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Unread 05-26-2007, 05:22 PM   #1
Suture
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Default PAWS-Explained

As with any treatment there are a wide range of experiences. None are right or wrong and one does not discredit another. I’ve seen a number of people come to this site and blame the treatment for any number of problems they have had. It stems from people without an adequate understanding of addiction attempting to explain their experience while supporting a non-evidence-based treatment protocol. This has lead to faulty conclusions and misinformation, sometimes prompting patients to be scared away from a treatment that could save their lives. I’m hoping the following will explain some of the biggest misunderstandings and hopefully prevent people from thinking a two day treatment with sub has ruined my life” (completely absolving themselves and years of addiction from all responsibility)

With opioid dependence there are two distinct sets of brain changes occurring. "Tolerance” and "addiction” Tolerance is basically the brain adapting to abnormally high releases of dopamine initiated by the exogenous opioid. The brain adapts by increasing a chemical inhibitor that counteracts the dopamine release, thus attempting to return to normal brain function. The dopamine inhibitor process takes time to develop and is why people do not become immediately tolerant. Likewise when this extra inhibiting response is no longer needed it takes time to change back. Early in the development of tolerance, The brain can compensate for this time by producing more dopamine on its own, again attempting to normalize brain function. Eventually, with continued opioid use, the inhibiting function increases to the point that in the absence of exogenous opioids, the brain cannot produce enough dopamine to counteract the inhibiting action and the result is an overall net reducing in dopamine. Whenever there is an inadequate amount of dopamine the body feels pain, malaise, and the other typical symptoms of withdrawal. This point is called "physical dependence” the body is "physically dependent” on and external source of opioids to maintain what it thinks is normal brain function. Tolerance and physical dependence are normal reactions to chronic exposure to short acting full agonist opioids, and tend to reverse themselves within a few weeks of cessation of all opioids. This is NOT addiction. These people do NOT experience PAWS. (post acute withdrawal syndrome)


Further prolonged intense dopamine release produces more long-lasting changes in the brain that may underlie the compulsive drug-seeking behavior and related adverse consequences that are the hallmarks of addiction. The compulsive behavior itself is thought to also have an impact on the physical nature of the brain compounding the problem. These brain changes specific to "addiction” produce different and more long lasting changes to the brain and may manifest as longer lasting symptoms of withdrawal that can persist for months or even years depending on the severity of these changes. These changes are even slower to develop or to reverse. They affect other parts of the brain including prefrontal cortex (involved in higher cognitive functions, including foresight and planning.) ventral tegmental area (a key part of the brain reward system; key targets of these neurons include the nucleus accumbens and the prefrontal cortex), memory and others. It is the changes to the brain associated with addiction” not physical dependence or tolerance that manifests as the prolonged milder set of withdrawal symptoms referred to as PAWS (post acute withdrawal syndrome)

Whether or not a person will have PAWS is determined by 1) How severe the brain changes caused by addiction became. 2) How effective the treatment has been at altering the addictive behavior and dopamine release, both thought to perpetuate these changes in the brain. People who have been able to both abstain from addictive behavior and avoid intense releases of dopamine reduce their chance of having PAWS everyday they remain in treatment. It is important to understand it is not the opioid itself that is addicting it is the large/ fast release of dopamine, that begins the addictive process, and the compulsion, that helps maintain it. Breaking the cycle of reward, and then the compulsion to seek reward, allows the brain to begin the process of repairing itself and returning closer to pre-addiction status.

Short treatments <30 days are not as effective for people with the brain changes we know as addiction but may be effective for people who are physically dependent ”.

This is why some people experience PAWS and other do not. It explains why long term treatments are more effective for addiction, and reduce the chance of PAWS. It explains why some people can succeed with short treatments. The main point is everyday the cycle of compulsion and rapid and intense release of dopamine is avoided, the brain continues to reverse the changes that caused addiction. It doesn’t matter if the patient is on an opioid medication or any other medication so long as the dopamine/compulsion cycle ends. Changing behavior and environment while in treatment, helps facilitate these brain changes mentioned above and reduce ones intensity and duration of PAWS.




Ref.
Koob, G.F., and LeMoal, M., 2001. Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology 24(2):97-129.
http://www.nature.com/npp/journal/v2...f/1395603a.pdf

Kreek, M.J., 1992. Rationale for maintenance pharmacotherapy of opiate dependence. In C.P. O’Brien and J.H. Jaffe (eds.), Addictive States. New York: Raven Press, pp. 205-230.
Kreek, M.J., and Koob, G.F., 1998. Drug dependence: Stress and dysregulation of brain reward pathways. Drug and Alcohol Dependence 51(1-2):23-47.

