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Avatar universal

Starting Suboxone ??

I’ve been taking 150mg Norco a day for the last couple years and recently just got fed up with the way it’s been controlling my life so I started a taper program.  Over the last month I’ve been able to cut back to 80mg a day.  I feel really good about getting some control back and my plan was to continue to cut back until the 15th of January and walk away clean and free.  That’s was my plan and it’s been going great.

I’ve been visiting two separated doctors to keep my supply up, my main doctor and a referral doctor from a friend who I’ve paid out of pocket.  The meds are for my back which is a problem, but I only need them (20mg – 30mg) for night time, I’m an addict for sure!

I went to my main doctor yesterday, confessed my sins and told him of my progress and plans to become clean by 1/15/13.  He basically said you’re done now, no more prescriptions and we’re starting you on Suboxone.  I’m terrified and mentally not quit prepared!  I also have a 2800 mile road trip starting in 3 days and have no idea what to do about the WD symptoms.  I explained all this to him and he said you’re starting now and that the Suboxone will stop the WD symptoms.

Does this really work that well, will I not have symptoms on my road trip?  For now I have the mental part under control, it’s been awhile since I’ve taken the drugs for a buzz vs just to feel normal so I can function.   Whenever I start to detox I get RLS (restless leg syndrome) really bad, that is my biggest concern for this drive.  

One more and sorry to ramble, is it difficult to detox off Suboxone?  Take long?

Thank you

19 Responses
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480448 tn?1426948538
Sounds very promising hon!  Way to go!  You're going to be in good shape.  Keep it up!
Helpful - 0
Avatar universal
Forgot to answer the Norco question, no I'm not going to refill.  With all your guys kind words of encouragement I believe I have this under control!  PLUS, the alternative motive of telling my doctor I've clean so many days!
Helpful - 0
Avatar universal
Leaving tomorrow morning at 3am on my road trip, Southern California to Spokane Wa and back.  No worries at all!

The subs are wonderful, I haven't taken Norco in over three days and I actually feel great. Once I'm down to 1/2mg every three days what can I expect when I quit?  Am I just prolonging the WD's off 80MG Norco or can I expect a milder effect?

I can’t wait to see my doctor next month, he’s expecting to see a full blown Suboxone addict at 16mg day and I’m going to tell him to go pound sand!!

Thanks again everyone, I’ll follow up once I’m in Spokane
Helpful - 0
480448 tn?1426948538
That's a shame that you had a bad experience.  Sadly, I think there are more lousy docs out there than good ones.  So many of them have NO kind of "program" in place at all.

We used to get patients coming in from another local clinic, often on sky high doses...at that point, just addicted to the sub.  Many were put off at first by all the requirements...until they started looking at it a little differently.

Thank goodness you got clean, despite your experience with subs...good thing in your case you WEREN'T on them longer.  With that kind of experience, no doubt you would have been worse off than when you started.
Helpful - 0
3197167 tn?1348968606
So your road trip must be behind you now huh?  
You have a very sensible sub dose taper going.  You aren't going to even entertain more norco now, right? No refill the norco thoughts, RIGHT???
  
I was only on subs for 28 days.  It was NOT a good experience for me.  The sub dr (psych) left much to be desired.  I have since educated myself abundantly about subs.  You have a really good plan working.  Now the next question, are you looking into SOME kind of aftercare.....?  It's a critical piece in the puzzle........and I sure hope you'll add that to your plan.
Getting off the subs as soon as you are will be a GOOD thing and I'm glad it helped you get thru your work and road trip.  Now the only road you have to be on is "the road to recovery".  
Thanks for checking back in and letting us know how you are doing.
Helpful - 0
480448 tn?1426948538
(cont....)

You should be required to give a urine sample for testing at every visit.  The less frequently the clinic requires drug testing, the more reason to stay away from that clinic.  Drug testing should also include random "send outs" to a lab for quality assurance type purposes.  This helps eliminate or reduce the likelihood of people trying to cheat a test...and it ensures the accuracy of the cups.  The tox screen should include a test for buprenorphine also (the opiate component of sub).  

Standard, less expensive tox screen cups do not include this, so there will be a seperate dip stick test...unless the clinic has purchased the newer cups that include bupe as a strip.  The testing process should be consistent.  The cups should remain sealed (until you open it in the BR), and your name (or initials) and DOB (or other unique identifier...last 4 of SS#) should be written in permanent marker on the cup.  After going in the cup, the test should be read right away, in the same manner every time.  It shouldn't be allowed to sit for long periods of time.  The clinic I worked at had a very regimented testing process.  They used different random methods to choose specimens for send out.  There should be a standard and consistent process in place to handle ANY + results, usually a send out to a lab, with the option for a blood test.  + results DO happen for various reasons on samples where people truly have NOT used.  A good sub clinic will want to assure that those situations are planned for, and a system is in place to deal with it, rather than just dismissing the patient.  There should be a very clearly stated written contract that a patient must sign at that first visit that should outline all of this stuff VERY well, including all of the costs involved.  READ READ READ that contract VERRRRRY carefully before agreeing to it. If you're shopping around for a good sub doc, ask to read their contracts first.

