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I need your advice: my pain mgmt dr is failing me
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    User88 is offline Junior Member
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    Default I need your advice: my pain mgmt dr is failing me

    Ok. I am a 62 yr old 100% disabled Vet with six damaged vert, 3 neck 3 thoracic. I live in pain and at times its so bad that I have wished for the peace of death. No, I am not suicidal, just the opposite, I want to live peacefully but the pain makes it impossible at times.

    About a year ago I was funneled, not by choice, into a pain management clinic in rural MN. I hoped it would offer respite. The emotional stress and unaddressed pain are not helping.

    I have had ups and downs with the Dr who is younger and not someone that probably should be running a one man clinic, simply due to visible lack of experience. For some reason this hospital entrusted an entire pain mgmt clinic to a dr that had never run one...and he is alienating patients and staff left and right.

    My most recent experience with him was so shocking that I am still in awe of it all. I had asked him to wean me off of MS Contin and he forgot that I asked him to do so. (I was/am still taking Oxycodone 10mg 4x daily) I called in a week into that experience of weaning off and asked them to mention to him to please have some medical suggestions for me because the pain that was rising up (that the MS Contin used to handle) was now unbearable. They never got him that message. I told Dr H that during this experience of weaning off the meds that I realized that I was now married to these medicatiosn and if something ever happened, ie: an apocolypse or the clinic closed, I would end up on the street looking for help.

    He FREAKED OUT. He immediately went into "must get this patient into treatment" mode and heard nothing else I said. He insisted, repeatedly that I was "now at a low point in my life" and that the pain I was experiencing was emotionally aggravated and not as bad as I thought it was.

    After the third time he said "you are at a low point in your life!" I got mad. I responded "F**k YES, I know" but it's not addicition thats the problem, its because my Dr doesnt hear or listen to me!"

    At that, he got up and walked out of the room. I said, mostly to myself and quietly, "why do I even bother coming here...?" and he snidely shot back, "you don't HAVE to!"

    Do I even bother trying to get help with him? I filed complaints with the hospital and they didn't take it seriously, to the point they never even called me back. My only concern is, of course, that I have no options for pain medication other than this Dr. and after almost a decade of taking this or other pain meds, I am married to this clinic for the moment. Or am I?

    What would you do? Would you feel painted into a very uncomfortable corner? I do.
    Last edited by Anonymous; 08-17-2017 at 12:06 PM.

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    User88 is offline Junior Member
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    addendum.

    1) I have been sober/clean of all alcohol and illegals since 7/14/1981 and haven't even had a puff of pot since.

    2) I have trouble with anxiety and depression and this pain mgmt issue isn't helping either of those. in fact, its making it much worse.

    3) I do not care what they treat my pain with, including rubber mallets on the back of the head if that will work! I only want to not have to live in grade 10 pain for days on end. I do not expect absolute relief and realize that would be unreasonable. I just want help...any, some, please?
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    Catrina is offline Diamond Member
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    UGH! I am so sorry that you are going through this! You apparently pushed the wrong buttons with this guy and he has now labeled you. That's really too bad and it's not his job. You said he's young and I agree with you that he doesn't belong treating pain patients. This field of medicine takes a very special doctor and staff. I'm gong to be the devil's advocate for just a second. Pain clinics get more than their share of drug seeking patients so I'm sure that it doesn't take too long to become jaded. When you contacted the hospital to make a complaint they probably reached out to this doctor and he told them his side of the story and that was that. NOT the right way to do things but that's my guess. There is no excuse for them not responding to you one way or the other.

    Is there another pain management clinic within reasonable distance for you? That might be my first choice but I also know that it's difficult to change. Sometimes they just can't accept new patients. People who legitimately need long term narcotics to treat their pain are all too often lumped in with the folks who are abusing their medication. Before trying to switch clinics, I think that I would make an appointment with this doctor and have a chat with him. Leave your temper and annoyance at home. As calmly as you can manage, try to explain to him what's going on with you and what led up to your disagreement. I would even apologize (even if he doesn't deserve it and you don't mean it). That will appease his ego. Next, I would ask for his help. Explain that your quality of life is very negatively affected because of your pain and your just want to find something that will help to make you comfortable. Try to get him in your corner. Provided it's true, tell him that you would be open to trying other things to treat your pain but that you'll need him to help to figure out what might work and to make the transition.

    You're in a spot and you need this guy (so sorry!). Play to his ego and hopefully he takes that bait and will begin to treat you the way he's supposed to be treating you.

