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Kevin

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PostSubject: Question about Suboxone.   Sat 07 Aug 2010, 10:08 pm

When they say less is more ,when referring to dosing, what exactly do they mean? Went to my doc this past Tuesday. Apparently I was taking the wrong dose. He didn't prescribed the right amount of pills anyway so I made do. I was taking 2 mg 3 times a day. He wanted me at 4 times a day. Truthfully, I felt ok except for a little problem falling asleep which I'm not sure was the Suboxone and a very slight case of the PAWS. I let him know this but he wanted me on 4 times, which would help with sleeping and the PAWS. It's 4 days at 4 times and to tell the truth I don't feel any better and the sleep thing is still there. Is this a situation where less could be better for me?
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PostSubject: Re: Question about Suboxone.   Sun 08 Aug 2010, 12:48 am



Kevin
I have always said "less is more" and what I mean when I say that is when you take Suboxone. Taking less of it actually works better than taking more. The less you take, actually you feel it more. Strange isn't it? Suboxone has a half life of 37 hours so it makes sense that if you are taking the same amount over time, it will build up in your system over time.
The average dose that people settle in at once they are in their maintenance stage is 16mg per day. That is the dose that your doctor has you at now.
But usually in maintenance, your dose is taken in the morning. Not all throughout the day unless it is a minor amount in the afternoon. (late afternoon) to help with some cravings if you have any. But I found in the past if I were to take it too late in the day, I was not able to sleep at night. Kind of like it was when I would take hydrocodone. Am I making any sense or just talking in circles?I know what I want to say but sometimes it doesn't come out right.
I am not a doctor so I can't really offer any medical advice. What I can do is give you my experience and the experience of others.
Listen to what your body tells you. When do you go back to your provider?

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PostSubject: Re: Question about Suboxone.   Sun 08 Aug 2010, 7:28 am

Hi Dee,
Yes , I think I understand what you are saying about the less being more. So if I am understanding this correctly I should get to a point and then start cutting the dose so it has the same effect? Maybe? I am not understanding the 16mg a day. I see myself at 8 mg a day. Wouldn't it be 2mg x 4 times a day = 8mg? Also, could you tell me more about all at once and not spreading it out over the whole day. What you say about dosing in the morning makes more sense when you take the 'less being more' into consideration. My doctor actually wants me to be taking my last dose at 12 am. I usually dose at 11pm as I do not want to be up that late on weeknights. This is not the first time I have heard of dosing all at once.
I'm also starting to think that staying up like that might be my problem. Last night I went to bed right after I posted here and slept through out the night. It was the earliest I went to bed since I started on Suboxone. I also think that part of it has been that I have been feeling so good lately that I don't mind being awake. If that makes any sense to you. I was usually feeling like crap so I couldn't wait to fall asleep or was doing the nod and fell asleep due to the dope. Usually was the nod going on.
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PostSubject: Re: Question about Suboxone.   Sun 08 Aug 2010, 4:06 pm




Kevin
I apologize. When I read your post I did read 2mg 4 x a day, but in my head I figured 4mg 4 x a day. I was so tired last night. That was my mistake.

A lot of doctors are certified to prescribe Suboxone. But a lot of doctors still don't know a lot about Suboxone. The class that is required for them to take can be taken Online. And to be honest with you, the doctor him/herself doesn't have to actually be the one to take the course. They can have anyone take it. But they are the only ones who are allowed to prescribe it.
Just because they are certified doesn't mean they have done their research. If they would, there would be a whole lot more educated doctors on the subject of Suboxone.
Don't get me wrong, I'm not saying that your doctor is like that or that every doctor that prescribes Suboxone doesn't know what they are doing, but I am saying that a lot of them don't.
I have been a Suboxone patient for going on five years now. I passed my four year mark in May of this year. I have read a lot and have talked to a lot of patients about their experience. I base my knowledge on what I have learned, experienced, and read. I have much more to learn. Education never goes out of style.