Lastly, the clinic should place a lot of importance on guiding the pt through setting up aftercare, encouraging outside support, educating about the different signs and stages of relapse...relapse recognition and prevention...and should educate a pt what to do in that case.  The clinic should follow up with a pt who has completed the program at LEAST once, and should have a system in place to fairly easily re-transition a patient back INTO the program in the event they relapse and return for sub treatment again.  If that happens, the subsequent program should have a much stronger focus on the aftercare, with a longer follow up period post program completion.

Also, a clinic should be able to provide upon asking, statistics about their success rates, average length for patients, and other tidbits of info.  A sub doctor can only have so many patients at a time (100 I believe per MD)...there are some different situations with insurance, and patients who are on a long-term maintenence program...where the numbers can vary.  Most sub docs will be at capacity or close to it the majority of the time.  If it's a GOOD doc, they will have openings more often than others...as they are getting people thru the program.  If the doc has a website, look for patient input, feedback.  Some docs will even have former patients available to act as liasions of sorts to current patients.  That's really very helpful.

Hope that helped a little.  I just cannot stress how important these things are.  Sub can either be a life saver, or a person's worst nightmare, depending on about 1000 different factors.  I've definitely seen more of the positive...but I have to say, after reading here...I realize just how many BAD sub docs are out there who are in it ONLY for the money.  They could care less how much a pt is taking, and for how long...thy hand out scripts just like a dealer would hand out the pills themselves.  The bad sub docs are nothing more than legal dealers, sadly.
Helpful - 0
480448 tn?1426948538
A GOOD Sub doc is just SO important for anyone choosing to use sub as a TOOL in their detox and recovery.  With Sub, less is more.  Actually, additional doses on top of a low maintenence do nothing (except prolong the taper when it's time to come off).  Even someone with a heavy habit can EASILY and comfortably be maintained at a low dose (2mg or less a day).  The initial induction dose may be a little higher than that, but not by much.

No one should EVER need to be on 16 or more mg a day.  For one, the ceiling effect applies, and again, it's just adding on unnecessary medication.  Due to the long half life, it isn't even necessary to re-dose several times a day.

GOOD Sub docs know all this, and won't get a patient stuck in these traps, of taking high doses, many times a day.  PLEASE people, do your homework.  I'm a supporter of Sub in a lot of ways, because I HAVE watched people succeed with it...but there is SO much to consider...whether it's right for you...whether you're trading for a MUCH higher comparable opiate dose (which many are), and if you're willing to do the work needed.  Whether it be Subs, or Methadone, or rapid detox, or CT...NONE of it will work without a lot of work, an aftercare program, and the desire to stay clean.  Jesus himself could not keep people clean without them being willing to put forth the effort and determination and the WANT to do it!

Here are some basic things to look for when researching docs (to make sure you're getting a GOOD Sub doc):  

Initially, you should be seen weekly.  You should be instructed to come to your 1st appt IN w/d, even if minimal, so the doc can properly assess you, and calculate an induction dose.  The doc should want to see you a day or two after your induction dose..a week max.  If a doc gives you more than a week's worth of Sub in a script at your 1st visit...find a new doc.  

You shouldn't be transitioned to a bi-weekly appt schedule for at LEAST a month (60 days is preferrable).  If you are going to be on Sub longer than a year...your appt frequency should not change to monthly until after that 12 months (if at all).  

The 1st visit should include a full set of vital signs, and a physical assessment by the doctor, along with a collection of your entire medical, psych and addiction, and social history.  1st visit should take at least an hour.  Some clinics will allow for a "non-doctor" visit once a month or so for people who are already stabilized and into the program.  This would be an RN, or CRNP doiong the bi-weekly assessment instead of the doctor.  If the clinic has you seeing a non-doctor more than a doctor, also a sign that it isn't a great one.  An occasional non-doc visit is okay though, and permitted...it can actually reduce costs, for the established patient.

Therapy should be PART of the program, and should be required.  This can be individual and/or group therapy.  The clinic I worked in did both.  They started out the pt out on 1:1 therapy and transitioned them to a group environment.  They offered same gender groups and mixed gender groups.  Never more than 10 people in a group.  The therapy was required at every bi-weekly visit (an hour's worth, in one of the two settings).  The doctor should be asking about therapy, and what the pt is getting out of it.  The therapist and doc should be comparing notes.

