![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 84. This is the beginning of the thread.
Posted by Chuckie on April 7, 2004, at 14:06:23
So this guy got himself a problem with poppy tea. He wasn't sure if to characterize it as a 'problem' until the other day. What happened was he was tapering, and he got a crummy batch of poppies, and so between the lower dosage and the poor quality, he woke up with some serious withdrawal symptoms. So that's a problem, for sure.
He doesn't want to go inpatient, mostly b/c he's never done this before and he's scared. He WOULD like outpatient help, but can't find it and/or doesn't know the routine. I.e. must someone test positive, and then go into detox, and THEN maybe he can have some maintenence meds?
In any case, the plan is he's gonna call in to work, say he had an accident or surgery or something, and give hmself a week off to be sick. Hopefully he doesn't lose his job, but that's secondary.
He's not so scared of the physical symptoms, which by all accounts are like the flu. If that's the case, he will be happy laying on the couch being sick and watching Bonanza and Little House on the Prairie. He likes that.
What DOES frighten him are the psychological symptoms, (confusion, agitation, depression, anxiety), all of which he already has in excess. His wife has her own life to deal with, and doesn't take well to craziness. She's absolutely NOT the nurturing sort, she thinks it's like 'mommying' or something. But he's hoping to lean on her at least a bit, for nutrition and encouragement. and most of all to determine if he needs to go to the hospital, because he probably won't know.
Besides all that, he has two main issues:
1) Depression was why he got on the tea in the first place, coincidently because of discussions here at Dr. Bob's. He's one of those folks whose depression is completely cured by taking opiates. He couldn't talk his doc into prescribing them, and so had to try non-prescribed medication. It worked great for a while, but when he naturally developed tolerance, the higher dosages made him feel crummy, which wasn't the point at all. The point was to feel normal. All of which is a roundabout way of saying detox doesn't solve the problem.
2) When he had his w/d symptoms, (and after he figured out what was happening to him), he fixed it with a small dosage, just enough to bring the symptoms under control and make him functional. He's wondering if he should do that while detoxing, for safety and a bit of symptom relief, or if the whole point of detox is to get it out of his system.
Any advice appreciated.
Thanks,
Chuckie
Posted by Chuckie on April 7, 2004, at 20:43:24
In reply to Home Opiate Detox?, posted by Chuckie on April 7, 2004, at 14:06:23
To clarify and a bump-for-relative-urgency:
My friend would like to know, ASAP, what is the usual routine for dealing with opiate dependence. And also what any experienced folks might think of the idea of an already mentally unstable person attempting to deal with it himself, mostly alone, at home.
Thanks again,
-Chuckie
Posted by Rianna on April 8, 2004, at 12:56:46
In reply to Re: Home Opiate Detox?, posted by Chuckie on April 7, 2004, at 20:43:24
> To clarify and a bump-for-relative-urgency:
>
> My friend would like to know, ASAP, what is the usual routine for dealing with opiate dependence. And also what any experienced folks might think of the idea of an already mentally unstable person attempting to deal with it himself, mostly alone, at home.
>
> Thanks again,
> -ChuckieTry doing some research on the internet by searching Opiate Detox to see if you can use just a little to get by. I am tapering off a perscribed drug ( a benzo) which requires it. So it may be the same. I don't know but searches could lead to free help lines and of course sights like this one. keep posting here with different ways like OPIATE TAKE OVER HELP!, others respond to it with caps it's easy to see. hope you find help. It is hard to fight something alone. I am doing it by myself too. With a Hubby that does not understand. How could he. He has the Happy's enough for 10 people. Any way good luck.
Rianna.
Posted by Chuckie on April 8, 2004, at 18:25:10
In reply to Re: Home Opiate Detox?, posted by Rianna on April 8, 2004, at 12:56:46
Thanks Rianna,
For the reply. Things are getting seriously serious and any support is appreciated.
Today my friend saw a pdoc, who convinced him that his plan was a very very bad idea. So he's going into the hospital on Monday.
GL to you too. I'm sorry your SO doesn't understand. That's tough. But he must love you, i mean he's still married to you, and maybe his Happys will be inspirational? Duh that sounds dumb even to me. But i know how my friend's troubles affect those around him... if there was someone who could remain happy through all that, it might be more better than feeling guilty for infringing on other people's Happys.
GL,
-Chuckie
Posted by btnd on April 8, 2004, at 19:10:34
In reply to Home Opiate Detox?, posted by Chuckie on April 7, 2004, at 14:06:23
From what I've read the most helpful for opiate w/d is GHB/Xyrem. Second most helpful are benzos,barbs.
Posted by krazybirdlady on April 14, 2004, at 13:22:03
In reply to Re: Home Opiate Detox? GHB/benzos » Chuckie, posted by btnd on April 8, 2004, at 19:10:34
forget any assisting drug, other than maybe clonodine or trazadone for sleep. physical withdrawls will last about 7 to 10 days (easing each day). for the depression issue...see a doc...under NO circumstances use any form of benzo...
