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Preparing to switch from Fentanyl to Suboxone (Few questions)
  1. #1
    wizard_irl is offline New Member
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    Exclamation Preparing to switch from Fentanyl to Suboxone (Few questions)

    Hi there and and nice to meet everyone,

    I have been a chronic pain patient for several years after a bad accident and am now preparing to switch to Suboxone from Fentanyl. I have previous experience with detoxing, but instead it was 80mg of Oxycodone and I cold turkey'd through it. Boy was that hell!

    Long story short, I was put back onto opiates by a pain specialist a year later and we decided to switch over to Fentanyl since I was experiencing tolerance issues again with Oxy. I am now only prescribed Fentanyl 100mcg 72hrs and we are getting ready to start Suboxone induction.

    I spoke to the Sub doctor and he said that I must wait 36 hours before we start induction with a small dose of Suboxone (1-2mg) to make sure I will not have precipitated withdrawals. From there, he said we will gradually raise the Suboxone to a stable dose.

    From what I have read, both Fentanyl and Suboxone have very strong binding affinity and I want to make sure this is a smooth transition. Below I have just a few questions if any experts out there can help me.

    1.) Does titrating with a very small dose around 36 hours sound like a good idea? According to my doctor, he said I should not be worried AT ALL about withdrawals if we start the Suboxone at a very low dose.

    2.) What is the true reality of how miserable this induction will be?

    3.) How much time will be needed from when I remove the patch until I am completely stable again on Suboxone?

    4.) I will have on hand Xanax, Valium, Gabapentin, Clonidine and Zofran to help me get through the 36 hours. Any other recommendations?

    Thank you all for reading my post and hopefully replying. I am very excited to get off the Fentanyl and switch to Suboxone and want it to be as pleasant as I possibly can make it. If anyone could chime in with some tips or advice, I would greatly appreciate it. Cheers!
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  2. #2
    Catrina is offline Diamond Member
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    Quote Originally Posted by wizard_irl View Post
    Hi there and and nice to meet everyone,

    I have been a chronic pain patient for several years after a bad accident and am now preparing to switch to Suboxone from Fentanyl. I have previous experience with detoxing, but instead it was 80mg of Oxycodone and I cold turkey'd through it. Boy was that hell!

    Long story short, I was put back onto opiates by a pain specialist a year later and we decided to switch over to Fentanyl since I was experiencing tolerance issues again with Oxy. I am now only prescribed Fentanyl 100mcg 72hrs and we are getting ready to start Suboxone induction.

    I spoke to the Sub doctor and he said that I must wait 36 hours before we start induction with a small dose of Suboxone (1-2mg) to make sure I will not have precipitated withdrawals. From there, he said we will gradually raise the Suboxone to a stable dose.

    From what I have read, both Fentanyl and Suboxone have very strong binding affinity and I want to make sure this is a smooth transition. Below I have just a few questions if any experts out there can help me.

    1.) Does titrating with a very small dose around 36 hours sound like a good idea? According to my doctor, he said I should not be worried AT ALL about withdrawals if we start the Suboxone at a very low dose.

    2.) What is the true reality of how miserable this induction will be?

    3.) How much time will be needed from when I remove the patch until I am completely stable again on Suboxone?

    4.) I will have on hand Xanax, Valium, Gabapentin, Clonidine and Zofran to help me get through the 36 hours. Any other recommendations?

    Thank you all for reading my post and hopefully replying. I am very excited to get off the Fentanyl and switch to Suboxone and want it to be as pleasant as I possibly can make it. If anyone could chime in with some tips or advice, I would greatly appreciate it. Cheers!
    Welcome!

    Well. First I have to say that the instructions and advice your doctor gave to you isn't as bad as some do but it's still not the best advice. All a physician has to do to become certified as a sub specialist is to take an eight hour online course that is given by....you guessed it....Big Pharma. I'm not a conspiracy theorist so if that's what you're beginning to think, that's not at all the case. My experience comes right from this Forum from reading and paying attention and then helping others begin their sub therapy. I'd recommend that you read some threads so that you become as familiar as you can with sub. In a nutshell, it's a partial agonist so it has opiate properties and its half life is very long. That's both the good news and the bad news, I suppose. If you do read other stories and they begin to scare you, move on. The people who have trouble are those who begin too soon after their last dose of whatever opiate they are taking, begin by taking too much, and/or stay on them for too long. May I ask, are you switching to subs for pain control or to begin a taper plan to get off narcotics all together? If it is for pain control, I'm sorry to report that it's a poor choice for that. They just don't work well for pain. If you intend to begin a taper, then you've come to the right place. Either way, Robert's Sub Taper Plan that is used here has proven successful for thousands of folks and I've witnessed many, many of them myself. I would suggest that you look for and read the Plan carefully until you fully understand it. Even if your plan is to stay on them with the hope they control your pain, the induction part of the plan is very important and will help you. If you have questions, ask away and someone will gladly answer them for you.

    The second very important thing that you should find, read and then use is the COWS. It's a worksheet that you should use once you stop the Fentanyl. The score sheet assigns a number for each of the typical withdrawal symptoms. As the symptoms begin to appear, you give yourself a score for each symptom. You may not experience all of them but you will likely experience most of them. Here's the MOST important part. You need to score yourself honestly and accurately and wait until you reach a score of 26 or higher. If you take your first dose of sub sooner than that, there's a real danger of putting yourself into precipitated withdrawals for which there is absolutely no solution except to wait for it to pass and those who have experienced this report without exception that it is the worst thing they have ever gone through. This is not to scare you needlessly, it's a very important warning so please do heed it. Everyone is different so the time they need before they can safely take their first dose of sub differs. Don't ever rely upon the time that's passed but use the COWS instead. It's fool proof.

    Before any of your symptoms appear, divide your tablet or strip (whichever you have been given) into small doses. You should have one piece that's .5mg (1/2mg) and divide the remainder into pieces that are .25mg (1/4mg). I know it seems impossible to cut them that small but you can do it. Be sure to note the size of each tablet/strip. They'll probably be 8mg each but they do have different strengths. If you need help with that, just ask and someone will give you some tips.