Additional reading:
The Neurobiology of Opioid Dependence: Implications for Treatment
http://archives.drugabuse.gov/PDF/Pe...s-Neurobio.pdf

Buprenorphine: An Alternative Treatment for Opioid Dependence, NIDA
http://www.drugabuse.gov/pdf/monographs/121.pdf
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Unread 05-26-2007, 05:28 PM   #2
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PAWS (post acute withdrawal syndrome)
post= after
acute=rapid intense onset


Withdrawal symptoms that are less intense that occur after the initial withdrawal is over typically is noticed after intense symptoms subside and can last for years or even indefinitely in some cases.

It is the result of brain changes caused by what we know as "addiction". It is the reason for many relapses, not because of its intensity but because of its persistence.

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Unread 05-26-2007, 05:36 PM   #3
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Treatment medications like buprenorphine generally do not cause addiction and thus do not cause PAWS. People who experience PAWS after treatment, already possessed the brain changes that are responsible for it.

Since PAWS results from addiction some patients will remember a time when they were only physically dependent when they were able to quit opioids and only have withdrawal for a few days until they began to feel back to normal. This is normal, the brain changes that cause PAWS are slow to develop. Some make the mistake to think the treatment medication caused their PAWS because of this. Their error is compounded if they stop and feel PAWS. It is easy to misconclude that since I didn’t have PAWS in the past and now I used buprenorphine and had PAWS, it must be the buprenorphine and like fast acting full agonist opioids, the longer I take it the worse the withdrawal.

This leads some to end treatment too soon, have PAWS, blame bupe, relapse, and not seek adequate treatment, some will die.

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Unread 05-26-2007, 05:40 PM   #4
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Simplified (non-scientific) explanation of PAWS:
http://www.tlctx.com/ar_pages/paw_part1.htm

In this case they are talking about alcohol addiction, but PAWS can occur with any addiction including non-chemical addictions like gambling, food, shopping, sex or internet. It is the changes to the brain that we know as "addiction" that causes PAWS and any addiction can do that.

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Unread 05-26-2007, 05:44 PM   #5
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If this all is not making sense to you, it might help to understand there is a profound difference ( both biologically and behaviorally) between "physical dependence" and "addiction" see glossary of this site (or any other) for definitions.
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Unread 05-26-2007, 05:50 PM   #6
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Now I will give you the TRUTH of PAWS is (POST ACUTE WITHDRAWAL)!!!!!!

BTW Suture I asked for no links, but whatever, I know how Reckitt works!!

Post Acute Withdrawal Syndrome (PAWS) is a set of impairments that occur immediately after withdrawal from alcohol or other substances. The condition lasts from six to eighteen months after the last use and is marked by a fluctuating but incrementally improving course.

PAWS/Rebound-Many substances can cause rebound effects (significant return of the original symptom in absence of the original cause) when discontinued, regardless of their tendency to cause other withdrawal symptoms.. Occasionally light users of opiates that would otherwise not experience much in the way of withdrawals will notice some rebound depression as well. Extended use of drugs that increase the amount of serotonin or other neurotransmitters in the brain (opioids including buprenorphine) can cause some receptors to 'turn off' temporarily or become desensitized, so, when the amount of the neurotransmitter available in the synapse returns to an otherwise normal state after wd's, there are still fewer receptors to attach to, causing feelings of depression/fatigue until the brain re-adjusts (Receptors turn on again).

Buprenorphine PAWS/rebound seem to differ a bit from the typical/textbook definition of PAWS. The lingering effects from bup/sub seem to be more of fatigue, lack of motivation, or lack of energy that slowly restores over the course of months. Sometimes you feel ok, and a week later you will feel crappy again. Its VERY frustrating and unpredictable, and its almost impossible to gauge improvement on a day to day basis, some entire weeks/months are better than others. One thing that does appear to hold some validity, the longer you were on sub, the longer the PAWS will last. I would not state that you are feeling depression initially. However, feeling exausted, fatigued, and lazy for months is certainly a cause for depression all on its own