    Peace,

    Cat

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    User88 is offline Junior Member
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    Thanks Cat, all good input and insight.

    I have an early appt in the morning and if I can get up and get there in time I will handle it just like you suggested. I need to kiss his posterior whether I like it or not. He knows by now that I filed the complaint so it will be a matter of finding out where he sits on this whole situation and if he's going to work with me on any level, or if his ego is damaged beyond repair. He left me hanging painwise last time and I have no reason to expect that he will be reasonable this time and offer medication to address it.

    I have made an appt with another Dr (in another hospital, different local rural community) that handles suboxone (sp?) and meet with him next Monday because I suspect that this Dr that I have been seeing at the pain mgmt clinic is going to stop prescribing Oxy (and probably any other medications since he's mad at me) so it may just be best to accept the fact that I will have to stop using Oxy (?) and see if I can find any medical satisfaction with cannabis or something else that the medical industry (and/or the media!!!) isnt so freaked out about.
    Last edited by Anonymous; 08-18-2017 at 02:49 AM.
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    User88 is offline Junior Member
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    I have tried in the past to open up politely and honestly and share aspects of why I am at this point in my life (how the injuries happened, how the pain affects me and has a headlock on me, of sorts, controlling my life) He listens to a point and then shuts down and absolutely goes into "I must get to the next patient" mode, and you can tell that anything said after that point is like a bulldozer pushing stuff over the edge of a cliff...it's just gone and nothing will ever be done about it.

    It's so bad that at this Pain clinic I am telling you about that the nurses and assistants will come knock on the door and interrupt and summon him off to another appt or meeting or...? I can't tell you how annoying THAT is, to be pouring your heart out to the Dr, hoping to find a solution to your medical situation and the door flies open and a nurse interrupts (ENDS) the appt and off he goes.

    If I am going to be absolutely honest about my feelings about the matter, I guess I would prefer to get out of this situation and find a Dr that was capable, willing, able, of listening and helping me and where I didn't feel like a cow in a cattle chute, where the nurse screams "NEXT" and off I go, and in shuffles the next patient!

    I have to admit that I am shocked. I thought the VA was the ultimate in medical nightmares and nothing would compare. Little did I know!
    Last edited by Anonymous; 08-18-2017 at 03:29 AM.

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    Catrina is offline Diamond Member
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    Quote Originally Posted by User88 View Post
    Thanks Cat, all good input and insight.

    I have an early appt in the morning and if I can get up and get there in time I will handle it just like you suggested. I need to kiss his posterior whether I like it or not. He knows by now that I filed the complaint so it will be a matter of finding out where he sits on this whole situation and if he's going to work with me on any level, or if his ego is damaged beyond repair. He left me hanging painwise last time and I have no reason to expect that he will be reasonable this time and offer medication to address it.

    I have made an appt with another Dr (in another hospital, different local rural community) that handles suboxone (sp?) and meet with him next Monday because I suspect that this Dr that I have been seeing at the pain mgmt clinic is going to stop prescribing Oxy (and probably any other medications since he's mad at me) so it may just be best to accept the fact that I will have to stop using Oxy (?) and see if I can find any medical satisfaction with cannabis or something else that the medical industry (and/or the media!!!) isnt so freaked out about.
    Hi,

    Please post again after your appointment. I'm curious now to know how this goes at the clinic.

    So, you made an appointment with a doctor who can prescribe suboxone. Do you know anything/much about subs? Do some reading on this site (lots of it!) paying the most attention to members who are tapering subs. Also be sure to find the COWS worksheet, read it until you are very familiar with it and understand it. Ask questions if you need or want to. There's plenty of folks around here who can help you. The other thing that you should find and read is Robert's Sub Taper Plan. This is the taper plan that's been successfully used here for thousands of people.

    Subs are a very strong opiate that is sometimes prescribed for pain management but is most often prescribed as a tool to get off of all narcotics without having to endure a cold turkey detox. The half life is very long and as I said, it's very strong. Estimates put it at around 30 times stronger than morphine. Most sub doctors, unfortunately, really don't understand what subs are all about. They almost always prescribe it at doses WAYYYY too high, as much as 12, 16, 24 or even more mgs/day when most people need 2-4mg/day (some a bit higher but not by much). Subs are entirely different than any of the short acting opiates that you have been prescribed in the past. Less is more. With the short acting drugs, if we don't get the pain relief that we are looking for, we take more. With subs, if you take more it will make you feel worse. When Robert's Plan is followed closely, you'll be able to find the correct dose for you.

