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Unread 12-04-2005, 11:51 PM   #51
Caroline
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Ratch, it takes time for the body to heal...and that goes for the psychological/emotional part of the mind as well. The best news is that you are feeling better and better as time goes by. I believe you will be a winner and get through this like a Nascar first, but don't forget, if you need anything we will be here for you.
Warmest wishes to you,
Caroline
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Unread 12-04-2005, 11:53 PM   #52
purple
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Thanks Mike a was having a bad day and was over sensitive this morning
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Unread 12-05-2005, 12:15 AM   #53
Caroline
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Rachet, I don't know about other doctors not having all the facts. I share office space with two docs who also prescribe suboxone, and I think they are pretty knowledgable. But then again I am in a large uban area, and I can understand that with a doc in a rural area there may be little opportunity for imput/assistance from colleagues. There is a national mentoring program for such docs by ASAM, American Society of Addiction Medicine, of which I have been a member for a number of years. Actually I got into addiction medicine about 10 years ago, a mere fledgling compared to some others. But I thought it was interesting, and the more I got into it, the more interesting it became. Anyway, as you know, it is not appropriate to lump all doctors into the same category. Playing golf is a mere sterotype and you would not believe how hard docs have to work.
Caroline
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Unread 12-05-2005, 02:01 AM   #54
ratchet
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Caroline,
I am sorry. I did not mean to even imply that "all" Dr's are out playing golf on the weekends (that's kind of why I threw in fishing) I just meant that a lot of medical professionals would not take their spare time to actually go above and beyond the call as yourself so to speak. It was only meant as a compliment to you for posting on a Sunday night and staying so involved in your patients well being.
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Unread 12-05-2005, 02:48 AM   #55
sara
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Hi Gwen, It seems your the only one that cares to respond to me and I reaally appreciate it. I guess maybe I may be in the wrong discussion group. I am not yet concerned about what lies ahead for me on this medicine, I am just so grateful to be on it. One of my problems at this point is I have no insurance and I really do not have the funds for this. My church has been helping, but I hate to ask. Is there anything out there to help someone like me. I realize it is cheaper than using, but my methods of getting money for dope was not always acceptable.I am trying to live a better life today and could really use some help! Any takers? Thanks Sara
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Unread 12-05-2005, 08:10 AM   #56
purple
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Sara, Good Morning. Are you eligible for ssi,ssd, medacaid or medicare???
You can go to yuor local dept. of social services to find out if you are, just walk right in and get on line and you can meet with someone to find out
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Unread 12-05-2005, 10:37 AM   #57
gwen
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hi sara, yes, purple has the best suggestions. you could also start at the town level. some towns also have assistance programs as well as the counties, states then the federal. please let us know how you do. peace- gwen
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Unread 12-05-2005, 02:05 PM   #58
rac1210
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I have been out of town so I am jumping in this topic late. Having read all responses to Ratchet's comments, I bring these observations and questions to the table. First, I have no financial interest in any drug company and I do what is right for my patients never the drug companies. Second, there will always be outliers who have atypical responses to any drug that is available to treat patients. Third, as Caroline so appropriately indicates, patient's with fatigue can have underlying medical pathology and must be carefully worked up to be sure an organic problem(ie: diabetes, anemia, thyroidism, malignancy,Cushing syndrome, Lupus,etc.etc.etc) have been reasonably ruled out. The benefits of low dose Sub seem to offer many patients a way to stay normal with both mood and physical being. If taking a Sub tablet (1mg) daily is the price one must pay for normalacy and a meaningful and productive life, I think it is well worth it to stay on Sub. Co morbities due exist with substance abuse, espeically Bi-polar disorder, depression, ADD,etc. It is important to have a good psychiatrist who has experience with these disorders,carefully and completely evaluate a patient to r/o these co-morbid contitions. Finally, it is well known that mu receptors take time to normalize with various classes of drugs (for example it can take up to five years after discontinuing cocaine for an abuser's mu receptors to become normal again. I do agree that long term use of Sub is still under investigation and more studies are needed. However, there are not many options really out there for treating opioid patients. Therefore, it is my opinion (present time) that Sub affords opioid patients the best chance of a normal life and a meaningful recovery.
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Unread 12-05-2005, 07:08 PM   #59
ratchet
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I agree with everything you and Caroline said 100%. And I also think it is the best available treatment right now. As far as medical problems pre-existing or otherwise, I am in good shape, with the excption of a few dozen fractures, a few non-union as well, all being properly treated without complications. All that I have said to cause a bit of a stir is the wd's for me lasted a while, and you would think the roof fell in. Since there is no published long term usage data available, I can only go by what I am experiencing.

