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Bupe first appointment with sub doc

olypen

Bluelighter
Joined
Mar 5, 2015
Messages
115
HE's a psychiatrist if that matters, the only sub doc here besides a pain management doctor and i do not have any pain. He list addiction as a focus and i actually know someone who goes to him and get subs. She said he's nice and empathetic.

I'm a little scared as to what to expect or how honest i should be. I've been using some sort of opiates off and on for about 11 years and have never admitted it to a doctor for fear of getting the dreaded "seeker" sticker on my chart. I rarely got anything from docs unless it was legitimate anyways, tussionex for a cold or dilaudid after surgery.

I tried moving to the coast a year ago and after developing a nasty dilaudid turned H habit came back here to kick with a few subs and benzos and a job lined up. Well after a month of being here i ran into tons of ultra cheap fent patches and was smoking a couple 100mcg patches a day for months. THey ran out and switched to morphine, IV'ing a couple hundred mg a day to feel normal.. all the while doing as much dilaudid as i could find in 24-32mg shots.. I have a substantial tolerance.

Years ago i was diagnosed as bipolar but i havent taken any meds for that in over a decade and have come to conclude i've probably been trying to manage my mood with drugs and failing miserably.

When i made the appointment i didn't mention addition or subs, just that i'd been off meds for quite a while and think it's time to get back on them. I ran out of morphine and my appointment isnt until wednesday, but i've got some kratom, benzos, soma and PST to make life bearable.

Should i mention i IV? What should i expect? I'm terrified he wont prescribe me any subs and i'll end up losing my job and back on the coast in an even worse situation. I know i cant stop at this point as my mood is just shit without something in my system. I also cant take a month off work for inpatient, i simply dont have the time and would break my lease and lose my house. Any advice or words of encouragement would be appreciated.
 
Let me understand...you are worried about not being prescribed buprenorphine but don't want to tell him that you are injecting? That doesn't make any sense to me. You obviously have a problem and it would be appropriate to treat you with buprenorphine, so why don't you just be honest with him. I know lying is often part of the disease, but you will never get better of you don't start being more honest.
 
I guess I'm nervous because I've been told by addicts that iv use instantly means inpatient. I have a job, a good one, and I don't have the paid time off, nor the desire to tell my employer that I need rehab. If inpatient is my only option I'm really screwed.

I'm also just nervous about the whole being honest with a doc for the first time ever. Guess I'm just looking for support and stories from people with similar situations.

I'd definitely do treatment or see an addiction counselor, I just can't afford a 30 day inpatient stay. I'm finally ready to be rid of this shit and I just hope I can make it work.
 
Don't worry man just tell him the truth. At most he will require you to do outpatient rehab but never inpatient. That is unless you continue to actively use while under his treatment.
 
If you want to mention the IV go for it....I didn't mention it to my Sub doctor because I didnt wanna be checked for track marks. I don't really see a difference it will make really though, I mean they know we are addicts, and TONS of addicts IV. And thats why they give out Suboxone instead of Subtex, which sucks cuz it makes no difference anyway and Subtex is sooo much freakin cheaper..
 
I know how you feel but I promise you, you wont shock the sub doc with anything you say. Just tell the truth and you will leave with a script of subs.
it is not entirely necessary for you to mention that you IV but for sure tell him the amount and frequency of your use.
 
thanks for the support. The whole thing is just driving me nuts. I tried calling and begging for an appointment today but got nowhere. Left my number incase there is a cancellation. I just don't know if i'll make it till wednesday @ 2pm.
 
Well for anyone who cares, or might be scared and reading this later, i got in a day early. i was so fucking nervous i took 60 mg of restoril before the appointment on top of the 1mg of xanax i had for breakfast and was still hyped and shaking.

When he started he said he needed to be able to trust me to be honest. I just unloaded and was 100% honest about everything. I told him i IV'd nearly 5mg, yes MG, of fentanyl over the course of the last night admitting i woke up with a rig in my arm after one shot. I told him i was considering ordering RC fent analogues online and that i knew i was going to accidently kill myself if i didnt get help either with an OD or complications from shooting pills.

HE asked about general drug use and what drugs i'd done.. i froze because i didnt know where to start.. i just said i was a polysubstance abuser.. he started naming things and of course i've tried them all and even added a few i dont think he had ever heard of.

