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Unread 12-20-2016, 09:07 PM   #1
pernicious_poppy
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Unhappy new here! happy on subs-what to do after clinic limit?

hi everyone! i'm new and looking for some advice on finding a new doc after you've reached clinic limitations, but still are in need of help and fear relapse if not taking suboxone.

the clinic i'm in has a strict 9-12 month treatment limit, after which, if you're not okay, you're basically SOL i suppose. i am approaching my 9-month anniversary, and i know i'm not ready. while i'm honestly kinda impressed by how much better a place my head is in, i am a bit of a difficult case-i've been regularly using opioids to deal with everyday life since age 17 (i'm 27 now), and am also a dual-diagnosis patient (having been diagnosed with bipolar, panic, and generalized anxiety disorders since my early teens-my mental illnesses actually far predate both diagnosis and any drug use in any capacity). i am in therapy in conjunction with my suboxone. i have not yet been able to return to work, and am still working on tweaking my psych meds to get the right combo to treat the bipolar and anxiety/panic, as well as an inherited sleep disorder. these illnesses were a large part of what drove me to use regularly-never in my life had i felt okay, then pills and heroin made me feel capable for a while...my brain made living a healthy, productive life-even without drugs-seemingly impossible. having started using drugs problematically at the very start of my adult life, i never developed the skills and habits necessary for a fairly normal and productive life. from poor hygiene to self-defeating lack of confidence to extreme financial difficulties and being incapable of keeping a job, i've got so little i need to be the person i wanna be-the lack of effective mental health care in my area, leaving me with no way to really gain control over my mental illnesses-which i know have contributed a lot to my lack of motivation, self-injurious and suicidal thoughts and behaviors, the abject poverty i've lived in since childhood, and dangerous, impulsive actions.
as far as i've come in these 9 months, i feel as though i have a lot more work i need to do to both gain control over my mental illness and develop the coping skills that i'll need to prevent myself from getting right back into the same place i was at the start of this year. but i have no idea how to proceed from here, and i am terrified, in all honesty, of the future. at the very least, i'd like to get well enough to keep a job before my insurance limit of 16 months suboxone coverage, so i'll have the resources to pay for my own until i'm able to say i'm well enough to taper safely. i don't mind being on the suboxone for as many years as it takes to get my mental health stabilized, develop coping skills to deal with difficult situations, stay motivated to work and take care of myself, and keep from falling back to the drugs that numbed my emotional pain and helped me forget about my awful station in life, but ended up doing nothing but make all of that worse. i'm scared, and i can't seem to find any info on how and if it's possible to transition to a new clinic or doctor at the forced end of one. any sort of advice, resources, etc. y'all may know of that might help would be SO greatly appreciated. i'm afraid of what's gonna happen in a couple months if i don't-i know i'll end up using again and lose a lot of the progress i've made with my mental health, but will i be lucky enough to survive this time? i'm not ready, and i am so, so scared.

Last edited by pernicious_poppy; 12-20-2016 at 09:10 PM.. Reason: *posted a version of this in another thread w/no activity for several years...oops
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Unread 12-21-2016, 05:39 AM   #2
NancyB
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Hi pernicious_poppy, welcome. Congratulations on almost 9 months! It's great that you're very aware of your situation and taking the steps to make sure you are totally ready when you do taper off of bupe.

Does the clinic start tapering off at a certain point in time? Have you spoken with anyone there about your concerns and that you want to continue treatment until you feel comfortable to taper off?

What you could do is start looking now for a new doctor. This thread has different ways to do that:
http://addictionsurvivors.org/vbulle...ad.php?t=21259

Explain to the new doctor what you've told us - that you're in a program, but you need more time on bupe to continue making progress.

Is the same clinic working with you on getting your other medications right? Is the therapy at the same clinic too?

Sorry for all of the questions.

