Suboxone help pls

[FiveGuys]

Hi there

I am scheduled to start Suboxone this Monday for a very extreme Oxy habit. We can please save the talk/comments about using Suboxone at all, I have thought long and hard and spoken at length with my GP, this is the way it is going to be for many reasons I can't begin to explain here. What I am looking for is help from someone who has gone in Suboxone maintenance therapy before.

I have a few questions that I would live some help with if possible:

The required withdrawl period:

I am going to do 24 hours prior in order to avoid any chance of PWD. I have never gone more than 6 hours without at least some level of bare minimum pills (15-20 mg for minuscule "relief") so naturally I am both scared and stumped as to how I am going to make it through 24 hours. I am intentionally running 100% out if everything before this so that there is no chance of cracking. I am going to take my last 80 mg of oxy Sunday morning and withdrawl until my appointment at 9am Monday morning. Is that too long/not long enough? Thoughts on this schedule. I want to go the absolute least amount if time WDing will still eliminating any and all risk of PWD.

Is the first 24 hours the worst in oxy withdrawl, or I think I heard day 2 or 3 is the worst but I could wrong? If the latter is true then I guess that's somewhat encouraging as I only need to do the initial period.

I don't know if I just have a very low tolerance to pain or if my body is unusual in this respect, but at even 6 hours, I am wishing with every cell in my being for anything to make it stop, it's that bad. I have a feeling it's going to be horrible, just getting to the point where I can take my first Suboxone. I am looking for any tips and advise on how to get through this 24 hour period.

The facts:

- I have this 24 hours and the following day off of work and the house to myself.

- I have roughly 8 mg of Lorazapam and 10mg of pure Xanax powder

- I can get any/all OTC stuff this weekend before it starts.

- I have a ride to the clinic so all I have to do is get in the car.

Some ideas I have:

- drinking alcohol. I am considering getting either a bottle of tequila or jäger or something to drink through this, hoping it will numb out some pain, or at least make me not care as much about what I'm going through. (Note: I am aware and careful with mixing alcohol with benzos)

- I have a hot tub. Ive heard this is good, though when I'm WDing I can barely get up to make it to the bathroom, getting in and out if the hot tub on my back porch seems like it will be tough

How should I ration the little amount of benzos I have, save them for the night time when I am guessing it will be the toughest? By the time night falls, that will be far and away the longest I have ever gone without oxy. Add that too the depression and panic of being alone in pain at night.

I think that's it, if anyone experienced would give me point by point advise on all this stuff I've mentioned above, I would be eternally grateful!

Thanks

[FiveGuys]

Sorry I am new and can't figure out how to edit my post, but I should add that I have a valid prescription for both the Xanax and Lorazapam. I'm just not sure how to use them in these circumstances. Thanks

[ImDONENoMore]

I can't offer any advice as far as the subs are concerned, but I will say this.  The bottle of tequila or jager?  Not a good idea.  If you were in a treatment facility, they would never in a million years prescribe either of those substances to help you through.

I say this because I tried having a drink after the first week of withdrawal and it was a HUGE mistake.  It made me feel a hundred times worse.

Good luck to you.  I hope the subs help you.

[ImDONENoMore]

And remember, part of getting clean means finding another way to cope with life without needing a substance to get you through.  Please find a good aftercare plan.  It's essential to staying clean.

[nursegirl6572]

I'm a little confused, you're making all these plans for the 24 hours of w/d before starting Sub?  You can't really go by a time frame when discussing when the induction dose of sub should be given...when you go into the doctor's office, you will be assessed using something called the "COWS" scale.  That will measure how severe your w/d symptoms are.  For some, it would be 6 hours, others would take longer to reach a more severe level of w/ds.  You typically would have to be in at least moderate w/ds (moderately uncomfy) before the intial induction dose is given.

As for the other stuff...if you're talking about the alcohol and benzos for while you're on subs, don't do it.  The sub clinic will perform regular tox screens, and you will run the risk of getting dropped by the clinic, especially for the benzos.  Benzos and sub together are a huge NO NO.  Very strongly contraindicated.  Most sub docs will not take patients who are even on legit Rx'ed benzos.  That is because people have OD'ed mixing the two, and while most of those situations involved injecting the drugs, there is still a very strong caution about mixing those meds together.

