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Unread 08-16-2014, 05:35 PM   #1
Ramona
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Angry Subs driving this newcomer nuts! Please help!!

So I finally got enough courage to get help for my pain medication addiction of the past 2-3 years.

I went to a doctor and got prescribed Suboxone strips. I was told to start with half of an 8mg strip (4mg) and see how I did. Then if that dose was good, I could keep taking it once or twice per day, depending on how bad my withdrawals are and how much I need.

It all sounded great, expect I never would have guessed this would be CONFUSING as @#$% to do properly!

Ok, so in my doctors instructions, it says that if you have a headache, nausea, and/or drowsiness, you are taking too much Suboxone.
But then on the other hand, my number one symptom of withdrawals is also an intense headache (sometimes with nausea) and drowsiness!

Now I started off Day 1 with only a half strip (4mg) dose because it was already night time by the time I started treatment. The next day (Day 2), I took a half strip (4mg) during the afternoon, then another one about 12 hours later in the late late night, around 2am, because I suddenly began getting what seemed like cravings for pills again.
So all in all, I thought that I was definitely taking the right amount of Subs at this point, and felt good and went to bed.

But this is literally torturing me now, because today, on Day 3 of my treatment, I woke up with a POUNDING headache that has not gone away for the past 10 hours. And I have no idea to tell if its from my withdrawals coming back, or the Suboxone that is causing it!

Well, I tried to experiment by taking only half of a half (2mg) this morning to see if it would make my headache better or worse. But it provided no change in my condition whatsoever. So I took the second 2mg, and I felt like my headache was gone. The next few hours I felt really good and had that "buzzed" feeling. But then next thing I know, as soon as I stand up and the buzzed feeling is gone, the terrible headache is back.

I have tried taking tylenol twice now (4 pills total), drinking coffee, going outside, drinking tons of water, etc, etc, etc. But NOTHING has worked to get rid of it, except taking more Subs, which I fear could be the reason I had it in the first place.

At this point I have no idea what to do, and feel like crying. All I wanted to do was give up my addiction... I didn't know I was in for so much hell and confusion. I'm shaking with fear as I debate on whether or not I should take another dose of the Subs. I wish there was a simple way to figure out what it meant to be taking too much or too little, but I just don't understand the difference.

Oh and PS: I know this would have been easier to just go and ask my doctor, but he told me he was leaving on a camping trip the day after he saw me and that he won't be back till Wednesday (thats when I have my next appt with him and am supposed to tell him how the Subs are working). So yeah, no one to turn to except the internet.
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Unread 08-16-2014, 07:39 PM   #2
Eliza12
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Hi and welcome,

Congratulations on starting sub treatment! Sorry you are having such bad headaches. Nancy will likely explain better but some people are sensitive to the nalexone (sp?) in the strip. You can try spitting it out instead of swallowing after the strip melts. I'll post more later but wanted to suggest you get some Excedrin for your headache. Generic is fine, but that should help way more than Tylenol.

Feel better!
Elizabeth
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Unread 08-16-2014, 08:04 PM   #3
NancyB
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Hi helpifeelsick, welcome. Sorry you're having such a hard time with the medication.

From what you've said and from what other people have experienced, I'm wondering if your dose is too high. Buprenorphine has about a 37-hour half life - so approximately half of what you took yesterday is still working today. When you took that other 4mg around 2am on day 2, you may not have needed that much.

Do you know if you were having urges or cravings when you took the other 4mg? Here's the difference. From: http://www.naabt.org/glossary.cfm

Craving: Powerful desire for a substance that cannot be ignored. Unnaturally strong desire/urge for a substance. An overpowering urge that people are ill-equipped to control through will. Usually it cannot be suppressed indefinitely and results in taking the substance. Cravings are a symptom of the abnormal brain adaptations of addiction.
Craving (formerly called psychological dependence ) is an intense desire to reexperience the effects of a psychoactive substance. Craving is the cause of relapse after long periods of abstinence.
(N Engl J Med 2003;349:975-86.)

Urge: Unlike cravings, urges can usually be suppressed by willpower. Urges are less powerful than cravings. Urges are often passing and temporary. Cognitive skills can be learned to effectively suppress urges. Urges can usually be traced back to a source like stress, depression, anxiety, etc. which provides motivation for the escape or comfort of the substance, while cravings may have no external source and the person may have no idea why they are craving and may actually not want to take the drug at all.