Posted by btnd on April 19, 2004, at 14:57:19
In reply to Re: Home Opiate Detox? GHB/benzos, posted by krazybirdlady on April 14, 2004, at 13:22:03
> forget any assisting drug
read studies on opiate and alcohol withdrawals + GHB on PubMed. there are few that show GHB as a great tool in overcoming withdrawals.
Posted by Chuckie on April 20, 2004, at 22:23:45
In reply to Re: Home Opiate Detox? GHB/benzos (nm), posted by arrie on April 20, 2004, at 22:14:52
I have clonazapam, i've been taking it for fifteen years. I have to be careful with it though, excess pills aggravate my depression.
Where does one get this GHB? All i can find out about it is what terrible stuff it is. Or wonderful stuff, depending which website i'm looking at. Is it something i can easily talk a physician into prescribing?
Four days clean and i'm NOT feeling well, at all.
Thanks,
- Chuckie
Posted by arrie on April 20, 2004, at 22:27:05
In reply to Home Opiate Detox?, posted by Chuckie on April 7, 2004, at 14:06:23
Hey, I posted on 3/17 an at home protocal for surviving an at home detox, I dont think many read it. Do a search under How to go off Vicodin on the Google and it will come up, lots of good info. How is your friend please share, he sounds like me.
Posted by arrie on April 20, 2004, at 22:31:26
In reply to Re: Home Opiate Detox? GHB/benzos, posted by Chuckie on April 20, 2004, at 22:23:45
did you find my post of 3/17 yet? hang in there, have your thought of a taper down instead? New meds for opiate withdraawl are Suboxone and Subutex. Hard to get though that doesnt help you now. I will pray for you
Posted by arrie on April 20, 2004, at 22:46:42
In reply to Re: Home Opiate Detox? GHB/benzos, posted by Chuckie on April 20, 2004, at 22:23:45
It takes more than four days, and just my opinion. You say 4 days clean, well you were never "dirty", you did something normal. Opiates DO help depression, maybe they are not the ultimate answer, but it is not a sin to not want to be depressed, only a depressed person understands. Just turn your self perception around a bit, because the last thing you need to be is down on your self at a time like now. Got that?
Posted by Chuckie on April 20, 2004, at 23:06:16
In reply to Re: Home Opiate Detox? GHB/benzos, posted by arrie on April 20, 2004, at 22:46:42
> You say 4 days clean, well you were never "dirty", you did something normal.
Yah, i know. But the fact is that if my tolerance is out of control and i have this much discomfort quitting, then i have a problem. I truly believe i wouldn't have had this problem if i could have been prescribed appropriate medication, but that's beside the point now.
Now i want to know how to get some this GHB if it's going to help with my w/d symptoms and sleep, as is claimed on various websites. Is it somrthing that a doctor would prescribe, or something i need to see a shrink for, or what?
It's taking every ounce of my willpower not to dose myself, and that's after a methadone taper and four days of no opiates at all. I really need something to help me, and counseling or twelve-stepping isn't the thing.
I know i shouldn't be hard on myself, but i did make a pretty serious mistake. I can blame it on the stupid drug laws and all that, but it don't help anything and ultimately i'm responsible for myself.
- Chuckie
Posted by arrie on April 20, 2004, at 23:19:21
In reply to Re: Home Opiate Detox? GHB/benzos, posted by Chuckie on April 20, 2004, at 23:06:16
Yeah dude, i know I am in the exact same boat and still on my vic's but not binging. Did you find my old post of 3/17, that has pointers. This GHB I am not up on, what does that stand for? It may be something that you get from a GNC or health food store. They say amino acids are good to take for withdrawls. i have been looking at a web site for a place in Miami called Summer House, they sound wonderful and have a "new approach" secret medicine to taper us down. A 12 day stay is 7200.00 and I have that in the back of my mind if I dont kick this or get it under better control. But as awful as withdrawl is, there is a tiny little spark we feel as humans as great personal achievement when we endure it, it doesnt make us happy, but tells us yes we are strong and capable, EVEN if we fall down again. I just question how good it is to keep going thru a WD, I think it leaves something like a post traumatic stress syndrome on us. I just cant do it again. Not sure what the answer is, but i am bugging God everyday and have faith I will eventually be healed.
Posted by bupe_fan on May 3, 2004, at 2:11:44
In reply to Re: Home Opiate Detox? GHB/benzos, posted by arrie on April 20, 2004, at 23:19:21
I began using opioids for depression 2 years ago, and after 18 months of taking whatever I could obtain and going through several withdrawals upon running out or from just trying to keep my tolerance down, I called up a doctor to try buprenorphine maintenance. The doctor said no way would he let me continue on buprenorphine for any longer than 10 days, but I just pretty constantly told him that whenever I lower my dose of bupe I get horrible cravings to do opioids because my ability to concentrate and feel at all sane or normal is ruined (all true). This has resulted in me remaining on buprenorphine for 6 months and it has definately improved my quality of life. If the doctor ever tries to taper me I will raise hell about how much better I am doing now than before when I was on street opioids and poppy tea, which was better than when I was on nothing at all.