Drugs that work with serotonin and catecholamines (dopamine, norepinephrine, and
epinephrine) quit working for one reason, Neurotransmitter levels in the brain drop below levels needed to keep the drugs working. Drugs that work with neurotransmitters do not work if there are not enough neurotransmitters in the brain to keep them working. When neurotransmitter levels in the brain are above the threshold drugs work. When neurotransmitter levels in the brain are below the threshold, drugs quit working. When neurotransmitter levels in the brain drop below the threshold, it is very clear.
Prescription drugs that work with serotonin or the catecholamines (dopamine, norepinephrine, and epinephrine), (Opioids, A/D meds) whose mechanism of action occurs by redistributing neurotransmitters from one place to another in the brain, can deplete neurotransmitters. The brain runs on electrical energy. All electrical energy in the brain is transferred by neurons with the electricity making the jump between neurons in the synapse. Electricity does not simply jump from one neuron to the next. Small chemical molecules called neurotransmitters are released by the pre-synaptic neuron into the synapse. The neurotransmitters then come in contact with receptors on the post-synaptic neuron, which in turn affects the transfer of electrical energy across the synapse. The neurotransmitters in the store are excreted into the synapse, where they affect the transfer of electricity across the synapse to the post-synaptic neuron. This is a dynamic process. The neurotransmitters excreted into the synapse do not simply stay in the synapse. One of their fates is to be reuptaked into the pre-synaptic neuron, where they are taken back up into the store and wait to be used again. If neurotransmitters in the brain are too low, proper transfer of electrical energy across the synapse does not occur leading to neurotransmitter dysfunction disease. (Fatigue, depression, malaise, lack of motivation, Chronic fatigue syndrome, adrenal fatigue/burnout, insomnia, aggression,…Extended use of drugs that increase the amount of serotonin or other neurotransmitters in the brain can cause some receptors to 'turn off' temporarily or become desensitized.
Role of norepinephrine in depression. AUTHORS: Delgado PL; Moreno FA,
Department of Psychiatry, University of Arizona, J Clin Psychiatry 2000;61 Suppl
1:5-12

(2002) Peter Lehmann Coming off Psychiatric Drugs, Germany: Peter Lehmann Publishing. 1-891408-98-4.
Buprenorphine seems to 'turn off' temporarily or desensitize receptors on a pretty grand scale , and the proof is when you quit, the extended WD symptoms and PAWS from sub/bup last a REALLY long time .
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Unread 05-26-2007, 05:56 PM   #7
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Suture,
These are all biased studie's towards SUB Maintence.

I've read Non biased Articles stating that your Acute withdrawals will be less, but the PAWS will LAST LONGER.
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Unread 05-26-2007, 06:05 PM   #8
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Jaden,
What is the matter with you? Why are you so anti-science? This in not my opinion but the opinion of the leading scientists in the country (as the references indicate)I don't work for Reckitt and none of my links have anything to do with Reckitt, what is your problem?

As far as your post, yes you've posted it before and it was just as inappropriate then. What respectable scientist would characterize a medical symptom as "feel crappy" Plus if you actually read what you posted you would see most of it doesn't dispute what I wrote anyways. I suspect you haven't taken the time to actually read either. All you do is come here with conspiracy theories and a non-scientific agenda, this is a site for adults and you obviously have no interest in supporting anyone. Why don't you take your voodoo science and negativity and leave?
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Unread 05-26-2007, 06:10 PM   #9
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Jaden,
You have had this explained to you over and over. If you don't like the answer then go find it somewhere else.
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Unread 05-26-2007, 06:57 PM   #10
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Suture,
Why are you so defensive about your little pill, afraid of the truth.
People are being told by you and this site they will have a wonderful experience with Sub, no to little withdrawals, no PAWS, its healing their brains and it's not Addicting.

If this is true than why are so many people having trouble getting off and feeling normal.

Truth is it is Addicting, it is an Opiate, and is not healing their brains.
All Sub is doing is giving the Addicts a legal prescription to use an Opiate.
This may stop their active behavior, but they are still addicted to an Opiate. I have already seen people on this site hoarding pills, worried about meds prior to vacation, running short before next refill and Drs. wanting to taper pt. off and them finding another Dr. to supply their Sub.
SOUNDS LIKE ADDICTION TO ME!!!

All the links and articles you send are scientist and doctors who are pro Sub and Methadone maintence, they are not going to include anything in their papers or studies that would show others wise.

Real life experiences trump scientific studies.
Scientific studies showed us the World Trade Centers could take a plane hit and not collapse, real life showed different.

Please stop pulling the wool over people eyes and tell them the truth, don't dazzle them with your pro Sub studies, telling them "it's not the Sub making them feel the way they do, it's a prior medical condition". You are deceiving people into believing they are being cured, you are hurting these people in the long run.

This is all the same stuff they used to say about Methadone years ago, know there is a major problem.

Opiates on the brain do damage, the brain does not heal while on an Opiate, it starts when you are Opiate Free.

Jaden
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Unread 05-26-2007, 07:12 PM   #11
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Jaden,
You just don’t get it… and now I’m convinced you never will. Despite our efforts and patience to try and explain it. Despite the answer spelled out for you over and over you choose to remain unenlightened. That’s fine.