    Once you reach a 26 on the COWS, you'll be ready to begin your induction. Take the .5mg piece, put it under your tongue and let it dissolve completely. Don't eat or drink anything for a bit after you've taken it so that you don't lose any. Wait one hour. If you still have symptoms, then take one of the .25mg pieces and wait another hour. Repeat this process until your symptoms are gone. We call this becoming stable. Make note of how much you had to take and that is your beginning dose. I'm sure you're going to need more than that first .5mg but this is the best way to find the lowest effective dose and in the unfortunate instance where someone does accidentally take it too soon, it will hopefully take you less time to begin to feel better. Subs are incredibly strong estimated at 30 times stronger than morphine. Taking a dose that's too high just might make you sick and at the very least, unlike ordinary opiates, less is more--the lower your effective dose, the better you're going to feel. Because of the long half life, It's much easier to increase your dose until you are stable than to reduce it if you did take too much.

    Please let us know if it's your intent to taper and be done with all opiates or if you are going to use them hoping to get pain relief. Once again, because of the long half life and the fact that it is also a partial antagonist which blocks the euphoric effect of the opiate, it they don't control your pain the longer you take them, the longer it will take you to switch back to ordinary opiates and get their full effect. Subs stack which means that they will continue to build in your system each day you take them. Say for instance that you begin with a daily dose of 2mg. On Day 2, you take another 2mg. You still have more than half from your dose on Day 1 or a total of at least 3mg. Day 3, you take another 2mg and you have perhaps .5 (or more) from Day 1, 1mg (or more) from Day 2 and the 2mg you took that day for a total of 3.5 and it just keeps building like that. Maybe an easier way for you to understand is that with a short acting opiate, you would test clean for narcotics in about 3 days. After taking subs for just a few days, you would test positive at least two or three weeks out. That's a big difference.

    Please post again soon to let us know your goal in switching to subs. That will help us to give you good advice on how to move forward but the information I just provided applies regardless of what your goal is. Find and read Robert's Plan because it will help you. One other important point is that once you find your lowest effective dose, be consistent both in the amount you take every day and the time of day you take it. You can either dose once a day or split your dose in half and take one dose in the morning and the other half about 10 hours later. Just don't take it too close to bedtime because for some people, it interferes with their sleep.

    Welcome again! Hope I see you post soon.

    Peace,

    Cat
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  3. #3
    Catrina is offline Diamond Member
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    Geez I forgot to add that while you are waiting to take your first dose, avoid all comfort meds including aspirin, Advil and all the prescription drugs you mentioned. They will delay your symptoms causing you to have to wait longer before you're ready to induct. Your goal, as mean as it may sound, is to get as sick as you can get as quickly as you can. You should begin to feel better even after that first little piece of sub.

    Peace,

    Cat
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  4. #4
    wizard_irl is offline New Member
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    Hi Catrina!

    Thank you so much for the thorough reply to my post. It is a great feeling to know there are people out there like yourself who are willing to take time out of their day to lend out a helping hand. I went ahead and researched Roberts plan, the COWS worksheet, and certain points you brought up and have a better understanding now of how this will play out.

    To answer your question, I have been prescribed Fentanyl for roughly 9 months due to being diagnosed with neuropathy; it hurts, a lot. With that being said though, the goal of Suboxone is to make me stop taking ALL opioids because I just can't do this cyclical routine anymore. HOWEVER, I would like to be stable on Suboxone at as low of a dose as possible for maybe a month or two since I just honestly need some relief and normalcy back into my life. From there, I would like to proceed with a gradual taper.

    This is where I am getting slightly confused though. Is it possible to be stable on a very low dose of maybe... 4mg or so for 1-2 months before I begin to taper? Also, I am prescribed monthly to Xanax and Valium which I have taken for years. I don't think it would be possible for me to stop them abruptly as this could lead to benzo sickness/early WD. That being said, I can obviously not use Gabapentin, Clonidine and Zofran as a crutch if I need to make myself truly sick. What are your thoughts regarding this? What are your thoughts about staying on Suboxone for a short period before weaning for the sake of my own sanity? Also, is titrating from .5mg versus 1mg a really big difference or is it strictly to make sure I do not end up in precipitated withdrawal? I have spoken to several Sub doctors and you are right, 75% of the referrals I spoke to want to start me on 8-16mg right off the bat versus the person I will be seeing who understands induction/titrating with low doses.

    I do have to say that you are 100% correct about reading people's horror stories about this exact transition and it has led me to be anxious and nervous which was why I originally reached out. I really do not know what to expect since I only have experience with cold turkeying from Oxycodone 80mg and that was pure hell for 5-7 days, and maybe 2 months of lethargy/depression.

    Thank you again Catrina for the thorough reply and I hope this answered most of your questions. My apologies for the late response but I wanted to do plenty of research before I replied to you.

    I hope to hear back from you soon and wish you all the best as well. Please let me know what your thoughts are regarding the few questions I outlined above. Thank you so much!

    -B
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  5. #5
    wizard_irl is offline New Member
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    Quote Originally Posted by Catrina View Post
    Geez I forgot to add that while you are waiting to take your first dose, avoid all comfort meds including aspirin, Advil and all the prescription drugs you mentioned. They will delay your symptoms causing you to have to wait longer before you're ready to induct. Your goal, as mean as it may sound, is to get as sick as you can get as quickly as you can. You should begin to feel better even after that first little piece of sub.

    Peace,

    Cat
    Cat,

    I understand now the idea of being truly sick to accurately rate myself on COWS, but IF there is a time requirement which seems to be pretty strict of 36-60 hours, why can I not use "comfort medicines" if I wait that long to begin the induction? My apologies for not including this in my first reply. Talk to you soon.

    -B
    Last edited by Anonymous; 09-12-2017 at 11:51 AM.

  6. #6
    Randy35 is offline Platinum Member
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    Quote Originally Posted by wizard_irl View Post
    Hi Catrina!

    Thank you so much for the thorough reply to my post. It is a great feeling to know there are people out there like yourself who are willing to take time out of their day to lend out a helping hand. I went ahead and researched Roberts plan, the COWS worksheet, and certain points you brought up and have a better understanding now of how this will play out.

    To answer your question, I have been prescribed Fentanyl for roughly 9 months due to being diagnosed with neuropathy; it hurts, a lot. With that being said though, the goal of Suboxone is to make me stop taking ALL opioids because I just can't do this cyclical routine anymore. HOWEVER, I would like to be stable on Suboxone at as low of a dose as possible for maybe a month or two since I just honestly need some relief and normalcy back into my life. From there, I would like to proceed with a gradual taper.

