Posted by Elizabeth on March 1, 2002, at 20:31:01
In reply to Re: Addiction » Elizabeth, posted by shelliR on March 1, 2002, at 15:03:00
> I can't believe that he took me off over 100mg of methadone to transfer me over to buprenorphine. From everything I've read, if someone has been takig a large dose of methadone, one should work on reducing the dose of meth down to less than 50mg before the switch.
Yes, that's my understanding also.
> Also I'm wondering if he might have given me like 0.08 or less of bupe, because he gave me one compounded cube. Which of course would do nothing for withdrawal.
0.08 mg? That would be about a quarter of a mL of the solution. And I'm assuming that you took it by the SL route, right? That could hardly be expected to have any noticeable effect on a person who'd been maintained on 100 mg of methadone.
What made you think that was the dose, though? (Like, why 0.08 in particular?)
> I have never seen those hospital records; I'm going to try to get hold of them.
That's a good idea.
> Elizabeth, absolutely *do not feel ANY guilt*.
Easier said than done. :-} I do wish that it had gone differently for you.
> I was taking vicodin for several years before my first post on PB, for premenstrual discomfort AND depression.
You weren't taking it on a daily basis, though; you were taking it intermittently, to avoid tolerance. I really thought that you could take oxycodone for depression without developing a tolerance. Looks like that's far from certain (and probably not worth the risk).
Anyway, taking a little bit of hydrocodone every now and then is a far cry from taking daily ever-increasing doses of methadone.
> So please, do not take on any blame. It has been (and still is) really great for me to have a place to be able to talk about using opiates for depression. Anyway, at one point, I remember you questioning my pdoc when he kept increasing my dose of oxycontin up and up.
Well, my understanding was that if you find a dose that works but then become tolerant to that dose, chances are that you're going to keep having to raise the dose. (Your experience has reinforced this belief.)
> Today I took 0.4mg x 2 and almost no chest pain/depression.
Excellent! How many hours did each dose last?
> No side effects yet except I may have to start eating ground flax seeds again to get my system moving. I put them in yogurt. They worked really well for me when I was on the oxy.
Flax seeds, eh? I'll have to try that. Can I find them at my local health food store?
> It worked twice before, but I was also taking nardil. I had a huge, uncomfortable water weight gain though, and will start a diuretic immediately this time if I start to gain weight.
I've been gaining weight recently. I'm not sure what is behind it; Effexor maybe? I do seem to be eating more than is good for me, but I don't think I'm eating enough to account for the weight gain. It's awkward for me; I've never watched my weight or eating habits before (except when I was on Nardil, I've never needed to), and it's taking some adjusting.
> The trend was been to keep people on the same AD which has worked before and augment.
Yeah, I know. Prozac appeared to work when I was a teenager (though in retrospect it could have just been the passage of time), and as a result I had a terrible time convincing the doctor I sought out in college to let me try something altogether different.
> This of course assumes that the combination is better than the adjunct alone. My new pdoc doesn’t think that the nardil had anything to do with the success of lamictal because the it had already pooped out.
I've heard it said that Nardil poop-out can lead to a very refractory depression, and this is consistent with my experience. Maybe something like that happened to you too?
> why do you think the absorption is lower sublingually? I haven’t read anything which implies that.
I'm sure that SL bioavailability is less than IM. There isn't really that much information about the intranasal route, though, so who knows.
> "It is particularly important to avoid using other depressant drugs, such as benzodiazepines (‘benzos’), e.g. Valium, with buprenorphine. Using benzodiazepines with buprenorphine may lead to breathing difficulties, coma or death."
Oh yeah. That's based on a few isolated case reports where people took overdoses of benzos (heroin addicts seem to like benzos) while on buprenorphine.
> Is klonopin a benzo? (Because I know you take klonopin prn.)
I take Xanax PRN. But yes, both of them are benzodiazepines. I was told to be careful with benzos (and Ambien) when I first started taking buprenorphine, because they might be more sedating. There was this one episode where I took Ambien and slept for 12 hours or something (this was when I'd just started buprenorphine), but I've had no problems since then. (After that I was scared to take benzos or Ambien for a while, though.) I find benzos helpful for taking the edge off, since buprenorphine makes me feel kind of jittery sometimes.
> Have any of your pdocs mentioned this? I do use valium prn and stopped when I started the bupe after I read that. I’ll ask my new pdoc about it next week when I see him.
At a minimum, you should avoid taking it when you'll need to be alert (e.g., driving) until you know what it does to you with the bupe.
> btw, are you feeling well enough to work or take premed classes?
Yes, I have been for some time, but there are other barriers (lack of driver's license, not living near a university that has an affordable post-bac pre-med program, etc.). I am in the process of job hunting, but given my limitations (have to be able to get a ride to and from work) and the state of the job market (bad here, as everywhere), that isn't trivial.
I hope that the Lamictal brings you up to speed so that you can limit your bupe use to PRN. Be well!
-elizabeth
poster:Elizabeth
thread:93100
URL: http://www.dr-bob.org/babble/20020301/msgs/96002.html