If you read this site at all you’d see nobody says there is no withdrawal, or that sub cures anything, (more misunderstanding by you) you don’t appear to understand what it is we are saying, so I don’t expect you to understand the science. And for the record the science AGREES with the experiences of both people who have PAWS and those who don’t. (as explained above) It’s you who disagree with the science and experiences.

Anyone can write a foolish article that’s why we have science, to dispel the myth. The science says buprenorphine will not make PAWS worse, there is no scientific evidence to the contrary, we have several examples of people here who didn’t have it, others with short term treatments did have it, it seems the experiences match up with the science, I don’t know why you are still arguing or really even what you are arguing about, since it changes so often.

Check out the credentials on the clown who wrote your article. He’s not even a doctor, never mind an expert scientist on the subject. He says he’s a social-pedagogist living in Germany. No wonder he had to create his own publishing company. I wouldn’t trust my recovery to this kind of opinion.
http://www.peter-lehmann-publishing.com/

Most studies will show penicillin is effective at treating bacterial infections. Does that make them bias too, Jaden?

Your bitterness helps nobody. Your unwillingness to learn only contributes to your foolishness. I really doubt everyone on this site, the medical community, research scientists, doctors, and nurses are all wrong and Jaden is right. I'm sure you'll disagree.

The sad part is the PAWS you are suffering was avoidable and had you came here to learn instead of harass you probably would not be suffering today.
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Unread 05-26-2007, 07:32 PM   #12
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Jaden,
If someone can quit without sub then of course that’s what they should do...duh, you buffoon. Sub is for people who would relapse without it. For these people the choice isn’t sub or just quit it’s sub or relapse; because they tried just quitting before and it didn’t work, as it doesn’t work for 98% of those who try it. Nobody on this site is saying stay on sub any longer than is needed. We tend to agree with the overwhelming evidence and personal experiences that support the efficacy of some sort of long term treatment for those who are actually addicted.

Everyone is different and will require their own treatment plan. Understanding addiction and themselves will help them and their healthcare team determine what an appropriate treatment duration should be.

In looking at your history of posts, it comes to mind that nobody could be so resistant to knowledge. I suspect you have some kind of financial interest in rapid detox or some other equally high profit, non-effective treatment and are challenged by a real treatment. What else could be motivating you? You’re clearly not here to help anyone. You've disputed the wisdom of the leading experts on addiction in the country. Just what is your deal?
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Unread 05-26-2007, 07:54 PM   #13
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Jaden,
Seriously, what is your deal? This is suppose to be a place for support,but you continue to bring nothing but negativity. As Suture said you are clearly not here to be supportive. Why do you continue with the same old stuff? Is it a way for you to get attention?
Emma recently posted to show those who are in the beginning stages what their future could hold. But like a selfish brat you had to jump in and try to ruin the positive feedback she was getting. Grow up-
You continue to ask the same old questions but refuse to accept the response you get. Haven't you had enough yet? Either use this forum as way to express support or please go somewhere else.
Susan
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Unread 05-26-2007, 08:00 PM   #14
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Suture,
I am not here to gain or promote any treatment, just want people to be well informed when making their choice.
So has everyone on Sub failed, and relapsed once, is this a prerequisite to being on Sub or can any addict who can no longer obtain their DOC just get on Sub to keep their addiction alive.

So your saying science is always right. Years ago maker of Oxy made a lot of claims also, see where their at today.

Over the years in my career I have seen many drugs used for different things, peoples experiences over years of using these drugs have proven science wrong and these drugs are no longer used, the drug were doing more harm than good.

So just believe your science and ignoring people’s experiences, most of the people on this site are still using and cannot speak from experience yet, there are very few here that can.

I believed all the same stuff you believe when I went on Sub. It was all a lie, still had to pay the price in the end. Taking another opiate just satisfied my addiction, it did nothing to heal my brain, and the healing started when I was off of opiates.

I’m not against Sub used as a tool in recovery; just don’t tell people they will be fine and normal when coming off Sub. Most people, maybe not all will have withdrawals and you will have Paws. For most addicts this is what they fear and keep them dependent on drugs.

Jaden
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Unread 05-26-2007, 08:14 PM   #15
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…So has everyone on Sub failed, and relapsed once, is this a prerequisite to being on Sub-Jaden

No Jaden. To be prescribed sub patients should meet the proper diagnosis for Substance dependence.” It is a very specific criteria. Here’s one of several, There is a persistent desire or unsuccessful efforts to cut down or control substance use.
http://www.naabt.org/glossary.cfm#152

…So your saying science is always right... -Jaden

No Jaden. But when it is Jaden vs. The scientific community the smart money’s on science.


