Posted by bupe_fan on May 3, 2004, at 18:36:30
In reply to Re: Buprenorphine - I INSIST YOU TELL ME MORE! » bupe_fan, posted by Chuckie on May 3, 2004, at 13:06:36
I know alot about where you are coming from, as I was on poppy tea (very low doses - 2 giganthemum pods per day) for the last months before I got the bupe appointment. Yes, I found the bupe doc at http://buprenorphine.samhsa.gov and it took me over a month to get in (kinda sad imagining a junkie having to needle himself for an extra month cause of a delay in admissions).
Well I can tell you what to expect: Your first appointment you will likely NOT be given any buprenorphine, but instead asked very many questions and made to sign very many forms. I realise that you, like most people who find themselves with opiate dependancy are only trying to treat your depression, but unfortunately you'll be treated like an addict the whole way. Of course a doctors office once a month is much more humane than waiting in line every morning at the methadone clinic, but no matter how hard the doctor tries to keep his words stigma free, its truly impossible as they have not experienced what you have experienced. You might experience like I did a nurse asking "do you regret ruining your life?", to which I responded "Excuse me!?", and she says "Becoming a junkie and having to deal with all this bullshit", to which I replied "I am glad I discovered opiates as they helped keep me from doing something I regretted such as killing myself or others".
My advice for the first appointment is to be pretty honest about your situation, however be very careful about what you disclose, because the doctor is quite likely to paint a picture of you in his mind biased towards what he first heard. You know the expression "first impressions always last". For example I told my physician that I had been using roughly 10-15mg morphine equivalancy in poppy pods for the last couple weeks (calculating that there is 5-8mg of morphine per Giganthemum pod), but unfortunately this did not account for my previous Oxycodone usage at 40mg/day, hydromorphone at 8mg/day and fentanyl usage at 1600mcg per day. Due to this information he considered me to have an "extremely low tolerance" and prescribed me 2mg of buprenorphine initially and suggested that I use 1mg once I stabilize. I found myself to be somewhat comfortable at 2mg (certainly more comfortable than without), but when I tried to taper to 1mg, I found that I was unable to concentrate enough to function at work (I have a job which involves the use of my brain intensely for many hours), I also found that tapering lead to misery at home, and my discomfort caused some conflict with my fiance.
After a couple months or so at 2mg, I realised that I missed the "good old days" of being able to feel as comfortable as I wanted any day of the week and decided to tell my doctor that due to the pain I was experiencing in my hands and arms (various things wrong with them: carpal tunnel, ulnar nerve and shoulder) and due to cravings and poor functioning at work whenever I tried to taper, that I viewed the benefits of using buprenorphine outweighed all cons, but that I needed a higher dose to prevent these cravings because I felt that I did not reveal the full extent of my opiate habit during my initial visits. So after much pleading and reasoning as well as providing many studies about buprenorphine dosages and buprenorphine in the treatment of depression (www.google.com and PubMed are my friends) he increased my dosage to 3mg/day, which is certainly perfect. It is great because it gives me some leeway to adjust how much I take in a day, some days I take only 1 pill (2mg), while others I take a full 2 (very rarely), but all in all the average is right around 1.5/day.
You should however realise that much of the "torture" you were experiencing comes from protracted withdrawal symptoms, as well as the initial depression you had.
As you seem pretty set on bupe as the treatment for you, you should be aware of the possibility that you might not get it at all from your doc, if he evaluates you and for any reason (personal, moral, religious, who knows) decides that he doesn't want to put you on bupe, you'll likely end up on whatever drug the pharmaceutical manufacturers are paying him to promote this month. (Effexor seems to be a biggie these days - despite telling my doc that I absolutely refuse to try to "Treat" my ADD with an anti-depressant and a severe allergic reaction to the closely related Buproprion (Wellbutrin) a couple years ago, he kept trying to push effexor on me.) Aslo remember it is quite likely that you are not going to start on bupe right away, and also they will want you to be clean from other opiates for 24 hours. In all honesty there is some safety margin in those 24 hours, and I was only off opiates (I switched to hydrocodone due to its short halflife) for 12 hours, to mimize the withdrawals I experienced at work, and I was feeling better within 10 minutes of putting the suboxone under my tounge. If you really wanna be certain about what day he would dose you, call and ask what his policy is. They usually dose on the 2nd day because they require a whole buncha signed paperwork (thank you litigous people for wasting my time) and also require a driver to take you home (you probably won't need it, but liability rears its ugly head).
Some doctors will require a urine test during your first visit to make sure you are "honestly a junkie" and also to make sure you aren't a "polysubstance abuser", because that increases the amount of work they have to do.
You will also be urine tested every week/month (depends how good you are) to make sure you aren't "relapsing" (which is fortunately very difficult to do thanks to the 72 hour blockade caused by the buprenorphine - in my personal experience all other opiates are wasted when attempting to do them within 3 days of buprenorphine, although you will get very uncomfortable when going 36 hours without, so its pretty much impossible to last 72 hours off bupe to actually get high.) If you fail opiates or one of the other substances on the test besides opiates, your doc can do whatever he feels is neccesary, including reccomending methadone maintenance instead, tapering your dose or whatever other punishment is appropriate (I realise its not really a punishment in the doctors mind, it just has that effect). Personally I failed for benzos once and didn't get anything more than a lecture from the moralizing nurse. Of course the only reason I failed is because they have not prescribed me anything which actually helps me sleep yet.
