Subutex information

[Lmr2424]

Hi my name is Lisa,  on Wednesday I started subutex after detoxing off fentanyl 100mcg and dilaudid. My pain management dr put me on subtext 8mg sublingual twice a day. I know my body is still adjusting, but I feel like at around noon I start to feel anxious. I'm just not sure if I should ask my dr. for an increase in dosage or just deal with it. I just don't want to fail. I've been searching for a chat room or just anyone to communicate with. I feel so lonely and scared.

[IBKleen]

Hi & Welcome,

What you are feeling could be a number of things. Either your dose is too high, too low or you are just adjusting to it like yous aid. the only way to find out is to phone your doctor and speak with share what you are feeling with him. He sees this type of thing all the time and will be able to give you an answer as to what it is. Best of luck.

[EvolverU]

Hi there & Welcome! :)

First, I want you to know that you're NOT alone & that you're in the right place! There are plenty of folks here in chronic pain & plenty who are either on Subs, tapering or have come off.

Can you tell us what sort of pain you're in? What the Subs were prescribed for?

While Dilaudid & Fentanyl are commonly used for pain management (& are quite strong), Subutex is not the usual choice for moderate to severe pain (more so in Europe than here). Subutex is highly addictive & binds more tightly to the receptors than any other opiate. It is what they call a 'partial agonist' or 'agonist/antagonist' -- meaning that it is not a full opiod painkiller like Dilaudid or Fentanyl. It has what is known as a ceiling dose past which, you will not feel further euphoric effects the way you would if you raised your dose with other opiates. I would be careful about going higher than 16 mgs. as it won't really increase the pain-killing effect & might exacerbate some of the side-effects that Buprenorphine is known for. You're right, It DOES take a while to adjust to this drug off of 'regular' opiates, though. So, maybe that's what you're experiencing. :)

I wanted to send you this link so that you could read about pain management & Subutext. Often, they give you other opiates with the Subutex for pain & they have to give it at increased doses since the Subs block them at lower ones.

http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_221.htm

Let us know what you think & how you're feeling. Thanks for posting!

We're here :)

[clean_in_ks]

Hi there Lisa and welcome to the forum.  There are lots of people here to talk with.  Since you were on 2 very strong opiates....and it's only your 5th day on subs.....I'd give it some more time to adjust.  Here's a conversion chart that will show you how much sub is equivilent to fentanyl and dilaudid.

http://www.medhelp.org/user_journals/show/18499/Conversion-table-other-drugs-equivalent-to-sub

Not knowing how much dilaudid you were on, it's hard to calculate the conversion dose.  But I surely wouldn't ask for an INCREASE in your dose.....16 mg is PLENTY, imo.  Your body is working VERY hard to adjust and it's not been a week yet on the subs.  If you are still having concerns, your sub dr should be able to explain and assist you.

Glad you found the forum...read all you can and keep posting, ok?

[lulu747]

I echo the advice of my wise friends above and would strongly advise you to keep your sub dose as low as comfortable and stay on it for as little time as possible.  This is not a drug to live on.  I was on both fentanyl and dilaudid at very similar doses.  I tapered the fentanyl until my dosage was low enough to switch entirely to an oral opiate.  Then I tapered until I reached 100 mg oxy and 40 mg dilaudid.  When I got there I jumped cold turkey.  It was by no means pleasant but the acute physical w/d's were like a very bad flu and lasted around a week.  The other stuff took about 3 weeks.  By a month I felt almost normal except for sleep.  By two months I felt fantastic.
You can do this.
Sending support...
Lu

[Gettingalifeagain]

Wow, such great responses to this issue for me too.   Lisa, I started on 4 mg June 13, and just before the 24 hour mark, I started to feel anxious, back in withdrawal.  Two days later, the doctor increased it to 6mg.  I have been taking that until 2 days ago, when he suggested I go back down to 2mg.  During this time of taking this drug, we need to keep on the same page as the doctor, and tell him/her what's going on.  I write in a journal, just for my feelings...., physically and mentally, and take it to my appointments, so he knows exactly how to gage this journey.  All the best, all takes time...you can do this!!

[lulu747]

Stoked to hear you are journaling!!!  This is an awesome recovery tool- one I still use to this day.  It's an awesome way to track our thoughts and feelings and then to reflect back on to see how far we've come.
Proud of you...
Lu

[Lmr2424]

Thank you so much for responding. I'm so confused and a bit brain scrambled. I can't figure out how to get around on this site. I had no idea anybody even responded. It means so much to me. Thank you

[Lmr2424]

Thank you lulu, I can't even begin to tell you and everybody who has responded to me how much it means to me! I went through withdrawals alone. It was horrific. I don't have anybody to turn to. I'm still trying to figure out how to post a thank you to everybody who gave me such great advice. My mind is still spinning from the withdrawals. Thank you for letting me know that there are still people out there who won't look down on me or judge me. You guys have literally saved my life. My Dr. Is on vacation for another week. So I've been desperately trying to connect to anyone. Sorry for rambling. This means the world to me.