Back to you.
Where the 16mg comes in is when Suboxone first came out, they did a study and 16mg was the average dose that people were able to remain stable on. That is not to say that 16mg is your best dose, just the average.
Now they are saying 12-16mg per day.
There are days where I don't feel the need to take 16mg everyday. I am prescribed 16mg, but I have gotten by on less and did just fine. I know a couple of days I got so busy and in a rush I forgot to take my medication, but I did fine all day.

The whole idea behind the dosing once a day is to get your mind as well as your body out of the habit of being able to take pills throughout the day. When in active addiction we get used to taking pills. Feel bad? Take a pill. Pain patients take pain medication every 4-6 hours. Which is great because most pain relievers are designed to be taken that way, unless it is a time released medication such as Oxycontin.
For people that are in recovery the opportunity to take their medication once daily gives them the opportunity to break the cycle.
Take Methadone for example. For addiction it is taken once a day. Patients go to the clinic early in the mornings, dose and go on with their day. Because it is a larger dose of medication they are able to do just that. Take Methadone for pain, the dose is lower and at a lower dose it last for 4-6 hours so it is taken every 4-6 hours.
Suboxone if taken for pain, a dose of maybe 2mg can be taken throughout the day, but a larger dose of say 12-16 mg taken in the mornings last throughout the day. Our brains need to be retrained. A lot of people in the beginning of treatment have found they have a problem in taking a medication just once a day, they are used to doing things one way. We often tell them when they get that urge to take a pill stop and think about it. Are you really needing to take a pill for the sake of taking that pill or are you really in withdrawal.
More often than not, it is the needing to take a pill. Take a vitamin, eat a piece of candy, take a tic tac. Something other than a pill.
Addiction to the way a medication is administered is just as real as the addiction to an opiate as well.
People who inject Heroin, become addicted to the needle just as much as the Heroin.

Kevin if you see yourself at taking 8mg a day and being comfortable with that without any cravings or withdrawal, then that is what will be right for you. As long as you remain at a stable dose. If you find yourself needing more, you can try upping that by 2mg and see how you do, 16mg may not sound like much to someone that is used to saying they took say like 240mg of Oxycontin a day. The number 16 is quite a bit lower that 240. But in reality. 16mg of Suboxone is a lot of medication. It's a very strong medication. In fact I was trying to find the conversion chart that I have, but my desk honestly needs some organizing right now.


Try making yourself a reasonable schedule. One that is reasonable to you. Get up as early as you normally do, take your medication, eat breakfast, etc. If you like to take walks take one in the morning if time allows you to. Getting a good start in the mornings can lead to a positive day. Remember the simple things while on your walk.
Try this and see how it goes, when you take your medication in the morning, take whatever you have been. Leave a small amount of your medication for later in the afternoon if needed.
See how you feel throughout the night and the next morning when you wake up. But keep in mind that sometimes it does take a few days for your body to get used to one dose. If at any time you don't feel right about the way you feel or start to have withdrawal symptoms take your medication.
The goal to treatment is to not suffer from any withdrawal, cravings and to allow yourself time to create a life free from any opiate abuse.
I hope that I have been of some help to you. If I left anything out let me know.
Enjoy your Sunday!
Dee

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PostSubject: Re: Question about Suboxone.   Mon 09 Aug 2010, 12:12 am