Once you have taken your induction dose, you should be pretty comfortable.  Within a matter of 15 minutes, your w/d symptoms will be mostly gone.  So, all of that preparation is unnecessary.  While it will stink to feel the w/ds, I'm sure you can endure it for a half a day or a day until you start the sub.  

It's important to remember a few things going in.  A LITTLE sub goes a very very long way.  How much oxy are you taking now?  Be very wary of a clinic who wants to start you on obnoxiously high doses.  For Sub, 4mg is actually a hefty dose that will cover even a heavy user (just an example).  If you're hearing numbers over 16mg a day, I would question it..as the ceiling effect is reached at 16mg for buprenorphine, meaning there is NO added benefit of ever taking more, you would just be stacking the sub, putting excess amounts into your system for no reason.

There is an adjustment period, because bupe is a partial agonist compared to the full agonist opiate oxy.   They fill the receptors differently, so it isn't unusual to feel some mild w/d like symptoms that first week after induction.  By mild, I mean, you will still be able to function...you may have a few aches and pains..nothing that Motrin wouldn't take care of.  Its important NOT to panic if you feel some w/d like symptoms and think you need more sub.  A lot of people do that.  You will be in close communication with your doctor about your dose..I just wanted to give you a heads' up that it's normal to feel some mild symptoms while you're adjusting.   After a week or so, you should feel pretty much totally normal, functioning very well.  

Good luck to you!  

[nursegirl6572]

To add...after rereading your thread...I think your preparations are for w/ds while you're on subs?  I think you have some misconceptions about sub.  While you're ON sub, unless you're tapering towards the end...and after you have adjusted, there should be NO w/d symptoms at all.  Once you start taking the subs, you won't have any w/d.

[FiveGuys]

Hi guys, thank you so much for your speedy replies, I am eternally grateful. I posted this on some other forums namely bluelight and basically got ignored. I am terrified of this. Responses help so much.

To clarify, the benzos/alcohol and anything else I me mentioned is JUST for the 24 hour period befor me getting my first dose. After I get my first suboxone, I'm staying off literally everything else and just putting all my trust in the subs. I am just so scared about getting the full 24 hours until I can get my first sub dose as I have never even attempted this long without oxy before, and when I have tried even 6 hours, it was the worst I have ever felt. I have anxiety issues and they were TENTOLD during this. Add that too body pains and all other symptoms like RLS and it's bad.

Nurse: Oxy habit is 300-400 + a day (instant  release) from the second I wake until going to bed, with a wake-up in the middle of the night to too up. It's very bad.

Nurse: he is starting me on 8mg should I ask for less?

[nursegirl6572]

Problem with taking benzos is two fold...the w/d won't be bad enough for you to start the sub, AND if you test + for it, they may turn you away.  I cannot stress enough that in order to do this right, you will need to endure the w/ds for a short time.

I cannot recommend specific doses.  That's not too incredibly high for your habit.  You can always ask to start at a slightly lower dose to see if it holds you.  The induction dose typically isn't maintained for too long.  You can taper down to a lower dose after a few weeks, after stabilizing.

Seriously though, don't take the benzos...you may sabotage the whole process if you do.  They may not care if it's prescribed or not, if it's in your system, they probably won't let you start.  I'm telling you that relief will come quickly.  Only you can know how long it will take you to be in moderate w/ds...if it's 12 hours, then do that.  24 hours is a reasonable goal, but like I said, the time frame is far less important than the w/ds.

[clean_in_ks]

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

This conversion table link above shows how much sub (bupe) 1.2 mg is equivalent to how much oxy (20mg)....so your sub dr should know the equivalency values and be able to dose you accordingly.   8 mg shouldn't be too high if you are taking 300-400 mg a day (you may even need more which your dr can determine for you)  If you are concerned about what to take during this necessary w/drawal period prior to inducting the sub dose, you can always call the office and leave a message for them to call you.
They would be the most capable to advise you as to what COULD be taken to ease you thru that first 24 hrs and what you DEFINITELY SHOULD NOT ingest.  Sound like a good idea?

