct dose is very individualized. It depends not only on the unique physical characteristics, but on the psychosocial state as well. Fortunately, it’s thought that patients do not develop further tolerance to buprenorphine, once stabilized, one will not become more physically dependent as time goes on. Remaining on a higher than necessary dose, will not have a significant down side. (except for the financial cost of the unnecessary portion) Reducing your dose can be stressful and may cause anxiety and fear of the unknown. Be sure to be prepared psychologically before reducing your dose.

Lastly, people with limited dependencies on opioids should be very cautious before starting buprenorphine treatment. Although there is a ceiling effect, and it is a partial agonist, people do become physically dependent on buprenorphine. Normally this level of dependence is below the level of dependence of the original addiction. But for anyone opioid naive or with a very limited dependence 16mgs of buprenorphine could be a higher level of dependence than they originally had. For those people a short low dose detox with bupe might be a wise first step.
S-


http://naabt.org/documents/Suboxone_Dosing_Guide.pdf

…The preponderance of research evidence and clinical experience, however, indicates that opioid maintenance treatments have a much higher likelihood of long-term success than do any forms of withdrawal treatment….”
http://naabt.org/links/TIP_40_PDF.pdf (page 20) pdf page 26

Practical Considerations for the Clinical Use of Buprenorphine
Science & Practice perspectives -- August 2004
http://archives.drugabuse.gov/PDF/Pe...s-Neurobio.pdf
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Unread 05-01-2006, 01:55 AM   #10
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HI guys...

I just wanted to say I am a newcomer and am finding you all quite amusing.

The computer is a fabulous way to get a true mix of how people REALLY feel. LMAO.... It's that "NO PLEASE tell me how you TRULY feel." I also belong to a board of parents of children with Down's syndrome and you wouldn't BELIEVE how engaging some posts can be. Fortunately I am able to pick what I can out of each post and see each side of the story. I am trying to get on sub now. It's tough finding a doctor. even here in l.a. Whoulda thunk???? I'm on meth maintenance now only since jan 17th but its just not working out to well for me at the moment. My husband is waiting for a liver and heart valve transplant(his 3rd heart valve) and the meds he has are waaaaaaaay too tempting . The docs are giving him every kind of pain med in town and me???? well they are great but having em in my face is far too tempting. Even knowing thry are in the house is too much for me. Oxys ms contins all of em. I think sub is for me and am going to try really hard to get a doc this week. Wish me luck and don't worry about the controversy it happens evcerywhere hopefully people who come here are smart enough to know to make up their own minds. Thanks for listening Steff
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Unread 05-01-2006, 02:54 AM   #11
Mike
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Welcome Steff,

How much meth are you on? You may already know the transition form meth to bupe can be tricky, be sure you are in withdrawal before you take any sub, and once you do be sure your doctor is willing to give you enough to stop the withdrawal.

See:
What is Precipitated withdrawal? http://naabt.org/faq_answers.cfm#70

SAMHSA updates the list of certified docs every Sunday night. So there might be new ones added. http://naabt.org/patient_dr_connection.cfm

Good luck.
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Unread 05-01-2006, 04:48 PM   #12
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thanks so much....... ((HUGS))) Steff
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Unread 05-01-2006, 05:20 PM   #13
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Steff,
Subs PERFECT for people like yourself. If you have a MAJOR habit then Suboxone is probably the BEST option out there. I believe what Elbow is trying to get across is the way some people try to turn Sub into a magical drug thats like Candycanes and Lollipops. When the fact of the matter is that for many people with "nickel and dime" habits the LAST thing they should try is Suboxone. Well next to last, it comes in just behind the drug from Hell namely Methadone. There are no other treatment options available at this point. Someone who has a 6-8 Vicodin a day habit switches to Sub Treatment? Not a wise choice IMO. Much better off just being sick a few days and be free. Once your on Sub, it ain't so easy to say: BYE BYE!!
For people like myself with nasty drug habits its a FANTASTIC option since there were NO OPTIONS prior. But its not something that people should consider lightly. You may be on it till the day you die, so if your NEW think long and hard before jumping in. Do your homework and ask people who have the same kind of drug habit you have. Go to AA/NA and ask them questions.
People get on Suboxone and do less research than if they were buying a toaster. Then they wonder why they can't get off the stuff!
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Unread 05-01-2006, 07:26 PM   #14
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Slave thanks so much for the advice. I think the reason It's taking me a bit longer to find a doctore is I am trying to weigh the options. And do lotsa research. I've only been on the meth since jan 17th and I hate it yet its my only option now. I can't get up w/o pills and I have to with my kids husband sick etc. I think I have been to hell for a while with the pills and the meth/ My habit got big real big. I mean too big for this girl. I had to have at least 10 lortabs a few oxys maybe some ms contins UGGG scary just think about what I did to myself. I'm trying to figure out if this is the best route for me cause even with the meth I am still using any higher dose on meth I fall asleep so I have a reduced dose and then go and take pills. CRAZY huh. Kinda like financially supporting my habit. EWWW and i hate the meth so bad. really do. I like the idea of going to a meting and finding someone there like myself. Hmmm should be interesting but someohow someway I probably will ..LOL Thanks again Steff
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Unread 05-01-2006, 09:26 PM   #15
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Welcome Steff,

For what its worth I think you are approaching treatment in the correct way. By researching the good, bad, and ugly of all options. Sub treatment is not for everyone, on the other hand it has saved many lives, so the best you can do is gather all the information and try and make a decision that is right for you.

I know exactly how you feel about the opiates. That's what led me to treatment, the realization I could wind up dead, or lose everthing. I had built such a tolerance that I could have easily overdosed. I have been on Sub since November and have opted to stay on maintenance therapy, for me it has worked well.

I wish you luck and encourage you to post any questions or concerns you may have.

Lisa
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Unread 05-01-2006, 10:33 PM   #16
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Steff.
I was on 80mg methodone, my last dose was 3-15-06. If your on a dose comparable to mine, I feel for you. I didnt recieve the instant releif most get from sub. It took 3 days before I could even think about going to work.
I've got some advice for you, Either plan to stay on methohell forever or get away from it ASAP. That sh*t is a hard one to kick. You have been on it long enough for it to get ya! Im not trying to scare you, Im just giving you my experience. What Dose are you taking?? If your at 60mg or more expect a battle. I cant even describe the bone pain associated with coming off meth. Find a Sub Doc soon. Its been 38 days for me, my only problem now is going to sleep. If you can leave the methodone alone for 2or 3 weeks and take oxy you will be much better off. Put as much distance between you and meth as you can.



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