Also, when you said you felt a little buzzed, that's a sign that your dose might be too high. One thing you can do is take a look at your pupils in normal light. If they're small, that could be an indication that your dose is too high.

How much have you taken today in total?

Do you have any hives, itching or swelling of the joints? Those are usually signs of a hypersensitivity to the naloxone. As Eliza12 mentioned, headaches may also be a sign of hypersensitivity.

I hope this makes sense. Please ask if I wasn't clear in explaining.

Let us know how you're doing when you can.

Nancy
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Unread 08-17-2014, 05:05 AM   #4
Ramona
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To Nancy; thank you for your quick and lengthy response.

So after this situation occurred, I still continued to take the same dose I have been. I ended up taking the other 4mg dose at night and it felt like my headache finally went away. Today I woke up without a headache, so again just took 4mg in the morning and again just now.
I don't really feel like the dose is too high anymore... I don't know, maybe. I do check my pupils before every dose and see that they are getting wider, just to make sure.

One other reason that might suggest overdosing is the way I tend to "nod" out on it. Literally any time I put myself in a comfortable situation after dosing, I feel like I am fighting for my life to stay awake. Its getting really annoying! It even happened in the tub during my bath yesterday, which scared me. I had to have my partner come in and check on me repeatedly. Is this another common side effect?

Oh yeah and in regards to the buzz feeling I was talking about... I have been getting this since my first dose. Also, before I even started treatment, I read peoples experiences with Suboxone and apparently they all had it too. It is sort of like an opiate high, but not really... more like a slightly drunk feeling. Just feel very uplifted and happy, without a body high or anything physical. All I know is I really enjoyed it. I hate to say this, but I think I enjoyed it because it kinda felt like I hadn't totally lost the benefits of using. *feels ashamed*

Lastly, I appreciate you trying to explain the difference between urges and cravings... but as of right now, I can't tell the difference when they happen to me. I don't believe that there would ever be a pill-related urge that I could mentally pass aside and not act on. Coincidentally, as I'm typing this, I am actually having a desire to use again. I won't go into detail about why, but something really depressed and stressed me out earlier. I feel awful emotionally because of it. Would taking an extra half of my regular dose (2mg) help these thoughts to pass?

Thanks again so much, Nancy. Sorry I had so many questions.
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Unread 08-17-2014, 07:35 AM   #5
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Hi again, I'm glad the post made sense. Yes, nodding out is an indication of too high of a dose. Not everyone gets that 'buzzed' feeling, but for most who do, it usually goes away with stabilization on the medication - which can take about a week for everything to level out.


In my opinion, if possible try not to take another 2mg. That could make you even more tired - and for some with too high of a dose, they can feel depressed, which could just make it worse for you.

Years ago, we had a member who was in the beginning of treatment. He did fine until 7:00 at night. When I asked what was there about 7:00pm that maybe be triggering the cravings, a lightbulb went off. Without realizing it until then, 7:00pm was around the time that he would sit down after work, after supper to relax and take his DOC. What he did was change things up. He did something different when he got home, ate supper later and the cravings went because he wasn't going to sit down at 7:00. If that makes sense. I wonder if how you were feeling earlier was not a craving, but an urge - because it seems to be situational. Was taking a pill a response you had when you did feel stressed out and depressed like you felt? If so, that might be something to work on - a different response to triggers like that. Cognitive Behavioral Therapy (CBT) has helped a lot of people with urges and sometimes even cravings. This site is free and a lot of people found it helpful, especially if they couldn't find a CBT therapist or were unable to get to counseling. https://moodgym.anu.edu.au/welcome

Don't worry about questions! Knowledge is power!

Nancy
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Important disclaimer: Any information in this post is not and does not constitute medical advice under any circumstances. Addiction Survivors, Inc. does not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. NEVER take any online advice over that of a qualified healthcare provider. Any information contained on AddictionSurvivors.org should only serve to inspire further investigation with credible, verifiable references sources such as your physician or therapist.
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Unread 08-17-2014, 05:32 PM   #6
Ramona
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Nancy- just curious, are you a doctor or something? You seem to have a lot of knowledge about this drug.

