Question about Subutex for someone who really really really knows :)

[Plumber101010]

Looooong read. I warn you now

Ok. PLEASE don't explain how it works or what it does. Save yourself the time. I am extremely familiar with how it works and what it does.

But I have a question that's been on my mind for many moons, forever actually (10 plus years) and I can't seem to get a straight answer to it no matter how many times I ask it and where I ask it. I am asking it here for the first time.

Just always get the usual, familiar rhetoric explaining to me how it works and where it binds and what it does, blah blah blah, but no one ever can explain the "why" behind all this wonderful science!

And at the end have one first hand case PROVING what I'm questioning to be true.

Ok so follow. So if buprenorphine is stronger than and has a higher affinity than let's say Oxycodoneas a real life example, and will kick off that opioidfrom the receptor, this meaning it "replaces" it and fills it, then WHY bother waiting to take it?

Immediately or 24 hours later, either way, it's going to sit in that same receptor and do the exact same job!!!

I'm so tired of reading about this precipitated withdrawal crap. Now tired of reading about it does NOT equate to not believing it. You would be an ***** not to believe it because there are just too many cases of it to be ignored so it's a real thing. I just don't understand WHY it's a real thing?

Because I cannot POSSIBLY imagine why having the opiate kicked off the receptor immediately, or having the remains of it kicked off 24 hours later, can produce such drastic night and day results?

Heck, I've know addicts that were given Narcan to reverse overdoses who didn't go through such pain as you read about some people trying to come off with Subutex or suboxone too soon and not waiting long enough!

24 stinking hours? Seriously? I mean I just don't understand WHY it would be ANY more painful OR horrible OR agonizing to just take the Subutex at anytime you want whether it's during opiate intake, an hour after Intake, or 24 hours after opiate intake, either way, no matter WHEN it is done, it is going to perform the exact same function. It's going to kick it off and replace anything that's in its way!

So why if you took it too soon would you go into agonizing withdrawal? You should NOT be going into ANY withdrawal whatsoever even if you take it immediately, because it immediately fills the receptor and prevents withdrawal.

I mean that's the entire purpose of this drug is to prevent withdrawal. That's what it is designed to do. That's what it's made to do. Whether you take it immediately or 24-36 hours later?

I mean if it took a couple weeks after you stopped taking opioids to go into withdrawal and then you could use Subutex maybe I could understand why it would matter if you did it immediately but 24 hours? That's absurd to my brain!

Now for the proof I was speaking of. After enduring watching my wife going on and off Suboxone a dozen plus times, each and every time having to watch her in agony as she detoxed off Percocetsfor 24 hours first. (Heavily researched this drug before I tried to put her on it for the first time and had that SAME question THEN 10 years ago)

Sitting back and watching her do something that I had ALWAYS considered to be useless, what I ALWAYS considered to be needless and what I ALWAYS considered to be nothing more than a ploy the doctors PURPOSEFULLY do as well as the manufacturer, that is to put the patient into DEEP detox so they can become their NEW PIMP, and heroes and rescuers, I ran across a small psychiatrist in Texas..

Giving up on explaining my theory to him as I had already convinced myself there was no need to detox first, was only being done to hook the patients on a very expensive product, the psychiatrist started laughing when I asked him about the usual 24 hour detox.

He became my white knight in shining armor when he said "no that's ridiculous, Suboxone will immediately replace the opiates and there's no advantage one way or the other to doing a detox first"

Smiling from ear to ear but refraining from telling him I have always thought that, for the first time after dozens of times I gave it to my wife WITHOUT waiting and guess what?

Yep that's right, she immediately responded, felt great, and took up right where she left off after just doing a couple Percocets a couple hours before, thus proving that she NEVER needed to do that 24 hours first as I have always thought.

But my question remains, I have seen far too many documented stories of precipitated withdrawal as well as read tons of agonizing stories that were NOT precipitated but just more or less people who went through living hell by doing it too soon... when there's absolutely no medical or scientific reason why they should have???

What gives???

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[sekio]

Because I cannot POSSIBLY imagine why having the opiate kicked off the receptor immediately, or having the remains of it kicked off 24 hours later, can produce such drastic night and day results?

because buprenorphine doesn't activate the opioid receptors at nearly the same efficacy level that oxycodone does

 

[shartito]

It’s because bupe is a partial agonist compared to a full agonist. I can’t speak to why your wife didn’t experience precipitated WD, but it’s absolutely a real thing.