…So just believe your science and ignoring people’s experiences… - Jaden

Jaden the science AGREES with ALL of the experiences, both good and bad, it’s just you that doesn’t seem to get it.

…it did nothing to heal my brain...-Jaden

....apparently not.
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Unread 05-26-2007, 08:18 PM   #16
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Suture,
Are you still taking Sub?
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Unread 05-26-2007, 08:22 PM   #17
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Quote:
quote:Originally posted by Jaden
Suture,
Why are you so defensive about your little pill, afraid of the truth.
People are being told by you and this site they will have a wonderful experience with Sub, no to little withdrawals, no PAWS, its healing their brains and it's not Addicting.
..The endogenous opioid system may indeed be set closer to normal baseline functioning when chronically exposed to the partial antagonist…

…Buprenorphine may have induced some receptor resetting during the month of treatment…
(Pages 115-116) Paragraph 2 Phase II Clinical Trials of Buprenorphine: Detoxification and Induction Onto Naltrexone--Thomas R. Kosfen, Charles Morgan, and Herbert O. Kleber Buprenorphine: An Alternative Treatment for Opioid Dependence http://www.drugabuse.gov/pdf/monographs/121.pdf

That IS healing, Jaden. Pay attention. Mike had PAWS after a short treatment then did a long treatment and didn’t have PAWS. The longer treatment allowed more healing time and allowed him to change his behavior

Quote:
quote:Originally posted by Jaden
If this is true than why are so many people having trouble getting off and feeling normal.
Suture explained this to you above. Have someone read his post to you until the answer jumps out at you.

Quote:
quote:Originally posted by Jaden
Truth is it is Addicting, it is an Opiate, and is not healing their brains.
All Sub is doing is giving the Addicts a legal prescription to use an Opiate. This may stop their active behavior, but they are still addicted to an Opiate. I have already seen people on this site hoarding pills, worried about meds prior to vacation, running short before next refill and Drs. wanting to taper pt. off and them finding another Dr. to supply their Sub. SOUNDS LIKE ADDICTION TO ME!!!
Sounds like avoiding withdrawal to me, as you don’t know that is not addiction.

Quote:
quote:Originally posted by Jaden
Real life experiences trump scientific studies.
If they differ it means one was wrong or misinterpreted
Quote:
quote:Originally posted by Jaden

Scientific studies showed us the World Trade Centers could take a plane hit and not collapse, real life showed different.
It did take the plane crash, it was the burning jet fuel that caused the collapse, the science wasn’t wrong, just your interpretation…again.


Sub
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Unread 05-26-2007, 08:35 PM   #18
Jaden
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According to the manufacture my car will get 35 mpg.
The millions of people who drive that model are getting 25mpg, just another misinterpretation I guess
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Unread 05-26-2007, 08:38 PM   #19
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I have to agree with Jaden!!

I hear More horror stories about Sub, people cant get off this Junk.
They can get down to 2mgs. Then Their stuck and its a B*tch for these people to get off of it!!

Sub did it Job for me...I was on for 3 weeks then I was done!

I myself still experienced PAWS!! and thats why I was a couch potato for a good amount of time. Beacuse I had No Motivation.


And as my Addiction doctor explained to me he said its because My receptors needed to heal he said Sub will only help me taper from my DOC and make my withdrawals a little easier.
We can All at least Agree that Withdrawals are brutal from Opioids.

HockeyNut
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Unread 05-26-2007, 08:38 PM   #20
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Try slowing down or just driving downhill.
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Unread 05-26-2007, 08:47 PM   #21
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That seem to be the answer here, take more, take less, see your doctor you have something else worng, it from your old DOC, and ITS NEVER THE SUB.
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Unread 05-26-2007, 08:50 PM   #22
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I don't understand why just because people are willing to acknowledge certain facts, this makes them anti-sub. I am not anti-sub. And furthermore I am happy for and congratulate anyone and everyone who successfully recovers after sub.

But the reality is that there are thousands of people having difficulty tapering off sub, stopping sub, and/or with prolonged PAWS after sub.

Now, if you go to the MMT sites, you don't see much of this because not many go off methadone. And they freely admit it's extremely difficult to get off methadone. This is because they ascribe to the "endorphin deficiency from birth" theory. However, sub was promoted as a detox tool and this WAS based on a healing of the receptors theory that was based on science. Because sub is a partial opiate agonist it only stimulates and upregulates some of the receptors that short-acting opiates do and therefore would allow for down-regulation (healing) of the ones it did not stimulate. The only problem is that they are learning that sub upregulates certain opiate receptors that the other opiates do not. They upregulate very quickly and if they take longer than normal to down-regulate, this could account for the prolonged PAWS.

