suboxone therapy

[4181steph]

Hello everybody!
I'm new here and I have been taking subutex for almost 4 yrs. I had to change Doctors (long story) and yesterday went to my new Doctor. He prescribed me suboxone instead of subutex and I'm not really sure why he doesn't prescribe subutex, but now I'm scared b/c I've been stable for so long. He also told me to be in mild WD's from the subutex b4 I take the suboxone b/c it has a narcotic reversal drug naloxone included in it. I took my last dose of subutex 4mg this morning so I'm completely out. I'm about to go p;ick up the suboxone now. Does anyone know why I need to wait if they are both partial agonists?? I know u need to be in WD's if u are coming off of a full agonist, but I don't want to wait if its not necessary. I cannot find any info regarding this on the internet. So basically my question is are subutex and suboxone interchangeable? Thank you and have a wonderful day!

Stephanie

[4181steph]

ok, 4 yrs ago my 1st sub doc gave me 8mg in office and told me to take 2 a day, he kept me on subutex the whole time. I did that until last dec when he left and moved and I got a new sub doc. she continued what he prescribed, until I told her I wanted to come down to 12 mg daily which I did w/no problem, after I got laid off in jan (1 mo later) I lost my health insurance so she prescribed a ridiculously fast taper that I was unable to do!! so the pills I had left I spread them out and came down to 4mg. I felt bad and knew I needed help so I made an appointment with another sub doc bc I could not go back to my last doc w/out insurance. he asked me how much I was taking and I told him 4mg but I needed more bc it wasn't helping (I guess bc I had been taking 16mg for so long) so that's why he prescribed 16mg a day. its just been a few months since I've taken that much and the 1st nite I took it I was fine. the next morning after taking 8mg I started feeling bad. I;m not taking one tonite. I tried to cut them in half, impossible!! they are super hard and not scored. they are orange round tablets not scored and printed on one side is AN415. I think i'm experiencing severe anxiety and stress. my friends drink so I guess i'll have no friends now as I've been ignoring their calls. I took 1mg clonazepam and a long hot bath and it helped (the bath), so while i'm not lightheaded,dizzy I need to drive about 1 mile down the street to feed my feral cat colony, i'll be right back. thanks to everyone!! any ideas on controlling these panic attacks would be nice too. sorry im rushing but its late and its been reported that feral colony caretakers have been attacked in the area so I try go b4 dark

steph

[abritt121222]

I honestly don't think someone should stay on 4mg to stay stable 2mg is plenty but the reason he won't prescribe you subutex is because you can shoot subutex and 99% of sub doctors won't prescribe subutex for that reason but when taken correct the naloxone in suboxone has no effect it is in suboxone to keep ppl from shooting it and switching from subutex to suboxone you will have no problems at all

[nursegirl6572]

I think some clarification is needed here.  You said you've been on the subutex for several years, correct?  What was your current dose of the subutex, and how long were you on that dose?

If you've been stabilized at that current dose (I'm thinking 4mg?)...then your dose of suboxone should not be increased, it should be the same...unless you had relapsed on another opiate?  You don't need to repeat the induction process...you should be transitioned into the new clinic starting at your same dose, if indeed you've been taking it for a while.

[weaver71]

If you went from 4 yrs at 4mg and jumped to 8mg, I think you are taking too much. I don't know all your story, but my last dose of methadone was 160mg and 8mg was plenty. You definitely don't want to take 16 mg. I know some pretty hardcore addicts, and post induction, non of them take more than 2-8mgs. You will be able to cut the film more easily. Hang in there. Call the doc about how to get your dose back to what it was. Changing dosage or taking subs at irregular times causes many to have bad side effects. PM me if you need to, but hang in there, you won't die or anything. You just feel bad, nothing bad is going to happen. Try to remember that.

[nursegirl6572]

And NO alcohol....that will exacerbate your anxiety something terrible.

[nursegirl6572]

wont slice those 8mg's in half. these pills are impossible to cut! so i have to take the whole 8mg pill. i was taking 4mg subutex a day

Oh woah honey!!!  You doubled your dose!!!  No wonder you felt funny!!!!