I can’t epxlain the science well, but I think this does a good job:

https://m.choosehelp.com/topics/sub...ne-2013-understanding-precipitated-withdrawal

Buprenorphine (the active ingredient in Suboxone) has higher affinity for the opiate receptors in the brain than opiates of abuse (like heroin or OxyContin, for example).

What this means is – if you are on an opiate drug and you take Suboxone, the buprenorphine in Suboxone will flood the brain, kick out the opiates from the opiate receptors and then fill and block these opiate receptors.

Buprenorphine only partially activates the opiate receptor, unlike regular opiates which fully activate this receptor, so when these receptors are suddenly filled with buprenorphine instead of the opiate they were filled with only moments before – the net result is a sudden and dramatic loss of activation of these opiate receptors. And it is when these opiate receptors do not get sufficiently activated that we experience opiate withdrawal symptoms.

It is for this reason that you must wait until you are experiencing opiate withdrawal symptoms before you can take your first dose of Suboxone. Once you are experiencing opiate withdrawal symptoms, many of your opiate receptors in the brain are already insufficiently activated, and taking Suboxone serves to increase this activation, thus reducing the discomfort you feel.

 

[Plumber101010]

It’s because bupe is a partial agonist compared to a full agonist. I can’t speak to why your wife didn’t experience precipitated WD, but it’s absolutely a real thing.

I can’t epxlain the science well, but I think this does a good job:

https://m.choosehelp.com/topics/sub...ne-2013-understanding-precipitated-withdrawal

Buprenorphine (the active ingredient in Suboxone) has higher affinity for the opiate receptors in the brain than opiates of abuse (like heroin or OxyContin, for example).

What this means is – if you are on an opiate drug and you take Suboxone, the buprenorphine in Suboxone will flood the brain, kick out the opiates from the opiate receptors and then fill and block these opiate receptors.

Buprenorphine only partially activates the opiate receptor, unlike regular opiates which fully activate this receptor, so when these receptors are suddenly filled with buprenorphine instead of the opiate they were filled with only moments before – the net result is a sudden and dramatic loss of activation of these opiate receptors. And it is when these opiate receptors do not get sufficiently activated that we experience opiate withdrawal symptoms.

It is for this reason that you must wait until you are experiencing opiate withdrawal symptoms before you can take your first dose of Suboxone. Once you are experiencing opiate withdrawal symptoms, many of your opiate receptors in the brain are already insufficiently activated, and taking Suboxone serves to increase this activation, thus reducing the discomfort you feel.

And so that's the entire issue here which is immediately versus 24 hours later. Understood everything you said but still don't understand why immediate versus later is going to be any different? OK so it doesn't activate receptors as well as opiates do but either way that's just withdrawal. It's withdrawal instantly versus withdrawal over 24 hours. Either way you're going to have withdrawal.

Narcan does the exact same thing, but even much worse, as it doesn't have anything to fill the receptors at all to give you any partial relief whatsoever. And I haven't yet read, doesn't mean it hasn't happened, but I haven't yet read any reports of people who did Narcan and went into precipitated withdrawal?

I have a tendency to start believing that it's not a one hat fits all situation. That its based on each individual. We already know that's true because some individuals go cold turkey and don't experience any of the issues that other people who go through cold turkey experience.

Some say it was not that big of a deal and they were over it in a few days and yet others talk about how it was a walk through hell. I think the same thing applies. I think it's probably how that individual reacts to withdrawal is what the entire thing is about. With that said, that would mean that some people can do it right away without waiting and not experience any issues, is my wife.

 

[shartito]

Yeah I mean I’m probably not going to change your mind by posting links to stuff, which is fine. But it’s the very last sentence in the quote I posted above that I think really speaks to the root of your question. I don’t know how to explain it any better than that.

At the end of the day, if it works for your wife to take it immediately, count that as a blessing.

Unfortunately it doesn’t work that way for everyone, and I don’t think it’s a lie by the medical/pharmaceutical industry.

But, I think you would be absolutely correct in saying it’s not a one size fits all situation.

Edit - And to answer your other question, Narcan definitely puts people into WD’s. Like immediately. They’re OD-ing one second, and the next second they’re in immediate WDs.