    This is where I am getting slightly confused though. Is it possible to be stable on a very low dose of maybe... 4mg or so for 1-2 months before I begin to taper? Also, I am prescribed monthly to Xanax and Valium which I have taken for years. I don't think it would be possible for me to stop them abruptly as this could lead to benzo sickness/early WD. That being said, I can obviously not use Gabapentin, Clonidine and Zofran as a crutch if I need to make myself truly sick. What are your thoughts regarding this? What are your thoughts about staying on Suboxone for a short period before weaning for the sake of my own sanity? Also, is titrating from .5mg versus 1mg a really big difference or is it strictly to make sure I do not end up in precipitated withdrawal? I have spoken to several Sub doctors and you are right, 75% of the referrals I spoke to want to start me on 8-16mg right off the bat versus the person I will be seeing who understands induction/titrating with low doses.

    I do have to say that you are 100% correct about reading people's horror stories about this exact transition and it has led me to be anxious and nervous which was why I originally reached out. I really do not know what to expect since I only have experience with cold turkeying from Oxycodone 80mg and that was pure hell for 5-7 days, and maybe 2 months of lethargy/depression.

    Thank you again Catrina for the thorough reply and I hope this answered most of your questions. My apologies for the late response but I wanted to do plenty of research before I replied to you.

    I hope to hear back from you soon and wish you all the best as well. Please let me know what your thoughts are regarding the few questions I outlined above. Thank you so much!

    -B


    Hello B -

    I'm Randy and it's nice to meet you! Cat and I work closely together helping those in need around here along with many, many others. I spent nearly 18 years addicted to every drug on earth (and I mean everything!) before going on methadone. Horrible drug in my opinion. I eventually made the switch to Suboxone and without a doubt it saved this guys life. I tapered off using the brunt of Robert's plan and now have over 3 years clean. I remain clean by involving myself in NA a those meds.nd AA support meetings.

    To answer your question about the benzo's (Xanax - Valium) you're taking.....You're so right, you NEVER want to stop those abruptly as that can be extremely dangerous. Benzo wd's are much worse than opiate wd's and can actually be deadly. I've been down that road too. Nearly died twice messing around with benzo's. So don't stop them while you're waitng to score on the Cows. They probably will have some effect on your score and it MAY take a bit longer than it normally would if you weren't on them. What you might want to do is take LESS than you normally would until the induction is over then resume your normal dose afterwards. Take as little of both as you can without getting too sick from benzo wd's. That's what I would anyway.

    As for remaining on the Suboxone a little longer....I personally see nothing wrong with this so long as it's not too long. Robert's plan takes around 6-8 weeks from induction to final jump give or take a week or so depending on the individual. That's usually enough time for most people. For me that wasn't long enough. I spent nearly 9 months on the sub and I truly needed that time to get addictive thoughts and behavioirs out of my head. I think everyone should stay on Suoxone until they too are past the urge to use everyday opiates. So if you want to stay on the sub a month or two I see no real issue with that personally. Just so you know, it's entirely possible to become dependent, even addictied to the subs if long term use is taken.

    You've done a great job on researching/educating yourself before you go o the subs. Wish more people would do that. I believe you will do great! I'm not here as much as I once was, but I'll check back and follow your progress. Take care.

    Randy
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  7. #7
    Catrina is offline Diamond Member
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    Quote Originally Posted by wizard_irl View Post
    Hi Catrina!

    Thank you so much for the thorough reply to my post. It is a great feeling to know there are people out there like yourself who are willing to take time out of their day to lend out a helping hand. I went ahead and researched Roberts plan, the COWS worksheet, and certain points you brought up and have a better understanding now of how this will play out.

    To answer your question, I have been prescribed Fentanyl for roughly 9 months due to being diagnosed with neuropathy; it hurts, a lot. With that being said though, the goal of Suboxone is to make me stop taking ALL opioids because I just can't do this cyclical routine anymore. HOWEVER, I would like to be stable on Suboxone at as low of a dose as possible for maybe a month or two since I just honestly need some relief and normalcy back into my life. From there, I would like to proceed with a gradual taper.

    This is where I am getting slightly confused though. Is it possible to be stable on a very low dose of maybe... 4mg or so for 1-2 months before I begin to taper? Also, I am prescribed monthly to Xanax and Valium which I have taken for years. I don't think it would be possible for me to stop them abruptly as this could lead to benzo sickness/early WD. That being said, I can obviously not use Gabapentin, Clonidine and Zofran as a crutch if I need to make myself truly sick. What are your thoughts regarding this? What are your thoughts about staying on Suboxone for a short period before weaning for the sake of my own sanity? Also, is titrating from .5mg versus 1mg a really big difference or is it strictly to make sure I do not end up in precipitated withdrawal? I have spoken to several Sub doctors and you are right, 75% of the referrals I spoke to want to start me on 8-16mg right off the bat versus the person I will be seeing who understands induction/titrating with low doses.

    I do have to say that you are 100% correct about reading people's horror stories about this exact transition and it has led me to be anxious and nervous which was why I originally reached out. I really do not know what to expect since I only have experience with cold turkeying from Oxycodone 80mg and that was pure hell for 5-7 days, and maybe 2 months of lethargy/depression.

    Thank you again Catrina for the thorough reply and I hope this answered most of your questions. My apologies for the late response but I wanted to do plenty of research before I replied to you.

    I hope to hear back from you soon and wish you all the best as well. Please let me know what your thoughts are regarding the few questions I outlined above. Thank you so much!

    -B

    Good job doing your research. Few people do and those are usually the ones who get themselves in a bit of a spot with subs. Respect them and use them correctly and you won't have any horror stories. Don't be nervous or scared. Just be diligent in following Robert's Plan and you'll be fine.

    Thanks for the additional info. I'm glad that you are deciding to get off opiates all together. That really is the smart thing to do. To answer your question related to this, there is nothing wrong with becoming stable on as as low a dose as possible and to remain there for a few weeks. Just don't become too complacent and plan to begin your taper as soon as you feel you're ready. The sooner the better.

    Because you've had scripts and been taking benzos for some time, you are absolutely correct that you should NOT stop those abruptly. Doing so is not only uncomfortable, it's dangerous. So, while you're waiting to induct after having your last dose of the Fentynal, stop all of your comfort meds except for the benzo but try to take them as sparingly as possible.