    The COWS worksheet is very important. When you induct (the first dose of sub you take) it's of utmost importance to have reached at least a 26 score or there's a real possibility of sending yourself into precipitated withdrawals. Trust me, you have never felt pain or been sick that has made you feel like you will if you do take those subs too soon after your last dose of oxy or any other opiate. This is not to scare you. Just to warn you.

    Before your appointment, read as much as you can about subs. Decide, if you haven't already, if your goal is to try and use the subs for pain management or if you are going to use them to try and get off all opiates and find a different way to treat your pain. That way you can be sure to get off on the right foot depending upon what your end game is going to be. If you do decide to begin sub therapy, keep that appointment with the sub doctor. Listen to him and agree with him/her regardless of what instructions he/she gives you. Hopefully, he/she won't make you take your first dose of subs in the office (they sometimes do). Get your script, get outta there, pick up your script, go home and jump back on the Forum here and someone will help you induct the correct way so that you will be taking the least amount of sub you need to be comfortable. If they do make you dose in the office, it's OK. Just do what you have to do to get that prescription and we'll get you back on the right track. I know it's not usually wise to advise anyone to ever NOT follow their doctor's instructions but this is one of the few exceptions. In order to prescribe subs, doctors are only required to take an eight hour online course to become certified. The course is given by Big Pharma whose goal is keep you on the subs long term. Because of the long life, subs stack in your system because it doesn't dissipate quickly enough. Say you begin at 4mg/day and you take that dose on Day 1. Subs' half life can be as long as 72 hours with a medium of 24-36 hours when short acting opiates half life is 3-4 hours. Because of this, on Day 2 when you take another dose of 4mg, you still have at least 2mg from the previous day so you've now got 6mg or more in your system. On Day 3, you take another 4mg dose. You may have around 1mg from Day 1, 2mg from Day 2, and the new 4mg dose for what's now a total of 7mg. You get the picture.

    Good luck and keep posting. This will all work out for you in the end. Perhaps not the way you want, but one way or the other, it will work out.

    Peace,

    Cat
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    User88 is offline Junior Member
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    Cat,

    I appreciate your sincere and in depth explanations! I can't thank you enough for the help and thoroughness.

    I chose not to bother to go to the appt with the Dr H at the original clinic, I felt that since I have an appt Mon with the new dr that I will spend my energy with him (lets call him Dr L) and attempt to get moving in the right direction.

    I can only tolerate so much unprofessionalism, period. Then I give up and move on. I have moved on. I have been thru the withdrawals once before when the VA Dr didn't get my messages and I ran out of medications so I know the hell that I am headed for. (I am 90 mi from that Dr and being rural can cause serious complications sometimes)

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    I should add, that your input is invaluable. I knew literally nothing about Subox and the COWS chart was equally appreciated! I read up on it a bit and will continue to do research and further prepare myself for the Sub and withdrawals. It helps SO much to have people that care and who are on our side.

    I also realize that I make mistakes along the way and that I am not infallable or omniscient. I try to write the details of the situation as realistically as I can and without tainting it too much in my favor. I endeavor to be honest and forthright versus say, attempting to sway you the reader, to be on my side.

    I view myself to be dependent on Oxycodone versus addicted, but I also know that honestly, when the prescription runs out, if I dont have an alternative or some medication, I will be a hurtin' unit, physically AND emotionally.
    Last edited by Anonymous; 08-19-2017 at 04:21 PM.
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    Catrina is offline Diamond Member
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    Quote Originally Posted by User88 View Post
    I should add, that your input is invaluable. I knew literally nothing about Subox and the COWS chart was equally appreciated! I read up on it a bit and will continue to do research and further prepare myself for the Sub and withdrawals. It helps SO much to have people that care and who are on our side.

    I also realize that I make mistakes along the way and that I am not infallable or omniscient. I try to write the details of the situation as realistically as I can and without tainting it too much in my favor. I endeavor to be honest and forthright versus say, attempting to sway you the reader, to be on my side.

    I view myself to be dependent on Oxycodone versus addicted, but I also know that honestly, when the prescription runs out, if I dont have an alternative or some medication, I will be a hurtin' unit, physically AND emotionally.
    I'm glad that you are upfront and honest. There is absolutely no purpose to trying to influence anyone that may be reading your posts and story. What point is there? We come here looking for mutual support and fellowship. We do our best to help one another and one of the Cardinal Rules here is to leave all judgement at the door. Thank you very much. To be honest, it almost never even occurs to me to doubt anything that anyone writes here. We are all anonymous and others can only help if we are honest with both ourselves and with others.