Also if you don’t mind me asking, what was your wife’s perc habit like? How many mg of oxy per day, and for how long?

 

[Plumber101010]

Yeah I mean I’m probably not going to change your mind by posting links to stuff, which is fine. But it’s the very last sentence in the quote I posted above that I think really speaks to the root of your question. I don’t know how to explain it any better than that.

At the end of the day, if it works for your wife to take it immediately, count that as a blessing.

Unfortunately it doesn’t work that way for everyone, and I don’t think it’s a lie by the medical/pharmaceutical industry.

But, I think you would be absolutely correct in saying it’s not a one size fits all situation.

Edit - And to answer your other question, Narcan definitely puts people into WD’s. Like immediately. They’re OD-ing one second, and the next second they’re in immediate WDs.

Also if you don’t mind me asking, what was your wife’s perc habit like? How many mg of oxy per day, and for how long?

To answer your first question, I didn't say that Narcan doesn't put them into withdrawal, I specifically said it doesn't put them in to precipitated withdrawal, which is a big difference. Just wanted to clear that up

And no I don't mind you asking what so ever! Anything and everything oxycodone. 10mg and 15mg oxy's, 40mg OxyContin, and 10mg Percocets. 150 - 200 mg per day. Plus about 50 mg or so of Norcos for dessert.

Put her on Subutex AGAIN two days ago with TONS of oxy in her system. Worked like a charm!

I do have suspicions though about me thinking that this is a ploy that's meant to get addicts simply hooked up with a dealer, masquerading as a physician. There's other reasons I think that as well. First is the ridiculous and absurd notion that they will only give you one, then you must return 24 hours later for what then turns into a one-week supply. And they keep you on this weekly for a couple of months. Of course charging you an extreme amount of money for all these continued visits!

What kind of crap is that? They label it under fictitious means, by saying you have to be closely monitored to make sure it's working and you don't have any kind of an adverse reaction. Really? Funny how there's no other medicine on the face of the earth that a doctor would prescribe for any reason at all that would make you come back to their office one day after doing it one time and then weekly while you're doing it.

Patients can always have an adverse reaction to all medications! I mean, antibiotics, pain meds, there are just tons of medications that are given out by doctors every single day and not once will you ever hear an absurd statement like I want you to do ONE and then come back tomorrow. And then I want to see you weekly after that.

All they have to do is give you one pill, at absolute best, keep you in the office for a couple hours which is also stupid because no other doctor with any other medication does that, and then give you a 30 day supply, if not a 90 day supply and just cut you loose.

This is all being done to generate excessive and massive amounts of income because they KNOW damn well that they have just become the new supplier to their new addicts that are solely dependent upon the them now and they can pull the strings in any direction they want!

If you complain about the cost, if I have heard it once I have heard it dozens of times, they say don't worry it's still much cheaper than buying pills on the street. They KNOW what they're doing and I think it's all one big guise. As well as I think this 24 hour thing is another hidden thing they do because they know once their patient detoxes they are going to be in major withdrawal and will basically do anything and pay anything and will beg the doctor for their next "hit".

I've just been through this routine way too many times to think any different!

 

[Kittycat5]

Ideally you should wait 24 hours after withdrawal kicks in not just 24 hours after you stop taking opioids. By that time, more drug has left the body and lets bupe do its thing.

And as sekio said, affinity and efficacy arent the same thing.

 

[Plumber101010]

Ideally you should wait 24 hours after withdrawal kicks in not just 24 hours after you stop taking opioids. By that time, more drug has left the body and lets bupe do its thing.

And as sekio said, affinity and efficacy arent the same thing.

But why? That's the going consensus yes. To wait till withdrawal. That's what everyone is told yes. But why? Would like someone to explain why that 24 hour period is needed for all the above reasons. Affinity and efficacy is all going to happen exactly the same at 24 hours as well as one hour? So even if you wait, those same complications should ensue.

Its the WHY waiting till withdrawal magically negates the same problems you incur by not waiting?

 

[sekio]

Waiting until you're in withdrawal is effectively waiting until your opioid receptors are at their lowest possible level of activation to ensure the buprenorphine produces the strongest possible effect.