Opioids in general have improved my ADD and bipolar/depression dramatically. Finally for once in my life I am able to concentrate and live without pain, psychological or physical. Thank god for the little loophole in the law which lets me admit/pretend that I am a junkie and need to stay on opioids to function. I even know someone who is on methadone because he is too depressed to live without opioids.
I'm not saying that opioid replacement therapy (maintenance) is the right answer for you, but its definately something to consider.
If you are interested in doing a home detox (although it has been 30 days since you quit - so I guess this advice is for whomever stumbles upon this thread), loperamide (immodium) alleviates almost all of the physical symtoms, which helps with the psychological ones. Benzos do help with the overstimulated feeling, and for opiate users with a heavy tolerance (methadone or heroin users), withdrawals carry a risk of seizure which benzos alleviate.
GHB = Gamma Hydroxy Butyrate - A wonderful, safe sedative/euphoriant drug, with no hangover symptoms and no toxic long term effects, when used CORRECTLY. Unfortunately, for those who do not measure their dose accurately (measuring syringe), those who use in excess (dosing 12 times a day 24 hours a day for months), or those who combine with other drugs (alcohol or heroin), the drug is very unforgiving. Unfortunately due to media demonization of this drug (they declared it "the date rape drug" based upon rumours, which gave many rapists a great idea), and the large percentage of stupid people within this country, GHB is now the only chemical which exists BOTH as a Schedule 1 substance (no potential for medical use and a high potential for abuse) AND as a Schedule 3 substance (a medically used substance with a moderate potential for abuse). This is a testament to the power of MONEY in the pharmaceutical industry, as the drug is currently licensed by Orphan pharmaceuticals under the tradename Xyrem, for helping narcoleptic patients with sleep. You have ABSOLUTELY NO CHANCE IN HELL of getting this substance. Thanks to the DEA in one of their rare "successes", it is no longer available, even at street level to the best connected druggies.
I do know from personal experience that it works wonderfully in preventing many painful opiate withdrawal symptoms.
I think you put the Doc which you saw into a situation where he only had one thing to reccommend. By going there and telling him you have a "drug problem", you made him feel that by letting you do ANYTHING by yourself, in the MINUTE chance that anything went wrong, the liability would be placed upon him, thus he reccomended you for inpatient treatment, and likely got a nice little referral fee for doing so.
In general if you are already using a long-lasting opioid (poppy tea qualifies) there is no real benefit in switching to a different one (methadone) to taper. This same advice applies to benzos and many other drugs. If you had been on a short acting opioid such as fentanyl or hydromorphone, then it would have been in your best interest to find a longer lasting one, to prevent "rebound cravings" every couple hours.
Also beware of ANYTHING related to detox which is "Too good to be true", because IT IS. The most notorious "addiction treatment" is UROD (Ultra Rapid Opiate Detox), also known as precipitated withdrawal with anesthesia. This procedure is where the patient is placed under anesthesia and then an opioid antagonist is administered intreveinously. This instantly propells the victim into the most severe withdrawal of their life, but the patient barely notices it due to a wide variety of other drugs they are on, and the diaper they are wearing. Every doctor who performs this procedure is acting highly unethically, as many deaths have resulted (the doctor thinks "They're just junkies anyways"), and is usually only in this business for the high prices that a junky may be willing to pay for a "miracle cure". $10000 is not unheard of. The saddest part is that this usually does not help the addict (or opiate dependant person), and many victims of this surgery commit suicide during the month-long period where withdrawal symptoms and other side effects of the implanted naltrexone pellet.
Don't believe me? see: http://www.atwatchdog.org/opinion_amysurod.html (there are dozens of other true horror-stories on their messageboard, which is unfortunately down right now)
Posted by Chuckie on May 3, 2004, at 13:06:36
In reply to Home Opiate Detox - GHB/benzos, posted by bupe_fan on May 3, 2004, at 2:11:44
Sorry for insisting, and so emphatically, but this is my life in the balance.
I admitted myself to the hospital a few weeks ago for detox. I was there for four days; they gave me decreasing dosage of methadone and then said well there you are. I spent the following week sick, in a spiral *much* more destructive than the drugs. After a week i should have been better but the fact was i was worse and on my way out. Couldn't take the torture anymore and now i'm back on the poppy and approaching my old dosage.
You say these things, and they raise questions which i hope you're kind enough to answer after i shouted at you:
>>The doctor said no way would he let me continue on buprenorphine for any longer than 10 days,<<
>>If the doctor ever tries to taper me I will raise hell about how much better I am doing now...<<What sort of doc did you see? And why is he reluctant? I thought bupe was a maintenance medication.