    Be sure to keep posting to let us know how things are going. Glad you're reading up on subs. They are an awesome tool but after having been a member here for over 7 1/2 years, I've learned that almost universally doctors do a really poor job of understanding how subs work so they don't educate their patients properly (or at all) and prescribe them incorrectly. If you ever have a question about subs, don't bother asking a doctor. Ask right here on this Forum and you'll get answers from people who have used them. That's the advice that I would trust.

    Peace,

    Cat
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    Hey, okay...Dr L is in and Dr H is out! I am happy to say that the new Dr is going to work out fine. He wants me to come in for an observation/induct next Monday am, and I am going to run out of Oxy about Sat night so it works out right.

    He's a likeable guy, he said that I can expect to get pain relief from the Subox and the good thing is that it will kill/neutralize the craving for oxy. he mentioned that he has one patient on it thats been on for...6+ yrs and gets great pain relief from it.

    Thats fine with me!
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    Randy35 is offline Platinum Member
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    Quote Originally Posted by User88 View Post
    Hey, okay...Dr L is in and Dr H is out! I am happy to say that the new Dr is going to work out fine. He wants me to come in for an observation/induct next Monday am, and I am going to run out of Oxy about Sat night so it works out right.

    He's a likeable guy, he said that I can expect to get pain relief from the Subox and the good thing is that it will kill/neutralize the craving for oxy. he mentioned that he has one patient on it thats been on for...6+ yrs and gets great pain relief from it.

    Thats fine with me!


    Hello, I'm Randy and I've been following your story and posts. Cat has given you amazing advice as she always does. I'm so happy you found a different doctor that has your best interest as a patient in mind. Makes a huge difference doesn't it? I found myself getting extremely upset at the former doctor. Lol.

    I was addicted to every drug on earth at one time or another for about 18 years. Went on methadone (egads) then made the switch to Suboxone. Tapered off the subs and now have over 3 years clean. Just wanted to give you a short background on me. I'm involved in both NA and AA supprt meetings and a sponsor in NA. I mainly help those new to Suboxone induct and taper off. If you follow Robert's sub therapy plan that thousands have used successfully you can't go wrong. Cat mentioned it to you previously and I wanted to provide the link to both that and the Cows chart Cat also mentioned. It's right below.....

    Robert's Suboxone Plan
    https://www.drugs.com/forum/suboxone...apy-66109.html

    Cows Chart
    https://www.drugabuse.gov/sites/defa...rawalScale.pdf

    I'm sure Cat will mention this to you, but it's very important you not take anything that will make you "feel better" between the time you stop the Oxy and you induct on the subs. Reason being it could and probably will delay you getting to the 26 score needed on the Cows. Even things such as Tylenol, Motrin/Ibuprofin can delay the Cows score unnecessarily and make you wait in wd's longer than you have to. Just try to gut it out. It's the hardest part to sub therapy, but once you take those first couple doses of sub you'll begin to feel better quickly.

    Read over Robert's plan so you completely understand it. I wish you the absolute best and will be around to help if you don't mind. I know Cat won't mind as we work together all the time. You are what matters and we're here to help and support you through this.

    Randy
    Last edited by Anonymous; 12-13-2017 at 07:33 PM.
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    My apologies, I "lost" this thread and it took me a few days to find it again. (age...sigh)

    Thank you for your support, Randy. Excellent input and suggestions as well!

    Ok. I have established what I feel is a good line of communications with Dr L and he understands my hesitation in making this transition but underneath it all, I feel very positive about getting off the oxy. I have mixed emotions about the logic of going from one medication to another, both opioids but...if I get rid of the dependence on the oxy, that!! is a good thing. There is whether I like it or not, an inability now for me to go without it for any period of time. I wake up, I go to the pill bottle to fight the pain. I start hurting, I open the medication bottle.

    I assume there will be a period of some unpleasantness but it will have to be 1000x better than quitting it cold.

    What concerned me the most about quitting it last time was the depression and anxiety and terrible mood swings. that part was NOT good. I am guessing that these meds will moderate that issue since it is an opioid itself.

    oh, and I bookmarked this conversation this time so I wont have that issue again of losing it.
    Last edited by Anonymous; 08-24-2017 at 02:29 AM.

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    Randy35 is offline Platinum Member
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    Quote Originally Posted by User88 View Post
    My apologies, I "lost" this thread and it took me a few days to find it again. (age...sigh)

    Thank you for your support, Randy. Excellent input and suggestions as well!