 

[Jekyl Anhydride]

Here is a story of a seriously tough bastard that got shot at and kicked in doors but couldn't handle inducing onto buprenorphine even after waiting till he was deathly sick. Give it a read and decide if you think he was faking the PWD's or was a pansy:

https://www.bluelight.org/vb/thread...kicking-my-opiate-habbit-once-again-with-subs

 

[Plumber101010]

Waiting until you're in withdrawal is effectively waiting until your opioid receptors are at their lowest possible level of activation to ensure the buprenorphine produces the strongest possible effect.

And that makes absolute sense to me and I can wrap my brain around that. The way you said it, was said in such a way that makes it understandable. That was the first time that somebody said something that made me understand it a little better in one aspect of it.

But that still only explains it as far as maximizing the results of the subutex, so that its given its best chance to produce the best possible results. Again, makes total sense.

But still doesn't explain why if you DONT do that, you would go through the precipitated withdrawal walk of hell.

 

[Plumber101010]

Here is a story of a seriously tough bastard that got shot at and kicked in doors but couldn't handle inducing onto buprenorphine even after waiting till he was deathly sick. Give it a read and decide if you think he was faking the PWD's or was a pansy:

https://www.bluelight.org/vb/thread...kicking-my-opiate-habbit-once-again-with-subs

Cool story, but I'm not sure the relevance of it as far as this thread is concerned. Nobody is disputing that precipitated withdrawal is real. Trying to find out why precipitated withdrawal (or really ANY withdrawals to be honest in any manner) would happen at hour one and not hour 24 when the subtext is going to sit on and fill the receptor as sufficiently no matter when you take it and you should not be going through ANY kind of horrible withdrawal.

 

[Jekyl Anhydride]

Maybe this then?

https://www.sciencedaily.com/releases/2005/02/050205093431.htm
or

Similarly, biochemical measures of rebound, such as increased neuronal adenylyl cyclase activity, have been widely reported during opioid withdrawal [32]. Although opioid agonists acutely inhibit adenylyl cyclase activity in the PAG [33], there is a compensatory increase in adenylyl cyclase signaling during chronic treatment with morphine resulting in rebound hyperactivity of this cascade during withdrawal [32]. The mechanism is suggested by Ingram et al., who showed that opioid dependence induces efficacious coupling of mu-receptors to presynaptic inhibition in GABAergic nerve terminals via adenylyl cyclase- and protein kinase A-dependent processes in the PAG [5]. Opioid withdrawal may therefore result in a loss of this coupling and neuronal hyperexcitation of opioid-sensitive PAG neurons [25, 34].

https://www.hindawi.com/journals/tswj/2012/940613/

 

[Plumber101010]

Maybe this then?

https://www.sciencedaily.com/releases/2005/02/050205093431.htm
or



https://www.hindawi.com/journals/tswj/2012/940613/

Wow!!! Good job my friend!!! I'm impressed if that means anything LOL. That is definitely the absolute closest that anybody has ever come to answering that question over a period of 10 years, and hundreds of replies that's for sure!

But to be totally honest, even though in general summary it "looks" like it COULD be the answer, I can't really say it does because it's WAY over my head and I didn't really understand it. I mean I do and I don't. Let's just say I understood it enough to know that it could possibly be an answer, but until I actually do some more research and look up the definitions of and those kind of things I would have to put this on standby as a possible long-awaited answer!

Here is the real problem I'm up against. Nobody will really know if I am right, other than me saying that I finally did this on my own wife and come to find out I was right. I kind of pushed this on her and it worked flawlessly. But the problem remains that nobody is doing it.

Everybody but everybody but everybody is waiting to detox before they do their first pill. And of course they would, because every single doctor tells them to wait, they read articles where they are being told to wait, they read articles on horror stories about what happens if people don't wait, while blah blah. So hypothetically if there's 1 million people that are going to start Subutex tomorrow, and all 1 million people are being told and instructed to wait until they detox or they could have a horrible reaction, how many people are deciding to ignore doing it that way and deciding to just do one anyway??

Not very many I can assure you that. Because even if they try to lie when they go back to get their pill the doctor puts them through a series of test and can tell if they are truly in withdrawal and lying about it.

But bottom line. I'd say the numbers are so minuscule that it does very little to prove my theory this is nothing more than doctors trying to get their patients HOOKED. And my wife is definitely proof of that as far as I'm concerned.

