Should I ask for Suboxone dose increase?

[abinoosh]

I have been pretty stable on about 1 mg. daily. My doc gives me 18 per month and writes the script for 1/2 to 1 film daily (2 mg film). I can tell when I take 2 mg. About 6 weeks ago I stopped drinking any alcohol. I had tried kratom and wasn't impressed, but I gave it another chance and now I've been sort of fiending for kratom - have used it most days for a month. If I order online and the package is late, I drive around to smoke shops. The intermittent positive reinforcement is getting to me. Most times I really couldn't tell you if I even feel any effect, but sometimes I do, and I seem driven to try different brands or vendors.

Last month my doc was on vacation. His office let me pick up my paper Rx for Suboxone. So I haven't seen him during my monthlong run on kratom. Sub does not seem to be much of an antagonist at 1-2 mg, in fact I have noticed more pronounced effects as I have gone lower in my dose. I'm wondering if going up to 2 mg daily would fend off the kratom fiending, which is behavioral as much as anything else - I need something to do when I get off work. I'm very happy not to be drinking though. For harm reduction, a few tokes is probably my best bet but I do work in a field with occasional drug testing.

I've never gone UP on sub but I kind of need the blocking effect.

 

[LucidSDreamr]

they say going over 2 mgs with bupe causes less of the more active norbupe metabolite to be able to bind your opioid receptors.
kratom may have other effects beside u opioid activity....so you may be addicted to the other effects. you just need to learn to accept the bupe as being enough...things that are behavioral you just need to rely on your resolve mostly....but i'm surprised kratom is even worth taking at all if you are on bupe....but like i said maybe it causes a high in other ways that the bupe isn't blocking

 

[Ilove2nod]

Are you paying out of pocket for your subs or are they covered by insurance? If you are covered by insurance it doesn't hurt to have more sub than you normally take. You can save what you don't use for times you may need a little more or whatever you want to do with it. If your paying out of pocket then its going to cost you double and sub strips are STUPID expensive without any discount or insurance. Even generic suboxone pills are very expensive. I recently switched insurance and the new plan I am on no longer covers suboxone or subutex, I had to switch to subutex because it was half the price of suboxone... anyways if money isn't an issue for you I would try to up your dose. I was on 2 2mg subs a day for over 2 years and found out that the 8mg tabs were just 2 bucks more a piece than the 2mg tabs at my pharmacy! I figured it couldn't hurt to get the 8mgs and save some money, so I actually asked for an increase to 1 8mg 'tex a day from 2 2mg a day and saved money while getting double the amount I take! but yeah it never can hurt to have too many subs but it can hurt to have too little sub just incase something were to happen like you lose them or they get stolen etc. plus like I said you can just stockpile them and have tons of extra for a rainy day...

 

[MrRoot]

Films are expensive? I'll be starting opiate replacement therapy with sub films next week and it costs nothing for me.

 

[Ilove2nod]

they cost nothing? how is that? where I am in the US unless you are able to get them thru your insurance they are pricey! I have heard of government funded suboxone programs where films are given to people who have had an opioid addiction and have low income from my friend who lives in California. but where I live in florida, I haven't heard of them doing this in my state. Plus I don't like the films personally I much prefer subutex.

 

[abinoosh]

I think the copay effect will work in my favor - I would pay $40, even with more films - but I'm not sure. However, kratom isn't super-cheap either. A lot of this is behavioral. It's just something to do, something to fixate on - feeling like scoring, copping, getting away with something. Maybe this behavior will give me the push I need to understand that I need a plan from transitioning from work self to leisure self. It can be as simple as popping open a can of ice-cold Diet Coke! This seems to be an experiment that I need to get out of my system.

As for feeling kratom on Suboxone - seriously, probably 50 percent of the time I notice nothing. I've seen YouTube video reviews - people actually don't know whether they're high or not!! It's chasing something that *might* happen as every now and then I notice I feel really, really good after taking kratom. But I also work out, have a job I like, enjoy eating ... all these things will fire up my endorphins.