You absolutely shoudl NOT be doing that.  Suboxone comes in other strengths, 2mg, 4mg, 8mg.  You need to contact the pharmacy and ask for a better option.  They should work with you!  Even if you ask THEM to cut the tabs for you.  I have worked with the tabs, they break very easily, they are scored.  

Yeah, you definitely need to stick to the dose you were taking..

[nursegirl6572]

I agree completely with the wise weaver that you're symptoms are most likely anxiety induced...you had yourself quite worked up about this, and the unfortunate thing about anxiety and worrying is that if we worry enough about something, we end up kind of making it happen.  It's kind of like a self fulfilling procephy of sorts....you know?  I have panic disorder, so I can totally relate. I'll worry myself right into a panic attack about something.  

The ONLY difference in your sub is the naloxone, which typically is very easy to tolerate for most people.  I've never seen anyone while working in the sub clinic that was unable to tolerate it.  Even allergic reactions to sub are quite rare...you know that possibility can be eliminated, because the onset would have been pretty fast.

It will be good to switch to the strips also, I'm glad to hear that.  The strips contain more evenly distributed amounts of the medications, whereas with the tablets, there can be inconsistent distributions of the meds, which is why the strip is especially more beneficial during tapering...you will get a more steady and consistent dose.  Now, don't misunderstand what I'm saying..the inconsistencies shouldn't cause you any problems, and won't be obvious, it's just that the strips are more accurate dose wise, when referring to the tapering process.  What dose are you on?

Another couple of tips..like clean said, make sure you drink some water before dosing, so your mouth isn't dry.  If you have chronic dry mouth, there are some things you can do...chewing gum, or sucking on hard candies will stimulate the salivary glans and help keep the oral cavity more moist.  Also, if it's really bad, there is actuallly an artifical saliva product you can use.  Now, most people react to that with an "EW!", lol, but it's honestly not gross, and really is very helpful.  Something to keep in mind.  

Also, the doc I worked for recommended not eating an hour before and after the dose, for better absorption and onset of action.  She also recommended to try not to smoke before or after (about an hour also).  Not sure how much of a difference all of that makes, but our patients sometimes reported that when they heeded her recommendations, they felt more "stable" with less peaks and valleys when dosing.  Just some recommendations.  How many times a day do you take it?

What are you doing to address your anxiety issues?  Are you in therapy at all?  If not, I would strongly recommend that.  Especially as you start to taper off over the next several months...the anxiety could worsen a bit, so you want to try to have that at a more manageable level.  Plus, a lot of people with addiction issues find themselves abusing various drugs to self medicate away the symptoms of anxiety/depression.  IF that's the case for you, if you don't address the anxiety and learn coping mechanisms, you will be at greater risk for relapse after the sub.

Distraction is one of the BEST ways to handle anxiety.  If you find yourself sitting and worrying about something (like the sub)...busy yourself...get up and do something...even if it's cleaning out a closet or something.  When you can get your mind off of the worries and the "what iffing", your anxiety will be much better.

Hang in there!

[4181steph]

sorry i guess i accidentally hit the post button b4 i was done:) anyway the fear of the unknown of our future is really frightening so maybe its the overwhelming stress that's causing this prolonged attack idk...another thing, the pill cutter wont slice those 8mg's in half. these pills are impossible to cut! so i have to take the whole 8mg pill. i was taking 4mg subutex a day so i think u may be right bc why else would i start to feel like this so soon after starting the suboxone,  not a coincidence. i will tell my doctor i want to only take 8mg a day max, not 16!! I might skip tonight's dose just to see if it helps. Right now I'm so dizzy and lightheaded w/no appetite. I have ENSURE and bananas so i don't have to cook, no energy at all i can barely read my vision is so blurred.any suggestions?. i'm very depressed too. 2 of my friends that don't understand what i'm going thru kept calling and texting me yesterday wanting me to come up to the pub but my doctor told me not to drink alcohol while on this med, they don't understand and think i'm being anti-social. i'm not a drinker anyway,never have been except the occasional, i have to go lay down i feel like im about to pass out

