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Unread 08-28-2008, 09:59 AM   #1
homosapien
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Lightbulb suboxone/subutex suppository(analy)

Hello im sara, new to this great forum. Im not advocating or suggesting this but it worked for me .Just quietly i thought i'd post that i now take my Suboxone like a suppository- intra rectally(I.R) -like you would with Prolodone suppositories etc (just gracefully stick it right up-if the coast is clear!- it absorbs dosent drain out)
I have gratefully been on subox.for 3 years-clean for 2 of them (4mg now-reducing successfully) How i came to the I.R decision is, i was getting alot of cavities frm subox (my smoking dosent help either) and it was awkward holding subox in my mouth-especially on the low down at work.
So i trawled the net for alternatives
and i came across a Patent applic. for a suppository form of Bupe. On further trawling i discovered a prac study of different methods of taking Bupe, which ive posted below from www.pudmed.com.
N.B; The stats below says absorption/bioavailability is better with I.R but in my experience its the same- i couldnt tell the difference. Out of curiosity i would like to know how big the test group was.
In Australia and other countries Bupe is restricted like methadone and you have to take it in front of the pharmacist to avoid spitting out,diversions(i.v)This is a reason doctors prob dont suggest I.R use i assume. Im not suggesting it for other people(like if you have diarrhea hemorrhoids forget about it) Most people get constipation wth Subox -I.R didnt make that any worse for me. I thought id mention it,in case people have dosage probs- i.e:
drooledge control !,work,existing nausea etc. Good luck all SARA.




Buprenorphine bioavailabilities:

intrarectal: 54%
"bioavailability of the drug was found to be: [... ]intrarectal (54%)..."
"Relative to the 100% bioavailability from the intraarterial route the mean bioavailabilities were [...] intrarectal, 54%..."


sublingual: ~30%

"Study results indicate that bioavailability of sublingual buprenorphine is approximately 30%"
"Literature on bioavailability of sublingual buprenorphine presents variable numbers ranging from. 19–58% of the administered dose."



oral: 10%
"the oral bioavailability for buprenorphine is state to be 10%"
"due to extensive first-pass metabolism, buprenorphine has very poor oral bioavailability (10% of the intravenous route) if swallowed"


p.s (ive deleted the i.v,i.m stats as injecting bupe peoples,can cause blindness,kidney damge etc)
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Unread 08-29-2008, 01:30 AM   #2
mikells43
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i have heard this. many people plug things. thats what its called. plugging lol. people even plug tar heroin when their veins hide from them after years of use.
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Unread 08-13-2009, 09:43 AM   #3
follydad
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I would advise against sticking Suboxone in your butt.
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Unread 08-13-2009, 02:32 PM   #4
mom_of_2
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I see the rationale. That area has lost of vessels for absorption. Never heard of it for sub though. Is there a special suboxone suppository? Interesting idea but don't think the tablets we take are made for this.
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Unread 08-13-2009, 02:49 PM   #5
m_styles78
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this is something i have never seen here.
however it makes sense, weird and kinda gross, but it makes perfect sense.
the anus had the ability to absorb a medication far better than any other method, that is why some people put medicines in enemas, really they do, it is more powerful than orally.
HOWEVER, i will not be putting my sub in my bum, rock on if you do, but naw i'm good,
if anyone does please share, i would like to know how it works for you
the things we talk about in naabt, i bet nancy didn't expect this!
take care all
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Unread 08-13-2009, 03:55 PM   #6
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Originally Posted by m_styles78 View Post
if anyone does please share, i would like to know how it works for you
the things we talk about in naabt, i bet nancy didn't expect this!
take care all
Hi Michelle, actually this thread is almost a year old. lol
And it's not the first time that mode of administration was brought up and probably won't be the last.

Nancy
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Unread 08-13-2009, 04:06 PM   #7
follydad
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Cool

Just remember, if you go this route, there's probably no going back. That is to say, I don't think one can retrieve a sub once it has, well, disappeared. Worse yet, what if it works? Does this become the preferred channel for everything -- Xanax, vitamins, chocolate? This could get ugly fast. And then you've got a whole nuther set of issues to deal with.
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Unread 08-13-2009, 10:48 PM   #8
gotoffmdone
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My problem with any route of administration is the range of bioavailability. Take the quote below.

"Study results indicate that bioavailability of sublingual buprenorphine is approximately 30%"

"Literature on bioavailability of sublingual buprenorphine presents variable numbers ranging from. 19–58% of the administered dose."