And one other thing that most people laugh about and make fun of me. But I just know it to be true. I have personally witnessed it and see that over 20 years to know any different. And that is?

NEVER underestimate the mind of a druggie or the mind of a junkie. It is extremely powerful and if they tell themselves that this particular brand of pill is junk and won't work, even if it was a SUPER PILL with twice the oxycodone in it they will swear up-and-down that it was pure junk and they didn't get anything from it. The mind of an addict is an amazing thing! Time and time and time again I have witnessed that. With dozens of examples with dozens of different drugs.

My point? Tell them that they will go through horrible withdrawal of they don't wait and I wouldn't be the least bit surprised if they created precipitated withdrawal on their own! I'm sure there are lots of really validated cases of it but I'm just saying once they get it into their mind that something will happen, it just wouldn't shock me to watch them bring it on themselves and have it happen!

 

[Jekyl Anhydride]

I'd have to say your wife's response was an anomaly and might occur in a small percentage of people but it is not par for the course. A long time ago before I knew much of anything about suboxone a friend failed to kick and gave me the rest of his Subs. I was on 200mg of Morphine a day and took one to see if it would enhance the Morphine. Without knowing about precipitated WD I got sweaty, then sicker and sicker till I was sure I was going to die. It took 600mg of Mor. to come out of it and then I KNEW PWD.

So to have it happen without any expectation of it proved to me it wasn't a psychosomatic response or Pavlovian junkie Jedi mind fuck but a physiological response. I assume your clean but if you ever have it happen to you it's something you'll never forget.

 

[Keif' Richards]

This is a pretty simple one. OP, you've actually completely and articulately explained the entirety of how these drugs work in your original post. You're correct about the relative binding affinities and such, but, the issue in question, is the rate at which these Opioids are kicked off of receptors. It's just like the oh-so popular Band-Aid analogy. Ripping it off fast involves less time in pain, but a more intense level of pain.

 

[Plumber101010]

I'd have to say your wife's response was an anomaly and might occur in a small percentage of people but it is not par for the course. A long time ago before I knew much of anything about suboxone a friend failed to kick and gave me the rest of his Subs. I was on 200mg of Morphine a day and took one to see if it would enhance the Morphine. Without knowing about precipitated WD I got sweaty, then sicker and sicker till I was sure I was going to die. It took 600mg of Mor. to come out of it and then I KNEW PWD.

So to have it happen without any expectation of it proved to me it wasn't a psychosomatic response or Pavlovian junkie Jedi mind fuck but a physiological response. I assume your clean but if you ever have it happen to you it's something you'll never forget.

Can't argue with your logic that's for sure. So you are someone it definitely happened to. It's the figuring out why that still gets to me, can't rest it in my curious brain

 

[Plumber101010]

This is a pretty simple one. OP, you've actually completely and articulately explained the entirety of how these drugs work in your original post. You're correct about the relative binding affinities and such, but, the issue in question, is the rate at which these Opioids are kicked off of receptors. It's just like the oh-so popular Band-Aid analogy. Ripping it off fast involves less time in pain, but a more intense level of pain.

And that in and of itself could very possibly be the answer. It's definitely a viable option. Just the fact of it being ripped off instantly vs slowly could be the very simple answer yes. Because we do know one thing for sure. That is the ONLY difference is ONE thing and one thing only. That is that it's filling either an empty receptor, or its filling an already filled receptor and booting whatever is in its way out first and then filling it.

Your post is intriguing because up until this point I have been focusing on the process of the Subutex "filling the receptor in either case" and as such should cause no withdrawl whether there was something in its place or not.

I have not been focusing on the difference of what happens when it does have to boot something out that's already there! And that is a very precise, specific difference that for some reason causes people to go into a precipitated withdrawal state.

So if what you're saying is correct, it's more simpler than anybody thinks. Not as complicated as I think. It doesn't matter if somebody has a new style Band-Aid with new Neosporin getting ready to go over that old wound. The fact that somebody ripped an old Band-Aid off is going to cause a certain amount of pain that nothing can prevent. Hmmmmm.