    Ok. I have established what I feel is a good line of communications with Dr L and he understands my hesitation in making this transition but underneath it all, I feel very positive about getting off the oxy. I have mixed emotions about the logic of going from one medication to another, both opioids but...if I get rid of the dependence on the oxy, that!! is a good thing. There is whether I like it or not, an inability now for me to go without it for any period of time. I wake up, I go to the pill bottle to fight the pain. I start hurting, I open the medication bottle.

    I assume there will be a period of some unpleasantness but it will have to be 1000x better than quitting it cold.

    What concerned me the most about quitting it last time was the depression and anxiety and terrible mood swings. that part was NOT good. I am guessing that these meds will moderate that issue since it is an opioid itself.

    oh, and I bookmarked this conversation this time so I wont have that issue again of losing it.


    User88 -

    Glad you found your way back! If it should ever happen again, once you log in just click on your user name at the top and it will direct you to your personal page. From there you can see the posts you've made along with other and your thread.

    It's important to understand that Suboxone is just a tool that's used when one wants to stop their drug of choice and be clean and get out of the nightmare of drug dependence and addiction. Nothing more than that and it certainly isn't a magic cure. Yes it's an opiate, but it's a partial-agonist so no high or euphoria like other full-agonist opiates or narcotice will provide. With long term use of Suboxone (months/years) it's entirely possible to become dependent, even addicted to the very drug that's intended to get away from that. So the shorter the time on subs the better, but just long enough to get past addicitve thoughts and behaviors.

    Re-read Cat's post about sub doctors. What she has to say about them not knowing or understanding this drug is absolutely true in most every case. Most are in it for the easy money to be made. I know people that go to their sub doctor to get their script and the doctor only spends 2-3 minutes with them. I'm serious. I've went along with a few that I was/am helping to their appointments They check their urine for other drugs then hand out the script and say see you next week, 2 weeks, or month. They could care less about the patient because they're addicts. Sad, but true. Now there are some good sub doctors out there, I had one of them and know several others. I hope you get one that knows this drug thoroughly. If not don't worry about it, the people of this forum do know how this drug works, and how to get someone on and off. You're in good hands here.

    The most critical part to Suboxone is the induction itself. Get it right and you're going to be fine. Take the sub too soon and you could pay a stiff price in the form of precipitated wd's. Take too much sub at induction and it will make you sick. The goal is to take small doses every hour until stable. Just follow Robert's plan and you'll be fine.

    The hardest part of this is the time after you completely stop your current opiate(s) and the time until you induct on the subs. It really sux, but you only need to do it once if you do it right. The time varies and that's why we always suggest using the Cows. It takes the guessing out of it. Once you're at the 26 score you know you're safe to take the sub.

    I'm sure you're reading posts and threads here, but make sure to read in both the Need to Talk and Suboxone sections of the forum. Valuable info that will really help you understand what you're dealing with. Stay away from the horror stories. All of them are always fro the same reasons....Improper induction, too much sub, on it too long, tapering too fast, tapering by too many mgs, and jumping from too high of a dose. there are other reasons, but those are the most common. If you induct correctly you've already won.

    Have a great day and I'll check back later.

    Randy

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    I am very lucky to have found this forum/thread originally, and am blessed to have you people for the support you offer/give!!! I need to emphasize that I DO appreciate it very very much!

    I have been reading and have avoided 99% of the negative or horror stories. I understand everyone has their own perspective but I don't enjoy the negativity.

    I have decided that I will give myself about 36 hours give or take, between my last oxy and the induction appt. I will monitor as suggested to make sure I am ready, I start twitching at about 12 hours after my last pill so 36 hrs should put me well into the initial stages of withdrawal. The important thing is, as you have all mentioned, to do it right the first time so you dont have to do it ever again.

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    I am starting to get nervous already. I went thru the nastiest wd 10 yrs ago and my mind keeps remembering that.

    I have been taking 40-60 mg per day of Oxy. I ramped off of MS Contin 45 days ago and realized how attached to these damn pills I really am.

    How much time do I need to allot so that I dont screw up and end up having problems. My appt is 1030 am this coming Monday. If I don't take any Oxy after 1030 on Sunday, will that be enough time? I get really edgy after 4-6 hrs and twitchy after 12 (at the most) I usually walk right over to tthe pill bottle when I first wake up.

    Also, he has me starting on "buprenorphine-naloxone 8-2 MG sublingual film" Monday morning. Will that be the dosage I take daily or?

    Thanks, as always!

    I KNOW I will be on here Sunday unless I can sleep...but I can't sleep all 24 hours, especially if I am twitching!
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    Hello!