[EvolverU]

We're so glad you're here! Congrats on your detox. What day are you on? Are the Subs helping with some of the symptoms?

(Btw, you just thanked us!! Much appreciated & you don't have to worry about writing individual notes, etc.) You've got enough to deal with right now. Stay with us & keep posting whenever you feel the need. This is YOUR place. :)

[Coloradobullygirl30]

I have a lot if sub experience I'm 2 months off everything. I'm here if u have any ?s. I know it can be tough adjusting to sub

[Coloradobullygirl30]

btw I started on 24 mgs and dropped to 16 but was forced to detox at that point which was a living hell. but I  know I wouldn't been able to do it any other way. good luck. everyone here will support u

[Lmr2424]

I've been on subutext for over a week now. I'm hanging on by a thread. I'm having such a hard time in the afternoon between my my 8am dose and my 6pm dose. I've been journaling, chanting, praying and breathing. I feel like I'm losing it! I can't fail I just can't . I know my body and mind are still adjusting. I'm just. I don't know what I am right now. Honestly I don't know what to do.

[clean_in_ks]

Hi, Lisa....was wondering about you today and how you are doing.

Your dr should be back from vacation this coming Monday, right?  
Maybe you can get in to see him to discuss how you are doing.

The other thing I was gonna suggest.....is to get the drug fact sheet that came with your subutex.  Read, in particular, the paragraphs that address "dosing instructions".  A lot of people think they must take the subs at very specific intervals...and if I remember correctly, the drug fact sheet gives you more than one option as to how you choose to dose yourself.  

Maybe you can shorten the time between doses and see how it works for you.  Just remember, you came off two very strong opioids and while the subs should "cover" you.....you may need to adjust your times between.
Glad you are hanging in there.....please keep talking to us....and call your dr as soon as you can with your concerns.

[Lmr2424]

Clean I'm trying so hard to hang in there. I can't get in until Thursday. I'm going to read the pamphlet again because I can't fail. I'm just so scared and anxious. I just want to scream....crying isn't helping. I don't know what to do. I'm still all over the place. I feel like I'm walking on eggshells. Like at any second I'm going to shatter. Sorry for rambling. I'm just at a loss or maybe I'm just feeling sorry for myself. I just don't know anymore.

[clean_in_ks]

A few questions for you, Lisa, ok?

Are you on any other meds at all?  What are you drinking and eating?
No alcohol, right?
Are you fully dissolving the subutex pill?  Not chewing it or swallowing it?

And, sorry to lamblast you with questions....last question...is the dr you are seeing Thursday the one that prescribed the subutex?

[Lmr2424]

Hi clean, yes I'm on a multitude of medications. Subutext, Wellbutrin, gabapentin(I stopped taking it), latuda, lamictal, klonopin, and levothyroxine(for some thyroid problem. And yes I keep the subutex under my tongue for sometimes 30 minutes as long as I can. I'm trying to drink a lot of water. Eating I'm not that good at. Oh and yes I see my pain management Dr. Who is also my primary care Dr. Who prescribed my the subutext on Thursday.

[Lmr2424]

Oh and no I don't drink alcohol because I have chronic pancreatitis.

[clean_in_ks]

Oh Lisa....I feel so bad for you.  Sounds like you are taking the sub like you need to be and getting fluids....that's all GOOD news.  But like you said in your journal....it would be REALLY good to get your psych dr and your primary together and have them check the mix of meds you are on now.
Just getting off 100 mcg of fent and the dialuadid is HUGE....and the gastric surgery you had may be affecting your absorption like you said, too.

With the mix of meds you are on I would want my dr's to check the interactions and be on the same page, too.  You said you stopped the gabapentin yourself which I hope you tapered off of....it isn't a med you should stop abruptly.  It is also a med that may help with opiate w/drawals...at least it has been used for that purpose in some cases.  I was on it when I quit my opiates and I feel like it helped me.  

If you can find some things that might relax you....warm epsom salt baths are REALLY important....some music that creates peace inside of you....and the journaling you are doing is good, also.

I will keep you in my prayers.....and hope that you can get your dr's heads together to discuss all the medications you are on and how they may or may not interact with one another.