After about five minutes of explaining i flat out told him that i was terrified he wouldn't think i was appropriate or already be at his 100 patient maximum and just plain asked if he was going to prescribe me some subutex. He assured me that he would give me bupe and i instantly was relieved. I really feel like i would end up killing myself if i didn't get on subs.

He was a very empathetic guy, started me at 16mg of suboxone. meeting again in a week to go over how things are going. He said he would write a month script at that point and potentially increase the dose if needed. I'm thinking i'll step up to 24 if for no other reason than to have some extra and because i dont know if 16 is going to kill the craving with my tolerance at this point.

I told him i would prefer subutex, because i have experience with it and its cheaper than suboxone. Unfortunately he said with my IV use, suboxone would be the better choice.. based on the cant IV myth. I didnt argue or really care, except i do like to save me AND my insurance company money whenever i can just to try to keep premiums from going up.

HE prescribed some other psych meds, a combo i had used successfully in the past without question, topiramate/celexa and valium, except he cut the doses in half. I remember titrating up on them the first time, so that was no concern for me. If the lower doses are effective I'm fine with that. Valium was the only thing i argued against cutting in half. I told him, truthfully, that i used 10mg valium 3 times a day and he wanted to cut that to 5mg. I told him after much experience with benzos, trying them all, valium was the one that worked best and 10mg was the dose required. He was actually fine with that but cut it from 3 times a day to only twice. Given my situation, i was satisfied he even gave me 60 10mg valium :)

After i left, scripts in hand and hours later he actually called back personally and said i might still feel discomfort and had actually called in a script for clonidine and gabapentin to the pharmacy if i wanted to pick them up.

He never did mention treatment or having to go to meetings or anything, although i think im going to give some a try. Overall i was all worked up for nothing and should have done this years ago. Taking that first step, actually admitting and having drug addiction in my medical record was a huge thing for me. I also inquired about times i might legitimately need pain control and the fear i woudlnt get it. He assured me that all i would need to do is call and that there are indeed drugs that will still be effective being on bupe. That put my mind at ease. i just don't want to break my arm and have them try to throw some 5/325 norco at me and tell me to suffer. Hopefully that doesn't happen and if it does hopefully he keeps his word.



So that's my story. I feel so relieved. If your in my situation, go for it. It's not as bad as it seems in your head at the time.
 
Welcome to recovery using bupe. A few things struck me. You should read the Suboxone MegaThread or the like (don't recall exact title, it's in this sub-forum)

In most people's experience even the most intense heroin habits are well covered by 4-mg/day of bupe. 16-mg is a massive dose that probably isn't doing more for you than 4- or at most 8-mg would. I would definitely consider NOT raising your dose any further, you likely will feel nothing different. For some this may not be true, but the vast majority of us long term bupe maintenance people have learned - "less is more with bupe." It's mixed agonist priorities make it an unusual acting substance.

But... Good for you! You're going to live a much better life moving forward. I'm always very happy to hear someone choose bupe or methadone after a bad opioid habit. It's imo, the only way out of the life. If going to meetings helps you great, do that. Be prepared though for AA and NA members to be kinda harsh on you about taking bupe, maybe not say anything, though that may violate your ethics and that's where medicated addiction vs., AA collide...

Don't be overly influenced by anyone other than your physician, who sounds pretty cool, and your own informed self.

That said, I'm giving opinions and ideas, these are both my own experience and that of others like me, but as I've said others have different experiences. But I can assure you bupe will eliminate the need to use any other opioid, and you'll be comfortable The only thing I see as an issue is the high dose, but even that's not terrible, coming down from 16- to 8-mg for me was darn easy. It's just better to start at the amount that works and no more.

The standard protocol many doctors use in the US is, they give you increasing doses of 2-mg until you're comfortable. I bet you'd have felt the same at 6-mg as you do at 16-mg. You'll read about this a lot of you read the mega thread.

Coming here for info and support is a great idea, remember everyone's experience is different and you'll read the whole spectrum if you really dig in, I suggest you read as much as you need to feel comfortable with your recovery plan.

It sounds like you have a good start, there'll be some strange days and nights as you adjust. It won't be long, eat well, exercise and in a, week or two you'll be amazed how good you feel. You won't feel terrible and that's huge. Excellent move. Congratulations welcome back to the other 95% of the world.

Best wishes.
 
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