major subox problems

cdbvrs · Joined: 13 Aug 2008 Posts: 4

Alrighty, I am obviously new to this medicine, and website. My problems though are not really getting better so decided to find some good sites with good people. I really enjoy reading all the info from doc's and patients. First and most importantly i would like to thank the doctors and patients who take time out of their day to answer our ?'s. Im sure you already live a very busy life and it means a lot to me and others for you taking your time out of your day.
K, I started methadone around late june, Dr. Drew Pinsky from the radio show loveline and his most recent show celebrity rehab grabbed my attention to what this guy had to say, and read his books(which I highly recommend, addict or not) in which he disagrees with methadone as do I. All the certified sobox doc's were backed up for atleast a month so really had no choice, and started the methadone. eventually got appointment and started soboxone. the first week was so so the week following was really well and i started on my 20 mg adderall 2x a day for my add.( school is about to start) I have never abused the drug and dont have any attention to, cause most doc would take away auto. for being a addict. Any way the following week(2wks into sub) i get extremely sick, vomitting , cold shakes, massive head aches that to this day have not gone away. the headaches is atleast a every other day problem. my symptoms were w/d's multiplied. I started taking less of the box. which went from 12 mg a day down to maybe 4 mg a day and the w/ds and sickness went away, other then the headaches. I think im six weeks into this and still find my self depressed anxious as hell, and cant ever seem to have appetite. I really need some advice. I don't know what else to do, every time I take recommended dosage of box, I get sick worse then when i started. I have just been low dosing it and tolerating the symptoms, but i really dont think i have any other choices then sticking to that. I have already put my parents through financial hell and dont want to have to have them spend the money on subtex, i got myself in this mess so i need to do what i can to get out. Occasionally ill smoke pot, which really helps but i figured, if im gonna stop one drug might as well stop them all. So, even though i dont really believe pot is a horrible drug that i could get addicted to, im just done with drugs in general.
So, any suggestions or advice is greatly appreciated.(sorry for grammar, key bored has crashed) thanks guys

suboxdoc · Site Admin Joined: 25 Feb 2008 Posts: 30

Let's see what we can do here. I am not sure what is going on, but there is always a reason for the problem, and we just need to figure it out.

First, even though you probably benefit from the stimulant, I would discontinue it until you get stabilized on the buprenorphine. It only complicates the issue-- you mention that you have no appetite for example and amphetamines are potent appetite suppressants. Once things are better on the Suboxone you can add back a stimulant. By the way, I strongly recommend that you consider changing to Vyvanse, instead of Adderall... it is more expensive than regular amphetamine salts (a horrible way to treat ADD!) but less expensive than taking two adderall XR's per day... and a much better medication for addicts and non-addicts both. It lasts much longer-- one tab, 16+ hours... has a smoother delivery, has low 'liking' scores by addicts, and has much less of the 'pull' of other stimulants. The active drug is amphetamine, so it would have the same therapeutic effect. But the med consists of amphetamine bound to lysine (a harmless amino acid), which makes it inactive until it the amphetamine is released by an enzyme in the intestine. One pill in the AM lasts all day and evening, and the offset is very gradual-- no 'crash' at the end of the day.

Back to Suboxone... my first concern was whether you are taking it properly, as that can affect the ratio of absorption of buprenorphine and naloxone. You want to make sure that there is good absorption from the mouth-- I recommend a technique where you crush the tab with your front teeth and dissolve it in a very small amt of saliva, and then 'paint' the inside of your mouth completely. To maximize absorption you want 1. a small amt of saliva, so that you have a high concentration of buprenorphine; 2. as much surface area as possible in the mouth-- NOT just under the tongue; 3. enough time for absorption to occur-- 10 minutes of constant 'painting and repainting' the surfaces with your tongue; 4. no eating or drinking for 15 minutes after a dose, so you don't rinse it away. Do these things and you will get good absorption of buprenorphine.

Buprenorphine is a very long-lasting medication. If you decrease the dose, the effect of the lower dose will take several days to occur. Some people who stop the medication have no withdrawal at all for 4-5 days! Keep that fact in mind as you make changes in things.

The most common reason for withdrawal is if a person is taking high-dose methadone and then goes to buprenorphine without a break in between. Methadone is also a long-acting medication, and so I usually have methadone patients stop methadone for at least 4-5 days before starting buprenorphine. If you are taking other opiates and also Suboxone, that will often make a person sick as well. I am assuming, though, that you have not taken any methadone or other opiates since starting the Suboxone. If that is not correct, STOP the other opiates.