I want to avoid your sort of situation. It doesn't sound much more workable than the old go-to-the-doctor-and-be-in-pain strategy for obtaining Vicodin or whatever. IOW, it can and likely will be taken away from you before you're ready to have it taken.
I ask, because tomorrow i have an appointment with a certified buprenorphine type doc. I'm nervous as hell because my only other options are continuation of the poppy, or methadone. The flower is illegal and makes me ill at the dosages i take. The nearest methadone clinic is a 45 minute drive from here, and i'd have to go every day until they decide i don't. And i don't want to be addicted to methadone.
This geographical area of the U.S. has only two buprenorphine docs listed in the gov't directory; the one i'm going to see, and the one i can't get hold of.
Of course i'll do whatever needs done, but the buprenorphine sounds like the thing that *should* be done. I want to get my body back in balance... start eating right again and get back into the gym, etc. And my wife is taking me to see a holistic practitioner; dietary plans and acupuncture and whatnot. I'm skeptical because it's my nature but i'm also open because that's my nature too. But i need a *somewhat* balanced place to start from.
Sorry. I'm likely rambling because of my nervousness. Bleh. Want my life back.
One of my more important questions: What is the bupe costing you? The receptionist told me that their visits start at $95 and go up, but that Medicare would pay "some portion." I have no idea what the medication costs around here but i've read official estimates of around $250/mo. This sucks, but the poppies were getting to be about $150/mo. and my ultimate purpose is to get de-drugged eventually so the cost is somewhat of a motivator. I just don't want to be priced out of treatment entirely.
Thanks for the info about GHB. I had sorta figured it out, i just hadn't figured "no way in hell." Oh well. Thanks to my government for protecting me so well.
>>I think you put the Doc which you saw into a situation where he only had one thing to reccommend.<<
Dangit, which thread am i on? I forgot what i said, and where. If you're talking about the intake person who tried to shanghai me, then no, she had no right nor justification for that whatsoever. You might be correct about the kickback but i think it had more to do with her bad day, her need for control, and the approaching 5:00 hour.
I'm still angry about that episode, can you tell? ;)
*cough*
Erm anyway like i said, thanks for ANY further info, comfort, advice, etc. you can provide. I get all worked up. Really feels like tomorrow's appointment is life or death in the balance. I'll not give up if it turns out badly, but it gets so very hard not to give up when things *keep* turning out badly. Ya know?
- Chuckie
Posted by bupe_fan on May 3, 2004, at 18:36:30
In reply to Re: Buprenorphine - I INSIST YOU TELL ME MORE! » bupe_fan, posted by Chuckie on May 3, 2004, at 13:06:36
I know alot about where you are coming from, as I was on poppy tea (very low doses - 2 giganthemum pods per day) for the last months before I got the bupe appointment. Yes, I found the bupe doc at http://buprenorphine.samhsa.gov and it took me over a month to get in (kinda sad imagining a junkie having to needle himself for an extra month cause of a delay in admissions).
Well I can tell you what to expect: Your first appointment you will likely NOT be given any buprenorphine, but instead asked very many questions and made to sign very many forms. I realise that you, like most people who find themselves with opiate dependancy are only trying to treat your depression, but unfortunately you'll be treated like an addict the whole way. Of course a doctors office once a month is much more humane than waiting in line every morning at the methadone clinic, but no matter how hard the doctor tries to keep his words stigma free, its truly impossible as they have not experienced what you have experienced. You might experience like I did a nurse asking "do you regret ruining your life?", to which I responded "Excuse me!?", and she says "Becoming a junkie and having to deal with all this bullshit", to which I replied "I am glad I discovered opiates as they helped keep me from doing something I regretted such as killing myself or others".
My advice for the first appointment is to be pretty honest about your situation, however be very careful about what you disclose, because the doctor is quite likely to paint a picture of you in his mind biased towards what he first heard. You know the expression "first impressions always last". For example I told my physician that I had been using roughly 10-15mg morphine equivalancy in poppy pods for the last couple weeks (calculating that there is 5-8mg of morphine per Giganthemum pod), but unfortunately this did not account for my previous Oxycodone usage at 40mg/day, hydromorphone at 8mg/day and fentanyl usage at 1600mcg per day. Due to this information he considered me to have an "extremely low tolerance" and prescribed me 2mg of buprenorphine initially and suggested that I use 1mg once I stabilize. I found myself to be somewhat comfortable at 2mg (certainly more comfortable than without), but when I tried to taper to 1mg, I found that I was unable to concentrate enough to function at work (I have a job which involves the use of my brain intensely for many hours), I also found that tapering lead to misery at home, and my discomfort caused some conflict with my fiance.