    It is better to begin your induction with as small a dose as possible both just in case you have an adverse reaction or precipitated withdrawal and also because you want to be on the LOWEST effective dose. I think you're going to be surprised at how little you may need. Everyone is different so there's just no accurate way to guess where you might land. I've seen folks come here coming off "H" or insane amounts of oxy and they get stable on 2mg of sub per day while others who seem to be at the lower end of the spectrum need 4. Only occasionally do we see folks who need 6mg and almost never more than that. Having said that, you can see why it's important to start with small doses because it's the only way to land where you need to be. Even after you take the first dose, you will begin to feel better so it's worth being patient for just a few hours. This is the hardest part but as my friend Randy says, "Do it right the first time and you will never have to do it again". It's pretty common to not feel the full brunt of the symptoms the first day and your COWS score to be really low but most often once the symptoms begin in earnest, they escalate pretty quickly. That's why it's important to not take any comfort meds that will slow things down. In your case, you're stuck with the xanex but like I said, do your best.

    When are you planning on beginning the subs? It's really helpful to stay close to this Forum leading up to inducting and then daily with updates. It keeps you keep in touch with others traveling the same road as you are and you can share concerns, tips, or just enjoy the fellowship and community.

    It sounds like you found one of the good sub doctors. We don't see that often unfortunately. We usually suggest that you listen to your doctor and eagerly nod in agreement. Get your script and get out of there. Then, follow the program used here. Doctors frown on patients taking the advice of a bunch of addicts. I don't understand why!! lol The truth is, that I've been around here long enough that I'd trust the advice I get here any day of the week. No one will lead you wrong and the information here is based on experience as opposed to books. You'll probably have lots of extra sub but that's OK. Just keep going to see your doctor when you're supposed to go and stockpile the extra sub. Do you know if he's going to make you take your first dose in the office? Some doctors do that. If he does, score yourself on the COWS before your appointment and if you are not a 26, bring the sheet with you. I'm sure he's familiar with the COWS. If he insists on you taking the first dose there, and it's more than the .5mg piece, don't worry too much about it. Go home and jump on here and you'll get help to get you get on track,

    Keep posting! You're going to do great.

    Peace,

    Cat
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  8. #8
    wizard_irl is offline New Member
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    Quote Originally Posted by Randy35 View Post
    Hello B -

    I'm Randy and it's nice to meet you! Cat and I work closely together helping those in need around here along with many, many others. I spent nearly 18 years addicted to every drug on earth (and I mean everything!) before going on methadone. Horrible drug in my opinion. I eventually made the switch to Suboxone and without a doubt it saved this guys life. I tapered off using the brunt of Robert's plan and now have over 3 years clean. I remain clean by involving myself in NA a those meds.nd AA support meetings.

    To answer your question about the benzo's (Xanax - Valium) you're taking.....You're so right, you NEVER want to stop those abruptly as that can be extremely dangerous. Benzo wd's are much worse than opiate wd's and can actually be deadly. I've been down that road too. Nearly died twice messing around with benzo's. So don't stop them while you're waitng to score on the Cows. They probably will have some effect on your score and it MAY take a bit longer than it normally would if you weren't on them. What you might want to do is take LESS than you normally would until the induction is over then resume your normal dose afterwards. Take as little of both as you can without getting too sick from benzo wd's. That's what I would anyway.

    As for remaining on the Suboxone a little longer....I personally see nothing wrong with this so long as it's not too long. Robert's plan takes around 6-8 weeks from induction to final jump give or take a week or so depending on the individual. That's usually enough time for most people. For me that wasn't long enough. I spent nearly 9 months on the sub and I truly needed that time to get addictive thoughts and behavioirs out of my head. I think everyone should stay on Suoxone until they too are past the urge to use everyday opiates. So if you want to stay on the sub a month or two I see no real issue with that personally. Just so you know, it's entirely possible to become dependent, even addictied to the subs if long term use is taken.

    You've done a great job on researching/educating yourself before you go o the subs. Wish more people would do that. I believe you will do great! I'm not here as much as I once was, but I'll check back and follow your progress. Take care.

    Randy
    Hi Randy!

    It is a pleasure meeting you too and I have actually been reading some of your replies to others for a couple weeks now. The input you have given others has really put my mindset at ease versus reading a few horror stories which made me start thinking about this in a much more respectful manner. I figured this was the case with benzos and I do know how serious it can be to abruptly stop taking them. Thank you as well for outlining the fact that I can be stable of Suboxone at a low dose for a couple months to finally feel alive and back to normal before I begin to taper. The stress I have been going through recently regarding all of this is absolutely insane.

    To make a long story short, I have severe degeneration in my spine and also diagnosed with neuropathy. My pain levels are typically a true 8/10 on a daily basis WITH the Fentanyl so this was primarily the reasoning for wanting to stop, on top of the fact that I want to free myself from the opioid demon that just impedes on my daily life.

    Also, thank you for your input on the Xanax/Valium as I figured that was the case. I actually know quite a bit about pharmacology from years of doing research so I understand to a certain level about half life's, receptors, binding affinity and so forth but I do know that this particular transition is very sensitive.

    Quick question though, since it seems to be a standard that you need 48-60 hours for the transdermal patches to wear off before starting induction, why would it be a problem to try and use "comfort medicines" (besides my benzos) if it will just help the waiting period to be smoother? I do understand this could effect the COWS worksheet, but it almost seems that just waiting enough time to let the half life wear out is the true mark of starting the induction. Both Catrina and Robert mentioned that I want to make myself as sick as possible, but if I am waiting for 2-3 days to start with comfort meds, I don't understand why this would be an issue.

    When I cold turkey'd off of the Oxy, I used Gabapentin and it truly did help. I am just confused why I can't make it a pleasant experience if I am waiting for the half life to slowly dissipate. If you could chime in to the above paragraph about these questions it would be very helpful.

    Thank you again Randy for reaching out and it is a blessing to know that my support system extends out to a wonderful community of people who truly want the best for others. I have been actively reading your posts on other threads and they have comforted me quite a bit. It is nice to know that you are here as well for my upcoming journey and I commend you for being clean this long after your previous history. Nice job! My goal is to be in the position you are and reach out to others and let them know that they CAN change their life around with willpower and a strong support system.

    Hope to hear back from you soon and again it is a pleasure meeting you.

    All the best,

    -B
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  9. #9
    Randy35 is offline Platinum Member
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    Quote Originally Posted by wizard_irl View Post
    Hi Randy!