I let myself use one of my 2 mg doses today - which means 1 mg for 9 of the next 10 days. I have a bad head cold and am being a brat. I'll let the doc know everything that's going on; I have no interest in hiding it. He also writes me 1.5 mg alprazolam daily and I don't usually use that much. And 100 mg amitriptyline nightly. This "holds" me physically - it's the fiendish thinking and behavior that bug me.

Thanks for the replies Bluelight!

ETA: I mean, I'm looking at my vaping eyedropper bottles and wondering how to make Suboxone nose drops - this is old thinking! But I am curious, I have never tried this ROA, and won't as long as I'm blowing out a liter of snot every hour.

 

[Ilove2nod]

Yeah I always sniffed my subs with the tablet form. But I would look up on google or use the search engine on this site and see if you cant find a way to make the strips into a nasal spray by using the proper water/sub strip ratio. I have heard about this before and also had a friend who used to put all his oxy in a nasal spray bottle with water and just act like he was using nasal spray all the time when really he was sniffing oxy lol. He said it worked awesome and no one had any idea what he was actually doing because it was in an afrin nasal spray bottle. If I were to guess id say if you normally do 1mg a day maybe getting an oral syringe from the store to measure the amount of water properly and make a solution in either a nasal spray bottle rinsed out thoroughly with water or an ear/eye drop bottle. I would think maybe just a small amount like 10-20 units of water per 2 mg strip would be fine? not sure though but if I had to guess I would use that ratio.

 

[MrRoot]

5-10ml of saline water works well for 8mg strips.

Ilove2nod, everything addiction related treatment is free here (well funded by taxpayers of course but free for the addict).

Also public healthcare is nearly free as after paying for three visits to Dr. you get rest visits free and those first three cost about 22€ per visit. Night at the hospital setting is 17€ and drugs are compensated either 40%, 60% or 100% depending on the condition the drug is for. 56 OxyContin 20mgs are less than a visit to a Pizza Hut or free if for cancer pain.

Also there is a ceiling for total healthcare costs which is 670€ at the moment.

But we do pay a lot of taxes. Value added tax is 24% and I pay 34% taxes for 5200€ income.

 

[Ilove2nod]

5-10ml of saline water works well for 8mg strips.

Ilove2nod, everything addiction related treatment is free here (well funded by taxpayers of course but free for the addict).

Also public healthcare is nearly free as after paying for three visits to Dr. you get rest visits free and those first three cost about 22€ per visit. Night at the hospital setting is 17€ and drugs are compensated either 40%, 60% or 100% depending on the condition the drug is for. 56 OxyContin 20mgs are less than a visit to a Pizza Hut or free if for cancer pain.

Also there is a ceiling for total healthcare costs which is 670€ at the moment.

But we do pay a lot of taxes. Value added tax is 24% and I pay 34% taxes for 5200€ income.

Damn. I wish it was that cheap or free and easy for anyone to get subs here! That's cool they are so much more understanding it seems towards people with addiction problems in Finland. Have you ever watched the documentary called 'Reigndeer Spotting' about a finnish IV subutex addict named Jani in Finland? When I watched that documentary they said it was hard to acquire buprenorphine in Finland at that time at least and also very expensive on the street because it came from other countries, apparently subutex was a lot of opioid addicts drug of choice for a while there for whatever reason. But reading your post it seems that they have become much more laid back on buprenorphine there since this documentary was filmed. Or are they still opposed to giving out/prescribing people subutex and only in favor suboxone? a lot of doctors here really dislike subutex and only will prescribe suboxone. My doctor is in favor of both being prescribed, but she is not your average sub doc.

