Author: tearj3rker
Posted: Mon Apr 16, 2012 11:24 pm
Yeah I’m with rule on this one. While in some ways it is "safe" for patients to be put on more than they need, there is big downside in the long run.
I just gotta say that I’m no doctor, and what I’m saying now is my personal opinion.
When a person stabilises on a high dose, essentially their tolerance to opioids goes up. Once tolerance goes up, it’s a LOT harder for it to go down. That process of tolerance rising and acclimatising to a high dose does create lasting changes in the brain. In some ways it makes it harder to stay off opioids long term.
Being high on Suboxone, to me, is a sign that dose is too high. This happened to me the first time I went on Subutex (years before Suboxone came out), when I was put on 4mg even though I only used heroin maybe every 3-4 days. I was barely physically hooked! (Really, I just wanted to get a legal high, so I’m the only one to blame). I was ..stoned.. from that dose, but after a couple of weeks my tolerance caught up. Then when I eventually got off Sub, I found myself more dependent on opioids than I was beforehand, with more intense cravings.
You do have a right to take less than you’re prescribed. If you allow yourself to stabilise on this high dose, that feeling of being high will wear off, but you will also be more dependent on Suboxone / opioids than you need to be. Hence it will be a lot harder to get off.
If I were in your shoes, knowing what I know now, I’d do what rule said and experiment on a much lower dose … under 4mgs. If that isn’t enough, then the next day try increasing by 2mg increments. If 8mg still got you high-as-a-kite, then you probably won’t even need 4mgs.
It’s your call. I ..hate.. disagreeing with a doctor’s opinion, and understand I’m saying this not as a representative of suboxforum, but just a non-professional opinion of someone who knows more about opioid addiction than I ever wished I would.
I’d encourage you to put your situation to Dr. J. This article of his might give some answers though:
| Quote: |
| A reader wrote with a question that I don’t think I’ve addressed on the blog.
Do you have a threshold for how much narcotic a patient must be using before you will put them on buprenorphine? I am concerned about narcotic addicts that are using 6-10 Vicodin (hydrocodone) a day for example. Many have very mild withdrawal symptoms, but are never-the-less unable to stop on their own. This is an insightful question that provokes enough discussion to fill at least one blog post. I don’t have a simple answer, other than to go on a case-by-case basis and try to determine who, if anyone, might be able to walk away from opioids completely (i.e. a person who I would be less likely to put on buprenorphine, as doing so would drive tolerance higher) vs. those who will need maintenance treatment eventually, even if their doses are not yet very high. Patients have a right to know if they are having their tolerance increased in my opinion, given the misery involved in bringing tolerance down. It is also important to tell people with lower tolerances that they are going to get a buzz from buprenorphine for a few days because of the potency of buprenorphine. This opiate stimulation is likely to occur even with a very small piece of a Suboxone tablet; a quarter tab or 2 mg of buprenorphine has almost the same potency as 16 mg because of the ‘ceiling effect.’ The potent opioid effect may make the doctor liable for a car accident, or could even lead to overdose if the patient combines buprenorphine with other respiratory depressants. … *more* |
http://suboxonetalkzone.com/buprenorphine-for-low-dose-opioid-use/