    It is a pleasure meeting you too and I have actually been reading some of your replies to others for a couple weeks now. The input you have given others has really put my mindset at ease versus reading a few horror stories which made me start thinking about this in a much more respectful manner. I figured this was the case with benzos and I do know how serious it can be to abruptly stop taking them. Thank you as well for outlining the fact that I can be stable of Suboxone at a low dose for a couple months to finally feel alive and back to normal before I begin to taper. The stress I have been going through recently regarding all of this is absolutely insane.

    To make a long story short, I have severe degeneration in my spine and also diagnosed with neuropathy. My pain levels are typically a true 8/10 on a daily basis WITH the Fentanyl so this was primarily the reasoning for wanting to stop, on top of the fact that I want to free myself from the opioid demon that just impedes on my daily life.

    Also, thank you for your input on the Xanax/Valium as I figured that was the case. I actually know quite a bit about pharmacology from years of doing research so I understand to a certain level about half life's, receptors, binding affinity and so forth but I do know that this particular transition is very sensitive.

    Quick question though, since it seems to be a standard that you need 48-60 hours for the transdermal patches to wear off before starting induction, why would it be a problem to try and use "comfort medicines" (besides my benzos) if it will just help the waiting period to be smoother? I do understand this could effect the COWS worksheet, but it almost seems that just waiting enough time to let the half life wear out is the true mark of starting the induction. Both Catrina and Robert mentioned that I want to make myself as sick as possible, but if I am waiting for 2-3 days to start with comfort meds, I don't understand why this would be an issue.

    When I cold turkey'd off of the Oxy, I used Gabapentin and it truly did help. I am just confused why I can't make it a pleasant experience if I am waiting for the half life to slowly dissipate. If you could chime in to the above paragraph about these questions it would be very helpful.

    Thank you again Randy for reaching out and it is a blessing to know that my support system extends out to a wonderful community of people who truly want the best for others. I have been actively reading your posts on other threads and they have comforted me quite a bit. It is nice to know that you are here as well for my upcoming journey and I commend you for being clean this long after your previous history. Nice job! My goal is to be in the position you are and reach out to others and let them know that they CAN change their life around with willpower and a strong support system.

    Hope to hear back from you soon and again it is a pleasure meeting you.

    All the best,

    -B


    Good Morning!

    Lets see if I can answer your question...

    As Cat previously mentioned, it's important and necessary to be as sick as possible in wd's from the Fentanyl before starting the Suboxone. Seeing as we're all different, and the half life of any drug can be different for each of us, it may take me 10-12 hours for the Fentanyl to be completely out of my system and ready to induct on the subs and it may take you a while longer, and may take someone else even longer. Metabolism's differ between all of us and can vary depending on our physical condition, fluid intake, exercise level, food consumption and other factors.

    I understand you want relief from wd's in the way of "comfort meds" while you're waiting to induct on the subs, but this most definitely will affect the Cows score by delaying any progress you've made towards that goal. And make you suffer longer than necessary.

    In other words you MIGHT have been ready for the sub induction at 12 hours after stopping the Fentanyl as an example. But if you take any comfort meds you might not be ready until the 24th hour. Or you could have been able to induct after waiting 24 hours, but the comfort meds taken could put off the induction another 12 hours or more. Does that make sense?

    Bottom line: the Fentanyl half lfie is different for all of us. Just as the Suboxone is also different. Suboxone has a half life between 24 and 72 hours. The mean or average half life is around 37 hours.

    I would continue taking the Xanax and Valium sparingly while waiting to induct and leave the Gabapentin and any other med or supplement that could make you "feel better" alone until after the sub induction is complete. The benzo's alone will most likely have an effect delaying your Cows score (hopefully not, but probable) but if you add in Gabapentin it will make the waiting worse, and longer. I know plenty of people that have delayed their getting to the 26 on the Cows by taking things like Tylenol, Motrin, Aspirin, etc.

    As for those horror stories where Suboxone is concerned....They are always for the same reasons....
    On way too much sub.
    On sub way too long.
    Improper induction.
    Tapering way too fast.
    Tapering by too many mgs.
    Jumping from too high of a dose.

    Those are the main reasons. Robert's sub plan has produced thousands of success stories from those that follow his plan closely. Most of those don;t stick around here because they received the help they were searching for. They are now living their lives clean and free and no longer feel the need to continue posting here. Once in a while one of those members pop in and let us know how well they're doing.

    I have no doubt you'll be another success story too!

    Randy
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  10. #10
    wizard_irl is offline New Member
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    Quote Originally Posted by Catrina View Post
    Good job doing your research. Few people do and those are usually the ones who get themselves in a bit of a spot with subs. Respect them and use them correctly and you won't have any horror stories. Don't be nervous or scared. Just be diligent in following Robert's Plan and you'll be fine.

    Thanks for the additional info. I'm glad that you are deciding to get off opiates all together. That really is the smart thing to do. To answer your question related to this, there is nothing wrong with becoming stable on as as low a dose as possible and to remain there for a few weeks. Just don't become too complacent and plan to begin your taper as soon as you feel you're ready. The sooner the better.

    Because you've had scripts and been taking benzos for some time, you are absolutely correct that you should NOT stop those abruptly. Doing so is not only uncomfortable, it's dangerous. So, while you're waiting to induct after having your last dose of the Fentynal, stop all of your comfort meds except for the benzo but try to take them as sparingly as possible.

    It is better to begin your induction with as small a dose as possible both just in case you have an adverse reaction or precipitated withdrawal and also because you want to be on the LOWEST effective dose. I think you're going to be surprised at how little you may need. Everyone is different so there's just no accurate way to guess where you might land. I've seen folks come here coming off "H" or insane amounts of oxy and they get stable on 2mg of sub per day while others who seem to be at the lower end of the spectrum need 4. Only occasionally do we see folks who need 6mg and almost never more than that. Having said that, you can see why it's important to start with small doses because it's the only way to land where you need to be. Even after you take the first dose, you will begin to feel better so it's worth being patient for just a few hours. This is the hardest part but as my friend Randy says, "Do it right the first time and you will never have to do it again". It's pretty common to not feel the full brunt of the symptoms the first day and your COWS score to be really low but most often once the symptoms begin in earnest, they escalate pretty quickly. That's why it's important to not take any comfort meds that will slow things down. In your case, you're stuck with the xanex but like I said, do your best.