I sincerely hope that they can remedy this in some way or come up with an even better detox tool. But the reality is that anyone who is still on sub cannot possibly predict what it will be like when they come off sub and the reality is that thousands are having problems after sub.

Wishful thinking is no guarantee of anything. And furthermore, will not help in finding a solution.

dee
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Unread 05-26-2007, 08:53 PM   #23
Suture
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Hockynut,
What you don’t seem to be getting is that there is a reason why some people are having trouble and why you had PAWS, but it is not caused by the bupe. It is caused by certain changes in the brain that happened long before you ever started bupe. Your brain will only heal so fast. If your taper outpaces your brains ability to heal you will have PAWS. This is what is happening to the people who are having trouble getting off of bupe.

But then people like Jaden come along and blame bupe for the PAWS. That not only is wrong but could prompt some people into speeding up their taper making things worse. Then its compounded when they do have PAWS (as predicted by the science) people like Jaden come along and say see I told you, that was too long to be on bupe when the reality was it wasn’t long enough.

PAWS can be greatly reduced or eliminated by a longer taper and stabilization period, AND changing behavior and environment, allowing the brain to rewire itself.

Now hockynut, you were on for 3 weeks and now you have PAWS. This is predicted by the science. It will probably go away, but you could have reduced your suffering with a longer treatment. I say probably because sometimes the brain changes that cause PAWS can be permanent. For these people they will never feel right without some kind of opioid supplement.

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Unread 05-26-2007, 08:56 PM   #24
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Dee please include links to back up your statements.
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Unread 05-26-2007, 08:57 PM   #25
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Suture, ARE YOU ON SUB, still taking it????
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Unread 05-26-2007, 08:58 PM   #26
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Dee-
Is Absolulty right!

Suture-
I dont even think you realise how Strong Suboxone really is?
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Unread 05-26-2007, 08:59 PM   #27
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Incorrect. You can blame it on whatever you like. The reality is that way more people are suffering from prolonged PAWS after methadone and sub than they ever suffered after short-acting opiates.

dee
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Unread 05-26-2007, 08:59 PM   #28
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Yes, I've been taking it for 6 years. I am on 4mgs now. It is just as effective as 24mgs once was. I often forget to take it.
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Unread 05-26-2007, 09:01 PM   #29
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Quote:
quote:Originally posted by sudokudee

Incorrect. You can blame it on whatever you like. The reality is that way more people are suffering from prolonged PAWS after methadone and sub than they ever suffered after short-acting opiates.

dee
PLEASE BACK UP THESE ASSERTIONS.
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Unread 05-26-2007, 09:04 PM   #30
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Quote:
quote:Originally posted by sudokudee

Incorrect. You can blame it on whatever you like. The reality is that way more people are suffering from prolonged PAWS after methadone and sub than they ever suffered after short-acting opiates.

dee
It only seems that way because until sub few people were able to remain opioid free for any great period of time.
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Unread 05-26-2007, 09:05 PM   #31
hockeynut
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Quote:
quote:Originally posted by Suture

Quote:
quote:Originally posted by sudokudee

Incorrect. You can blame it on whatever you like. The reality is that way more people are suffering from prolonged PAWS after methadone and sub than they ever suffered after short-acting opiates.

dee
PLEASE BACK UP THESE ASSERTIONS.
It is reality, I see it everyday in NA/AA and I am also working for a drug rehab that is NOW trying to get People off of Suboxone.
It is really sad.[V]
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Unread 05-26-2007, 09:08 PM   #32
Suture
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See you've proved my point. This refusal to understand what is actually happening is casing people to decrease treatment durations in direct contrast to the evidence. This is why education is so important.
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Unread 05-26-2007, 09:08 PM   #33
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Suture,
So what experience do you speak from, you just keep quoting scientific crap.
I believed all that too till my experience showed me different.
You seem to thing you have all the answers for someone who has not been there.
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Unread 05-26-2007, 09:18 PM   #34
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Suture- Just out of curiosity what was your DOC and how long were you Addicted to it??