After a couple months or so at 2mg, I realised that I missed the "good old days" of being able to feel as comfortable as I wanted any day of the week and decided to tell my doctor that due to the pain I was experiencing in my hands and arms (various things wrong with them: carpal tunnel, ulnar nerve and shoulder) and due to cravings and poor functioning at work whenever I tried to taper, that I viewed the benefits of using buprenorphine outweighed all cons, but that I needed a higher dose to prevent these cravings because I felt that I did not reveal the full extent of my opiate habit during my initial visits. So after much pleading and reasoning as well as providing many studies about buprenorphine dosages and buprenorphine in the treatment of depression (www.google.com and PubMed are my friends) he increased my dosage to 3mg/day, which is certainly perfect. It is great because it gives me some leeway to adjust how much I take in a day, some days I take only 1 pill (2mg), while others I take a full 2 (very rarely), but all in all the average is right around 1.5/day.
You should however realise that much of the "torture" you were experiencing comes from protracted withdrawal symptoms, as well as the initial depression you had.
As you seem pretty set on bupe as the treatment for you, you should be aware of the possibility that you might not get it at all from your doc, if he evaluates you and for any reason (personal, moral, religious, who knows) decides that he doesn't want to put you on bupe, you'll likely end up on whatever drug the pharmaceutical manufacturers are paying him to promote this month. (Effexor seems to be a biggie these days - despite telling my doc that I absolutely refuse to try to "Treat" my ADD with an anti-depressant and a severe allergic reaction to the closely related Buproprion (Wellbutrin) a couple years ago, he kept trying to push effexor on me.) Aslo remember it is quite likely that you are not going to start on bupe right away, and also they will want you to be clean from other opiates for 24 hours. In all honesty there is some safety margin in those 24 hours, and I was only off opiates (I switched to hydrocodone due to its short halflife) for 12 hours, to mimize the withdrawals I experienced at work, and I was feeling better within 10 minutes of putting the suboxone under my tounge. If you really wanna be certain about what day he would dose you, call and ask what his policy is. They usually dose on the 2nd day because they require a whole buncha signed paperwork (thank you litigous people for wasting my time) and also require a driver to take you home (you probably won't need it, but liability rears its ugly head).
Some doctors will require a urine test during your first visit to make sure you are "honestly a junkie" and also to make sure you aren't a "polysubstance abuser", because that increases the amount of work they have to do.
You will also be urine tested every week/month (depends how good you are) to make sure you aren't "relapsing" (which is fortunately very difficult to do thanks to the 72 hour blockade caused by the buprenorphine - in my personal experience all other opiates are wasted when attempting to do them within 3 days of buprenorphine, although you will get very uncomfortable when going 36 hours without, so its pretty much impossible to last 72 hours off bupe to actually get high.) If you fail opiates or one of the other substances on the test besides opiates, your doc can do whatever he feels is neccesary, including reccomending methadone maintenance instead, tapering your dose or whatever other punishment is appropriate (I realise its not really a punishment in the doctors mind, it just has that effect). Personally I failed for benzos once and didn't get anything more than a lecture from the moralizing nurse. Of course the only reason I failed is because they have not prescribed me anything which actually helps me sleep yet.
If you have read anything on the net about how buprenorphine is "withdrawal free" or anything of the sort, its not entirely true. Once you have been on buprenorphine for a couple weeks or more (6 months in my case) it becomes extremely unpleasant to go without for 36 hours... If someone uses this drug to wean themselves off opiates in a period of 2 weeks it would definately be less unpleasant than using methadone or quitting cold turkey, and this is why the rumours about "withdrawal free detox" got started. While quitting is still very hard, the thing I've been impressed with about bupe is the lack of any creeping tolerance! 2mg still feels exactly the same as the first day I did it.
As for actually dosing, pick a time when you've got 15 minutes without talking to anybody (due to sublingual administration), and take 2/3rds of your daily dose when you first wake up, and 1/3rd about 12 hours later... This provides the best balance of feeling comfy when you need it most (morning and night), and the body actually gets more use out of such a dose, due to the partial agonist nature of the drug.
Lastly remember bupe is not a magic cure, although it definately helped me with my depression, ADD and bipolar disorder, I still work hard every day to find better ways to cope with my natural limitations. Excersize and diet are the most important ways to combat depression. And I highly reccomend DLPA and L-Tyrosine for a little boost in the morning and Melatonin at night. Proteins are the only way to get a lift without a subsequent crash.
Yes, so sad about GHB, I have commented to my fiance that if I had a steady supply I would be able to wean myself off bupe and experiment with living without (my original plan), but a wedding, a full time job, and a housing search have prevented the taper.
Good luck! and don't be scared of the docs! they really are trying to help! They're doing their best but they're only human and motivated by profit (after all medicine is a BUSINESS). Read up on opiate addiction at one of many harm reduction related sites such as www.bluelight.nu and www.at-watchdog.org (I provided this link earlier).
> Sorry for insisting, and so emphatically, but this is my life in the balance.
>
> I admitted myself to the hospital a few weeks ago for detox. I was there for four days; they gave me decreasing dosage of methadone and then said well there you are. I spent the following week sick, in a spiral *much* more destructive than the drugs. After a week i should have been better but the fact was i was worse and on my way out. Couldn't take the torture anymore and now i'm back on the poppy and approaching my old dosage.