    When are you planning on beginning the subs? It's really helpful to stay close to this Forum leading up to inducting and then daily with updates. It keeps you keep in touch with others traveling the same road as you are and you can share concerns, tips, or just enjoy the fellowship and community.

    It sounds like you found one of the good sub doctors. We don't see that often unfortunately. We usually suggest that you listen to your doctor and eagerly nod in agreement. Get your script and get out of there. Then, follow the program used here. Doctors frown on patients taking the advice of a bunch of addicts. I don't understand why!! lol The truth is, that I've been around here long enough that I'd trust the advice I get here any day of the week. No one will lead you wrong and the information here is based on experience as opposed to books. You'll probably have lots of extra sub but that's OK. Just keep going to see your doctor when you're supposed to go and stockpile the extra sub. Do you know if he's going to make you take your first dose in the office? Some doctors do that. If he does, score yourself on the COWS before your appointment and if you are not a 26, bring the sheet with you. I'm sure he's familiar with the COWS. If he insists on you taking the first dose there, and it's more than the .5mg piece, don't worry too much about it. Go home and jump on here and you'll get help to get you get on track,

    Keep posting! You're going to do great.

    Peace,

    Cat
    Hi Cat!

    Thank you for following up again with me. Between you and Randy I have a much better feeling of the induction and the critical components to start Suboxone treatment. I think for now, I am going to follow Robert's guide even though my PCP says that it will take more than 4mg to keep me stable, but he is also NOT that familiar with Suboxone treatment/induction versus my actual Suboxone doctor. That being said, it seems to be the general rule that I SHOULD find myself stable at 4mg after a few days.

    I am supposed to begin my Suboxone treatment on September 30th, however I have a wedding to attend on October 7th and I'm not sure this is adequate time to stabilize on the Subs before the wedding.

    What are your thoughts on this? How long does it typically take from when I begin induction until I start feeling "normal" again? Will 8 days be enough or should I potentially call my Sub doctor and push the appointment back until I return on the 9th? I am not sure if he will dose me upon my first visitation but instead give me a 2 week supply and then follow up with him again. I basically need a timeframe at this point from the period I begin induction to when I am stable and well on Subs. If you have any input on this please let me know.

    I will also follow the guidelines from what you, Randy, and Robert have said regarding comfort meds aside from the benzos I take on a monthly basis. I will keep updating you along the way until I begin W/Ding, induction, and start titrating. I am so thankful to have found you and Randy in my thread which has REALLY set my mind at ease, minus the fact of knowing how sick I am going to be. I just don't want my partner to see me in fetal position while screaming/puking/and potentially having bowel movements unintentionally. This is all new to her and I am old enough (30) to be able to put myself in her position and know how scary a sight like that can be.

    Thank you again Cat for the reply and answering my questions. I think I am getting closer to finally feeling "comfortable" with this induction period.

    Hope to hear back from you soon!

    Best wishes,

    -B
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  11. #11
    wizard_irl is offline New Member
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    Quote Originally Posted by Randy35 View Post
    Good Morning!

    Lets see if I can answer your question...

    As Cat previously mentioned, it's important and necessary to be as sick as possible in wd's from the Fentanyl before starting the Suboxone. Seeing as we're all different, and the half life of any drug can be different for each of us, it may take me 10-12 hours for the Fentanyl to be completely out of my system and ready to induct on the subs and it may take you a while longer, and may take someone else even longer. Metabolism's differ between all of us and can vary depending on our physical condition, fluid intake, exercise level, food consumption and other factors.

    I understand you want relief from wd's in the way of "comfort meds" while you're waiting to induct on the subs, but this most definitely will affect the Cows score by delaying any progress you've made towards that goal. And make you suffer longer than necessary.

    In other words you MIGHT have been ready for the sub induction at 12 hours after stopping the Fentanyl as an example. But if you take any comfort meds you might not be ready until the 24th hour. Or you could have been able to induct after waiting 24 hours, but the comfort meds taken could put off the induction another 12 hours or more. Does that make sense?

    Bottom line: the Fentanyl half lfie is different for all of us. Just as the Suboxone is also different. Suboxone has a half life between 24 and 72 hours. The mean or average half life is around 37 hours.

    I would continue taking the Xanax and Valium sparingly while waiting to induct and leave the Gabapentin and any other med or supplement that could make you "feel better" alone until after the sub induction is complete. The benzo's alone will most likely have an effect delaying your Cows score (hopefully not, but probable) but if you add in Gabapentin it will make the waiting worse, and longer. I know plenty of people that have delayed their getting to the 26 on the Cows by taking things like Tylenol, Motrin, Aspirin, etc.

    As for those horror stories where Suboxone is concerned....They are always for the same reasons....
    On way too much sub.
    On sub way too long.
    Improper induction.
    Tapering way too fast.
    Tapering by too many mgs.
    Jumping from too high of a dose.

    Those are the main reasons. Robert's sub plan has produced thousands of success stories from those that follow his plan closely. Most of those don;t stick around here because they received the help they were searching for. They are now living their lives clean and free and no longer feel the need to continue posting here. Once in a while one of those members pop in and let us know how well they're doing.

    I have no doubt you'll be another success story too!

    Randy
    Hey Randy!

    Hope you are having a nice day today and my apologies for the delayed reply as I was busy last night I understand now how important the COWS worksheet is and truly making myself sick, which I now feel comfortable with and have a rough idea of how I will be feeling during the W/D. As far as the benzos are concerned, I am prescribed a pretty high dose of Xanax and Valium (4mg, 30mg) and without taking them I experience rather severe tremors and anxiety through the roof. I know this will impact the COWS worksheet to a certain degree but I will try my best to cut my doses in half during the W/D and induction phase.

    You are absolutely correct about the above variables you mentioned about the horror stories, and those are exactly what I was reading that scared me enough to reach out to the community.

    I will make sure to keep you updated along the way and also stay very close to the forum during my transition. How long do you think it will take until I feel stable on Suboxone after I begin induction. As I mentioned to Cat, I have a wedding to attend to on October 7th and am expected to see the Sub doctor on September 30th. Is this adequate time to be stable on subs so I can attend the wedding, or should I push back my appointment until the day I return from the wedding. I am having a hard time researching how long it will be until I am stable on Subs once induction begins.

    I hope all of this was clear and to the point, and if you have input regarding the above I would greatly appreciate it. I plan to be active on the forum after I am stable, weaned off, and have the knowledge to lend out a helping hand if I ever see people who need help! It is a great feeling to know that this community cares so much to help others and returning the gesture is the least I can do.

