SUB program was a big FAIL!!

[VictorZ06]

Long story short...

32mg of dilaudid daily and decided to stop and just live with my pain.

Found a doctor who was totally clueless (didn't know what the COWS sheet was or anything)...she was middle eastern and hated soldiers. Was treated like a criminal.

I waited 25 hours before I was induced. And for some reason, my ass went right in WD. BAD BAD BAD WD.

Tried calling the doc...seeing she didn't know her head from her ass, I didn't get anywhere. No call back or anything.

At the 25 hour mark and a 30 on the COWS, I took 4mg of subs. 30 mins later (less) I wanted to die. I have seen lots of different types of hell in my life, but never this.

I was going to go to the ER...but got on line to see if there was anything I could do. I read here that some that went into WD after induction, took an opiate & got better.

Was told to take a large dose because the subs are far stronger and won't feel them. I was vomiting so I slammed them just to make sure I don't throw them up.

I feel "OK" now. Do I feel OK because of the 4mg of subs I took today, or do I feel OK because of the large dilaudid dose I took?

So now....getting ready for bed. I don't know what to do tomorrow. Take a small 1mg dose of subs and see what happens? Or wait to reach 26 on the COWS and start over?

Thanks for your help....I don't understand how I got into PWD after 25 hours of waiting from a short acting opiate like Dilaudid. Thanks fellas...

 

[Kittycat5]

First, dont worry about 25 or 30 on the COWS scale. I can get to 25 on that scale and not feel like a whole lot is wrong. It is a tool for clinicians to try to objectively evaluate their patients but will probably do you more harm than good dwelling on it.

Focus rather on your symptoms and its ok to be subjective. Some are worse than others and its fine to prioritize what is worse for you. You said you vomitted and Im assuming this was before you injected the bupe (which I recommend against and very well could be a factor as to why you feel like shit). But since its all I have to go on, you would be better served at figuring out a way to stop it than measuring on some scale. I dont care if you take Zofran, ginger, or count backwards from 1000, just do whatever to make it subside. Same for any other symptom.

Now moving forward. I guess we need a bit more info. How long were you taking hydromorphone for? And were you taking smaller doses that equal 32mg or doing a more once a day big dose thing? It wouldnt be so suprising that you threw yourself into withdrawal if you did the former.


As for tomorrow, I cannot say what your dose should be. You already have some bupe on board so this will be more difficult, but it may be best to wait until you are actually feeling withdrawal and not being told to start at some arbitrary hour after last dose. Then, take what you feel is needed. Usually less is better, but Im not so dumb to realize that doesnt always cut it.

But yeah, find a new doctor if possible. Good luck.

 

[VictorZ06]

Sorry for the confusion, I didn't inject bube, I injected the dilaudid. I have been on for about 2 years....8mg 4X a day.

So....I guess I should just wait until I am as sick as possible before taking a sub dose again. Ugh....not what I wanted to hear, I though I might just be ok taking small doses starting in the morning. I can barely find the energy to blink....how am I going to do this again tomorrow. But...I will induce at .5mg....not 4mg, and see how that goes I guess. Thanks...

 

[Kittycat5]

Ah sorry. I saw slammed and assumed. But what exactly did you mean by slamming?

 

[VictorZ06]

Ah sorry. I saw slammed and assumed. But what exactly did you mean by slamming?

Slammed = inject. I didn't take my dilaudid orally because I was violently throwing up and didn't want to risk wasting it. So, prepped it for an injection. I don't usually do that, just when I need instant relief ASAP. I occasionally have slips and falls....last time I fell down a flight of stairs and needed relief right away, so instead of taking it orally....I injected. It is a fantastic feeling, but I don't do it often in fear of it becoming a habit. Either way...I'm done with opiates for good. Can't believe I have to wait to get sick again tomorrow to start subs again. 25 fuckin hours and I still went into PWD of a short acting opiate like dilaudid??? WTF??? I did this once before, and waited 14 hours...and was good. This time I waited 25 hours....and got fucked! Don't get it....

 

[Kittycat5]

Yes, yes. Of course. For some reason I was reading that as you injected the bupe rather than the Dilaudid, then you said you didnt inject bupe, so was trying to figure out how else I could take slam.

Idk, man. I find the more time we put in the harder it gets. What was true 6 months, a year, ten years ago isnt always the same now. But stay committed. It only really sucks for a short time, which means nothing. Its how to live without them that really fucking blows. Not something that cant be beat, but its the much more difficult of the two. I probably shouldnt even say such things to someone in your situation but think it can be greeted with optimism. You mentioned your a soldier so assume you know how to overcome some shit. Treat this like that.

 

[RaizdByWolvz]

Hey man a general rule with inducting buprenorphine that alot of doctors don't do is to start small say at 25-30 hours from your last full agonist dose is to induct with 1mg bupe, wait another hour or 2 then take another 1-2mgs bupe, titrate to effect of comfort. With bupe its absolutely true, less is more

 

[Phil.McKeer]

Hey man a general rule with inducting buprenorphine that alot of doctors don't do is to start small say at 25-30 hours from your last full agonist dose is to induct with 1mg bupe, wait another hour or 2 then take another 1-2mgs bupe, titrate to effect of comfort. With bupe its absolutely true, less is more

Yes, induct slow. Especially if you're worried about pwd. If you think it's still a possibility, go ~0.25mg, wait an hour, do another ~0.25mg, wait an hour, do maybe ~0.5mg, and if no pwd has present then take 1mg. An hour after that, if there's definitely no pwd, you can take a larger dose safely. What you just did was "gently wash off" the agonist currently bound at a slow enough rate not to put your body into shock as if you just got slammed with narcan while high on H.

 

[RaizdByWolvz]

Yes, induct slow. Especially if you're worried about pwd. If you think it's still a possibility, go ~0.25mg, wait an hour, do another ~0.25mg, wait an hour, do maybe ~0.5mg, and if no pwd has present then take 1mg. An hour after that, if there's definitely no pwd, you can take a larger dose safely. What you just did was "gently wash off" the agonist currently bound at a slow enough rate not to put your body into shock as if you just got slammed with narcan while high on H.

Well said Phil, especially that last line! Absolutely true and it still troubles me that after all these years bupe doctors still don't put this into practice.

 

[Phil.McKeer]

Well said Phil, especially that last line! Absolutely true and it still troubles me that after all these years bupe doctors still don't put this into practice.

Thx Wolfie. I think it has something to do with only having to take an 8 hour class, money, and that whole "I have a Ph.D so fuck you, you junkie fuck" mentality many doctors have.