>
> You say these things, and they raise questions which i hope you're kind enough to answer after i shouted at you:
>
> >>The doctor said no way would he let me continue on buprenorphine for any longer than 10 days,<<
> >>If the doctor ever tries to taper me I will raise hell about how much better I am doing now...<<
>
> What sort of doc did you see? And why is he reluctant? I thought bupe was a maintenance medication.
>
> I want to avoid your sort of situation. It doesn't sound much more workable than the old go-to-the-doctor-and-be-in-pain strategy for obtaining Vicodin or whatever. IOW, it can and likely will be taken away from you before you're ready to have it taken.
>
> I ask, because tomorrow i have an appointment with a certified buprenorphine type doc. I'm nervous as hell because my only other options are continuation of the poppy, or methadone. The flower is illegal and makes me ill at the dosages i take. The nearest methadone clinic is a 45 minute drive from here, and i'd have to go every day until they decide i don't. And i don't want to be addicted to methadone.
>
> This geographical area of the U.S. has only two buprenorphine docs listed in the gov't directory; the one i'm going to see, and the one i can't get hold of.
>
> Of course i'll do whatever needs done, but the buprenorphine sounds like the thing that *should* be done. I want to get my body back in balance... start eating right again and get back into the gym, etc. And my wife is taking me to see a holistic practitioner; dietary plans and acupuncture and whatnot. I'm skeptical because it's my nature but i'm also open because that's my nature too. But i need a *somewhat* balanced place to start from.
>
> Sorry. I'm likely rambling because of my nervousness. Bleh. Want my life back.
>
> One of my more important questions: What is the bupe costing you? The receptionist told me that their visits start at $95 and go up, but that Medicare would pay "some portion." I have no idea what the medication costs around here but i've read official estimates of around $250/mo. This sucks, but the poppies were getting to be about $150/mo. and my ultimate purpose is to get de-drugged eventually so the cost is somewhat of a motivator. I just don't want to be priced out of treatment entirely.
>
> Thanks for the info about GHB. I had sorta figured it out, i just hadn't figured "no way in hell." Oh well. Thanks to my government for protecting me so well.
>
> >>I think you put the Doc which you saw into a situation where he only had one thing to reccommend.<<
>
> Dangit, which thread am i on? I forgot what i said, and where. If you're talking about the intake person who tried to shanghai me, then no, she had no right nor justification for that whatsoever. You might be correct about the kickback but i think it had more to do with her bad day, her need for control, and the approaching 5:00 hour.
>
> I'm still angry about that episode, can you tell? ;)
>
> *cough*
>
> Erm anyway like i said, thanks for ANY further info, comfort, advice, etc. you can provide. I get all worked up. Really feels like tomorrow's appointment is life or death in the balance. I'll not give up if it turns out badly, but it gets so very hard not to give up when things *keep* turning out badly. Ya know?
>
> - Chuckie
>
Posted by arrie on May 3, 2004, at 19:37:06
In reply to Re: Buprenorphine - I INSIST YOU TELL ME MORE!, posted by bupe_fan on May 3, 2004, at 18:36:30
Thanks for all the bup info. Now heres what happened with me. I too looked at the "gov" website to find out what docs in my area had this med. After many exasperating calls, many of the listed docs referred me to just one who works in a University hospital meth clinic setting. I went in, upper crust house wife look and all, forced myself to talk to them. They WOULD not give me Bup unless I signed my life away to them, I was pissed. They wanted me to get in line every day like i was getting meth, attend groups and have mandatory counciling with them once a week, for only the first 90 frickin days. They are the only game in town, my city is almost 800,000 in population. asked how drug was working out they said " oh youre our first one". In other words they are doing a poor shit ass job of helping anyone. I walked out.
Posted by Chuckie on May 3, 2004, at 19:38:29
In reply to Re: Buprenorphine - I INSIST YOU TELL ME MORE!, posted by bupe_fan on May 3, 2004, at 18:36:30
That was beautiful, just beautiful. Thank you.
I just have a couple more questions, if you have the patience.
Firstly you didn't tell me how much this costs. I have some resources at my disposal, but i did lose a contract over all this and so money is tight. I only have Social Security and some miscellaneous odd jobs. And credit cards, lots. :D
Secondly what means "polysubstance abuser," to a doctor of this sort? I've been on clonazepam for fifteen years, and i'm not about to even try to give that up at this time. It helps me out a great deal as my depression is triggered by stress. I handle it much like you do the buprenorphine; adjusting it to circumstances to maintain balance. My script is for 2mg/day, generally i take 1 to 1.5mg. Do you think such usage makes me an "abuser"?
Good grief i can't imagine the pain of having to quit that too. For no good reason either, since it does no harm and in fact helps me.