The doc should THOROUGHLY explain sub from the 1st appt, both verbally, and with take home paperwork.   Taper schedules, goals, and plans should be discussed at the first visit also.  Some chronic relapsers CHOOSE a long term program...although the doc should always encourage tapering, and educate the pt how tapering works.  The biggest fear is the taper and w/d.  A good doc will recognize that, and address it...both to reasure the pt...but also to make them realize that he/she will work with them..that doses can be adjusted if the pt isn't tolerating the taper.  

A sub doc who has a pre-printed taper program for every single patient isn't taking into consideration that EVERYONE is different.  Some people taper quicker than others...some go up and down...some even relapse and need to regroup and replan.  The doc needs to be flexible to allow for that.  The doc I worked with would have her pts that successfully tapered come in and talk in the group therapy sessions...that was amazing.  It gave people hope that they too would be successful...and they realized that when done right, a sub taper is totally tolerable, and not a nightmare like many think it will be.  The pts loved it, and were always FULL of questions.

A typical program should last about 6-12 months...start to finish.  This obviouisly will vary GREATLY.  A 1 or 2 week Sub prgram is pointless...it can't be utilized properly in that short of time (you'll hear people say...get on and get right back off...there's no point in that...you're better off skipping the sub all together).  It takes up to 2 weeks for your body JUST to adjust...for your DOC to be completely eliminated from the body, and for the subs to properly FILL those opiate receptors.  Stabilization between dosage adjustments is important, and is why a sub program takes some time.  Also, in that 6-12 months, a person can get some "clean time" under their belt, where they are fully functional, not using their DOC, and taking sub once or twice a day.  That does wonders to help build the pt's confidence.  They want to continue that feeling.

(cont...)
Helpful - 0
2198453 tn?1343244740
When it comes to doctors I would never take subs from a family doctor versus a specialized doctor who knows WAY more about sub use and everything involved. :) Perhaps you should search for that sort of doctor may be way more help and could answer your fears and questions better.
Helpful - 0
Avatar universal
Sorry was away for a couple days, this is what I did / am doing now.  After 24 hours without Norco I felt fairly bad so decided to try one of the Suboxone 8mg tabs.  It was scary, I’ve never been so drugged and not in a good way.  Fortunately one of the fellow Med Help members reached out (THANKYOU) to give me some very help full advice and it really saved me.  

I cut the 8mg in to 1mg and 1/2mg pieces, the last 2 days I’ve take 1.5mg (per day) and feel wonderful,  I will take 1.5mg today and starting tomorrow take 1mg (per day) for three days and finally a 1/2mg for 3 days.  From this point I going to take 1/2mg piece every 3 days and do this for 9 day total (3ea doses total over 9 days) then jump to freedom!  Not sure what to expect when I stop but I’ll keep you posted as I go.

As far as I’m concerned this doctor was trying to get me hooked so he could take a couple years of my money to get me clean, that’s a crook in the worst sense!!  There should be a law against something like this, some type of formula or chart on when and when not to prescribe.

Thank you everyone!
Helpful - 0
Avatar universal
Things like this make me mad. I've learnt that it never pays to be honest with doctors. I wish you would of just lied to him and continued with your taper plan because it seems you have willpower to stick it.

