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Unread 03-08-2008, 01:32 PM   #1
kashka
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Default New person here and CONFUSED!! Help


Hello all, this forum I found this afternoon has been a God send and thank you to whoever created it and to all who post such intelligent and inspirational writings on the forums.
I live in Australia (our physicians here have to do quite a bit of training to be able to prescribe sub - and the one I was referred to seems like a wonderful man).
I have been addicted to first codeine then oxycontin which was prescribed by a doctor I went to to "get off the codeine". What a joke!! After 2 months I found I was severly addicted to Oxy depiste feeling "off the plant" and losing my job thru taking them. I've took them and woken up elsewhere but in my bed aching all over from falling asleep slumped over or sitting on the floor. My cigarette consumption has also risen during that time from 1 to 2 packs a day and I was so severly constipated I was worried I had an impaction.
So today at 4pm I had my first dose of suboxone. Here in Oz - you need to go to the pharmacy every day to receive it. I had to just get over the embarrassment of going into the little room with the curtain because I look like an everyday normal Mum of an 18 year old which I am in all other ways. When it came down to it I could not have cared less.
By that stage I was in some withdrawal - it had been almost 24 hours since my last oxy dose and the pharmacist made me wait there for 1/2 hour after I had taken the dose (6mg) "just in case".
I didn't feel anything (except panic - I am always panicky about new drugs) and after around an hour I realised any w/d's I'd started were gone (apart from some diarrhea).
I stay on 6mg for the next 3 days and will then be bumped up to 8mg which I think is where he intends to leave me for a while. We have not dicsussed for "how long".
Now - here is what I am totally confused about. I've read two very diff posts (both long and informative) - one was called "Less is More" and gives a convincing argument about keeping the dose of sub low and tapering off it as quickly as possible.
Then another one was called "The Importance of long term vs short term therapy" which was equally as impressive.
So which is correct? I start a new job in two weeks so I'm fortunate to have this time up my sleeve but I don't want to start and be in the middle of sub withdrawal. Nor do I want to think I will be on sub for a huge length of time as I've read too many horror stories about the w/d. I tried to cold turkey off codedine and ended up on a hydration drip in hospital due to the inability to eat, drink, the diarrhea and the vomiting - I sure don't want that to happen again!!

Background info - addicted to codeine up to 200mg per day for almost 2 years - then the oxy at doeses up to 160-200mg for the last two months. I take 7.5mg of valium per day for generalised anxiety disorder - 2.5mg am and 5 mg at bedtime. I have also been on lexapro (10mg per day) for depression for a few years now.

So - I guess I would like to hear peo0ples thoughts on these two opposing articles and find out what has worked the best for most people? I am uncomfortable in that I view the suboxone as just a "band aid" - ie; it's still an opiod. However I am tremendously grateful that it is available and that my physician seems to know exactly what he's doing. He has also immediately referred me to a mental health outreach program for counselling. He even phoned me this evening to see how it had gone!! Here in Australia it is Government subsidised so it only costs $4 per day. And the physician bulk bills through Medicare (our National Health Scheme)thus the visits to him won't cost a thing. I feel very lucky in this regard!!

Well - thank you in advance to all you great people out there.
Hugs to all, Susan in South Australia.
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Unread 03-08-2008, 01:43 PM   #2
gotoffmdone
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My opinion, after being on Sub for over a year and a half, is long term treatment is best. It gives your brain more time to rebound from the damage done by oxycontin. When the time comes that you will want to get off Sub it may be easier from the physical wd standpoint.

I did not feel that way initially but my thoughts have evolved over time.

Now, just how long is "long term" can depend on your DOC, how much you took, and for how long.

I love the fact that Drs where you live have to put in their time, so to speak, before gaining the ability and priviledge to precribe Sub. In this country a Dr can get a CD and sit in front of their home computer for a few hours and get into the Sub "business". For that reason there is an awful lot of inconsistencies in the way Sub tx is practiced in this country(USA).

Wayne
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Unread 03-08-2008, 02:00 PM   #3
Stacey
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Susan

My belief is that long term treatment is the best option as it gives you time to work on your behaviors and allow for brain changes to heal. I was on sub for nine months.

My interpetation of the 'less is more' theory is this: The lowest possible dose to keep away withdrawal and cravings. Not time frame. For example: if your doctor puts you on 24mg's daily, how do you know you won't be ok on 16mg or 12mg, etc...if you don't try to find your lowest dose. This is how I view and practiced the less is more theory.

Welcome the NAABT!!!

Stacey
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Unread 03-08-2008, 02:07 PM   #4
TIM
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kaskka,
Less Is more can be confusing and lead people to misinterpretation. This post explains it nicely-IMO
Quote:
quote:Originally posted by Suture

This self-contradictory statement (Oxymoron) can be confusing to people. What people are really trying to say by this is that it is essential to be on the right dose of Suboxone. Sometimes that correct dose might be a lower dose than the one you are on. Unlike full agonists where more brings more effect buprenorphine is different, less can bring the desired effect. So finding your optimal dose is important. The dose that is right for you is the lowest dose that accomplishes all of the following; stops or greatly reduces cravings for opioids, suppresses withdrawal symptoms, and prevents you from taking full agonist opioids.

Another thing is your optimal dose may change. Commonly people feel better when they reduce their dose periodically. Occasionally someone many need to increase their dose too, but that's not as likely.

Taking less and felling better is hard to get used to at first, we are all programmed that more is better, or at least more provides more effect, but sub is different. We also find counseling and working your recovery plan decreases your need for higher doses.

This also only applies to the post induction period. During induction a much higher dose may be required to stop the initial withdrawal, it's once the patient is stable that slowly adjusting and working with your doctor to find the right dose for you is important.

