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Unread 10-21-2006, 08:38 PM   #1
snipes
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Default Less is MORE?

I just wanted to touch on this subject for all the people new to the group. Doctors are prescribing as much as 32mlg a day of suboxone to people... and I have been reading a lot bout people with appertite problems.. and headace's... and Im wondering if this is because of HIGH doses.. rather then LOW doses. So.. Im wondering.. Is less suboxone ... better for us all around? Im just throwing this out there again to get people responses about how they feel. Let me know how much you take and your experiences with Less is more???

Thanks in advance,
Tim
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Unread 10-21-2006, 08:46 PM   #2
OhioMike
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The only thing we in Sub Therapy need to worry about in terms of less, is that we always strive to stay on the lowest possible dose for our body, our system. If you do that, then the natural progression of the program will take you to the desired end result. Naturally that will be a different dose for each of us and we will all move at a different rate.

Mike
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Unread 10-21-2006, 08:52 PM   #3
Suture
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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 1mg/day or 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. Differences in absorption rate may also play a role.

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, if they have been unable to stop without medication.
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://www.drugabuse.gov/PDF/Perspec...-Practical.pdf
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Unread 10-22-2006, 02:28 AM   #4
kirk
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that was the first phrase that intrigued me in 2004. seems i don't hear it so often now...iwas thinking about it yesterday. less is more...you may need the ceiling dose initially but your comfort zone will come with reductions for i don't think anybody could be truly comfortable at 32mg. side effectes manifest more often on the higher doses(for me)
kirk
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Unread 10-22-2006, 02:55 PM   #5
snipes
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kirk,
I have also noticed that in the last year that I have been learning about sub. It seems at higher doses people experience more problems... That is just my opinion. You just have to listen to your body... You know when its time to take it down a bit... I personally couldnt imagine taking 32mg of bupe. I know for chronic pain issues its good for people. Im lucky in that I dont have to worry so much about pain issues...

Tim
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Unread 10-22-2006, 05:45 PM   #6
Bassdad
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I started Bup treatment at a 32mg dose.I have since learned through my own treatment(since stabilizing) that I have the same results at 16mg a day.The ceiling seems to kick in around 16mg. After stabilizing, taking more than 16mg is a waste of medicine. This is not true for everyone though, for instance someone that was on high doses of Methadone(Maybe you know who I am talking about)it may take more Bup for awhile, till the methadone is out of ones system. We are all differant, no matter how alike we are.

Later, Bassdad
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Unread 10-22-2006, 06:08 PM   #7
snipes
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Bassdad,
I couldnt have said it better myself! LOL.. I 100% agree with you. I feel after the stabilizing time frame that more then a 16mg dose is usually a waste. All tho there is those rare cases. I sometimes feel some doctors jump to the 32mg dose too quick, and make people think they need that much. Without a doubt, everyone is different... and we are all just trying to achieve the same thing... L-I-F-E..

Tim
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Unread 10-22-2006, 06:15 PM   #8
Brett
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Every person's ideal amount is the lowest amount to maintain a comfort level, any less and there is WD anymore is just a waste of medicine. Right now my ideal dose is 16mg. I have tried doses from as high as 28mg down to as low as 8mg. I feel the best at 16mg. I have no side effects that are troublesome, so I will stay at my lowest dose until my body tells me to take less, I always think about the time to take my dose so I know Im not ready to drop. If you find yourself forgetting to take your dose, thats a sign you need less, Ive been there at the higher doses above 20mg. I guess thats the best indicator, if you are forgetting or taking your dose late then you probably need to drop.
So less is more only if your taking to much.

Brett
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Unread 10-23-2006, 02:32 PM   #9
snipes
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Brett,
Well said! I agree with you. Everyone's ideal amount is different. I think people or doctors should play around with the dose to get the right ammount. Sometimes I feel people are told to take 24mg or 32mg so they do, and it works fine... But I think If they tried 16mg instead they may get the same result. I know that methadone clients may need more then 16mg... but there is some doctors out there telling people they need this much.. when I think they could go on a lower dose. I feel the best at 12mg.

Tim
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Unread 10-23-2006, 02:32 PM   #10
snipes
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Brett,
Well said! I agree with you. Everyone's ideal amount is different. I think people or doctors should play around with the dose to get the right ammount. Sometimes I feel people are told to take 24mg or 32mg so they do, and it works fine... But I think If they tried 16mg instead they may get the same result. I know that methadone clients may need more then 16mg... but there is some doctors out there telling people they need this much.. when I think they could go on a lower dose. I feel the best at 12mg.

Tim
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Unread 10-23-2006, 09:04 PM   #11
glimmertwin
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After experimenting with doses, I learned that 16mgs is best for me. I can make it on less, as far as not having any cravings for opiates, but I need at least 16 for my depression. I tried different doses and 16 is what has kept me out of complete darkness. And as long as I am out of that darkness, I have a better chance at remaining sober.

Sheryl
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Unread 10-23-2006, 09:04 PM   #12
glimmertwin
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After experimenting with doses, I learned that 16mgs is best for me. I can make it on less, as far as not having any cravings for opiates, but I need at least 16 for my depression. I tried different doses and 16 is what has kept me out of complete darkness. And as long as I am out of that darkness, I have a better chance at remaining sober.

Sheryl
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