At 80mg going CT will not be fun and is manageable. Is there anyway you can space out the rest of your pills so you can make your road trip. Suboxone is like a last resort kinda thing and is a long term commitment. I stopped using vicodin and tramadol 10 days ago and was seriously considering doing the subs. I'm so glad I didn't. It's all a big money scheme. First they get you hooked on pain meds then they get you hooked on meds to stop the cravings. For me it just wasn't worth it. With that being said if I was doing anywhere 300-400mgs of vicodin I prolly would of gone the suboxone route. I found that kratom was a good replacement instead considering I was doing about 50-60mgs of vicodin. It's legal and I found that has helped. You can addicted to it but I would say it's nowhere the withdrawals like suboxone.
Helpful - 0
900459 tn?1304993259
Sorry I didn't post back again but what did u end up doing if ya don't mind telling us. And I'm sorry Andie I completely disagree suboxone is not the key it is simply a tool and in this situation it is the wrong tool because it is to much especially at 16mg a day for the poster here because 16mg a day even for someone that was like me at huge amounts of the strongest opiates is very high. 4mg twice a day was the most I took once I got past the first week and that was plenty I don't meant this to calls out or anything like that but please please don't post things like this not knowing much about this medicine because suboxone can be a miracle drug but it can also take an addiction and make it ALOT WORSE because it is a narcotic and a VERY STRONG ONE AT THAT so being on suboxone is not being clean so being on suboxone for a year is really not a good thing it is just continuing and addiction instead of recovering from it I mean if you wanna say one or the other yes suboxone doesn't have the euphoric effects like other opiates so you don't get high so being on it is in my opinion better than being on oxy or whatever but that still doesn't mean you or anyone else should be content being n suboxone because that is defeating the purpose of suboxone because suboxone is meant to be a means to an end not a long term thing
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Avatar universal
Suboxone is the key. It works so well. I'm a 13 year addict...I'm on 16 mg a day of suboxone and I feel no cravings at all. It really is a wonder drug.  The first couple of times I used it I did feel a little high... Now I don't feel a thing... Just content. Give it a real shot. I'm at 52 days clean now...it truly is a miracle drug.
Helpful - 0
271792 tn?1334979657
I followed your posts hun, I know what you did and it is wonderful. That is why I suggested that you keep it going I think going back on the Norcos would be a step back and going on the Suboxone would be a huge mistake. But that is MY opinion. I hope you make a good choice that will help you to stay on this side of the fence.
Helpful - 0
Avatar universal
I haven’t started the Suboxone program as of yet.  The Norco program was a very slow taper, I reduced my pill intake by one pill every four days and it was working great.  I reduced my daily intake by almost 50%.  It feels really good to have some control back, I just want to keep it going and don’t want to set myself back but taking the Suboxone
Helpful - 0
271792 tn?1334979657
We cannot give you taper information. you have to do this through your doctor. I really hope you change your mind about getting more Norco. You are already starting withdrawal. You will get so lost in all of this and the whole program of Suboxone will be out the window. I don't agree with the Suboxone for the Norco in the first place but since you have come this far I say go for it and get clean. I wish you the very best. Let us know how you are doing.
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Avatar universal
I want to taper down but I'm out (Doc said no more) and haven’t taken any since yesterday!  I'm sitting here like an idiot staring at this box of Suboxone and I don’t know what to do.  I feel like crap and have a mountain of work to get done before I leave.  Could I cut the Suboxone film into tiny pieces and take it that way rather than the full dose (an 1/8 morning / an 1/8 evening)?  

When I return, I’d like to get 90 more Norco to complete my taper but this means going to my other doctor.  I signed paperwork stating I would not do this and the last thing I want is to end up in jail or paying some penalty or something.  What could happen if I did that??

Thank you
Helpful - 0
Avatar universal
I agree with abritt. The doctor gave you 16mg of sub a day, that's 640 mg of morphine or close to 1000mg of hydrocodone. I think the subs will get you high at that dose. You are at 80mg of hydros now, that's about 1.5mg of suboxone or buprenorphine.  I was on 200mg of methadone and 8mg of subs completely took away my withdrawal. Definitely educate yourself before using subs. Subs have a withdrawal much, much longer than hydros. Read the suboxone/subutex FAQs in the health pages at the bottom of this page. There's a lot of good info on short and long term use of subs. I would do a fast taper, if it where me. Don't give yourself time to get addicted to the subs. I'm sorry your doctor sound ignorant, though it sounds like he is trying to help.
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Avatar universal
Thank you abritt!!  I feel stuck because he won't refill my Norco; I was doing so well on the taper and felt I had it.  All I needed was another 90 pills to finish my taper and I'd be done, then struggle through a couple weeks of mild WD's and that's it.  Sadly I did this once before several years ago, this is my second time coming down and feel like an idiot.

If I didn’t have this long drive ahead of me I’d probably bite the bullet and go cold turkey.  

He prescribed 8mg/2mg Suboxone to take twice a day, if I cut this in half would it still work to eliminate the discomfort while on the road then when I return (7 – 8 days) get off it or will I be in a worse spot than before?

What would you suggest?

Thank you
Helpful - 0
900459 tn?1304993259
I'm gonna be honest with you even at the 150mg a day hydrocodone I wouldn't suggest going to suboxone and I say that because suboxone is SO MUCH STRONGER than hydrocodone. No doubt suboxone saved my life but I was also taking 450-600 mg of oxy a day or 250-350 mg opana a day when I went on it. Switching from hydrocodone to suboxone in my personal opinion is only switching to a stronger drug. Bupernorphine that's the narcotic in suboxone is 40x stronger than morphing while hydrocodone is I think .5 stronger than morphine. As bad as it is a lot of doctors do not know near enough about suboxone as they should before prescribing it and do it simply for the money which is completely wrong. I would suggest doing some research and seriously talking to your doctor about it before you switch because again in my opinion it is not a good idea at all just tapering down more and more on the hydrocodone would be the best route in my opinion.

Good Luck and Godspeed
ABritt
Helpful - 0
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