 

[MrRoot]

It isn't easy to get buprenorphine (except temgesic =0.2mg bupe) because it isn't actually prescribed but instead dispensed at state organized clinics or local health centers. Also for the first three months you have to go daily to get your dose and you dissolve it under supervision. Then you can get doses with you for few days and maximum is for fifteen days when you have been six months in the treatment. The treatment is started always inpatient and you'll stay there for two to five weeks depending on how big your dose has to be to feel "normal".

Also you need to give drug test weekly and if it shows something extra you can't get your dose with you for a while. Most people in the treatment use something else so there are only few people in every city who get their doses to home.

I've seen Reindeer Spotting and it was filmed in Rovaniemi area which is in the northern parts of Finland and it is rural area and as middle of nowhere as it gets and therefore drugs cost your arm and a kidney in there. After reading posts in BL it feels weird that in here buprenorphine is drug of choice for most people but nearly everywhere else it is just used as maintenance drug and others find it weird that in here plenty of people are getting high on it

In our capitol Helsinki it is much easier to acquire buprenorphine as you can go to Estonia by ferry within hours and go to private doctor and buy dose for two weeks from pharmacy and then import it legally to Finland.

Also availability of treatment varies. I live in the middle of Finland in a smallish town and there was no actual queue for the treatment except that the facility in which it is started was closed for a month in summer. The bigger town next to my area has plenty of people waiting to get in the treatment as there isn't enough nurses to supervise daily dosing and people have to wait even for six months for their treatment to start.

 

[Ilove2nod]

Wow! That is kind of like getting on methadone maintenance in the US, from what i have heard from friends on MMT. Except there is no required inpatient rehab to get on it, you just simply fail a drug test for opioids the first visit to the clinic and as you go there more and gain trust with them they slowly start giving you take homes for more and more so you don't have to keep coming in. When you go to a sub doctor here, first visit fail a UA and there u go a script for subs. I myself love the feeling of bupe, even after being on it for 4 years. It is a nice feeling if you don't take to much at once, it starts out very sedating for me then becomes almost energetic feeling as it kicks in more, for me at least. A lot of people don't like bupe and feel nothing from it they just take it to stay well and keep cravings away.

Its crazy how different it is to get access to bupe in different countries. Yeah in the US its extremely easy to get a script, but also very expensive with no insurance. That is why i was switched from suboxone to subutex. my doctor felt bad and didn't want to make me pay almost 2x the amount of money for suboxone witch is almost exactly the same. The doctor i go to is one of the few around my area that will prescribe subutex to almost anyone, my previous doctors looked at me like i was trying to get prescribed oxy or something when i asked them to switch from 'boxone to 'tex haha.

 

[abinoosh]

Someone up thread said the Suboxone could be completely blocking the opioid effect of the kratom, while still allowing me to feel other alkaloids. I kind of hope this is the case as I am expecting this kratom phase to end soon and am not really able right now to deal with withdrawal. Suboxone is kind of my fail-safe - I can always go up, knowing I have a pretty good relationship with bupe.

The less-is-more aspect of Suboxone is amazing. I can't believe there are people who take .2 mg for pain and am astonished to hear IV opiate drug users saying a pretty tiny dose fends off the worst of withdrawal. I had weaned down from 120 mg methadone to 32 mg and walked out of the clinic in anger after being told I'd need counseling to lower my dose further. Then 48 hours later I still hadn't gone into methadone withdrawal. After close to 72 hours the doc decided to induct me anyway. No precipitated withdrawal until the next day and bam - I cried for 24 hours straight. The kind of crying that dehydrates you. I was taking 24 mg, he upped it to 28 and that's a lot of big orange pill to get under your tongue. It was staining my teeth. Only when I got to using 1 mg most days did I notice that 2 mg gave me a good feeling.

I don't think my doc would prescribe Subutex because it invites closer scrutiny of federal officials.