    Getting close now. It's a good thing that you got rid of the MS Contin. I think Randy provided you with a link to the COWS worksheet, didn't he? If he didn't, Google it and use it. It will measure your symptoms to be certain you are far enough into withdrawal to safely take your first dose of sub. It's important to reach at least a 26. There is absolutely no way to guess based on time. The tried and true method is the COWS. Please do look for it, print it and then use it.

    I think we also talked a little about the size of the dose the doctor will prescribe. Almost without exception they prescribe doses that are way too high. If your current dose is 40-60 mg of oxy per day, I would be mighty surprised if you needed more than 3 or 4mg/day of the sub and maybe even less than that. I think that Randy also provided you with the link to Robert's Plan so that you know how to properly induct so that you're on the lowest effective dose. Subs are VERY strong and the lower the dose that keeps you well the better you are going to feel. Most doctors will start their patients on 12, 16, 24 or even more mg per day. That's crazy high! Estimates are that subs are approximately 30 times stronger than morphine. Do the math. This is many, many times more than what you're taking now and high doses make a lot of people sick. Please read Robert's Plan and follow that. I think you'll be surprised at how little it takes. I've seen people induct on subs from long histories of 200mg/day of oxy or even "H" and they only need 4-6mg/day. Plenty of people with habits similar to your's only need 2mg of sub. Everyone is somewhat different and that's why it's so important to take it slow. Respect those subs and they'll treat you well. I'm sorry to say that most doctors just don't really understand how they work. It's hard to believe but it's absolutely true. Not their fault. They have never used them and got their training from Big Pharma who wants to keep their sales high by people taking high doses and having to stay on them for a long time. The chemists who developed them haven't used them either. The folks around here speak from real life experience and not from the lab. Please, please listen to the advice you get right here.

    Check in. I'll try to be around Sunday to check on you. Good luck!

    Peace,

    Cat
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    User88 is offline Junior Member
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    Cat, thank you for reminding me. I am concerned.

    Here is why: I have a Dr prescribing me meds and telling me to take that amount, and how do I tell HIM what the correct dose should be?

    I surely don't want to get off on the wrong foot with him but...I don't want to die from OD either.

    (also, I have ADD or similiar and I can't read all that info, it confuses me. so with the nervousness and the overwhelming information, I am scared now)
    Last edited by Anonymous; 08-26-2017 at 02:49 AM.
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    Quote Originally Posted by User88 View Post
    Cat, thank you for reminding me. I am concerned.

    Here is why: I have a Dr prescribing me meds and telling me to take that amount, and how do I tell HIM what the correct dose should be?

    I surely don't want to get off on the wrong foot with him but...I don't want to die from OD either.

    (also, I have ADD or similiar and I can't read all that info, it confuses me. so with the nervousness and the overwhelming information, I am scared now)
    OHHH I'm so sorry! I honestly didn't want to scare you. You don't need to be scared. You won't die of an OD so don't worry about that. Just get that right out of your mind.

    I don't know if you are up to it but what we generally try to tell people is to just listen to their doctors and nod in agreement. Get your script and fill it and then come right back here and we'll help you get on the right track. If you post at least every single day and tell us how you're feeling and follow the advice, you'll be just fine. I never advise people to not listen to their doctors but this is the one exception. If your doctor insists upon giving you your first dose in the office, it's OK. Really! Don't dispute what he tells you. Just go home and let us know how much he gave you or has prescribed and how you're feeling. So long as you get right on track it isn't hard to get you adjusted correctly.

    I wouldn't mention much about you read here or that we're advising you differently than he might. He's a trained physician and we're just a bunch of addicts. Don't worry about the induction process right now if that's making you nervous but please do find and print out the COWS sheet. It's easy to follow. It's a list of withdrawal symptoms and you just need to score each one as they arrive and then add them up. Be honest with your scoring and even be conservative with the numbers you give yourself. If you think you're between a 3 and 4 for example, score the 3. Score yourself again right before you leave for your appointment and if you're not at at 26 or higher, bring the sheet with you and show your doctor that. He may know about the COWS sheet. Most do but not all. I'm sure he'll at least agree with that. Just tell him you were reading up on subs because it's new to you and came across the COWS.

    Take this one step at a time so that you aren't overwhelmed. Stop your oxy like you were going to anyway, use the COWS and keep your appointment. Don't discuss what you're learning here with your doctor. Fill your script and then check in here. That's it for now.