Anywho, you were right! When I took the extra 2mg last night I got so sleepy that I almost fell down while standing cause I was dozing off within seconds. I definitely won't be doing that again. But as far as the 4mg twice a day goes, I still think thats a reasonable dose for me. I feel like I am getting adjusted to some of the side effects now, like the headache and sleepiness. This morning when I dosed I didn't even feel the buzz anymore as intensely.

Today is Day 5 for me... it's a miracle that I've already made it this far. I'm definitely going to ask my doctor this on Wednesday, but on what day of treatment do you usually start lowering the dose and tapering down? And how long is the entire treatment generally take to complete?
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Unread 08-17-2014, 06:18 PM   #7
NancyB
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Hi helpifeelsick, no, I'm not a doctor or nurse. I got involved because a couple of people close to me probably would be dead if they hadn't found Suboxone. Over the past 8 or 9 years, I've done a lot of reading, talked with many doctors, researchers, attended conferences and learned as much as I could so that I might be able to help someone. And in being here on the forum for the same amount of time reading people's experiences, even though everyone is different, there are many general commonalities with the medication. So I always like to toss out possibilities for people to look at/ask their doctors about. Phew. THAT was long winded! lol

I'm glad you're leveling out now. The trickiest thing about bupe, I think, is the long halflife - it can take about a week for the dose to level out. And when tapering, many people wait at least a week between reductions because it takes about that much time to stabilize when reducing.

The length of treatment varies for everyone. I've seen people be successful with short-term treatment (less than 2 months); and some people need years until they make all the changes they need to make and then are ready to be both addiction free and medication free.

This might be of interest to you. It talks about the phases of treatment and you might be able to see where you're at with it.
http://www.addictionsurvivors.org/vb...ad.php?t=23809

I'm really happy you're stabilizing and the side effects aren't as intense!

Nancy
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Unread 08-17-2014, 06:37 PM   #8
reti4455
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Hi, Welcome. Just wanted to say that you may be taking too much. Subs are very strong. I may have read it wrong but it sounded like you took 12mgs in around 36hrs. That may be too strong a dose.
You could try just taking 4mgs 24hrs after your last dose. Wait 24hrs and just take 4mg again. Of course I,m not a doctor so this is just a guess.
I spit out the liquid after the strip desolves and it works just the same. You could try this and if the headache goes away in about a day it,s a good bet it,s the Naloxone that's causing it.
I never got a buzz off subs but I do know about that kind of nodding off feeling. I do get that way some times but not sure if I,m just tired or whatever. I have read about that side effect.
Everything you wrote just makes me think that your dosing to high.
I hope you get feeling a lot better real soon.
Be sure to tell your Dr. wed. exactly when and how much you,ve been taking. He should be able to get you all straightened out.
Don,t forget to give the spitting thing a try!
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Unread 08-17-2014, 07:08 PM   #9
theswan
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Welcome I am happy you found suboxone and this wonderful forum. Nancy is one of the most helpful people I ever met. You will never be spoken down to in any form of judgement or given bad advice from Nancy.

I am glad you mentioned the bupe gives a slight buzz feeling because I too get this. This is however my second go around. The first time I had been searching the web for "safer narcotics" and/or safer opiate's, safe pain medications" etc etc..This led to be being enrolled in a study at Columbia Preyspertrian/NY psych inst inpatient unit.
The study was on the effects of suboxone on pain patients who were not able to take their opioid medication exactly as prescribed (yep this was me for sure lol) in fact, they are doing this study again I hope to find a link

https://clinicaltrials.gov/ct2/show/...w+york&rank=51

This is a similar study but not the exact one I was seeking.

Anyway, after I found 16mg to be the best dose, they hooked me up with a doctor who agreed to take me as a patient. He was a substance abuse psychaitrist, a decent guy and I stayed on over a year. I did slowly taper off and went a year without needing to take it but, the pain got too bad and I returned to use bupe as my pain medication. I take 2mg about every 4 hours as it is prescribed but honestly, I take 2 to start my day then one afterward in maybe 6 hours etc..in other words, I am not locked into a certain time or dose except I never take more then two pills. I did tell my doctor and he is ok with it but has to prescribe a certain way. He writes it as an "off label" pain medication and I think it has to read "PRN"

Whew! I got off track the point I mean't to make was I did not get a buzz the first time taking it back in 2008 but I do get a mild euphoric feeling these days. I simply enjoy the feeling because I know it would last long and taking more never makes it feel better. I feel if I deny what I feel or try to pretend it isn't pleasant, I am only lying to me!