If you can't eat.....getting a protein drink down will help a lot....our brains need the protein to assist in the healing process.  Some people drink Ensure, others Muscle Milk, some Carnation Instant Breakfast Essentials.
You can try to eat some lean meats or mac and cheese...or some soup.
Just get little bits down....and keep drinking all you can.  A drink with electrolytes like Emergen-C or Gatorade/Powerade or Vitamin Water would be good, too.  I ate A LOT of eggs.....I just craved them.  

Hope some of this helps until you can see your dr.  I'm praying for you....bless you, Lisa~

[Sosadinny]

I'm back on subs again starting today.. It does take a bit to adjust the dose... I am at 2mg but DOC was hydros which is much weaker than what you were on. You should be so proud of yourself for doing this. I know a lot of people would have started at a higher dose than you but I think you are better off keeping it as low as you can. Remember it has a long half life so it does build up in your system as the days pass... Also I know for myself I am so used to popping pills throughout the day so it's part mental for me just putting a small piece of a pill in my mouth two times a day.  I do sometimes break it in 3s though just because I don't want a big jolt initially.. I always break it in twos at the minimum though.
I hope you are feeling better soon... Remember to drink a lot of water as well. You are in my prayers?!

[meegWpaw]

aw, im so glad you bumped up your thread Lisa.

Meeg

[Lmr2424]

22 days off the hard fentanyl and dilaudid. And 18 days on my subutex treatment plan. I'm so ANGERY!!! At everything and everybody. After my dr's appt yesterday it just escalated. I was told by one Dr that with my history and medical condition that 16mg of subutex was not enough that 8 mg should be added in the afternoon. My primary who is also my pain management Dr didn't agree. I brought a list of questions to ask him,  but I just gave up wrinkled up my paper shut my mouth and just went with everything he said. He handles alot of hight profile patients on South beach. Sometimes I feel they are his priority. And he just rushes through my appt to get back to them. Sorry to rant. I'm just all over the place in my head still. I know it takes time. Maybe I'm just being inpatient and feeling sorry for myself. I don't know. On top of the I'm trying to find a therapist who deals in duel diagnosis and some understanding of my malabsobsion problems. Because my psychiatrist is no help. Just feeling lonely and frustrated. Had to get it out before my head exploded. Thanks

[Jinx_777]

at 3pm today it will be 8 days since i took off my 50 mcg fentanyl patch.  i take oxycodone for breakthrough pain and have for years.  i didn't like the way i felt on fentanyl.  felt like my brain was a marshmallow and i was walking through knee high mud.  exhausted, mentally and physically. so i asked to be switched to a different med.  what did she do??  prescribed 10 mg of oxycontin. yes, that is right. it is like adding 2 breakthrough meds a day.  NOT EVEN CLOSE to an equal switch..  needless to say it has been a week of he!!  still not through it.  fentanyl gave great pain relief, but the side effects were too much to take.  it is also THE HARDEST med i have ever detoxed off of.  it just won't let go.  hang in there.  

[clean_in_ks]

Hi Lisa.....which dr did you see yesterday?  The psych dr?  Is the psych dr the one that suggested you go UP on the subutex from 16 to 24 mg/day but yet isn't even the dr PRESCRIBING the subutex???
And the one that didn't want to spend any time answering your questions? Also the one prescribing you all those meds you are on?

I understand that your primary dr is also your pain mgmt. dr.  And you said today above... that your primary does NOT agree with the increase in the sub?  (that's a GOOD thing)  LOL

I am still a bit confused about which dr is doing what?  I was hoping that ALL your dr's would get their heads together (your charts and medical history) and look at your CURRENT situation.  Getting off the fent and dilaudid and going on the sub is being handled by your primary/pain mgmt. dr, right?  So WHO wants you to increase the sub?  
You said the other day that you were currently on the following:

"Subutext, Wellbutrin, gabapentin(I stopped taking it), latuda, lamictal, klonopin, and levothyroxine(for some thyroid problem."

I am NO dr but I can see that being on an antidepressant, TWO antipsychotic/mood stabilizer drugs, a benzodiazepine, a thyroid med AND subutex is really messing with your central nervous system, your brain and respiratory system.  There ARE interactions with some of these drugs...and THAT'S precisely what ALL the dr's need to take the time to figure out for you.
I would be angry too.  
I don't think the dose of the sub needs to be UPPED....I think the interaction of all those other meds you are on needs to be checked as to how they interact not only with each other...but also WITH the addition of subutex.  
You are taking a lot of meds, girl.  They all affect your brain in different ways....and you need to seek someone you can trust to sort this all out for you.  
I definitely AGREE with your primary/pain mgmt dr though.....your subutex dose does NOT need to be increased.
I sure pray you can find some answers, Lisa.  I feel so badly for you~  

[Jinx_777]

do you use the same pharmacist for all your meds??  have they ever cautioned you about the mix of meds you are on?  sometimes they will catch things your doctors do not