Assuming the study's findings to be accurate, dosing with a single 8mg Suboxone tablet would mean getting the benefit of between 1.5 and 4.6mg of Buprenorphine. Divide those numbers by 4 and you get the range in available Bupe, when dosing with a 2mg Suboxone tablet.

I assume the study was set up in such a way as to determine whether there were variations in bioavailability of the administered dose from person to person.

I wonder if the study, also, showed such variations within the same person. Or, if that is something that could be inferred.

If the latter is the case, seems it would be difficult for a person to determine that dose which works best, and to assure stability.

A person can have all the studies ever conducted in front of them. Still, their own personal experience will always override the results. And they should. Results from a study are nothing more than a compilation of the test subject's personal experiences.

wayne

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Unread 08-14-2009, 02:14 AM   #9
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Rock on! Naw, I'm good! That's funny Michelle

I haven't laughed that hard for a while. And yeah, like Follydad said, what if it works? Or worse yet what if it doesn't? There would be one pretty expensive pill "up the tube"?

But, like Denise, I also right away thought hum.... 54% , might not be that bad. Just not too sure about the "delivery"

Okay I'm over it. I figure it's working good the way it is now, so why fix it? Besides taking my meds the way I do (under the tongue - didn't ever think I'd have to make that a point) is inconvienient enough sometimes. Don't need to throw that in the mix. And what about the new people looking to start? Not a real selling point. Although I'd have done it in a heartbeat if that was the only choice

Thanks guys I needed that. The laugh that is.

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Unread 08-14-2009, 07:26 AM   #10
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Quote:
Originally Posted by gotoffmdone View Post
My problem with any route of administration is the range of bioavailability. Take the quote below.

"Study results indicate that bioavailability of sublingual buprenorphine is approximately 30%"

"Literature on bioavailability of sublingual buprenorphine presents variable numbers ranging from. 19–58% of the administered dose."

Assuming the study's findings to be accurate, dosing with a single 8mg Suboxone tablet would mean getting the benefit of between 1.5 and 4.6mg of Buprenorphine. Divide those numbers by 4 and you get the range in available Bupe, when dosing with a 2mg Suboxone tablet.

I assume the study was set up in such a way as to determine whether there were variations in bioavailability of the administered dose from person to person.

I wonder if the study, also, showed such variations within the same person. Or, if that is something that could be inferred.

If the latter is the case, seems it would be difficult for a person to determine that dose which works best, and to assure stability.

A person can have all the studies ever conducted in front of them. Still, their own personal experience will always override the results. And they should. Results from a study are nothing more than a compilation of the test subject's personal experiences.

wayne
Hi, to add to Wayne's post, this is another study that has a different average (50%) for absorption of Suboxone taken sublingually.

From:
"Pharmacokinetics of the combination tablet of buprenorphine and naloxone"
Drug and Alcohol Dependence 70 (2003) S39-S47
C. Nora Chang, Richard L. Hawks
Division of Treatment Research and Development, National Institute on Drug Abuse. Received 19 December 2002; accepted 4 February 2003

Page S43
"The relative bioavailability was reported to be 50% (range of 11-82%) in a single dose study..."

It went up to 64% in a multiple dose study, citing that the patient may have learned to hold the table under the tongue better.


Just thought I'd throw that one out there.

Nancy
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Unread 08-14-2009, 07:31 AM   #11
OhioMike
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Smile

Being a redneck heterosexual and being a Greek I have always been "very" protective of my bum!

Thankfully those hang ups inspired me to find more effective (creative) ways of getting more results from taking it orally.

http://addictionsurvivors.org/vbulletin/showthread.php?t=13397

However, I have never been one to judge another so, yes, rock on, bend over and enjoy! ........................

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Unread 08-14-2009, 07:46 AM   #12
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Originally Posted by neisy58 View Post
orange smelling toots,i bet my dogs would love that.
people will think of anything to get something to work better.
denise
ORANGE SMELLING TOOTS...lmfao!
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Unread 08-14-2009, 11:17 AM   #13
follydad
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I've been sticking them in my bum for two days now with excellent results. Regarding the orange-smelling toots, I found that following the Sub with two or three Tic-Tacs has a canceling affect. But not the orange Tic-Tacs. Okay, I'm just kidding. I'm forty-something going on 13.
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Unread 08-14-2009, 12:40 PM   #14
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I dont know,,,ive been on sub 5yrs and under the tongue has always worked just fine. It seems sometimes its the people who have just begun sub find different ways to take it. Im not saying theres anything wrong with that,,,but id hate to see everybody keystering(up the butt),because they want more out of it.
If your having problems and feel your not getting the full affect from sub then go for it. or if you just cant stand the taste. But i think in most cases under the tongue will take away wd;s and stop the craving.
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Unread 08-14-2009, 01:44 PM   #15
follydad
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Has anybody here really ever taken them this way? I was just joshing.
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Unread 08-14-2009, 02:02 PM   #16
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Has anybody here really ever taken them this way? I was just joshing.
welllllll.......