There's a lot of intelligent people on this forum

Still, we can say that my wife is an anomaly. But there is one big hurdle left to jump, and that is the psychiatrist in my original story. We can only assume that he has seen hundreds of patients over the years other than my wife. We can also assume that he is giving the same advice to all of them. And we can also assume that those patients didn't have any bad adverse reactions or he would not be continuing to give that same advice to a new patient! He was not just a random jerk, he was actually on the list of doctors authorized to prescribe Suboxone / subtex so this is something he does on a regular basis. And after many years of seeing these doctors he was definitely the only one who agreed with me and in fact was the one that gave me the confidence to try it on my wife!

That is one gigantic hurdle to jump over!

 

[shartito]

But there is one big hurdle left to jump, and that is the psychiatrist in my original story. We can only assume that he has seen hundreds of patients over the years other than my wife. We can also assume that he is giving the same advice to all of them. And we can also assume that those patients didn't have any bad adverse reactions or he would not be continuing to give that same advice to a new patient! He was not just a random jerk, he was actually on the list of doctors authorized to prescribe Suboxone / subtex so this is something he does on a regular basis. And after many years of seeing these doctors he was definitely the only one who agreed with me and in fact was the one that gave me the confidence to try it on my wife!

That is one gigantic hurdle to jump over!

That is definitely a hurdle. I agree. I'm not even sure what to say... I mean I can tell you that of all the research I've done (and I've done a LOT, I'm actually going to my first sub doc appointment next week), in all of the conversations I've had with sub patients (and there have been many of those conversations as well), that psychiatrist is the VERY first person I've heard of in the medical profession to dispense that advice.

Let me play devil's advocate a little bit and talk about one of the factors of your original post that hasn't been touched on much yet... Let's say I'm a suboxone doctor. Let's also say it's a fairly new product, and not a lot of people know about it yet, nor do they know about treatment details. So, I'm a doc, and I get my very first call from a prospective sub patient. This caller is a 10 year heroin junkie, ready to change his life. If I'm in it just for the money, would I say "well I'm gonna need you to wait at least 24 more hours"?? I mean, kind of putting myself in the mindset of a doctor who might not have the patient's best interests at heart, I would be thinking to myself "I need to get this guy in here as soon as possible, before he changes his mind. If I make him wait, he's gonna go score some smack, and I'm going to lose that $300".

Again, just playing devil's advocate, but if it's a scam, if it's deliberately misleading possible patients, I would think it would be the other way around. I mean, they're gonna get hooked on it either way, whether they wait or not, right? It's an opioid, of course they are. So, why not get them hooked sooner rather than later?

I'm not sure I explained that well, but do you know what I mean?

Just food for thought

 

[Plumber101010]

That is definitely a hurdle. I agree. I'm not even sure what to say... I mean I can tell you that of all the research I've done (and I've done a LOT, I'm actually going to my first sub doc appointment next week), in all of the conversations I've had with sub patients (and there have been many of those conversations as well), that psychiatrist is the VERY first person I've heard of in the medical profession to dispense that advice.

Let me play devil's advocate a little bit and talk about one of the factors of your original post that hasn't been touched on much yet... Let's say I'm a suboxone doctor. Let's also say it's a fairly new product, and not a lot of people know about it yet, nor do they know about treatment details. So, I'm a doc, and I get my very first call from a prospective sub patient. This caller is a 10 year heroin junkie, ready to change his life. If I'm in it just for the money, would I say "well I'm gonna need you to wait at least 24 more hours"?? I mean, kind of putting myself in the mindset of a doctor who might not have the patient's best interests at heart, I would be thinking to myself "I need to get this guy in here as soon as possible, before he changes his mind. If I make him wait, he's gonna go score some smack, and I'm going to lose that $300".

Again, just playing devil's advocate, but if it's a scam, if it's deliberately misleading possible patients, I would think it would be the other way around. I mean, they're gonna get hooked on it either way, whether they wait or not, right? It's an opioid, of course they are. So, why not get them hooked sooner rather than later?

I'm not sure I explained that well, but do you know what I mean?

Just food for thought

Yeah, maybe, I would say that's the flipside of the coin for sure. But then again if somebody is really serious enough about changing their lifestyle that they're seeking a drug to help them, they should be able to go at least 24 hours?

I posted the same question on another website and I finally got my first response and the person said they decided not to wait and they had no adverse reaction's!!!! Plus one for me This was their response:

"I have taken subutex and suboxone 3 hrs after taking opiates like oxy 80 or morphine and it has never happened to me. I wonder if it is certain people. I have done it more than I can count and never had precipitated withdraws"