Some other meds will interact with buprenorphine and affect metabolism of the drug-- are you taking prozac or other antidepressants? I will assume no.

The symptoms you describe and the pattern you are having them-- please clarify, when do you get sick? Right after taking the Suboxone, or a couple hours later, or much later? It is possible that you have a sensitivity to naloxone-- either you are getting a reaction to it, or perhaps your liver is not breaking it down and so it is causing withdrawal. If this is the case, you will get sick about an hour after each dose of Suboxone. To fix this problem, after dosing with Subooxone, instead of swallowing the rest of the saliva, spit it out. The saliva contains unabsorbed naloxone, and you can reduce the amount you take in by spitting the leftover saliva. Another solution is to try Subutex-- this has worked for many of my patients who got headaches from Suboxone. Unfortunately, though, Subutex is much more costly than Suboxone.

Other things that I have found to be problems for Suboxone... do you have liver disease? Have you had a gastric bypass or ulcer surgery? Do you take Ultram?

I encourage you to keep your daily dose of Suboxone constant, take one dose per day in the morning only, stop other meds if possible, and yes, stop the pot-- it may not be all that harmful (although I think it does cause an 'apathy syndrome' in many younger people), but it keeps the fires of addiction burning, and it is hard enough to stop opiates doing everything right!

Let me know how things work out, and good luck to you. Suboxone is not perfect but it is better than active addiction by a long shot.

SuboxDoc

cdbvrs · Joined: 13 Aug 2008 Posts: 4

Doc, i have not even got to finish reading all the info you have gave me befor i had to write you stuff. i forgot to update you with all meds, i am on, and a little background history, to further help ya. also I talked with my mom today and before even reading this we both agree that stopping the adderal would be a good idea, and then you just confirmed as well........sweet

1) taking 20mg lexapro a day

2.) valtrax

3) adderall(starting tomorrow going to take a break from it), and when i start back on it i will definitely try out the med you recommend. sounds of something more along the lines that im looking for,even though i don't abuse it, i have heard good things about vyvans.

4.) bought sobox off the street, before getting my act together and getting it from a certified doc. and used opiates on it before and learned the hard way not to combine the two( horrible w/ds and a headache that can drive you mad...... so, no i have not relapsed or tried opiates since got on right path.

4) went from methadone clinic to sobox. as you were saying four to five day break from methadone before you start your regemine. doc said the exact same thing, I and ended up taking loratabs a day before my visit. methodone is by far the worst medicine coming off of. highly recommend to be last resort if nothing else works for somebody,withdrawls were unreal from just 50mg liquid.

5) let me read the rest of your letter and get some more info off ya

thanks soboxdoc

cdbvrs · Joined: 13 Aug 2008 Posts: 4

Funny that you mention spitting it out cause the week i got really sick and could not even swallow my own saliva, cause just ended up dry heaving it up. i actually did just that, spit out the left overs. Ill start writing down symptoms,dosing times, dosage amount, sleeping schedule and anything else i think of that you might need. I'll write it all down day by day, and in seven days from now will have a whole weeks worth of info for you to look at.

thanks box doc

see ya in seven days

jimmmy · Joined: 26 Aug 2008 Posts: 3

I'm on my 7th day of suboxone after switching over from methadone. My feeling is methadone comes out of the body so slowly that it creates problems in the beginning on suboxone no matter how carefully one switches over. I'm being maintained on 24mg daily and I've had constant headaches, body aches -- just feeling uncomfortable a lot. High anxiety and a weird feeling in the head, similar to how I felt whenever I came off an ssri depressant medication. In fact, I've felt worse the last two days on the suboxone than I did the first five. I do know, though, I would be feeling MUCH WORSE going through the protracted, extended withdrawal that is typical with methadone if I wasn't taking the suboxone. I intend to stick it out. I'm just expecting the first month to be somewhat uncomfortable at times. I was thinking maybe I was having reactions to the naloxone but understand that sublingually, virtually no naloxone gets into the system. It appears just 1 out of a 1,000 people actually have bad reactions that can be directly tied to the minimal amount of naloxone. I encourage you to stick it out. Methadone worked well for me but was causing swelling in my legs and lowered my testosterone levels to almost nothing. I had to start taking testosterone shots every two weeks. For you male methadone users who break out into heavy sweats occasionally (hot flashes), I encourage you to get your testosterone levels checked. There are studies that show methadone does knock down testosterone levels significantly. I wonder if buprenorphine has the same effect.