Thank you and have a good day,
Stephanie

[weaver71]

Yeah, I've been diagnosed with a few mental illnesses, bipolar being the major one. Now that a little clean time is behind me, I realize that maybe I am bipolar, but nothing a clear headed sober person can't handle. People who are not addicted to other opiates describe subs like a speed ball, and upper and downer mixed together. That may explain the heart rate issue, expecially combined with anxiety. You shouldn't feel any different after switching to suboxone, so it sounds like anxiety is main culprit. Try to focus on recovery. I felt like I woke up in the city dump when I got clean. Lots of garbage to work out in life, but getting staable is more important than anything. All those things will work out better if we can get you stable. If I feel emotions that are out of control, I've learned to wait. No decisions, no spontaneious actions, just focus on letting time pass. I feel manic sometimes and depressed sometimes, but I am clear enough to see if it is my life that is causing it or my brain. So lets focus on getting you feeling more relaxed.  What dose have you been taking for the past 4 years?

[4181steph]

Ok weaver u just explained a lot, thanks. I have the orange suboxone 8mg tablets and a pill cutter I got free from the pharmacy. The first time I took the pill I did get a little lightheaded and racy heart, but it only lasted for a minute. That was sat nite. Now all day yesterday and now even worse today I feel very lethargic , no appetite and the worst thing is I feel like I'm having a long drawn out panic attack. I have been diagnosed with: generalized anxiety disorder, panic attacks w/o agoraphophia (sp?) mood disorder bipolar 2 whatever that means...anyway my heart was pounding and racing so fast yesterday and continues today that I went to publix to take my blood pressure on those machines and my b/p was good at 119 over 78, but my pulse was 102. I took a clonazepam 1mg last nite and this morning but its not helping and my new doctor told me to never take more than that. but i have a lot going on (divorce, laid off, now in foreclosure, u name it!) I'm so scared about whats going to happen to me and my cats that i love dearly

[weaver71]

That dizzy feeling, or light headed feeling is common. It could be that a lower dose will work just as well. For long term sub maintenance, I would suggest getting stable on as low a dose as possible. A friend who had a 1800mg Oxy habit takes 4mg a day and it works great. That's just an example. Another friend kicked heroine and took 2mg for 2 yrs. He had a relatively easy time coming off subs with a long slow taper. You may want to talk to your doctor about getting your dose down. Subs are very long acting and build up in your system. Another friend started taking her husbands subs, before her appointment. She was given 16mg and felt dizzy and sick for 3 days. They are my old dealers and aren't really working on personal growth and recovery. She is too scared to try again. There is a right way to use subs, just wanted to tell you some real life stories. Glad you found this site and are educating yourself. What kind of program are you in? What kind of aftercare do you have?

[clean_in_ks]

Hey Stephanie......couple things

A tip for the dry mouth syndrome and getting your sub to dissolve under your tongue faster.......drink a good bit of water just B4 you dose the sub.
(and you're right...the suboxone tastes a LOT better than the subutex....and the strip you said you were going to get next, will be even better)

If your question "what are tickers" refers to this forum and your profile page...at least I think that's what you mean, huh?......the answer is....if you want to have something "counted" like your clean days.....you can go to your profile page and put in the necessary information and it will change automatically for you and keep track.  I have 3 tickers going on my page cause I wanted to keep track of how many days I had off 3 different drugs.
Plus, I love having those MedHelp cheerleaders throwing up their arms to the sky in praise for me...hahaha!

If you have any trouble....give a shout out.....you can set a ticker and track whatever you want really.  There's also some tips for newcomers about how the web site works in our Health Pages.  I'll post the link here for you and maybe that will help with any questions you have, too.  Glad to have you aboard.....you're already contributing your voice to help others.....that is simply GRAND~  

http://www.medhelp.org/health_pages/Addiction/PLEASE-READ-SITE-NAVIGATION-FOR-NEW-PEOPLE-/show/369?cid=66

To get to the health pages, scroll down and look at the bottom where it says "most viewed health pages" and it will give you an option to click on "see more health pages".  There is some GREAT reading in there if you want to take the time to page thru the articles others have made available to all of us.  