[hope6hope]

I was on subs to get off fentanyl. I had to wait the 24 hours also and be assessed on the cows chart then when I was far enough in withdrawal starts subs. What they said above is great advice and all true. You will be drug tested when you go. Benzos such as Xanax, etc are a absolute NO!! In fact my subs doctor said you take the 2 together (benzos and subs) you will die there is no if about it. My subs doctor didn't allow me to be on any controlled substances. He did random drug screens and at any time it was positive for anything other than subs you were immediately kicked out of the program. Suboxone is heavily regulated and the doctors that prescribe it are also. There are certain rules you have to follow. Aftercare or na is usually not a option but mandatory. This is all in place since suboxone is designed to get you clean. I think the 24 hours before you start put the suboxone you should not take anything your doctor doesnt ok. Good luck to you

[FiveGuys]

Thanks guys,

I actually emailed my sub Dr. and asked about taking Xanax/Lorazapam during the induction WD period, and his reply offered nothing in the way of an answer. SO I have no idea what to make of that.

However, as I understood it - the suboxone works on your opiate receptors. The reason for being in opiate withdrawal first, is so that your receptors are free of any other drug and the suboxone can sweep in and do it's thing. SInce benzos do not touch those receptors, how would they affect the process? In other words, being ready to take suboxone does not require just feeling ****** in general, it requires those specific receptors to be "empty"

Though you guys are saying otherwise... I must be missing something..?

Again, thanks so much for the help, as you can see I have a lot to learn

[abritt121222]

U don't want to take any benzos at all while on suboxone its dangerous for one and two u won't need it as it can be a more serious problem them opiods and u already know u have a problem with addiction. U also won't need to wait a full 24 hours before taking the suboxone 12 is usually enough and while I was in active addiction I would take it as early as 7-8 hours after last opana or oxy but I wouldn't suggest taking it that soon I would say 12 is plenty long enough tho.

Good Luck and Godspeed
ABritt

[FiveGuys]

Sorry to be clear, I would not be on benzos and suboxone at the same time. I will be taking benzos BEFORE ever taking my first dose of suboxone, as a crutch to get through the initial withdrawal period. Once I take suboxone, I will not take benzos after that. Does this make sense?

[dominosarah]

Please PLEASE stay away from the alcohol.

[nursegirl6572]

Hi again.  What exactly did the doctor say?

I do see what you're saying, however, the problem lies in the fact that the benzos will help to alleviate the w/d symptoms, which, if the doctor properly follows the induction assessment tools, would not put you in severe enough w/ds to be inducted.  Plus, the obvious contraindication with the benzos is a problem.  

Your induction dose will be the highest dose of sub you will be on throughout the course of the sub program, and most likely, you will end up taking a substantial amt of the benzos to make a difference in the w/d symptoms.  That really could be a dangerous mix.

It also makes it VERY difficult to assess the effectiveness of the sub, and what an appropriate dose would be for you, because again, the symptoms won't be a true and accurate representation of your w/d.  So, the benzos will interfere with that part of the assessment process as well.  The w/d symptoms are really the most crucial part of the assessment tool.  You're taking that out of the mix.

There are really good reasons that the precautions are in place, and a good reason why the assessment process is how it is.  A person really should be in w/ds when starting sub.  There's no other good way to assess the level of effectiveness, and what a good dose would be.  I understand that you're fearful of the w/ds, but you have to hang onto the fact that it will just be for a very brief period of time, and then when you start the sub, your w/d symptoms will be almost completely alleviated.

I would NOT recommend medicating away the w/ds...not with anything besides something like Tylenol or Motrin.  Yes, you will be uncomfortable, but not for long.  You REALLY want to do this the right way, and the SAFE way.  If you mix benzos, alcohol and sub..you have a VERY good chance of getting very sick...then you won't be able to properly assess how the sub is working, and the doc may tell you it isn't for you.  Just a bad idea all around hon.

YOU know yourself best, so you would know how long it would take for you to be in significant w/ds (moderate, doesn't have to be severe), so THAT'S how you judge when you take your last opiate dose.  Like I said before, if you know you will be in moderate w/ds after 12 hours, then plan it that way.  While 24 hours is generally a good number to pick to be safe, again, it goes more by level of w/d, and for some people. after 24 hours, they would be in very severe w/ds.  As long as you're having w/d symptoms to the point of being uncomfortable, you will not have precipitated w/ds.

