Can anyone help me convince my Doctor to switch me from Suboxone to Subutex?

[princenamor]

I want to convince my Doctor to give me Subutex instead of Suboxone. I’m trying Suboxone right now; it’s doing some positive things, but I’m having several problems with it. The two main problems are chronic drowsiness, and worse it hurts my concentration making it hard for me to read, write, and do detailed work; also, my leg swelled up for no reason last week, and I’ve read that that is a side effect of Suboxone. I feel that these negative things are the result of the Naloxone that is in the Suboxone. I’ve taken many types of medications (most psychiatric), and feel I have become something of an expert med taker, identifying what effect comes from what ingredient of the medication. Can anyone help find information on the web, or information you could cut and paste here, or email to me if that’s possible; that would help me convince my Doctor that these counter productive side effects are caused by the Naloxone in Suboxone, and that I should be on Subutex instead. Please remember that the more official the information (official in the eyes of a psychiatrist that is) the more credible my argument will be. . If you can help, I see my doctor again Tuesday. If you can send me some info before Tuesday I’ll owe you one. Even after Tuesday information could help.

If my Doctor is unwilling to listen does anyone know where or how I can find a Doctor who will? The doctor doesn’t have to be a psychiatrist; he/she just needs to be willing to write me regular prescriptions for Subutex for what is ultimately a mental problem; if they’re a pain doctor that’s fine with me.

-Thanks

PS
What is a pain doctor’s title? (Proctologist=anal doctor, Neurologist=brain doctor, etc…)

[rag-doll]

How long have you been on Suboxone, and what was the reason you were originally taking it for?

[kitty77]

alot of ppl here that have complained of being tired , trouble concentrating, found that their dose was too high. I would definately talk to your dr about these problems & they should be able to come up with a solution.(honesty I've found works best) did u just start taking it? Everyone has an adjustment period when it comes to almost everything in life. JMHO

[hairgirl]

Just because you have taken lots of different drugs, does not mean you have the knowledge to tell a doctor what you need.You may be an expert of how it made you feel, but you should never put your recovery into your own hands.There could be many different reasons you have these symptoms.
I would discuss your symptoms with the doctor and give it time.Drowsiness is normal.As far as concentration, what other drugs have you been on recently or are taking with the Sub??Rule out all possibilities before making such a request.

[NancyB]

Hi princenamor, First of all, three things. Some physicians will just not prescribe Subutex because Suboxone is the preferred formulation; some insurance providers will not cover it for the same reason; and it's more expensive than Suboxone. In some places a 2mg Subutex tablet is almost as much as an 8mg Suboxone tablet.

That said, the amount of naloxone in the Suboxone is deemed 'clinically insignificant'. It really only comes into play when the Suboxone is injected, and then it may cause the rapid onset of harsh withdrawals. Here is more information on what the naloxone does.
http://www.naabt.org/faq_answers.cfm#64

As has been said before, the most commonly reported cause of drowsiness is too high of a dose of the medication. Or some people need to only take it at night.

Is the leg swelling a consistent problem or a one-time thing?

I've frequently seen 'Pain Management Specialist' referring to, well, doctors specializing in pain management.

Nancy

[Sub-Zero]

prince,
The studies show there is only a difference in suboxone and subutex when the patient is aware of which one they are getting. In double blind studies there is no difference.

Your symptoms may be coming from the naloxone, but you have no way to know that based on your post above. plus your symptoms are common in people who take either subutex or suboxone, which tells me it probably isn't the naloxone, and your focus should be on dose timing and amount instead of switching medications. If you are pushing to switch to subutex needlessly, you might be making more trouble for yourself. Not only as Nancy said that it cost more, it is also harder to find and you may be flagged as drug seeker by your doctor just for asking, and especially for pushing.

I would do everything you can to eliminate the other causes of these symptoms, before assuming it is this normally inert additive in the suboxone.

Sub

[Madison7]

My doctor kept me on subutex for the first month or so. He did this because I was taking 120mgs of methadone daily. I know now that it probably wouldn't have made any difference. I was concerned about making the switch from subutex to suboxone, but I had no problems. Like others have said, I don't think the naloxone would cause excess sleepiness and lack of concentration.

I think the main reason some people are switched from suboxone to subutex is that naloxone will sometimes cause headaches. Have you been having headaches?

PS To Nancy: When I copied and pasted a quote from Princenamor's text which was in bold, I found that after I pasted the quote, everything I typed subsequently was in bold. Thought you might find that curious.

[NancyB]

Hi Madison, did you use the Quote feature or plain old copy and paste? It is indeed strange.

Thanks!
Nancy

[Madison7]

Nancy, I used copy and paste only. See the post....Induction quandaries by packrat. It happened there also.

[azg2b]

Hi princenamor,

I'm in agreement with the posts above as well. And that's coming from a person who's presently on the -Tex product and has been since induction several months ago.