I wish you the best and don't worry about a buzz as long as it does not push you into doing more or finding other things to enhance it. Also, try and make positive changes in you life and look into programs

Glen
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Unread 08-17-2014, 08:19 PM   #10
Ramona
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Thanks everyone for all the great advice!

And Glen - very awesome to know that you get the buzz too and I'm not just crazy! Also, I too am a sufferer of chronic pain like you. It is the reason why I became addicted to Oxycodone and had a steady supply for about a year. When I mentioned this to my doctor, he asked if Subs were something I wanted to do long term as a pain management. To be honest, I still have no idea if I would ever consider that. I'm really scared of becoming addicted to them, and living everyday anxiously awaiting for that buzz; that feeling forever reminding me of an opiate high (like it does now). I'm not sure if I could still consider myself clean or 'not an addict', because it'd still be something that I'm reliant/dependent on. The only reason I don't feel guilty about it now is because I know it's short term and its' purpose is to work towards a greater good: to ultimately be sober.

On the other hand, it scares me to death thinking about how I am going to cope with my pain without opiates, Subs, or anything powerful enough to fight it. I know there ARE other ways, and many people with my problem don't believe in having to take opiates... but everyone's pain tolerance and coping ability is different. I just don't know how I would handle it. Sigh.

Did you have a hard time making this decision as well? Were you previously an addict, or did you go straight to Subs just for pain management? Let me know if you have any advice. Thanks.
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Unread 08-17-2014, 09:24 PM   #11
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Hi, I never went straight to subs for pain management. It was because of the pills from pain management that I went to subs. Find your right dose. I take about a 1/2 mg. This is some strong stuff. Once u find your dose, you will feel great. Keep up the positive attitude!!! We are here for you!! Julie
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Unread 08-17-2014, 10:28 PM   #12
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I am sober via AA since 1987 But have slacked off meetings for the most but still stick my head in the door now and again. 99% of friends are from AA and still call my sponsor every few months to chat.

He and most in AA were always cool about me requiring pain meds even when I lost control. I believe if you need to take opiates for more then a year, one will become dependant on them. I first detoxed inpatient in 2001 and was on 270mg a day of morphine but it still did not work. I really believe they all stop working after a time except so far, the bupe. Anyway that detox was a horror show because it was only a week and I left in bad shape. I did get well but pain brought me back in 2005 to pills, I did the clinical trial in 2008 and finally found bupe. I went off just basically to get to "baseline" on my pain and see if NSAID's and tylenol would get me through-and it did for a time.I went as far as Ultram (tramadol) but that did not work after a few months. I was off the bupe over a year and then returned to it with zero guilt about it. If one searchs their motives and calls upon God, I trusted I'd not get addicted to subutex and since 2011 it has worked out well.

I first tried the buspan patch then 1/2mg (quarter of a pill) but did work up to the total 12mg a day I now take (some days less some more and have been able to even save a few just in case which NEVER happened with regular opioid meds)

So I'd suggest you do a similar trial of bupe then when ready, taper slowly off (slow I say this is not a race!) then see if tylenol or aspirin etc will work for you and worse case, come back to a lesser dose of subutex but worry about today as said you have plenty of time to get well.

To answer the question about having a hard time deciding to take opioid meds I'd say my view has changed over time. I was scared s--less before but now trust my higher power will give me the right answers. Yeah I do get twinges of guilt at times but that is my nature to be hard on myself and question my motives so I say now screw guilt and learn to trust.

Bupe is a decent painkiller by the way but I admit it is not as good as oxys or morhine but hey, it does the job!
One last thing. I had hip surgery and they just adjusted my post surgery pain meds to a higher dose to overcome the bupe in my system, after a day or so I went back to subutex so do not worry about emergencies

Glen
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Unread 08-19-2014, 09:02 AM   #13
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Hi helpifeelsick. I would talk with your dr about that. Never had those symptoms but do think i have heard of someone else with them. Again i would ask your dr. Thanks and good luck to you! Matt
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