    You're going to be just fine. I know you've had trouble with doctors in the past and you don't want to alienate this one. I don't blame you so just go with the flow and don't disagree with him. Everything is going to be OK.

    Peace,

    Cat
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  19. #19
    Randy35 is offline Platinum Member
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    Quote Originally Posted by User88 View Post
    I am starting to get nervous already. I went thru the nastiest wd 10 yrs ago and my mind keeps remembering that.

    I have been taking 40-60 mg per day of Oxy. I ramped off of MS Contin 45 days ago and realized how attached to these damn pills I really am.

    How much time do I need to allot so that I dont screw up and end up having problems. My appt is 1030 am this coming Monday. If I don't take any Oxy after 1030 on Sunday, will that be enough time? I get really edgy after 4-6 hrs and twitchy after 12 (at the most) I usually walk right over to tthe pill bottle when I first wake up.

    Also, he has me starting on "buprenorphine-naloxone 8-2 MG sublingual film" Monday morning. Will that be the dosage I take daily or?

    Thanks, as always!

    I KNOW I will be on here Sunday unless I can sleep...but I can't sleep all 24 hours, especially if I am twitching!


    Hello!

    You asked if you don't take any Oxy after 10:30 (am/pm?) on Sunday will you be ready for inducttion on Monday at 10:30? Answer: Probably, but you might not be if I'm being 100% honest. That's the exact reason for the Cows. You shouldn't take the chance either. And I'm NOT trying to scare you, I'm speaking from experience. If I were you I would STOP the Oxy a little earlier to be sure.

    I hesitated about giving you that advice, but you asked the question, and I don't want to see you going into precipitated wd's either. I've been there and it's not something you want happening to you. Plenty of people are fine taking the sub after 24 hours, but sometimes it's not enough time. I say why take the chance?

    Remember, the entire point of being able to induct on subs is to be SICK enough in wd's beforehand. It's the hardest part of sub therapy. Everyone goes through this that inducts on subs correctly. You stop the drug of choice in plenty of time before you start taking the Suboxone. The Cows tells you when you're fully ready to take the subs. Just in case you missed it in my last post here's the link to the Cows again....

    https://www.drugabuse.gov/sites/defa...rawalScale.pdf

    Score yourself honestly and accurately. And you may not have all of the symptoms on the Cows either. You are going be to fine.

    Glad the doctor is giving you the film strips. Much easier to cut into smaller doses when you're tapering. We'll help you with that when the time comes.

    The 8-2 Buprenorphine Sublingual Film he's referring to simply means an 8mg Suboxone film strip. The "8" is the amount of Buprenorphine and the "2" is the amount of Naloxone added. Naloxone is added to deter IV addicts from injecting the drug. It will make them extremely sick if they do.

    As Cat said, just do what he says, get your script and come back here. Everything is going to be fine.

    Randy
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  20. #20
    User88 is offline Junior Member
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    Thank you to both of you. Sincerely. I appreciate your help more than you know!

  21. #21
    User88 is offline Junior Member
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    Its rainy and cold here and a great excuse to drive 45 mi round trip for....SUSHI! Want to get good food in my system now so that it's amped up and healthy, going into this fiasco!

  22. #22
    User88 is offline Junior Member
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    well...it's officially at hell stage.

    I am twitching like I have epilepsy (NO offense to anyone) but my body starts jerking and my arrms and legs just fly around. I can't control it. headache, nose running. first time in 10+ yrs I haven't been medicated. Its bad...and then there is the pain, that is screaming at me
    Last edited by Anonymous; 08-27-2017 at 04:08 PM.
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  23. #23
    Catrina is offline Diamond Member
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    Quote Originally Posted by User88 View Post
    well...it's officially at hell stage.

    I am twitching like I have epilepsy (NO offense to anyone) but my body starts jerking and my arrms and legs just fly around. I can't control it. headache, nose running. first time in 10+ yrs I haven't been medicated. Its bad...and then there is the pain, that is screaming at me
    Hang on tight! I know this isn't easy. Take frequent hot baths and remember to drink, drink, DRINK! Water, Gatorade...whatever you like so long as it's caffeine-free. Try heating pad(s) on your legs and back. Stay tuned here and post as much as you can. It just helps. What time is your appointment tomorrow? I know you told us, but I can't recall. You'll feel much, much better once you begin the subs.

    Peace,

    Cat
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  24. #24
    User88 is offline Junior Member
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    1030 cst am

    grrrr

    still twitching and cant sleep

  25. #25
    Randy35 is offline Platinum Member
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    Quote Originally Posted by User88 View Post
    well...it's officially at hell stage.