I really think the kratom is a phase - it will probably go on another week or two since I have ordered more. I dose just like I did with opiates, wanting a new hit every 3-4 hours. This is also the way I was drinking when I stopped 6 weeks ago. A good swig every 3-4 hours. I'm very happy not to be drinking. My doc has me dose once a day on the Suboxone and I never take more after taking that first dose. I can get a mild buzz but it's not something I'm chasing.

One question, I don't know why people would go on Suboxone to break a hydrocodone habit. Once you're in withdrawal the meter is running - why not just endure the opiate withdrawal with the short-term help of sedatives? For me it made a lot of sense to switch from methadone to Suboxone, but if I'd been on a short-acting opiate I might have done things differently.

 

[Prescottdave]

Maybe I am confused by some posters but in the U.S there are all types of suboxone programs. Most are just a one time a month drop into the docs office to take a UA and get a 30 day script. Some programs have you come in every two weeks for the first few months. Most require one hour each month of individual therapy.

There are even less programs that operate like a methadone clinic but instead with sub. I would avoid these unless they have weekly group therapy available.

In the U.S people who are low income get medicaid. This form of insurance should completely cover the cost of your medication.

I found a dose of 1.5 mg was enough to keep me well for 24 hours while taking away my cravings and blocking 75% of the effects from other opiates. The higher you go the longer it will take you to taper if you every try and get off. Even doses of 0.25 mg act as an antagonist and can precipitate WD.

To the poster above PWD only occurs within the first few hours after taking bupe. If WD occurs a day after taking the sub thats just normal WD not PWD. Subutex was discontinued in 2011. It now should really only be called bupe mono or generic buprenorphine. My doc routinely corrects me when i call it subutex. I believe the more people call it generic buprenorphine the quicker docs will catch onto the idea that it really is not much different then sub.

Bupe mono used in ORT carries the same clinical and regulatory guidelines as suboxone but is slightly more frowned upon. They can stick their misplaced frowns up there pharma company backed educated asses.

 

[wowens08]

I'm not trying to insult your doctor but my doctor actually took me off alprazolam when I started taking Suboxone. It wasn't for the pill aspect either seeing how I went almost four months for a refill on my script. He had said that it is HIGHLY dangerous to take a bupe and a Xanax within the same time period.

 

[wowens08]

Check with your insurance to double check that because I have $10 copays for my generics and $20 for name brand presciptions and I have to pay over $80 a month for a prescription of Suboxone.

 

[wowens08]

I think the copay effect will work in my favor - I would pay $40, even with more films - but I'm not sure. However, kratom isn't super-cheap either. A lot of this is behavioral. It's just something to do, something to fixate on - feeling like scoring, copping, getting away with something. Maybe this behavior will give me the push I need to understand that I need a plan from transitioning from work self to leisure self. It can be as simple as popping open a can of ice-cold Diet Coke! This seems to be an experiment that I need to get out of my system.

As for feeling kratom on Suboxone - seriously, probably 50 percent of the time I notice nothing. I've seen YouTube video reviews - people actually don't know whether they're high or not!! It's chasing something that *might* happen as every now and then I notice I feel really, really good after taking kratom. But I also work out, have a job I like, enjoy eating ... all these things will fire up my endorphins.

I let myself use one of my 2 mg doses today - which means 1 mg for 9 of the next 10 days. I have a bad head cold and am being a brat. I'll let the doc know everything that's going on; I have no interest in hiding it. He also writes me 1.5 mg alprazolam daily and I don't usually use that much. And 100 mg amitriptyline nightly. This "holds" me physically - it's the fiendish thinking and behavior that bug me.

Thanks for the replies Bluelight!

ETA: I mean, I'm looking at my vaping eyedropper bottles and wondering how to make Suboxone nose drops - this is old thinking! But I am curious, I have never tried this ROA, and won't as long as I'm blowing out a liter of snot every hour.

Check with your insurance on that copay amount. I usually pay $10 for generic and $20 for name brand, and my Suboxone still ends up costing me around $80 for a months supply.