You realize, you know, that you've reinforced just about every fear i have about my appointment tomorrow? But i guess i needed to hear it. It's just strange, and wrong, that such judgements should be passed in a practice specializing in harm reduction. Or that there should be any question about the propriety of buprenorphine maintenance, when the alternatives are illegal substances or methadone.
Here's what i plan to say, for lack of anything else; see what you think:
1) I took the opium for depression, after every conventional AD had failed me.
2) Opium turned out to be a mistake.
3) Detox put me in Hell. (I honestly don't remember what sort of Hell it was. I remember a few Bonanza episodes, otherwise the only objective information i have is what my wife observed. All i know for sure is i couldn't take it.)
4) I don't want to continue doing opium because it's illegal and unhealthy. I don't want to do methadone because it's impractical hour and a half driving per day, and i don't want to be addicted to it.
5) My current dosage is 12 level tablespoons/day (~ 3/4 cup) raw product. (I equate this to approx four 750mg Vicodins, i have no other reference. Sound right?)My whole point, as i think i said, is to be in a balanced state from where i can accomplish things. I have a plan in place for my mind and my body, however when i'm so wildly imbalanced i'll never get a damb thing done and i know it.
In any case, thank you very much for the descriptive picture. I hope my experience to be a bit more copacetic, but now i understand some the potential pitfalls and i'll tread lightly. If you have any further advice based on my specific plans, please share.
Thanks Again. Really.
- Chuckie
Posted by Chuckie on May 4, 2004, at 21:17:16
In reply to Re: Buprenorphine - Thanks! And... » bupe_fan, posted by Chuckie on May 3, 2004, at 19:38:29
Well i have some good news, and some good news.
I saw the doctor today. I was a half hour late because of traffic jams, but the staff was friendly and understanding. The clinic is actually a family practice; in fact it's housed in a comfy converted residence.
The doctor was all smiles and helpfullness and REAL. None that clinical distance and uncomfortable feeling of being sized up for to pass appropriate judgement. He's a family doctor with a background in methadone clinics.
We talked for about ten minutes. He asked me to approximate my current poppy usage, in terms of Vicodin, and i told him i thought about four 750mg pills/day.
Then he called in my prescriptions.
No pee tests. No counseling. No judgement. And apparently i can call the pharmacy for my monthly refills.
To top it off i now have a GP for my family. One who will also refill my clonazapem and wellbutrin scripts, should i need them, without concurrent whinging about my 'substance abuse.'
This is almost too good to be true. But, the scripts are called into the pharmacy. It actually happened, already. The pharmacy doesn't have any, but they're supposed to have them by tomorrow afternoon.
The only downside is the cost. Of course i'll pay whatever it takes to get started on my new life, but wow. Something like $90 to get started on Subutex, then $360?/mo. for suboxone maintenance.
Although he's got me at the 'target' dosage of 16mg. Judging from anecdotal stories like from ^bupe_fan, who is comfy on 3mg, i should think i should be able to live with at least half or third of my prescription. So in theory, half to a third of the cost.
The other downside is i guess i have to be dopesick before i can start the bupe. Hopefully this happens by tomorrow evening. If not, i'll just stay up until it does. And hopefully i judge properly how sick i should be before taking it. I mean i hope the runny nose and the shattered nerves are sick enough, since if i call it wrong i guess i could make myself even sicker. But even that should pass, after all i will be getting opioid medication into my system.
That's my only real criticism of my experience. I think the doc could have been a bit more detailed about how to proceed. But then, his original plan was to have me off the flower for TWO days and then start me on Suboxone, so maybe he feels everything be OK with the gradual introduction of Subutex instead. I also note the lack of an office visit for my first dose, as seems traditional, and the lack of actual verification of my dependence. But here again, buprenorphine is a poor choice for abuse, so maybe he skips the formality based on experience. I mean he probably doesn't have a lot of people traipsing in to bs him for a fix, esp. considering the cost.
All in all, a great day for Chuckie. I'm feeling a bit sad for all the stories i hear of less fortunate situations. But... after 40+ years of suffering in one form or another, i think it's about time i get a chance at a life. I mean before it runs out entirely.
SO...
This is probably my last comment on this thread, unless someone asks for more commentary. I'll post my progress on new thread(s?), as i'm embarking on a new life now.
Thanks All. Just for being here.
- Chuckie
Posted by bupe_fan on May 4, 2004, at 22:21:48
In reply to Re: Buprenorphine - Thanks! And... » bupe_fan, posted by Chuckie on May 3, 2004, at 19:38:29
Chuckie: Regarding the cost, I have very expensive health insurance through my work (a health industry related business) and thus all I pay is $10 copay + $30 for the Urine tests (for some reason insurance won't cover those!)... I've read elsewhere that the 2mg pills are $2 each while the 8mg pills are $6 each.