[abritt121222]

Just make sure you are really in withdrawal to I know that sounds crazy but I have done it to myself more than once by just thinking I don't feel to good so I can take the suboxone now when I was letting my mind play tricks and took the suboxone to soon cause precipitated withdrawal is absolutely a nightmare

[FiveGuys]

HI Nurse :)

His reply consisted of "Please make an appointment with my office. He was not aware that I already had my appointment set. While he does answer email, he runs an addiction clinic and is not my GP. My guess is he just skims email and fires off responses on a general basis. My question was not very poignant or too the point, I sort of rambled it out. I can see him skimming it and just saying "hey, come in."

Ahhh, ok I totally get it now. The avoidance of benzos is not chemical, but more so that the important part of the process (COWS) is done properly. Otherwise I run the risk of screwing up the initial assessment and thereby messing with the whole process. Thank you for the clarification.

Ok, I am going to attempt to squeeze more info out of you:

Last night I did a test. I took my last Oxy at 9pm, and had small naps in front of the TV, ultimately going to bed for good around 3am. I woke up today at 11:30am in a lot of pain. That means that I went just over 14 hours without Oxy.

My symptoms upon waking:  

- moderate/severe anxiety- Upon opening my eyes I immediately fixated on how bad I felt (moderate panic, elevated heart rate, depression)

- moderate severe aches and pains - joint pain, full body aches

- sweating

- a bit of stomach issues, though still constipated from constant opiate use every day, I was able to have a small bowel movement, but not much.

Then I took less (just over half) than my usual Oxy dose half hour after waking. While it did help with the mental issues (I was no longer panicing, mood elevated somewhat), it did not relieve my physical symptoms and as I sit here I am still in physical pain (I feel like a 90 year old man moving around, I am an otherwise healthy 35 year old of proper weight)

ANYWAY. Do you, with what little info you have, think that 24 hours from my last (half) dose of oxy to my appointment will be enough time? That's roughly double what I experienced last night/today.

Also I am nixxing the alcohol, bad idea.

Regarding benzos - they are short acting as you may know. 4 hours half life tops. So if I am to use them to get to sleep the night before the appointment, surely they would be long gone from my system and not affect the COWS test the following morning. no?

Thanks

[nursegirl6572]

From what you described, the 14 hours was enough to put you into moderate w/ds.  In my personal opinion, yes, I think it will be enough time.  Your doctor will have to assess you, but it sounds as though you will be in moderate w/ds at least, if not more by then.  Up to you, but like I said, and abritt said, you probably don't need the whole 24 hrs.  If 14 hrs put you in substantial enough w/ds...then you will be fine.  Precipitated w/ds won't occur if you are at that level of w/ds.

I honestly wouldn't take the benzos at all, because if the clinic you're going to strictly follows the guidelines like most do, you will not be permitted to start if you test + for benzos (which you will).  The clinic I worked at would not admit a patient taking benzos at all.  I think you're running the risk of being turned away if you use the benzos.  

Just try to keep yourself distracted from thinking about this...as that will make you feel worse.  You won't have the most pleasant night, and you may even have trouble sleeping, but it will be only for a short time.

[4181steph]

I know how u feel! I was on methadone for 7 yrs b4 I switched to subutex. The first time at the Doc's office he gave me one 8mg tablet and 30 min later I went into precipitated WD's. Apparently I wasn't in moderate WD. The 2nd time it worked! But I cannot emphasize the importance of making sure u are in moderate WD's b4 the induction!!! The 24 hrs u are worried about is a piece of cake compared to precipitated WD's. DO NOT DRINK ALCOHOL and please try not to take a lot of any benzo b/c it may still be in ur system at the induction. A 15 yr old girl died after drinking 1 beer, 1 valium and 2mg buprenorphine (but she was non-tolerant). Still u have to be careful. I think u should take advil/motrin and use the hot tub for muscle aches also melatonin is a herbal sleeping aid. DO NOT DRINK ALCOHOL!!! It will make u feel worse trust me! Its true that bupe and benzo's do not go together especially w/alcohol, but I've been on 2mg of clonazepam since 2006 and I've had 3 suboxone Doctors that didn't have a problem with it b/c I followed their instructions, I never take more than prescribed and I don't drink alcohol. Most overdoses occur in non-tolerant people that mix all this together, and even tolerant people at high doses. The lorazepam/Xanax will not help with opiate WD's in my experience however everyone is different and u should call your doctor and tell him ur concerns.  Good luck to u!!!!