Congratulations to everyone who has successfully put their addiction in remission!!

As far as treatment duration experts and the current body of evidence agree that longer treatments have higher likelihood of success on the average. This isn't to say longer treatments are more appropriate for everyone. It must be determined on an individual basis, considering patients addiction history, current situation, support, and treatment plan

Sometimes short term is appropriate and sometime long term is. What determines treatment duration is how long it takes your brain to adapt back and undo some of the changes caused by addiction. For some people without long histories of compulsive use, a short treatment may be enough. For most addicted people it will take 6-18 months (some longer) before the brain is significantly affected by the counseling/therapy, the absence of non-addictive behavior, and the general change in environment and routine, to be capable of remaining addiction free without the help of medications.

How long to stay in treatment is hard to establish at first, it depends on so many things. Nobody should be on any medical treatment any longer than it is needed, but knowing if it is still needed is difficult. One thing to consider is the consequences of discontinuing treatment prematurely far outweigh any consequences of remaining in treatment.

People on this board who have been successful, pay little attention to time lines and focus on rebuilding and learning the tools that will prepare them for medication-free recovery at some point in the future.

There is no credible evidence that supports the notion that the longer someone is in treatment with buprenorphine the more difficult the taper will be. In fact, there quite a bit of evidence that suggests the opposite is true and personal experiences of members of this board and others are consistent with that as well.

Congratulations at beginning treatment, and welcome to NAABT!!

Tim
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Unread 03-08-2008, 06:36 PM   #5
A.S. ADMIN
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Quote:
quote:Originally posted by kashka

Thanks guys.
3 reply's - thank you!!! and in a short time frame.
Thanks Tim for that post you supplied - that now makes much more sense and to others from personal experience agreeing!! I will now just go about my Dr's recommendations but I will argue I do not want to go above probably 12mg if I'm doing fine on it and will probably insist on a fairly quick drop down to 8 or 4 depending on my body.
Thanks guys - truly appreciated. To gotoffmdone - yes you're right. I feel very lucky to live here. My nephew (0nly 7 years younger than me) is Professor/Director of Cardiology at the Royal Adelaide Hospital and has travelled worldwide both practicing and at speaking engagements thinks we have some of the best trained physicians in the business...which is always nice to hear.
I also can't believe the prices you guys have to pay!!! Don't they want people off drugs??? I sure hope you have lobby groups out there campaigning for change. If not......????????? LOL.
I've woken this morning and it feels very weird not reaching for my pills and I slept well. Still have some slight stomach cramping - like I'm going to have diarrhea - is this normal? Does it mean the sub dose is too low (I am on 6mg and moving to 8 on Tuesday). Or possibly too high? Sorry for the "more questions".
Anything new is "scary" in terms of you seem to be constantly self monitoring yourself.
As you think we say over here "G'day mate from Australia" LOL!! What I will say is Thanks all!!! Hug, Susan from South Oz
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Unread 03-08-2008, 06:45 PM   #6
Warrior_Ali
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If you taper slolwly then you will be alright.

As Mike and few others who were on long-term bup treatment they tapered slowly by weaning off every month by 2mgs and when reaching 2mgs they take it steady from there & how your body and brain tell you to and when they are ready.

If you taper fast and jump from high dose then of course u be in WDs, i personally aint off the bup, am currently on 8mgs and been on bup for 3 years now but the support here is overwhemling, the experinces of some ppl on long-term bup give me inspiration as they do to many other ppl.

It take determination, dont be too hasty, and dont be negative, keep ur mind busy, work with ur Doc, tell him/her u want to reduce slolwy & then take it from there, i belive its common sense to taper (wean or reduce) slowly as it takes time for bup to build in ur system and come out aswell. Good luck.
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Unread 03-08-2008, 09:30 PM   #7
Pearl
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Hi Susan from Australia! I too wish to welcome you to NAABT! We all come here on our own paths, but find such great support and truly caring people. I sure hope, your experience is the same. My initial question is why where you put on pain medication to begin with and do you still have a reason to take it? This plays a big part in how your treatment is going to proceed. Mike, Cally, Stacey, Mary and many others have tapered off Suboxone, after doing a ton of work on themselves with success and not much discomfort. But, that is not where you are now, so I would deal with what is in front of you for the time being. Become stabilized on the least amount of Bup. possible. If you still need pain relief, then breaking up your dose throughout the day helps. This is my protocol I was started at 16 mg. in the middle of August and was told to up it to 24 mg. as needed for pain relief. I didn't take the 24 mg. much. I stayed at 16 mg. and have dropped form there. I break my 8 mg. tabs. into 4 pieces and dose 2 and 2. I've had ongoing sweating, which, for a lady my age, could be the "other", if you know what I'm saying. I had a dental procedure which required me to be put on morphine for a couple of days, and the sweating dissipated. This leads me to believe that I may need a higher dose of Bup., and I'm bouncing between 4 and 6 mg. per day. This isn't the best route to take, as keeping our blood levels stable is very important, but, for now, it's ok. Finding a doctor that is knowledgeable and caring is a HUGE part of the battle. I've found my best advice here, on the NAABT forum, as I'm not blessed in that particular area. (between you and I, doctors are not my favorite peeps ;})

I guess the most important information I wish to impart is, don't stress about your taper at this juncture. You not only need to stabilize on the Bup., but also need to engage in counseling or whatever else you chose to do to deal with why you find yourself here and heal that which lead you to this point. It takes work, but is soooo worth it. Don't be scared off by the scare tactics of some, and listen to the success stories. I've only mentioned a few that continue to give us support and wisdom above.

I hope you find a little something in what I and the others have said. I'm so glad you are here!

Elizabeth;}
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