[4181steph]

I picked up my new Rx this afternoon but waited until about an hour ago to take it. I have dry mouth syndrome per my dentists and it takes longer to dissolve under my tongue about 45 min! as soon as it was completely dissolved I felt very dizzy and my heart started beating fast and hard but that only lasted a few minutes. The mind is a powerful thing! I feel great! I was so worried for no reason. Thanks again:)) btw, what are tickers?

Goodnite,
Stephanie

[nursegirl6572]

Well, it's more of a psychological thing than anything, to keep people from using while on Sub.  It's true that the bupe blocks the high of other opiates, much in the same way that methadone does, but adding the blocker is easier to understand for people, and the psychological impact of it is very significant.  For people who are compliant on their sub programs, it does act as an effective deterrant.  The naloxone helps to block other opiates a wee bit, but unless nalaxone is administered via IV, it doesn't have much of an effect, it's the bupe itself that acts to block other opiates.

You will be just fine.  Just take it like you were taking the subutex.  Nothing will change except the tablet itself.

[4181steph]

thank you! I was hoping I'd get a reply from someone b4 tonite. I worked in the G.I. Endoscopy lab for 10 yrs and we had narcan on hand just in case we gave the patient too much fentanyl and versed. It really doesn't make sense why they would add a narcotic reversal drug to a narcotic (to me)

[4181steph]

thank you for replying so fast! I just picked up my suboxone. I guess I'll go ahead and take 4mg soon. hopefully I'm not allergic to naloxone! I'm such a worry wart, sorry! I found this site by accident when researching my original question. I really like it! Everybody's so helpful. I do know that I will be switching to the suboxone film at my next visit and I read that it taste better:)))

[4181steph]

I want to be off of this medication in 1 year.

[weaver71]

Taken orally, the taste will be the only difference. Suboxone has a bad aftertaste. Our local sub doctor just retired, the new doctor induces in the office with Subutex and prescribes Suboxone with no transition. I found it crucial to research everything my sub doctor said. He was misinformed on some things. So, what's your plan? Do you intend to stay on subs indefinitely?

[nursegirl6572]

I second what clean has said above.  You shouldn't have any problem transitioning if your dose is the same.

Subutex is just the buprenorphine, which is the opiate, Suboxone is buprenorphine plus the nalaxone, which is the opiate blocker.  There are NO other differences.

To be honest, the reason Sub blocks other opiates has MUCH more to do with the way Sub fills the opiate receptors, not the naloxone.  Many clinics, docs and pharmacies are really trying to get away from the subutex, because it has a greater potential for abuse and diversion.    There are some other reasons Suboxone is the preferred form of bupe to be Rx'ed, that has to do with reiumbersements and insurance..  

Really, there would only be a few circumstances where Subutex is indicated over Suboxone, that would be if someone had an allergy to nalaxone (aka "Narcan"), or if they were pregnant.

You have nothing to worry about.  If your dose is the same, you won't notice a thing.

[clean_in_ks]

Welcome to MedHelp, Stephanie!!!  Glad to have you aboard and see that you are finding your way around the different forums already.

To answer your question above on this thread.....NO you don't have to wait to be in w/drawals when switching from subutex to suboxone.  YES they are interchangeable as to their effect and mg. dosages.  I can understand why you were confused since you got different information from 3 different dr's.  But you have researched this and you are correct about the only difference being the Naloxone in the suboxone.  Some dr's won't (or don't) prescribe subutex "just in case" the patient would attempt iv'g it.  Other sub drs just "keep it simple" in their practice by only prescribing suboxone.

Your transition should be "uneventful"....haha!  That's a GOOD thing~




I saw you had posted on an older thread from Jan 2008 and OBXman has really good info that he shared on that thread