http://www.addictionsurvivors.org/vb...ghlight=rectal

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Unread 08-14-2009, 03:40 PM   #17
m_styles78
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ok, ok, now i am even more curious,,,, i read that link nancy, wow i am amazed, i just can not picture myself bent over putting my little 2 mg up there, what if i drop it? what if it... well you get the idea,
orange smelling toots, denise you crack me up, mike you too, i almost peed my pants reading this,
i can not even imagine what i would say to cam if he walked in on me "administering" lmao that would just be awkward... so i vote that denise tries it first.... ok denise??
let us know how it is. i would wear orange undies, just in case... hehehe
this is too much, i wouldn't have these talks with my best friend. i love you guys.
and btw, naw i am still good, lol
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Unread 08-14-2009, 04:02 PM   #18
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Originally Posted by m_styles78 View Post
ok, ok, now i am even more curious,,,, i read that link nancy, wow i am amazed, i just can not picture myself bent over putting my little 2 mg up there, what if i drop it? what if it... well you get the idea,
orange smelling toots, denise you crack me up, mike you too, i almost peed my pants reading this,
i can not even imagine what i would say to cam if he walked in on me "administering" lmao that would just be awkward... so i vote that denise tries it first.... ok denise??
let us know how it is. i would wear orange undies, just in case... hehehe
this is too much, i wouldn't have these talks with my best friend. i love you guys.
and btw, naw i am still good, lol


omg michelle....lol,
i have a butt phobia,that would be the last thing i would do....lol.
i can't even stand for a dr to go there
i thought i got banned from the site cause i couldn't log on,i emailed nancyb and she told me i wasn't ...lol
paranoid much,i guess i am
nancyb,if you are reading this,i guess i just jumped to gun,i couldn't respond and it was after i posted on the morning thread.
well i vote that since follydad is looking like the brave one,he will be the first.
they say laughter is the best medicine and second to suboxone i would say laughter has been a great tool for my recovery.
hugs to all and squeeze those cheeks..lol
denise
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Unread 08-14-2009, 08:08 PM   #19
m_styles78
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lol denise!!!
ok ok, follydad..... batter up....
dinise, don't worry so much, you are safe here i am sure of it.
and i actually am really curious about this, i might even, well try it???????
hmmmm, nope i won't. but i hope someone does,,, golly, its for medical research,,, you should feel honored!
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Unread 08-14-2009, 09:34 PM   #20
gotoffmdone
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I'd cram something up by butt hole or in my ear, before I would my nose. I have had nose trouble since I can remember.

I am not sure whehter Stadol is an opiate but it is designed as nose spray. I wonder if Bupe could be formulated to be administered that way.

I do not know if they are still working on it but, personally, I am not at all crazy about Sub implants.

Nancy,

Considering the way in which it must be administered, I can understand why there is such variation in the amount of Bupe. It sure would be nice if we able to get close to 100 percent bioavailability. We could lower our cost, by taking less.

There are times when I think, for sure, all the Suboxone has melted. It's had plenty of time, I would tell myself. Plus, it feels as though orange goo is all that's left. But, when I finally spit or swallow, I notice there are some chunks left.

Strange as it may seem, that scenerio never happened when I was using Subutex. It seem to melt easier and more quickly. I did not mind the taste, so I never spit out the residue

Then there are those times when the phone rings, soon after I put Sub in my mouth. Or, I am keeping my 2 1/2 yr old granddaughter and, believe me, unless I dose late at night, after she goes to bed, there is no good time to do it. She will not allow me to be still or quite. And if I tell her to be still or quite, well that dosen't help me either.

wayne

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Unread 08-15-2009, 07:50 AM   #21
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Hi Wayne, I wonder if it has to do with the difference in ingredients in both? From the PI: http://www.naabt.org/documents/packageinsert.pdf

SUBOXONE is an uncoated hexagonal orange tablet intended for sublingual administration. It is available in two dosage strengths, 2 mg buprenorphine with 0.5 mg naloxone, and 8 mg buprenorphine with 2 mg naloxone free bases. Each tablet also contains lactose, mannitol, cornstarch, povidone K30,
citric acid, sodium citrate, FD&C Yellow No.6 color, magnesium stearate, and the tablets also contain Acesulfame K sweetener and a lemon / lime flavor.