If you have read anything on the net about how buprenorphine is "withdrawal free" or anything of the sort, its not entirely true. Once you have been on buprenorphine for a couple weeks or more (6 months in my case) it becomes extremely unpleasant to go without for 36 hours... If someone uses this drug to wean themselves off opiates in a period of 2 weeks it would definately be less unpleasant than using methadone or quitting cold turkey, and this is why the rumours about "withdrawal free detox" got started. While quitting is still very hard, the thing I've been impressed with about bupe is the lack of any creeping tolerance! 2mg still feels exactly the same as the first day I did it.
As for actually dosing, pick a time when you've got 15 minutes without talking to anybody (due to sublingual administration), and take 2/3rds of your daily dose when you first wake up, and 1/3rd about 12 hours later... This provides the best balance of feeling comfy when you need it most (morning and night), and the body actually gets more use out of such a dose, due to the partial agonist nature of the drug.
Lastly remember bupe is not a magic cure, although it definately helped me with my depression, ADD and bipolar disorder, I still work hard every day to find better ways to cope with my natural limitations. Excersize and diet are the most important ways to combat depression. And I highly reccomend DLPA and L-Tyrosine for a little boost in the morning and Melatonin at night. Proteins are the only way to get a lift without a subsequent crash.
Yes, so sad about GHB, I have commented to my fiance that if I had a steady supply I would be able to wean myself off bupe and experiment with living without (my original plan), but a wedding, a full time job, and a housing search have prevented the taper.
Good luck! and don't be scared of the docs! they really are trying to help! They're doing their best but they're only human and motivated by profit (after all medicine is a BUSINESS). Read up on opiate addiction at one of many harm reduction related sites such as www.bluelight.nu and www.at-watchdog.org (I provided this link earlier).
> Sorry for insisting, and so emphatically, but this is my life in the balance.
>
> I admitted myself to the hospital a few weeks ago for detox. I was there for four days; they gave me decreasing dosage of methadone and then said well there you are. I spent the following week sick, in a spiral *much* more destructive than the drugs. After a week i should have been better but the fact was i was worse and on my way out. Couldn't take the torture anymore and now i'm back on the poppy and approaching my old dosage.
>
> You say these things, and they raise questions which i hope you're kind enough to answer after i shouted at you:
>
> >>The doctor said no way would he let me continue on buprenorphine for any longer than 10 days,<<
> >>If the doctor ever tries to taper me I will raise hell about how much better I am doing now...<<
>
> What sort of doc did you see? And why is he reluctant? I thought bupe was a maintenance medication.
>
> I want to avoid your sort of situation. It doesn't sound much more workable than the old go-to-the-doctor-and-be-in-pain strategy for obtaining Vicodin or whatever. IOW, it can and likely will be taken away from you before you're ready to have it taken.
>
> I ask, because tomorrow i have an appointment with a certified buprenorphine type doc. I'm nervous as hell because my only other options are continuation of the poppy, or methadone. The flower is illegal and makes me ill at the dosages i take. The nearest methadone clinic is a 45 minute drive from here, and i'd have to go every day until they decide i don't. And i don't want to be addicted to methadone.
>
> This geographical area of the U.S. has only two buprenorphine docs listed in the gov't directory; the one i'm going to see, and the one i can't get hold of.
>
> Of course i'll do whatever needs done, but the buprenorphine sounds like the thing that *should* be done. I want to get my body back in balance... start eating right again and get back into the gym, etc. And my wife is taking me to see a holistic practitioner; dietary plans and acupuncture and whatnot. I'm skeptical because it's my nature but i'm also open because that's my nature too. But i need a *somewhat* balanced place to start from.
>
> Sorry. I'm likely rambling because of my nervousness. Bleh. Want my life back.
>
> One of my more important questions: What is the bupe costing you? The receptionist told me that their visits start at $95 and go up, but that Medicare would pay "some portion." I have no idea what the medication costs around here but i've read official estimates of around $250/mo. This sucks, but the poppies were getting to be about $150/mo. and my ultimate purpose is to get de-drugged eventually so the cost is somewhat of a motivator. I just don't want to be priced out of treatment entirely.
>
> Thanks for the info about GHB. I had sorta figured it out, i just hadn't figured "no way in hell." Oh well. Thanks to my government for protecting me so well.
>
> >>I think you put the Doc which you saw into a situation where he only had one thing to reccommend.<<
>
> Dangit, which thread am i on? I forgot what i said, and where. If you're talking about the intake person who tried to shanghai me, then no, she had no right nor justification for that whatsoever. You might be correct about the kickback but i think it had more to do with her bad day, her need for control, and the approaching 5:00 hour.
>
> I'm still angry about that episode, can you tell? ;)
>
> *cough*
>
> Erm anyway like i said, thanks for ANY further info, comfort, advice, etc. you can provide. I get all worked up. Really feels like tomorrow's appointment is life or death in the balance. I'll not give up if it turns out badly, but it gets so very hard not to give up when things *keep* turning out badly. Ya know?
>
> - Chuckie
>
poster:bupe_fan
thread:333744
URL: http://www.dr-bob.org/babble/subs/20040409/msgs/342968.html