The part that I just dont understand, in every one of my posts I have stated that I still think its a great treatment, even after my experience. Yet people still feel the need to shove roses and flowers around sub, and guesstimate that there is no possible way that it could be the long term buprenorphine. Why is it so impossible to believe that there may be imperfection after longer term treatment? Why must there HAVE to be some other excuse? Can you please name me just one medication that has no flaws at all? I was just trying to come here and get an opinion about my extended wd' symptoms, not get into a debate on what a 100% perfect flawless treatment sub is. That opinion seems to be established here already, and I did not come slithering in to undermine. However, why are there no published reports on long term use or any real reports of specific findings with discontinuation of use except the words "mild to moderate compared to other opioids"...what about duration of syptoms? When the drug has been available for over 25 years why are there NO studies over 52 weeks?
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Unread 12-05-2005, 07:10 PM   #60
spanky
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Hi everyone I just wanted to chime in with my 2 cents.First off I know of this fatigue that ratch speaks of I personally experienced it for myself in fact it was exactly that crippling fatigue that lead me to start Bupe treatment after being clean for 70 days.I know it exsists.My hope and someone can correct me here if I'm in error.I hope that because Bupe only stimulates a portion of the receptor sites and no tolerance is built that in fact the damage that was done by my addiction CAN HEAL while I take the Bupe so as I can function.If that is not the case and the only way to overcome the fatigue is TIME then it appears I have (2) choices.(1)To discontinue Bupe after a slow tapor of course so I can let the HEALING BEGIN,or (2)Stay on Bupe permantly.I do not want to deal with that fatigue ever again .To anyone who has never experienced it ,it is not possible for you to understand.IT IS CRIPPLING.My job demands me to function at a very high level witch requires a great deal of energy,even when NORMAL it catches up to me by the end of the week!As for staying on Bupe permantly I'm not sure my Dr. would go along with that.So my question will I have to deal with this fatigue when I come off?Just a bit confused as I thought that by being on Bupe I would actually HEAl.Is there anybody out there who experience this fatigue then start Bupe then tapor and find that condition improved?Any Input for your old friend SPANKY would be helpful!!I really hope that I'm not just prolonging the agony.....TROUBLED YET HOPEFUL SPANKY
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Unread 12-05-2005, 07:44 PM   #61
gwen
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hi ratchet and anyone else, would it be worth seeing if there are any studies on the after-effects of someone coming off 7 years of any other opioid low-dose as a comparison? i'm just wondering, since there aren't any long-term studies on bupe - (as an aside i wonder if there are any european studies since it was used quite extensively there first). as i said, i have no experience in that since i'm on 12mg now, looking to taper down again 1st of year (i'm lucky, i have a good physician who doesn't believe in more is better). i'm just throwing that out there to see if has something to do with the brain getting back to normal endorphin-making process. something that may need a little more time? peace- gwen
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Unread 12-05-2005, 09:08 PM   #62
leeglegle
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Hi Ratchet:

You performed a real service by starting a vigorous debate and discussion. I think it brought out the best in all of us and proved the necessity for this website. Real science was discussed and I learned a lot. I hope you can say the same.

On display, as well, was a recovering addict's predisposition to extreme thoughts and behavior. I am referring to you. This applies to many active addicts as well as many who are in recovery. I understand your comments that you perceive the participants on this site have closed minds and wear blinders when it comes to suboxone therapy. But, you are wrong.

It is a given that there are few absolutes in this world, and most certainly in the world of addiction treatment. We come to this site for information and support. We also hope to spread awareness of a radically new and effective form of addiction treatment.

Thank you for acknowledging the civility of our discourse. Moderation is an important part of recovery and in life. Contrast the tone and content of this site to the site(s)upon which you were relying and to which you referred our participants. No hysteria here.

So, thanks for "stirring the pot", but in the future please be careful with your words and knowledge. It is apparent that you are intelligent and well informed. But a little knowledge can be a dangerous thing, and more, but not enough, can be fatal.

I hope you stay with us. I enjoyed the debate surrounding your contrarian views. They are a necessity. That's how knowledge is advanced.

Question. Always question.

Peace.

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Unread 12-06-2005, 12:51 AM   #63
leeglegle
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Sara:

I feel terrible that you've not been given the attention you deserve. However, as always, Saint Gwen stepped into the breach. I have been distracted by work and "ratchet". I suspect others have been, as well.