SUBUTEX is an uncoated oval white tablet intended for sublingual administration. It is available in two dosage strengths, 2 mg buprenorphine and 8 mg buprenorphine free base. Each tablet also contains lactose, mannitol, cornstarch, povidone K30, citric acid, sodium citrate and magnesium stearate.


Have you tried breaking the pill up and putting some under each side of your tongue? That's helped some expedite the 'melting time'. Along with the rinsing with hot water right before you take it, that might speed things up.

As far as I know, the company that was doing the clinical trials for probuphine, Titan Pharmaceuticals, had stopped them at the Phase III phase because of financial difficulties.
http://www.titanpharm.com/products-c...probuphine.php
http://clinicaltrials.gov/ct2/results?term=probuphine

There was talk of a listerine strip-type mode of delivery, that would probably be great if it happened. They would dissolve quickly and hopefully patients would be able to cut them down easier for tapering.

I guess we'll have to wait and see what's happening with that, along with the generics.

Nancy
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Unread 08-15-2009, 08:44 AM   #22
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Hi Wayne, Stadol is a narcotic, used for migraines. i remember that from when I worked in a doctors office and was in charge of counting drugs(imagine that!) As far as this butt thing goes....Im out! Deanna
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Unread 08-15-2009, 09:07 AM   #23
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Hi Wayne, Stadol is a narcotic, used for migraines. i remember that from when I worked in a doctors office and was in charge of counting drugs(imagine that!) As far as this butt thing goes....Im out! Deanna
I dont remember where i read it but if im not mistaken stadol comes right after dmerol in the line of narcotics such as morphine and stuff.
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Unread 08-15-2009, 12:12 PM   #24
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Nancy

Makes sense as to why I feel Tex melted better than Oxone. The coating and all.

Some of those litle chunks I speak of seem hard, kinda like its the coating I am feeling.

For the life of me, I can't understand why Subutex is more expensive than Suboxone. Given the difference in formulation(suboxone has 2 active ingredients and it is coated) and what it must take to mfg Suboxone, it makes no sense.

The only thing I can figure is that Subutex is more expensive because it has more abuse potential. Drug companies know people are willing to pay more for drugs they can abuse, if that is a person's desire. Or it could be more expensive because it is used less because there is less demand from those who write the scripts.

As consumers, some of us would prefer Subutex, not to abuse it, but because the Naloxone causes some of us problems. But if we say that is the reason, I am not so sure we are believed.

My first Dr believed me and, for over 2 years, Subutex was all I took. After going back and forth my first month in tx, we settled on the one that worked best, Subutex. And I never shot, nor snorthed it.

When searching for another provider, I asked several staff members, at numerous Sub Drs, if they ever gave Subutex. Odd as it may seem, they'd never heard of it. That was my answer.

One Dr I saw had my records in front of him, documenting my trouble with Naloxone and that I had taken Subutex for over 2 years. When I walked into his little exam room the first words out of his mouth were, I do not write for Subutex. Not hello, how are you doing, my name is Dr____ or kiss my butt. I went to him once, then sent him a fax telling him I would not be back and why.

I wish Drs would allow the patients to take what has PROVEN to work best, especially in the face of overwhelming documentation.

Rhetorical question_why do Drs have to be so rigid, in their thinking, when there are alternative ways of doing things. (Kinda like us as patients).

wayne
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Unread 08-16-2009, 06:10 AM   #25
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Yea,im on tex myself,,,after being on subone for years i like the tex alot better. the taste doesnt bother me near as much as suboxone and it "does seem to melt faster.
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Unread 08-16-2009, 08:18 AM   #26
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Hi Wayne, the only thing I can think of why -tex is more expensive is that it is 'the preferred formulation' and is not prescribed as often.