    All the best,

    -B
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  12. #12
    Randy35 is offline Platinum Member
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    Quote Originally Posted by wizard_irl View Post
    Hey Randy!

    Hope you are having a nice day today and my apologies for the delayed reply as I was busy last night I understand now how important the COWS worksheet is and truly making myself sick, which I now feel comfortable with and have a rough idea of how I will be feeling during the W/D. As far as the benzos are concerned, I am prescribed a pretty high dose of Xanax and Valium (4mg, 30mg) and without taking them I experience rather severe tremors and anxiety through the roof. I know this will impact the COWS worksheet to a certain degree but I will try my best to cut my doses in half during the W/D and induction phase.

    You are absolutely correct about the above variables you mentioned about the horror stories, and those are exactly what I was reading that scared me enough to reach out to the community.

    I will make sure to keep you updated along the way and also stay very close to the forum during my transition. How long do you think it will take until I feel stable on Suboxone after I begin induction. As I mentioned to Cat, I have a wedding to attend to on October 7th and am expected to see the Sub doctor on September 30th. Is this adequate time to be stable on subs so I can attend the wedding, or should I push back my appointment until the day I return from the wedding. I am having a hard time researching how long it will be until I am stable on Subs once induction begins.

    I hope all of this was clear and to the point, and if you have input regarding the above I would greatly appreciate it. I plan to be active on the forum after I am stable, weaned off, and have the knowledge to lend out a helping hand if I ever see people who need help! It is a great feeling to know that this community cares so much to help others and returning the gesture is the least I can do.

    All the best,

    -B


    Hello B -

    The question of "how long until I'm stable on Suboxone" is a common one. The 8 days you have available is plenty of time if you follow the induction protocol correctly. In my own personal experience I was coming from Methadone and that's one of the toughest drugs to switch to Suboxone from. Reason is it has a half life very similar to the Suboxone so it can take days before you're ready to safely induct. I got in a big hurry to induct the first two times I tried and put myself into precipitated wd's both times. Talk about sick. It was horrible. The third time was a charm and the switch was successful.

    I took no chances the third time. I used the Cows and not only scored the necessary 26, I went beyond that to be absolutely certain precipitated wouldn't happen again. I believe my score was between 28-30? I was extremely sick in wd's, but as soon as I took that first small dose of Suboxone I felt better, much, much better. After I took the second dose I was feeling even better. After the fallowing few doses I was feeling as normal as normal can be. From that moment on I always felt the same on the subs, not ever high or euphoric, just normal and able to do anything I wanted to do without worrying about how I felt.

    I have seen it take 2-3 days for some people to get to the stable point, but it rarely happens if the induction is followed as outlined. If you get to an honest 26 (or higher) score on the Cows, and begin the induction by taking small doses of sub every hour you'll be feeling quite well in a manner of 2-3 hours. I'm involved in both AA and NA and I work with lots of Suboxone patients in those meetings. I've inducted LOTS of individuals and those that follow the plan closely do very, very well and are feeling good in a few hours.

    I've seen MANY people come here that have taken 4mg - 8mg (or more) as their first dose and the sub doesn't agree with them because they've taken too much. Suboxone is one powerful med and a tiny bit goes a loooong way. Suboxone is about 30 times stronger than Morphine to give you an idea of just how strong it is. The goal is to "build up" the sub by taking small amounts. You want to be on the LOWEST effective dose, not the highest.

    You have nothing to worry about. You have plenty of time to become stable because I know you'll follow the plan correctly.

    Randy

  13. #13
    wizard_irl is offline New Member
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    Hi everyone,

    Thank you guys for your ongoing support and following along my journey. I went ahead and saw the Suboxone doctor on the 30th as planned, however she did not feel comfortable to treat me given that I am on benzos. She did not care about how MUCH benzos I was on which is a lot (30 mg Valium, 4mg Xanax), but merely but the fact that I AM on benzos period, even given that I am on a Fentanyl 100mcg patch on top of this. That being said, the meeting did not go well, I did not receive my medicine, and I ended up in a minor argument setting with the Doctor because some of her statements seemed paradoxical to me about the combination. That being said, I DO understand that this is a lot on my CNS/Respiratory system but I ALREADY am on the combination and have perfect heart rate and blood pressure.

    When I mentioned to her that going through withdrawals will increase BP and HR and my long term RX of benzos will combat that to keep these more stabilized, she walked out of the room and the in-house counselor said to me the Doctor did not feel comfortable talking to me anymore because I seemed too "knowledgeable" about all of this and thought I would self treat myself with Suboxone and recommended I go to impatient rehab to induct even though I have never had issues with drug abuse.

    I am scheduled to see another Suboxone doctor next Monday and I told his office up front that I am on a combination of benzos/Fentanyl and he said he feels comfortable to treat me. That being said, there was a brief mention of the fact I might have to taper down my benzo usage in order to be treated or even seen. I'm not sure how this will go but I will on Monday.

    Technically wouldn't this just make my withdrawals/body go through MUCH more stress if I am in minor benzo withdrawals while also going through opiate withdrawals? Will no Sub doctor work with me since I am on benzos? I have been on the same dosages for 5 years now and do suffer from very bad anxiety.

    What do you guys think? Am I stuck in a rut of Sub doctor hunting until I find one who will give me Suboxone given that I am on benzos? Please let me know as this was a HUGE let down and also took roughly 3 hours of waiting/paperwork/going over everything just to be denied from her practice.

    Thank you all for listening and providing me with all the knowledge I could have going into this. If anyone could chime in, please do so and let me know. Have a blessed day and good luck to everyone else in the struggle.

    -B

  14. #14
    Randy35 is offline Platinum Member
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    Hello B -

    Thought you had disappeared for good.

    I hate to tell you this but I agree 100% with the doctor that refused to treat you with Suboxone while you're on the benzo's. Especially with the amount of benzo's you're taking which is a lot. No good Suboxone doctor would ever prescribe subs to someone that's taking that amount of benzo's daily. Both Suboxone and benzo's are CNS (central nervous system) suppressants that can slow breathing down to dangerous levels. You go to sleep and don't wake up. I know that's not what you want to hear, but I'm just being honest. You may have a perfect heart rate and blood pressure for now, but that could change at any time. I'm not being overly-cautious either, I'm truly concerned abvout taking those two drugs together, benzo's and Suboxone.