IMO, talk with your physician about your symptoms and let a certified health professional decide what formulation may be best for you. Best wishes to you!

j

[NancyB]

Nancy, I used copy and paste only. See the post....Induction quandaries by packrat. It happened there also.

Hi Madison7, I can't seem to get it to do that. lol
I'll ask our IT guy on Monday about it.

Very perplexing.
Thanks!
Nancy

[princenamor]

How long did it take for each of you to get used to Suboxone? Especially, how long did it take for your body to get used to the sedating effect, so that you no longer felt sleepy? For me, reducing the dose won't help because I feel sleepy even at the lowest doses. Also, if you had concentration problems or impaired thinking, how long before that went away? I've been on Suboxone for about a month.

I'm going to put a copy of this question on the main forum so more people may see it and relay their experiences.

[princenamor]

Also, keeping in mind that a smaller dose won't help, is there anything I can do to get rid of the tiredness? I've tried taking my whole dose at night, but I find the effects I need from the medication don't continue to work after a whole night's sleep, so I still need to take at least 2-4mg in the morning even if I take the bulk of my dose at night? If there is a medication or dietary habit that would help please share. When I took Vicodin it actually made me feel more awake, so I don't know why Suboxone makes me feel so sleepy.

[kitty77]

some ppl say that vicoden had an energizing effect. Sub does not.( that was actually 1 of the first things my dr said to me) since you've only been on it a month, everyone has an adjustment period. U said u tryed smaller doses, but did u know it takes a few days for it to take effect?(long half life)maybe u didnt give it enough time to notice the changes. If suboxone is making u sleepy at that dose, subutex would too. The only difference between them is the naloxone which is there to prevent IV use. I'd definately talk to your dr either way. (s)he may have u split up your dose, or may adjust it for u. Your dr should be able to help u out, when we try to do the medicating ourselves, that's when we get all kinds of up & down, yo yo, can't get stable kind of feelings. How much/what were u on prior to your induction?

All of this is as always, JMO : )

[kitty77]

....what kind of " impaired thinking" are u having?? As far as diet, any knit of refined sugars will make u sleepy/no energy. Turkey has trytpophan or however u spell it. Which will make u sleepy. Try smaller meals more often. Sometimes eating 1 big meal can make us sleepy cause it uses so much energy trying to digest.
JMO

[princenamor]

:confused:Because of my mental problems preparing food is a problem. The Vicodin was helping me with the Lethargy and Lack of concentration that has always held me back with food preparation and other areas of life. Right now since the Suboxone has caused me so much Drowsiness and impaired thinking I haven't been eating quite as much as I should (I've been trying to watch my diet because of food reactions that cause sinus problems, but I like so few foods it's hard to come up with an alternative diet.); eating more might help, but the drowsiness is so strong that that might only be part of the cure. Taking the whole dose at night should help, but morning is my worst time, and the night time dose isn't felt in the morning, so I need to take 2-4mg to feel better; if the half life is 20-37 hours it shouldn't be this way; I don't know why it is. I'm not sure what you mean by induction; are you asking how much Vicodin I was taking, or my opening dosage of Suboxone?

:eek:When I say impaired thinking I mean confused thoughts, trouble reading and concentrating; it's probably linked to the drowsiness. For the first week or so I took Suboxone it was energizing, but now that element has largely gone away while the drowsiness and impaired thinking have not; do you think this means my body can never adjust to them? A month is a good deal of time; how long did it take you? I really need this to work if possible. Opiate medications are the only thing that have helped my mental illness, and Suboxone is the only one anyone will prescribe for me. The more accepted mental health drugs not only don't work for me, but make my condition worse, and have caused some permanent damage. I don't want to return to nonlegal means of treatment. It's terrible that the drug war has limited my very real medication needs. Do you think the trouble I'm having can be surmounted, or do you think Suboxone just won't work for me? At night I don't feel so tired. My body has always preferred the night to the day; it's a lifelong problem that hasn't been helped by good sleep hygiene habits, but one of the advantages of the Vicodin was it helped me stay awake during the day when my body tends to feel more tired without being speedy; obviously I can't use the Suboxone this way. My body works in such a non conventional way it's hard for some people to understand.

[NancyB]

Hi princenamor, have you stayed on a consistent dose for any amount of time during the month you've been taking Suboxone? Because of the long halflife, if you haven't, that might be something to consider trying. As kitty mentioned, it can take a couple/three days to notice any dose reduction, so be mindful of that.