I think you stepped into the middle of a topic, ("ratchet"), involving a spirited discussion that was not focused on you, thereby getting lost in the debate at hand. Saint Gwen responded to you while others, including myself, were distracted by the topic of the moment.

My suggestion: Begin a new topic under your name, "Sara".

You will then be the central focus of whatever your concerns and needs are. Please do it as soon as you read this. We all want to help you. Saint Gwen has begun the process.

Gwen,thanks for stepping into the breach. You truly are a saint. There is a special place in heaven awaiting you.

Sara, we eagerly await your next post under your own topic.

God bless.

Robert


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Unread 12-06-2005, 03:10 PM   #64
Dr.Will
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Ratchet and all,
Many long-term symptoms experienced by post opioid addicted patients can be attributed to the changes in brain chemistry that occurred throughout the addiction, not in response to the last form of treatment. The symptoms that many patients on the heroin-detox board are experiencing can be predicted and are documented with the discontinuation of any long term opioid addiction. Depression, lethargy, weakness, and hypersensitivity to pain, are all symptoms of the body adjusting to the absence of an external source of opioids.

A scientific study assessing the long-term effects of buprenorphine in the way that you are asking is unlikely. Here's why, In order to isolate buprenorphine and eliminate other factors, the patient would have to be a non-opioid dependent person and then made dependent on buprenorphine, maintained, medically tapered, and assessed at various intervals later on. There are ethical issues to creating a dependency in an otherwise healthy person.
W
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Unread 12-06-2005, 04:12 PM   #65
gwen
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robert, you are too kind. i always say i'm going to hell because all my friends will be there! so i don't know if saint gwen is quite appropriate! love you and all your help and insights. gwen
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Unread 12-06-2005, 05:18 PM   #66
ratchet
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Dr Will,
That is an excellent point. Its just a little "convenient" that MMT and Buprenorphine, two opioids with a very long 1/2 life (up to 72 hrs) both produce similar wd symptoms. While you are correct in the fact that it would be hard to determine what actually caused the extended wd's symptoms and consequential PAWS to a specific "timeframe" of abuse or treatment.

I simply ask this question, in multiple studies Buprenorphine has been used to treat refractory depression, TRD Treatment Resistant Depression, and other forms of depression.(with great success) None of these patients were on any opiates/opioids prior to many of these studies. Would it be safe to say that after discontinuing the Buprenorphine they would simply return to exactly where they were before the study, without ANY extended symptoms of WD'?

Just curious if that test would have/could still be a proper "gauge" regarding extended treatment.

Thanks
Ratch
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Unread 12-06-2005, 05:32 PM   #67
Dr.Will
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I simply ask this question, in multiple studies Buprenorphine has been used to treat refractory depression, TRD Treatment Resistant Depression, and other forms of depression.(with great success) None of these patients were on any opiates/opioids prior to many of these studies. Would it be safe to say that after discontinuing the Buprenorphine they would simply return to exactly where they were before the study, without ANY extended symptoms of WD?

Quite the opposite. It would be expected that they would go through a withdrawal period proportionate to their dose, and length of treatment. Those studies could be looked at to see if there were any long term adverse effects, other then depression and conditions that can be attributed to depression. However, doses used for depression are often less then 1mg.daily.
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Unread 12-06-2005, 08:53 PM   #68
Dr.Will
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interesting study:
http://opioids.com/buprenorphine/v-methadone.html

Sublingual buprenorphine and methadone maintenance treatment: a three-year follow-up of quality of life assessment
W
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Unread 12-07-2005, 04:29 PM   #69
ratchet
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Thanks Dr Will.
I found a pretty good chinese study that explains a little more. The variables are a little rough. And they left out sneezing! no joke! anyhow here is the link.

http://www.chinaphar.com/qikanbj/aps...083/24/448.htm

Ratch

PS- How does one get "partial insomnia" I mean either you have it or you dont..how do they rate that a 1.3???
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Unread 12-08-2005, 02:18 AM   #70
bluewind
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My Doctor told me Fatigue could be a factor when I decide to go off Subutex. He said he prescribes Ritalin with a high succes rate
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Unread 12-08-2005, 02:29 AM   #71
ratchet
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Spanky- I sent you an email re the DLPA, and we are going to try it with 3 other folks in the same boat as me for a detailed result. It seems to do something but too early to tell.

Bluewind- I will try some Adderall and see how it goes, I have no problem being a guinea pig when it comes to getting back together again.

Thanks Again for all the help
Ratch
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Unread 12-08-2005, 04:33 PM   #72
Dr.Will
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Thanks ratchet,
I have not seen this study before.
W
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