    I'm certain you'll find a sub doctor that will prescribe you Suboxone despite your benzo use. Most of them are in it for the easy money to be made. It will be your decision if you want to go that route.

    As to your question about your body going through stress if you're getting off the Fentanyl and also tapering down the benzo's, the answer is yes, it could be much more stressful. It would be a double-whammy of sorts. You should never stop any benzo abruptly as they need to be tapered very slowly. The question is: how low do you need to go on the benzo's for a safe time on the Suboxone? I'm not sure it's ever safe, but the lower you can get the benzo's the better it will be for you. Seeing as I was on benzo's for years, and abusing them just like all the other garbage I was taking, they scare the syhte out of me. Nearly died twice on benzo's as my heart rate and breathing slowed down to critical levels. And that was without Suboxone in my system at the time.

    Lets see what this other Suboxone doctor has to say about this and go from there. I really hope it goes well for you.

    Randy
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  15. #15
    wizard_irl is offline New Member
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    Quote Originally Posted by Randy35 View Post
    Hello B -

    Thought you had disappeared for good.

    I hate to tell you this but I agree 100% with the doctor that refused to treat you with Suboxone while you're on the benzo's. Especially with the amount of benzo's you're taking which is a lot. No good Suboxone doctor would ever prescribe subs to someone that's taking that amount of benzo's daily. Both Suboxone and benzo's are CNS (central nervous system) suppressants that can slow breathing down to dangerous levels. You go to sleep and don't wake up. I know that's not what you want to hear, but I'm just being honest. You may have a perfect heart rate and blood pressure for now, but that could change at any time. I'm not being overly-cautious either, I'm truly concerned abvout taking those two drugs together, benzo's and Suboxone.

    I'm certain you'll find a sub doctor that will prescribe you Suboxone despite your benzo use. Most of them are in it for the easy money to be made. It will be your decision if you want to go that route.

    As to your question about your body going through stress if you're getting off the Fentanyl and also tapering down the benzo's, the answer is yes, it could be much more stressful. It would be a double-whammy of sorts. You should never stop any benzo abruptly as they need to be tapered very slowly. The question is: how low do you need to go on the benzo's for a safe time on the Suboxone? I'm not sure it's ever safe, but the lower you can get the benzo's the better it will be for you. Seeing as I was on benzo's for years, and abusing them just like all the other garbage I was taking, they scare the syhte out of me. Nearly died twice on benzo's as my heart rate and breathing slowed down to critical levels. And that was without Suboxone in my system at the time.

    Lets see what this other Suboxone doctor has to say about this and go from there. I really hope it goes well for you.

    Randy
    Hi Randy,

    Thank you for the reply and I am definitely not the person to post and leave the situation high and dry! I truly appreciate you following my journey as YOU have given me courage to go through all of this. Regarding the benzos, I know. I know. I just DON'T know what I am supposed to do at this point as I am prescribed high amounts of them and tapering them down while trying to transition does not seem that plausible of an option as this could require an entire year to process tapering drugs (narcotics and benzos) and that alone is mind-bending.

    That being said though, how much harsher IS Suboxone on my body as opposed to 100mcg Fentanyl with what I am already prescribed? What options do I really have? I have ran short before on my benzos from using too much (very infrequent) so I am familiar with early WD symptoms (tremors/increased anxiety/imbalancement), but never to the point where I had none in my body. I would sometimes end up in a month with maybe 1mg Xanax daily and 10mg Valium with what I just mentioned and those were my side effects. Is impatient treatment really required for a case like me? Even given the experience/support (24/7) system that I have in the event something happens? Please let me know your thoughts.

    Again, my plan is merely to use Suboxone to taper off narcotics entirely, not to transition from one narcotic to another (permanently) but I do understand that benzos come into play regarding this.

    Thank you again for the response and God bless to everyone who is going through a hard time.

    -B

    Edit: Added (Permanently) into my last statement.
    Last edited by Anonymous; 10-05-2017 at 02:31 PM.
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  16. #16
    Ming23 is offline Platinum Member
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    Hey Wizard!
    I think Randy is asking "How low can u drop/taper on the benzos?" Perhaps slowly reduce the high benzo dose--don't have to be completely off them. Quite a few folks on this site were taking benzos during sub taper. However, Randy & ur doctor both say that ur benzo dose is currently too high for u to undertake the sub taper. That's why I suggested First slowly reducing the benzo dose with ur doctor's help. One step at a time to reach our ultimate goal: getting off the fentanyl.
    You can do this! It's hard work but worth the effort as once ur benzo dose is low enough, u can transition off fentanyl. That will be a very happy day for you!
    Randy's advice has helped so many folks, myself included. If i were you, I'd do as he suggests. It's a complicated situation but you can do it!! Post when u like...

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    wizard_irl is offline New Member
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    Quote Originally Posted by Ming23 View Post
    Hey Wizard!
    I think Randy is asking "How low can u drop/taper on the benzos?" Perhaps slowly reduce the high benzo dose--don't have to be completely off them. Quite a few folks on this site were taking benzos during sub taper. However, Randy & ur doctor both say that ur benzo dose is currently too high for u to undertake the sub taper. That's why I suggested First slowly reducing the benzo dose with ur doctor's help. One step at a time to reach our ultimate goal: getting off the fentanyl.
    You can do this! It's hard work but worth the effort as once ur benzo dose is low enough, u can transition off fentanyl. That will be a very happy day for you!
    Randy's advice has helped so many folks, myself included. If i were you, I'd do as he suggests. It's a complicated situation but you can do it!! Post when u like...
    Hi Ming!

    Thank you for the post and and also following along my journey. I do understand tapering down the benzo dose is an option but this will also certainly prolong the period of inducting Suboxone as I am eagerly waiting to transition since I am plateaued on my opiate dosage very bad. That being said, I DID forget to mention that my PCP did prescribe me Phenergan for my opiate/early WD symptoms that I do take the night before my patch change as I start to feel really >>>>>>. Normally I cut the Phenergan tablet (25mg) into 2 and 12.5mg curbs my WD symptoms as I know this is another drug that should not be played around with and people use for opioid potentiation.

    Randy is waiting to hear what the Doc says on Monday as I am waiting as well. My PCP and I decided to try and see 1-2 Sub docs a month for my own sanity and maintaining my own personal life. Thanks for your input as well and I definitely will update again when I see this new Doc on Monday.

    Cheers,

    -B

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