HockeyNut
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Unread 05-26-2007, 09:19 PM   #35
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Buprenorphine has a high affinity at all 3 major opioid receptor types and the Orphan Receptor, opioid receptor-like 1 (nociceptin) (mu, delta, kappa, and ORL1/NOP) (Miller et al., 2001, (1))

Order of affinity (How much attraction to and how tightly it binds to each receptor): mu &gt; kappa &gt; delta &gt; ORL1 (Miller et al., 2001) (delta has about 30 fold less affinity than mu) (Negus et al., 2002)

Buprenorphine is a partial agonist at mu, delta*, and ORL1. It is a full and potent antagonist at kappa. (Miller et al., 2001) It's efficacy at the receptors is related to dose. The higher the dose, the less efficacious it works, (1) until it reaches a dose (~32mg SL) where increasing it any more would make it work less efficacious, although more data is necessary. (See Buprenorphine and Dose)

Order of Efficacy (how much activation it causes at the receptors): ORL1 (34%) &gt; mu &gt; delta* (Miller et al., 2001)

The fact that it is efficacious at ORL1 is significant, as I am unaware of any other traditional opioids that can stimulate ORL1 (this includes morphine and Heroin.) ORL1, the opioid receptor-like 1 orphan receptor is a G-protein coupled receptor with functional and structural homology to opioid receptors, namely mu.

Nobody is making grandiose claims here about any of this. They are simply learning more information about sub as it is utilized as a medication, just like they learn about all medications after they are deemed safe and put on the market. Nobody can claim they know everything about any medication that has not been utilized for many years yet.

And as far the PAWS with short-acting opiates, well honey, I can read and I can count. Go to all the multiple addiction sites and compare yourself. They may get cravings to use, sure, but prolonged PAWS, not often.

dee
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Unread 05-26-2007, 09:24 PM   #36
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hey hockeynut how long did u have the no motivation thing. i was on sub for about a month or so too. been off 2 weeks and a day. having some depression and no motivation too. my doc was percocet and around 75 mg at its worse a day. so it wasnt awful but not good. just hoping to get back to normal. i am not trying to get into this fued here just hope all gets what they are looking for like me.
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Unread 05-26-2007, 09:25 PM   #37
Suture
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It's not about my experience. I've witnessed many experiences here and on other sites. And nearly all of them including yours follow what the science predicts. I'm no addiction expert and I recognize that, but I respect those that are and would second guess my own conclusions or experience before condemning theirs. So far the experiences and the science agree. Interpretations of the science and the cause of experiences is where the discrepancies lie.
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Unread 05-26-2007, 09:30 PM   #38
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And suture, I totally agree with you there. You don't see me using my own experience with sub as any type of scientific model. I certainly don't believe that my experience is indicative of what everyone else's should be. I simply go by my analytical observations. And I have no specific agenda here except to help people.

The problem is that wishful thinking, defensiveness and rationalization doesn't really help anyone or fix anything. There are many who I might recommend sub for but I would still want to learn information and want everyone else to know and to learn real information.

dee
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Unread 05-26-2007, 09:31 PM   #39
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Hi Baddaddy,
When I hit the 4 month Mark It was Way better!! It really just takes time.
You know what helps me is exersise!! Also did you get some vitamins??
Plus make sure you eat 3 meals a day, its crucial not to let your blood sugar go to low.
This will speed up the healing process, you will start feeling better each day...You just need to be patient and it will come! I promise you.
I think I read where you started to take an Anti Depressant?? Just wondering if you did?

Take Care
HockeyNut

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Unread 05-26-2007, 09:38 PM   #40
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I am also here to help people Suture! And It just makes me upset to see so many people strugging each and everyday trying to get off this Drug(Suboxone)....It just seems there really are Not enough long term studies on Sub.....and to be quite Honest, WE ARe their studies, very unfortunate, but true.
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Unread 05-26-2007, 09:38 PM   #41
Suture
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Dee,
Those references DON'T support your claims that:

"However, sub was promoted as a detox tool and this WAS based on a healing of the receptors theory that was based on science."

"Because sub is a partial opiate agonist it only stimulates and upregulates some of the receptors that short-acting opiates do and therefore would allow for down-regulation (healing) of the ones it did not stimulate." --Your ref. actually disputes this claim, it says buprenorphine has a high affinity for all three opioid receptors.

"They upregulate very quickly and if they take longer than normal to down-regulate, this could account for the prolonged PAWS"

Do you have anything at all that supports any of this?????


It is a documented fact that 2% of people who quit colt turkey succeed longterm abstinence. So before sub very few people made it months without opioids to talk about how they felt. I'm suggesting just as many had PAWS and is the very reason why 98% would relapse, or do you think they just wanted to get high? The fact that more people are complaining about PAWS now (by your math) is a testament to the efficacy of sub treatment, more people are getting to "addiction free" than ever before.