As for some doctors not prescribing it when someone is hypersensitive to the naloxone, this is right from the Suboxone PI.
http://www.naabt.org/documents/packageinsert.pdf page 2

Allergic Reactions:
Cases of acute and chronic hypersensitivity to buprenorphine have been reported both in clinical trials and in the post-marketing experience. The most common signs and symptoms include rashes, hives, and pruritus. Cases of bronchospasm, angioneurotic edema, and anaphylactic shock have been reported. A history of hypersensitivity to buprenorphine is a contraindication to SUBUTEX or SUBOXONE use. A history of hypersensitivity to naloxone is a contraindication to SUBOXONE use.


You clearly showed that hypersensitivity and in your the records from your last physicians. Then I've heard of doctors who only prescribe -tex because they're misinformed and think that the naloxone can cause withdrawals.

Why that doctor would not prescribe -tex to you, I haven't a clue.

Nancy
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Unread 08-16-2009, 09:55 AM   #27
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To add to that, that same paragraph from the PI is also in the TIP40.
From the TIP40: http://www.naabt.org/links/TIP_40_PDF.pdf
pdf page: 69

14. Has the patient had prior adverse reactions to buprenorphine?
Cases of acute and chronic hypersensitivity to Subutex® have been reported both in clinical trials and in the post-marketing experience. The most common signs and symptoms include rashes, hives, and pruritus. Cases of bronchospasm, angioneurotic edema, and anaphylactic shock have been reported. A history of hypersensitivity to buprenorphine is a contraindication to Subutex® and Suboxone® use. A history of hypersensitivity to naloxone is a contraindication to Suboxone® use. (Reckitt Benckiser Healthcare [UK] Ltd. et al. 2002).

Interesting.

Nancy
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Unread 08-17-2009, 11:39 AM   #28
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Nancy
The Dr I spoke about who, before even saying hello, told me he did not use Subutex did so because he had my records in front of him and, therefore, knew Subutex was what I had been using. It was a pre-emptive strike on his part.

He could clearly see, in those records, where my first Dr and myself had tried Suboxone several times. You would think, just out of curiosity, this 2nd Dr would ask me what problem I encountered when taking Bupe + Naloxone. As a Dr, I would want to know all the side effects. Who knows there may be others who complain of similar problems.

But the thing that bothered me most about this Dr was his rationale for never giving Subutex. He was the Dr I think I told you about who said it was the Naloxone that seved as the sole deterrent factor when it came to not taking other opiates.

With a straight face, he actually told me that Naloxone served as the deterring factor against my taking other opiates, by making me sick if I took them together.

I told him that I sure had it wrong, that I had been under the impression, all this time, that the Naloxone served no purpose, other than to prevent the Buprenorphine from being injected. That taken sublingually, Naloxone did not even penetrate the brain in any significant way. I told him I thought Buprenorphine, the only active ingredient in Subutex, was the most important ingredient. That it did not make a person sick if they took another opiate, it just blocked its effect. That Bupe was there to help a person deal with cravings and to stop wds.

The Dr said well I just do not write for Subutex.

My concern, still, with a guy such as this being a Sub provider has to do with whether he was flat out lying to me or worse, if he truly believed what he was saying. I hope he was lying, and is not that ignorant. If he took the course and I assume he did, then there is a point where ignorance turns into stupidity.LOL I have walked out of many a class, myself, feeling stupid.

wayne
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Unread 08-17-2009, 03:33 PM   #29
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hi wayne,
how have ya been?
the thing i have noticed about the drs that perscribe suboxone is alot of them are 1 size fits all.
they start everyone out with the same mgs, and only will do the suboxone.not tex.
what i have been wondering is,if they are being taught different ways in different states or areas.
by reading alot on here,i have seen where a dr will be more lax with the mgs or if you are having problems with the sub,will give that person the tex.
my dr only does the 8 mgs from the beginning no more,no less and does not do the tex ,even if the suboxone makes a person sick.
one of the girls i am in group with asked to be put on tex and he flat out told her he didn't do that.
she ended up going to a pain managment dr that put her on methadone.
it has bothered me from the beginning of my treatment,i like my dr ,but he is so dead set on his ways,it doesn't help exspecially if you need more or less of the sub.
i have felt like i needed more and even took more than i was supposed to take,due to withdrawal feelings and bad cravings.
all that did to me was cut me very short every week.
the sad thing is ,i am still doing it,and due to that,i suffer for about 3 days for it.
you would think i would have learned my lesson by now,but addiction diasese is what it is,plain and simple.
i also pay cash for my suboxone and one of these days i sure hope the price goes down.
some weeks it's between getting groceries or suboxone,well suboxone wins,i am not going back to that life,i can't.
i hope you get the tex you need and everything starts going better for you.
denise
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Unread 08-17-2009, 06:04 PM   #30
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Hey Denise
Some Drs do have a cookie cutter approach. I suppose the easiest, most simplistic thing to do, is to treat everyone the same. Give every patient the same dose of SUBOXONE.