 

[wowens08]

Someone up thread said the Suboxone could be completely blocking the opioid effect of the kratom, while still allowing me to feel other alkaloids. I kind of hope this is the case as I am expecting this kratom phase to end soon and am not really able right now to deal with withdrawal. Suboxone is kind of my fail-safe - I can always go up, knowing I have a pretty good relationship with bupe.

The less-is-more aspect of Suboxone is amazing. I can't believe there are people who take .2 mg for pain and am astonished to hear IV opiate drug users saying a pretty tiny dose fends off the worst of withdrawal. I had weaned down from 120 mg methadone to 32 mg and walked out of the clinic in anger after being told I'd need counseling to lower my dose further. Then 48 hours later I still hadn't gone into methadone withdrawal. After close to 72 hours the doc decided to induct me anyway. No precipitated withdrawal until the next day and bam - I cried for 24 hours straight. The kind of crying that dehydrates you. I was taking 24 mg, he upped it to 28 and that's a lot of big orange pill to get under your tongue. It was staining my teeth. Only when I got to using 1 mg most days did I notice that 2 mg gave me a good feeling.

I don't think my doc would prescribe Subutex because it invites closer scrutiny of federal officials.

I really think the kratom is a phase - it will probably go on another week or two since I have ordered more. I dose just like I did with opiates, wanting a new hit every 3-4 hours. This is also the way I was drinking when I stopped 6 weeks ago. A good swig every 3-4 hours. I'm very happy not to be drinking. My doc has me dose once a day on the Suboxone and I never take more after taking that first dose. I can get a mild buzz but it's not something I'm chasing.

One question, I don't know why people would go on Suboxone to break a hydrocodone habit. Once you're in withdrawal the meter is running - why not just endure the opiate withdrawal with the short-term help of sedatives? For me it made a lot of sense to switch from methadone to Suboxone, but if I'd been on a short-acting opiate I might have done things differently.

I am a recovering pill head to any pain pill you will lay in my hand, and even though the puking, sweats, and crying only lasts about 5-6 days, my mental side would still be shitty after 2-3 weeks and physically I would be drained, not even wanting to get out of the bed. I don't know how if you know how hard that is to pay bills, BUT I take Suboxone to function like I functioned before I took 20 pills a day.

 

[abinoosh]

To the poster above PWD only occurs within the first few hours after taking bupe. If WD occurs a day after taking the sub thats just normal WD not PWD.

That never occurred to me! But it was an atypical withdrawal for me. No kicking legs but being an emotional wreck. I'm not that worried about tapering now - I'm at a fairly low dose even if I do go higher - to 2 mg from 1mg - and more likely to have a blocking affect. The amount of bupe may be larger bit it fends off temptation that I don't want to invite.

The doc also gave me extra for surgery as I didn't want to take the few oxy's offered and we decided bupe was safer for me. I'm not sure how well it killed the pain but it was a nice little compensation.

 

[abinoosh]

I'm not trying to insult your doctor but my doctor actually took me off alprazolam when I started taking Suboxone. It wasn't for the pill aspect either seeing how I went almost four months for a refill on my script. He had said that it is HIGHLY dangerous to take a bupe and a Xanax within the same time period.

He doesn't seem concerned; I am on pretty low, stable doses and I trust he knows what he's doing. Taking someone off abruptly could create problems of its own. Everyone's different, but in the doses I am taking it he doesn't see a problem, as I've never had an adverse effect in 5+ years.

 

[CfZrx]

they say going over 2 mgs with bupe causes less of the more active norbupe metabolite to be able to bind your opioid receptors.

It should be said that when they say 2mg in this context, they prob mean IV, so at 30% bioavailability, a sublingual dose of 6mg would equal 2mg IV. I find Sub to be a rather potent opioid all the way up to 10 or 12 mg/day. I take it in 1 or two mg doses throughout the day.