Nancy
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Important disclaimer: Any information in this post is not and does not constitute medical advice under any circumstances. Addiction Survivors, Inc. does not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. NEVER take any online advice over that of a qualified healthcare provider. Any information contained on AddictionSurvivors.org should only serve to inspire further investigation with credible, verifiable references sources such as your physician or therapist.
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Unread 12-22-2016, 04:10 PM   #3
pernicious_poppy
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oh no, i'm happy to answer questions! clarity is my aim

there's no particular date when they start tapering-it's on a case-by-case basis, and it doesn't happen without discussion with the patient unless the patient hasn't been compliant specifically with the suboxone (indicates they're probably just selling it and taking a spot away from a patient who will use it). however, i was told that the doctor sees no need to go much beyond a year of treatment, which i don't think is very fair but i guess it's partially because it's a high-demand area with too few openings for treatment. still, i sincerely believe that it should be the patient's decision as to when they're ready. when i mentioned that i was concerned, i was told they recommend getting the vivitrol shot, which i do not see as a safe or viable option for me. cravings and a need to escape my circumstances drive my drug use far more than avoiding the discomfort of withdrawal, and from what i've learned, vivitrol has no craving suppression effect-and beyond that, since it's an antagonist rather than a partial agonist, you're left with severely reduced opioid tolerance that puts you at far higher risk of overdose even from a small amount of full-agonist opioid. that's a dangerous situation to put myself in imo :/ but i'm afraid to voice my concerns completely, because i don't want to be seen as drug-seeking, which they believe is a possibility i'm not sure how to broach the issue without risking immediate taper. not sure if they can even do that, but i'm scared.

i've decided that yeah, starting my hunt for another doctor early especially is my best bet to preventing relapse-i was afraid of being laughed off the phone if i asked that, but i suppose if i call around enough i'll find someone who takes me seriously!

my current clinic does deal with dual-diagnosis issues-i get my therapy and my mental health meds from there. the only other place in town that provides full mental health services is severely overbooked and understaffed, leaving patients with 10-min psychiatrist visits and therapy that's very generalized geared more toward overcoming circumstantial depression than serious disorders. the therapy has been very helpful, and it's nice to have my bupe and my mood stabilizers/sleep meds from the same doctor, but they're very hesitant about treating anxiety and panic due to the nature of the meds most effective in panic situations. they lean more towards the "practice mindfulness" side of anxiety treatment, which isn't terribly helpful when you feel like you're literally going to die of a heart attack or your lungs collapsing in your chest. i have a long way to go with anxiety and panic control before i can be an effective employee, and i'm still trying to perfect my ability to cope with the mood swings and violent outbursts in ways that don't involve getting high. at the very start of my journey here, my dad died, and i had a very difficult relationship with him...it took a long time to get past that. now i keep being faced with new, trying situations that i've never experienced as a sober adult, and the urge to run back into the numbness is sometimes so overwhelming...

thank you so much for your kind, supportive reply <3 the fact that i'm still not stable makes me feel ashamed of myself, even though i know i ought not to feel that way, and just hearing some words of understanding is incredibly helpful in building my confidence to speak with both my doctor and other doctors so i can ensure i have all the chance i need to make my life what i want it to be. i am extremely grateful and happy to be part of the community!
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Unread 12-23-2016, 06:37 AM   #4
NancyB
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Hi again, please don't feel ashamed of yourself! When you start to, please look at how far you've come and all that you have and are still doing for yourself! Don't compare your situation to anyone else's, as everyone is different.

I would hope that your therapists would be able to talk with the suboxone doctor to extend your treatment past a year. No one should be forced off of any medication if they are not ready. Maybe printing out the first post in the thread you first posted in and showing it to your therapist might be helpful?
http://addictionsurvivors.org/vbulle...ad.php?t=23809

As far as the Vivitrol shot goes, the thinking behind it is that since it will block opioids from the opiate receptors for about a month, it will give patients time to adjust to not taking opiates. But that doesn't help if a patient is looking to number him/herself from taking non-opioids that will not be blocked. And if you are facing things you haven't faced as a sober adult and are afraid of numbing yourself, it doesn't seem as if naltrexone would be a productive avenue to go for you.

If I may ask, what do you take in addition to the buprenorphine? Over the years here, some people have found Cymbalta effective in treating anxiety disorders - especially those in your situation where doctors may be hesitant to prescribe a benzo. Could that be an option for you?

Be your best advocate. I think just by saying what you told us to doctors and your therapist is brilliant: "so i can ensure i have all the chance i need to make my life what i want it to be."

Keep us posted on how you are doing in your quest to continue treatment!

Nancy
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Important disclaimer: Any information in this post is not and does not constitute medical advice under any circumstances. Addiction Survivors, Inc. does not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. NEVER take any online advice over that of a qualified healthcare provider. Any information contained on AddictionSurvivors.org should only serve to inspire further investigation with credible, verifiable references sources such as your physician or therapist.
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