    I am twitching like I have epilepsy (NO offense to anyone) but my body starts jerking and my arrms and legs just fly around. I can't control it. headache, nose running. first time in 10+ yrs I haven't been medicated. Its bad...and then there is the pain, that is screaming at me

    I'm sorry it's so rough for you right now. As I mentioned previously this is the worst part of sub therapy, and also a necessary part unfortunately. It's almost over, and as Cat said once you get a little sub in you things will improve dramatically. I fully remember exactly what you're feeling right now, but I also remember how good I felt after taking the first and second dose of sub.

    Use Cat's suggestions and post as soon as your appointment is over. Hang in there as best you can. You'll never need to do this again.

    Randy

  26. #26
    User88 is offline Junior Member
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    how bad is kicking sub though?

    I am 1/5 of the way thru wd and might as well stop for good

    thoughts
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    Randy35 is offline Platinum Member
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    Deleted by Randy.
    Last edited by Anonymous; 08-28-2017 at 07:41 AM.

  28. #28
    Catrina is offline Diamond Member
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    Quote Originally Posted by User88 View Post
    how bad is kicking sub though?

    I am 1/5 of the way thru wd and might as well stop for good

    thoughts
    Just checking in. It's always my recommendation to attempt to do this cold turkey if there's anyway that you can get through it. It's doable. I, and many others, have jumped from far higher doses than you're taking but this is very individual. As far as stopping the subs, if you follow Robert's Plan exactly, you shouldn't have a difficult time. The difference is that it MUST be a slow taper to avoid the worst of the withdrawal symptoms. Small (25%) reductions done in regular intervals as outlined in the Plan is the very best way to get it done. I would suspect that you'll only need 2-3mg of subs per day so you could complete the taper in around six weeks. How far you reduce (it should be down to 1/4 of a mg or less per day) will probably determine how you'll fare when you do jump from the subs. Most people that reduce way down to .125 and then do skip days will experience a period of having a bit of trouble sleeping and some lack of energy but the really uncomfortable symptoms are usually avoided. While this is true for most people, it's not true for everyone. Occasionally, there will be folks who have some other minor (very minor) symptoms for a few days but not nearly what you're feeling now.

    This is very individual and until you start the subs, it's hard to guess how you're going to respond but most people who follow the Plan closely feel well throughout their taper. Only rarely do people not respond to the subs well, just like any other drug.

    If you think that you can get thru this cold turkey, I would absolutely advise you to go for it. What you can expect is for your symptoms to peak around the 24-36 hour mark from your last dose of oxy and remain fairly consistent for the next four days or so. Then, the worst of the physical symptoms like restless legs and aches should stop abruptly. What will remain for a little longer are bathroom issues, trouble sleeping, and lack of energy. There will also be the dosing habit that you'll need to break. Whether you are physically dependent or addicted, there are some mental challenges that you'll have to deal with. It's just the way it is but so long as you recognize that for what it is, you'll learn to cope with the cravings and urge to dose. It's tough to avoid that part of it but very much worth it in the end. I should mention too that whether you're able to jump now or do the sub therapy, you'll still have to work on breaking the habit.

    Check in later and let us know if you decide to try and ride out the storm or begin the subs. Some people do go and get their script but will give the cold turkey their best effort and if that doesn't work, we can help you induct the subs. Either way, you'll be beginning your journey. Your choice. Just let us know and we'll be here to help.

    Peace,

    Cat
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  29. #29
    User88 is offline Junior Member
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    t y both very much

  30. #30
    Randy35 is offline Platinum Member
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    Quote Originally Posted by User88 View Post
    t y both very much

    I completely agree with Cat. If you can do this without the subs I say go for it. About a weeks worth of symptoms you can treat with vitamins, supplements, fluids and exercise.. The Thomas Recipe has helped many through it. Here's the link to the recipe below...

    https://www.drugs.com/forum/featured...wal-35169.html

    The recipe does sugggest using a benzo and I would leave that out myself as they are highly addicitve even when used for short periods of time.

    Subs are just a tool to help fight addiction and nothing more. They aren't a magic cure-all. Used correctly they do what they're supposed to do, help the individual off other opiates and get their life in order.

    Cat spoke of the "dosing habit" you'll need to break and for most of us that's one of the most difficult things to do. The habit of obtaining and taking drugs is repeated for years in some cases and we get in a daily routine that's hard to break. It takes work to get past it, but it can be accomplished with some positive energy and willpower.

    Let us know what you decide.

    Randy

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