I hear all this talk about the "truth" like scientific evidence isn't. What I hear is lot of speculation passed off as fact with nothing to back it up at all but misinterpretations of personal experiences.

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Unread 05-26-2007, 09:41 PM   #42
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I have done the same, read many other sites.
So your saying if someone had PAWS they needed to stay on longer, I have read many stories of people on long term 5 years or so, started with very small habit and still have PAWS.
How about those who have been on Sub long term and the Sub is not making them feel good any more.
Maybe you need to experience first hand, comming off of opiates and when you don't follow the science than there must be something else wrong with you because the science said you would not have PAWS
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Unread 05-26-2007, 09:43 PM   #43
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I am also here to help people Suture! And It just makes me upset to see so many people strugging each and everyday trying to get off this Drug(Suboxone)....It just seems there really are Not enough long term studies on Sub.....and to be quite Honest, WE ARe their studies, very unfortunate, but true.
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Unread 05-26-2007, 09:46 PM   #44
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There doesnt seem to be in set pattern to this madness,

Some people can stay on sub a year taper off and only have mild withdraw with no PAWS, I admit there are very few cases compared to the number that have trouble.

Yet others can take sub a year properly taper off and suffer for extended periods, Why do some ( the Minority ) have little to no problems and others (the majority ) Have PAWS ?

For every success story you read on the internet you will read 5 unsuccessful ones.
Most people say the reason for that is the successful people dont post on adiction forums and the suffering people do.
I have not tried to come off sub and dont have any plans to try in the near future, I hope when or if my time comes, I will be in the Minority.
Does science have an answer as to why some suffer and others dont?

Brett
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Unread 05-26-2007, 09:47 PM   #45
hockeynut
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Do You want to know where they get Scientific proof?? Its From us the people who take the Drug.
Maybe it would be wise if they would re access their studie's. From a Non biased group unfunded by Reckitt..? You know
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Unread 05-26-2007, 09:50 PM   #46
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Another reason I come here is because I am very Passionate about hepling people...You think I have nothing better to do On a Saturday then to sit on my computer??

If I can help 1 person then you know what, that makes me feel Alive.

God Speed in everyones Journey
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Unread 05-26-2007, 09:53 PM   #47
Suture
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In Summation:
Buprenorphine has a lower potential of causing addiction than full agonist opioids. Addiction causes the brain changes that manifest as PAWS. Therefore there need not be studies to assess the amount of PAWS post buprenorphine treatment, it's already known not to be the cause. If scientists thought it was the cause wouldn’t there be numerous studies about it?

With a given buprenorphine treatment of say 6 months, some people would have PAWS after and some wouldn’t. it would have nothing to do with the bupe treatment. The brain changes responsible for their PAWS would have pre-existed the treatment. People with the least brain change may not have PAWS after 6 months and appropriate psychosocial care and the people with severe brain changes will have PAWS, and may for life.

This happened long before bupe came to be and it happens with other addictions too, even non-substance addictions like gambling.

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Unread 05-26-2007, 10:02 PM   #48
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If Bupe has lower potential of causing addiction than why is it the #2 abuse drug in India.
Just give it time in the US people will be doing anything to get their Bupe, it's already being sold black market.

Talk to me when you are off your little pill, and I will tell you you can't be in PAWS because the science says so...
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Unread 05-26-2007, 10:06 PM   #49
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yeah i started the zoloft 3 days ago. i cut the 50 mg. pill in half today. it made me real tense. bad side effects. lil better today so far. i dont have much of a appetite to 3 meals. no to the vitamin thing. hockeynut if u dont me asking what was your doc and amount. thanks for your help. i hope it dont take 4 mos. for me. i will go crazy. lol. thanks
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Unread 05-26-2007, 10:13 PM   #50
Suture
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Quote:
quote:Originally posted by Jaden

If Bupe has lower potential of causing addiction than why is it the #2 abuse drug in India.
Just give it time in the US people will be doing anything to get their Bupe, it's already being sold black market.

Talk to me when you are off your little pill, and I will tell you you can't be in PAWS because the science says so...
The science doesn't say I won't have PAWS Jaden, have you not learned anything??

In India they only had Subutex and people were crushing it and injecting it. When a drug is injected it reaches the brain faster, releases dopamine faster, and more intensely. This does raise the addictive potential and people can become addicted to it. If they do then it CAN cause PAWS. But when taken sublingually, the addictive potential is reduced and addiction to the bupe is unlikely, yet possible for some. In the US injecting buprenorphine is not a big problem largely because of the naloxone in suboxone but also because of the availability of other more potent drugs at lower prices. For someone intent on getting high bupe is a poor and expensive choice.

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