Stephanie

[dominosarah]

Doing it our way got us here.  Talk with the doctor and follow his directions.  Sub is nothing to mess with.

[FiveGuys]

Ok. I am going to try everything to get through without the benzos. The thing is, I have sever panic issues, and especially when you pile WD on top, I am ready to run head first into a wall just to stop the panic. But the last thing I want is to be denied the subs after all this.

Another thing, I'm not sure how it is where you are, but in Canada they actually dose you at clinics regardless of what's in your system, though if you are on other drugs it severely limits your freedom for dosing. Fo example a friend of mine is on Methadone, and she constantly does valium. cocaine, alcohol while on the program. They won;t kick her out of the program, but they will not give her take-home doses at all. And they lowered her methadone dose recently because she would not stop with the other stuff. I am thinking that regardless of what I test positive for, I will get my sub dose and after that my urine test results will pertain mostly to my freedom or take-home doses.

I only mention this, because as it stands I will test positive for benzos even if I don't take them again, seeing as how I took my xanax yesterday for anxiety before all this discussion. Thoughts on this prediciment?

[weaver71]

Knowing there is a light at the end of the 24hrs should help. I agree with all the above.  I found that benzos, alcohol, nothing helped acute detox. I went from about 200mg of methadone to Subutex, pure buprenorphine without  naloxone. I was given Valium, but  I only took them once. They made me feel weird and more aware of my discomfort. I took 8mg of sub the first day. I felt great in 30 minutes. It was about 3 days of adjustment and then stabilized. As for the WD for induction, keep in mind you can't die from opiate detox. No matter how you feel, you will be okay. The pain you are experiencing is likely rebound pain, it is a symptom of detox. A lot of folks, including me, have less pain after getting clean. Try not to feed your anxiety with anticipation. You can do it. What kind of counseling or 12 step program does your sub doctor have you participating in?

[nursegirl6572]

You are trying to talk yourself into it being okay to take a benzo if you do.  You can't know that for sure.  Every clinic is different, but here in the US, MANY clinics will not take people who are on benzos at ALL, Rx'ed or not.  It largely depends on the clinic.  

You may be right about the clinic you're going to go to, but what if you're wrong, and you find out, after it's too late, that you would be turned away if you have benzos in your system?  I just honestly think it's not worth chancing...just my opinion.  The fact of the matter is, subs and benzos ARE strongly contraindicated together...and many sub doctors take that very seriously.

You already may test + because of the xanax you took yesterday, but I wouldn't add anything on top of that.  I understand about your anxiety, I have panic disorder myself, so I get it...but you're talking not even a whole day.  It would be BETTER for you if you went into the clinic in moderate w/ds, not taking anything else to complicate matters.  You have to decide what to do.  I would like to see you get started in the best way you can!

I agree too with the others about psyching yourself out, making w/ds worse.  You're already overly focused on this, which will likely make you feel worse.  Get out, get busy doing other things...get out of your head as much as you can!

[nursegirl6572]

You could always try e-mailing the doctor again, to find out for sure.  Just ask a very brief simple question (as a long email is likely to generate another canned response)...make it clear that you already have your initial assessment scheduled for Monday, and ask if you are allowed to take your prescribed anti-anxiety meds before the appt, and ask for clarification as to how long before the appt is adviseable to take your meds.

If the doc answers and says it's okay, I would take the minimum necessary, so that the assessment process goes smoothly.

Let us know how you do, good luck!

[VICourageous]

I just wanted to add..I took a bezo with the Methadone and nether my Dr nor Phams told me how dangerous the two where mixed..It was right on the done paper..Also a benzo just like all opiates and alcohol and all street drug Ect..Many of them do the same Thing to the Neuro-Chems..and Benzo is right there Two..There is a chart that tell you which ones and there are a lot!!!
So Please Do Your Homework on this Situation it is your Life you are talking about..OK I sure do wish you the Best traveling down this Road..But remember that the Road to Recovery was not meant to be walked alone.
Bless.