I wish there was such a thing as anal Sub. I could have told my 2nd Dr to wrap his mis-information around the Suboxone, he insisted on writing, then cram it, all, up his anal cavity.LOL

There are numerous ways in which Sub tx is practiced, from Dr to Dr. The difference that surprises me most concerns refills. My first Dr gave his patients one refill. If a patient was struggling he required monthly visits until they got things worked out.
He charged $50 every other month. Twenty-five dollars a month(avg cost) was not bad at all.

I know of persons who get 1 refill and 2 refills. I have read on this forum where one person was getting 5 refills, the maximum allowable by law. When looking for a Dr, after my first one left, I ask all the Drs I called if they gave more than one refill. Forget more than one, they seem shocked I mentioned even one refill. And here I thought one refill was standard operating procedure. That was all I had known up to that point.

I learned real fast my first Dr was the exception, and not the rule. Several Drs told me it was against the law for them to give me refills, that they HAD to see me weekly or monthly. It was mandated. I know this weekly and monthly business is SAMSHA guidlines. It may be strongly recommended Sub Dr see patients that way. But Bupe is Class III, controlled drug. That DEA designation allows Drs to write up to six months worth at a time, if they are so inclined. Now if they made Bupe a Class II drug, then Drs would, by law, have to see patients monthly. They would be telling the truth, then.

If someone is thinking about being treated for addiction with Sub, the best thing they can do is read, read, read.....learn as much about Bupe and Bupe treatment from all available resources. Then ask of your Dr, any lingering questions you may have.

wayne
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Unread 08-17-2009, 07:12 PM   #31
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Hi, I thought you might be interested in what it says in the TIP40:
http://www.naabt.org/links/TIP_40_PDF.pdf
pdf page 90:

Frequency of Visits
During the stabilization phase, patients receiving maintenance treatment should be seen on at least a weekly basis. Part of the purpose of the ongoing assessment is to determine whether patients are adhering to the dosing regimen and handling their medications responsibly (e.g., storing it safely, taking it as prescribed, not losing it). Once a stable buprenorphine dose is reached and toxicological samples are free of illicit opioids, the physician may determine that less frequent visits (biweekly or longer, up to 30 days) are acceptable. Visits on a monthly basis are considered a reasonable frequency for patients on stable buprenorphine doses who are making appropriate progress toward treatment objectives and in whom toxicology shows no evidence of illicit drugs. However, physicians should be sensitive to treatment barriers, such as geographical issues, travel distance to treatment, domestic issues such as child care and work obligations, as well as the cost of care.
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Unread 08-17-2009, 09:44 PM   #32
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wayne,you have alot of knowlage to share with all of us,it great to be posting with you.
there has been alot of people on here that have taught me more than where i go every week will teach me.
i thank g*d everyday for finding this site,i would have still felt so alone in my recovery.
i feel for the people that don't have meetings,a computer and this site to go to.
what a lonley process they must be going through.
thank you wayne and have a great nite!!!!
denise



hi nancyb,
i just wanted to say hi to you sweetie.
what a catalog of info you must have,it doesn't matter if it's in your head or on your computer,you always have great answers and info to give.
not only that you are quite the cheerleader when it comes to feeling out peoples feelings,you cheer them up and help them out.
you are the greatest!!!!
hugs,
denise
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Unread 08-18-2009, 09:25 AM   #33
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i agree neisy!



Quote:
Originally Posted by NancyB View Post
. However, physicians should be sensitive to treatment barriers, such as geographical issues, travel distance to treatment, domestic issues such as child care and work obligations, as well as the cost of care.
wow i wish this were tru with my sub doc. i have tried to work out a schedual with them b/c i have no car, don't have a ride until 4pm, and have to get to group3x a week. they are in the same building, luckily, because there have been times i had a 11am appt with them and had to stay there and wait for my group to start @ 530 pm!
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Unread 08-18-2009, 09:48 AM   #34
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Hi Bqb247, do you think it would help or hurt if you printed that page out from the TIP40 and showed it to them? You know your doctor, so you'd know what the reaction would be.
How long do you have to go to the group 3x week?

Nancy
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