Best wishes,
Nancy

[princenamor]

I've definitely had trouble finding a consistent dose schedule because of the drowsiness; when I first started taking Suboxone, I was planning to take my entire dose in the morning. I have tried to take only a certain amount each day; right now it's 12mg or less. For the last week or so I have been taking 2-4mg in the morning for the reasons I mentioned, and planned to take the rest of my dose before bed. Some days I feel a hard depression (one of the things I'm taking the Suboxone to avoid) in the early evening and take another 2-4mg then, later taking the remainder of my dose before bed. I've been up most of this night with a small nap. I was hoping to get some stuff done I was too tired to do during the day, but I still felt somewhat out of it, but now I feel a little clearer (though I'll probably try to take a small nap before I begin the day); I'm not sure what this means. For me living life in itself is very hard because of my very traumatic past that didn't instill in me on an automatic level basic day to day skills:eek:; I'm not sure how better to put it. The Vicodin made it easier to adjust to the world's clock when I couldn't do it on my own; something the Suboxone obviously won't help with, unfortunately. My Doctor basically left it up to me to find a schedule, I don't think he knows all the ins and outs of Suboxone, but seems to prefer once a day dosing.

[gotoffmdone]

The problem expressed seems to me, at least, more related to the Bupe rather than the naloxone. Most people who switch to Subutex have had adverse side effects, headaches being the most common.

In any case, good luck finding a Dr that will switch you. When it comes to Sub Drs being willing to switch people from Suboxone to Subutex it seems to be a flip the coin type of thing. Some will and some won't. Some view merely putting foward such a request as addictive type behavior.

You would be amazed at how many Sub Dr's office I have called in my quest to find a new Dr, that, when I asked the staff person answering the phone if they were taking new Subutex patients, they had me to repeat what I was asking them. I would have to say Suboxone, before they knew what I was referring too. Even when I would say Buprenorphine, they were clueless. But, as I said, I was not speaking with the Dr.

wayne

[princenamor]

Actually, I'm not trying to switch just yet. Since people who have tried both have said there was little to no difference, I'm going to try and make the Suboxone work if I can. If I can't get rid of the drowsiness and impaired thinking I'll probably have to find a different opiate drug all together, and I don't know if I can get a prescription to that.

[princenamor]

:confused:I haven't taken any Suboxone since last night. Should I take 12mg or 8mg or something else tonight? Keep in mind I want to wake up feeling functional if that's possible. Should I be counting on taking a small amount in the morning, or hope it won't be necessary; so far it has been everyday. If I took 12mg would that maybe make me feel well enough in the morning, or should I take 8mg tonight to lower my dose, and cross my fingers that I will feel OK in the morning? I've set myself up today to possibly lower my dose, or to take a dose possibly large enough to make my morning feel tolerable. I'm not sure which to try, and I don't see my Doctor till Tuesday. Suggestions before I go to bed?

[gotoffmdone]

With this medicine, I would start low and go from there, based on the way you feel. It is easy to titrate upwards but impossible to take away any that has already been dissolved.

Actually, it has been stated that the ideal dose of Sub is that amount that keeps any other opiate cravings at bay. You may not even need as much as 8mgs. I was on 400mgs of Methadone and I take 8mgs. Sometimes I wait 36 hours in between doses.

Ideally, your Dr should be the one to tell you which dose is optimum for you but when it comes to this medicine, we often have to be our best judge. Sub is unlike any opiate I have ever taken.

I am surprised that anyone gets a "buzz", a boost in energy or sleepiness/lethargic from this drug. That has not been my experience at all with any amount of Sub I have taken and my doses have ranged from 32mgs a day down to 4mgs a day.

I expected or, hoped is a better word, that Sub would make me feel energetic. I guess it is a good thing it hasn't met my expectations. That is why I got so attached to hydros and oxys, the codone cousins.

Wayne

[flier1]

Prince,

Suboxone, has always made me tired so I started taking it at bedtime, and I sleep all night and wake up refreshed . No matter what dose it was always the same effect. Good Luck

Helen

[sommerrae]

Prince,
As a person who has been on both Subutex and Suboxone there really isd no physical difference that my body has felt. I dont know how long you have been off the other meds and on the treatment of Sub but it takes a long time for you r body to ever feel what would be normal.Wow for every so many days of harm to our body it takes years to actually feel better.
As far as you and all the problems you are feeling you def need to find a Dr you can be confident in telling your concerns and be taken seroiusly.There are alot of Drs that are in the Sub uisnessas a buisness not in it for patient care.That is sad to say but true.Your health all around mental and physical is upmost important in recovery.You have to be strong in mind body and spirit to be able to actually feel well.
I have a great Dr and I love him he cares for me and my family I am lucky!!
However there are two other Drs in the area whom are horrible at the Sub recovery.
You need to remember you are most important in getting well and things need to be addressed becasue if nothing changes than nothing changes...


One more thing I see you talk about the Vicodin alot too..Was you the one whom made the decision to come off of it or was it kinda pushed..I knwo sometimes we battkle within ourselves trying to make one thing the same as it was and it will never be so we have a wall that allows things to not function as well as they should..That is the sad thing about us...We are so strong in mindset it is a hard thing to break.....
Anybody whoever said a addict was weak obviusly never was a addict.....

Prince Good Luck!!
If you have any questions feel free..I do have alittle experience like I said with both and would love to be able to help you with you concerns...
Take Care!!
Sommerrae