I think in the doctors eyes benzo use is abuse if its not prescribed, and if it is prescribed, he may have his own reasons for wanting you to quit them. I do know that in the physicians manual at http://buprenorphine.samhsa.gov it says to excersize caution with mixing bupe and benzos due to some overdose deaths caused by IV benzo+bupe usage in france in the 1980s... Some physicians take this a little too far and are overcautious to the point of not prescribing benzos to bupe patients (even though the deaths were from massive dosages IV)... I have no idea how your doctor will react in your specific situation.
Good luck!
Posted by rianna on May 5, 2004, at 18:29:27
In reply to Re: Buprenorphine - Thanks! And..., posted by bupe_fan on May 4, 2004, at 22:21:48
> Chuckie: Regarding the cost, I have very expensive health insurance through my work (a health industry related business) and thus all I pay is $10 copay + $30 for the Urine tests (for some reason insurance won't cover those!)... I've read elsewhere that the 2mg pills are $2 each while the 8mg pills are $6 each.
>
> I think in the doctors eyes benzo use is abuse if its not prescribed, and if it is prescribed, he may have his own reasons for wanting you to quit them. I do know that in the physicians manual at http://buprenorphine.samhsa.gov it says to excersize caution with mixing bupe and benzos due to some overdose deaths caused by IV benzo+bupe usage in france in the 1980s... Some physicians take this a little too far and are overcautious to the point of not prescribing benzos to bupe patients (even though the deaths were from massive dosages IV)... I have no idea how your doctor will react in your specific situation.
> Good luck!I've been reading your post Chuckie and Hope things work for you. Do be careful with that klonopin. It is my living nightmare...And thanks for your comments on my post.
Posted by Chuckie on May 5, 2004, at 19:17:10
In reply to Re: Buprenorphine - Thanks! And..., posted by rianna on May 5, 2004, at 18:29:27
Thanks Rianna,
Not feeling so good right now, as i'm unsure how long i'm supposed to wait before i take my medication. If i wait long enough, it will make me feel better. If i don't wait long enough, it can make me feel worse. At least as i understand things.
I wish i understood things better. :(
Hey, if it's any consolation i've been reading about benzo dependence as well. I can't find the link ATM, but i know i read something very encouraging about ditching the stuff after the last bit of tapering.
Here's a FAQ i found:
http://www.benzo.org.uk/FAQ1.1.htm
... looks like lotsa good info.Also, although i only did it once, i *did* taper myself organically, simply owing to living a healthy lifestyle. I was down to .25mg clonazepam, from a high of 2mg. I hardly noticed the taper, and if i'd had any sense i probably should have stopped entirely because i probably wouldn't have noticed that either.
I'm saying it can be done, so don't give up. Of course this is just my experience, but from that experience i think the best angle at it is to get healthy and happy, so you don't need the drug so much.
That's my plan, anyway. :)
GL
- Chuckie
Posted by Festus on May 5, 2004, at 22:54:31
In reply to Re: Buprenorphine - Thanks! And..., posted by Chuckie on May 5, 2004, at 19:17:10
I,too,have just gotten absorbed in the "Will Chuckie make it?"saga,and I think that ,combined with a bit of luck and plain honesty,the Dr. you found was willing to help you without all the usual BS one would get in this situation.A"Good Doctor",as this one,knows you,ve already got BS up to your ears,as it is,so I,m real glad for you.Please wait till you are steady and sure from the opiate stoppage before trying to dis-continue the Klonopin.Gettin off that stuff is dangerous,sometimes.I,ve heard of some using Xanax to stop the Klonopin,then weaning from it.I wondered if you had any Chronic Pain issues?I take Methadone because of Chronic Pain that keeps me from being able to work without meds,and also because it,s cheap(no insurance).I don,t like taking it,but I don,t have much choice.At one time,I was on 640-720mg. of Oxycontin a day,I was very relieved to go to the Methadone.The Oxy was $1,750.00 a mo.without insurance.The Methadone is 50 bucks a mo. and does a better job controlling my pain.I take Dexedrine for ADD,also,so between the 2 meds,I,m able to keep a clear enough mind and able body to run a business,but I wish I did,nt have to depend on the Meds.I,m grateful that I have a"Good Dr.",too,that will give his patients what they need,not what he feels"safe"giving them.Good-Luck,Chuckie!Festus
Posted by rianna on May 6, 2004, at 19:11:54
In reply to Re: Buprenorphine - Thanks! And..., posted by Chuckie on May 5, 2004, at 19:17:10
thanks your support is great. keep yours up! you can do it. You have gone through a lot to get help so don't give up. Your info has been very inspiring for me and many others.
Posted by arrie on May 6, 2004, at 23:56:05
In reply to Re: Buprenorphine - W00T!, posted by Chuckie on May 4, 2004, at 21:17:16
Great news Chuckie on getting the Bup. Keep us posted. How did you find this Doc, was he on that government sponsered web site? I am still confused on this very important point, can any qualified Dr prescribe this, or only a certain few? Please tell me what you know, if any Dr can prescribe it, I will get the yellow pages out again, anyone out there know? Anyway congradulations and please keep us Bup wannabes posted on your progress.
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