Aww heck Dee. No need to apologize. I just wanted to make sure there wasn't something about Suboxone and math I didn't know about. Honest mistake and all that....
Ok, On to what you wrote about doctors and Suboxone? I'll be honest with you. I'm probably going to ask you any questions I have about my treatment if you don't mind. I really think my doctor fits into the category of the doctors that don't know a lot about Suboxone.
Ok, more honesty here. I first met my doctor while going through my second detox I did in a hospital. I felt he was trying to sell me Suboxone maintenance like a salesman would. I already had a bad experience with it when I did the first detox in a hospital so I declined. Four months later and after my good exp with Suboxone I changed my mind about maintenance and he was the first one I thought of. Why? Because I didn't know a lot about the requirements and such when starting this and I felt he might be a little lax on requirements if I fell short. I was desperate at that point as I probably would have relapsed, again, if I was turned down.
I actually think you know more about Suboxone, and I will soon, than most doctors. I think those of us who are at a point, trying to find anything that will help, go the extra mile and get well educated about addiction and treatments.
I still wonder why I was so sick while detoxing on Methadone.
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PostSubject: Re: Question about Suboxone.   Mon 09 Aug 2010, 12:33 am

Kevin,
Ask away. I believe you are right. Before you are finished you will probably know more about suboxone then your own doctor does.
When I first started taking Suboxone, I knew nothing. Nothing at all, the only reason that I tried it was because I couldn't find a Methadone clinic near enough for me to go to. There I was sick from running out of Methadone and someone asked me why I didn't just go out and buy some bupes. I didn't even know what they were. In Alabama I never heard a word about them even though they had been around for a few years by then. Then, I started reading and searching the Internet.
Sometimes I think I owe my life to the Suboxone Assisted Treatment website. It was through that website that I learned most of what I know.
I owe a lot to Deborah Shrira. Had she not created the website, I honestly don't know where I'd be right now.
After discovering the website, I joined what at that time was the old Suboxone Forum, from there I met Deborah and eventually became one of the moderators of this new forum after MSN closed down all of their forums.
It's strange how things turn out. When I was taking Methadone I used to tell one of the counselors that I wanted to help other people who were new to recovery and he would tell me to just do it.
The rest is history and here I sit. "Just doing it"
I have a feeling that you are going to do good things. I was reading what you said about not giving up your old friends, maybe there is something there for you. Maybe one day you will be there for them when they are ready.
It really doesn't matter why you went to your doctor or what you thought, what matters is that you did. And where you are now, today. Thanks for sharing your honesty with me, to know that I am able to help someone is all that I can ask for.
I am headed off to bed now. I didn't realize how late it was when I came back on here. I have been on this computer all day and I feel like it.

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PostSubject: Re: Question about Suboxone.   Mon 09 Aug 2010, 12:34 am

By the way, math never was one of my strengths.
lol!

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PostSubject: Re: Question about Suboxone.   Mon 09 Aug 2010, 11:12 am

Dee, I hear ya about Math. For me that would also include, Science, English and S.S.. I really regret not doing better in school as I could have done much better than I did if I had put in half the effort as I did getting clean. Live and learn. Not saying I would be doing anything different as far as a career goes but it might have opened some other avenues for me.
Speaking of small worlds.... Where in Alabama did you live? I lived for a short time in Madison and worked in Brown's Ferry Nuclear Power Plant near Decatur. I lived there from Nov. of 06 to March of 07. Had a chance to get away for the winter. I was also going through a rough time, personally, and make some money during, what is usually, my slow time. So I went.

Long before I got clean I started researching Heroin, the addiction to it, the home remedies for detoxing, what to do for yourself after detoxing, inpatient rehabs, out patient rehabs and once I decided on it, some of the Suboxone. I knew full well the road I was on and where it was going to end up if I didn't clean up. It took quite a few times and some trial and error.
To be honest, I didn't have much faith in the care that's out there for addicts. From my experiences anyway. I'll find much more useful information here than I would at places like my H.I. web site. CIGNA. There is a lot to look at there but not much useful information for the addict who has tried all the obvious ways to get clean. If that makes any sense. Like I said, I took the time to educate myself long before I even tried to get off. I knew the battle ahead of me the first time I was dope sick.
Yesterday, I went to an N.A. meeting at noon time. Was going to go to another last night but I figured the time wrong from the N.A. web site, they show it in military time. I thought 1930 would be 8:30 and I drove to the wrong place to begin with. I sat there counting on my fingers and realized I had the wrong time and drove home. When I got home I checked the web page again and realized I was at the wrong place anyway.

Gonna try and make, at least, 1 today.
Well off to get some things done. Have a great day, Dee.
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PostSubject: Re: Question about Suboxone.   Thu 19 Aug 2010, 9:43 am

It has been my experience that Suboxone works best if we reduce our dose and we make headway in our recovery. I suppose it is designed this way as most I have spoken to have had the same experiences. We need more early on but was we work on ourselves and address all of the other issues with our addiction then we simply don't need as much Suboxone. I was on over 20mg per day and now only take a little bit each day. I just kind of went with the flow listening to my body like if I began to feel tired or a bit sluggish then I would reduce my dose. Other times I just said heck lets reduce some and see how it goes. If it didn't work I could always go back up. I know it took a couple of days to feel the effects if I felt them from any reduction. Hope my experience helps some.

GMJ
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PostSubject: Re: Question about Suboxone.   Thu 19 Aug 2010, 10:35 am




Welcome GMJ
How long did you stay at 20mg before you started to reduce your dose?
A lot of patients think or seem to think that taking a medication alone is all they need to do. Working on their recovery is so important and in some cases it is hard for them to understand. The doctors are telling them "here take this pill" without adding the part about working on your life to get the other stuff worked out as well.

I appreciate your post and I think it will be a help to a lot of people who come to the forum and read the posts.
Please feel free to post anytime. The more the better,
Best wishes,
Dee

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PostSubject: Re: Question about Suboxone.   Thu 19 Aug 2010, 7:49 pm

Hi Dee! I was at my starting dose for a couple of months. I didn't feel bad but I guess it didn't feel right so I tried lowering some and it worked great so I just kept doing that from time to time. Well said Dee about patients thinking that the medication is somehow recovery for them. I think the doctors are playing catch up with the medication because it seems a lot of doctors are offering it who don't understand addiction. I have used so many things in my recovery I just kind of opened the flood gates and welcomed all suggestions and then used what worked. Ya know?

Without the medication though I would have never had that opportunity I had relapsed too many times. So now I have my life back and that is so cool to actually get up each day and be able to live life.

GMJ
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PostSubject: Re: Question about Suboxone.   Thu 19 Aug 2010, 9:25 pm

I know exactly what you mean. And you know what you are also right about the doctors, I know there are some things they need to do in order to become certified to prescribe Suboxone, I just wish they would somehow get into some continuing education to keep up with what is going on.
Too many times "old school" thoughts about addiction seem to over ride new ideas and that can be bad not only for the patients but the providers as well. I like the provider that I see, she is old school but she also takes a lot of time doing research on other topics. Not just Suboxone, but addiction and recovery, new techniques. The counselor that I see does the same, the thing I like about him is if there is something that I don't understand all I have to do is ask him and he will get on his laptop and show me where to find the answers and not just tell me. I remember when I asked him about receptors and how they work, he took out a sheet of paper and took the time to draw a diagram and explain it in a way that I could understand.

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PostSubject: Re: Question about Suboxone.   Fri 20 Aug 2010, 12:35 am

Dee, well said and the description of your doctor & therapist are a good model of what others should look for when choosing theirs. Sometime ago I saw the certification course & exam which is taken so that doctors can prescribe Suboxone. Though it touched on some things in regard to overall recovery it mostly focused on the medication it's self. So unless a doctor is making a effort to get additional addiction training they are going to be limited in their understanding of what the patient is dealing with.

Dee you are right about the old school way of thinking and some not wanting to stay up on and accept new methods and ways to deal with addiction. Me being in the same age group as you I appreciate the old school ways and know that we need them but I had to also open myself up to new ways in order to save myself from the hell I was living in.

I think it's cool that a site like this can help do that. I guess the old school part of us still needing to do it for ourselves as in learning about this medication and relying on each other still holds true.

GMJ
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