dopetalk
Core Topics => Treatment, Recovery and Rehabilitation => Topic started by: DeadCat on June 01, 2016, 12:14:42 AM
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Without going into too much detail I have what may be an opportunity for kicking buprenorphine (Suboxone).
I've ben prescribed bupe since about 2003, from almost s soon as it becoming a prescribable drug for detox and/or maintenance. Thses days I am prescribed 16mg/day but I don't take that much. Like any experienced junkie especially with so few doctors able to prescribe it I've learned to tell my prescribing doctor that I take 2X aas much as I do so I can keep a healthy "emergency supply" stashd "just in case. Besides having to visit the doctor once a month to get my pills so that I can avoid withdrawal just rubs me the wrong way.
Anyway, a close family meber has cancer. She's had it for some time and it isn't malignant or immediately dangerous. She opted for "pallative care" just trating her symptoms and not doing chemo. Her pallative care docor just wnts to keep he comfrotable and able to have a normal life. He prescribed her 5mg of methadone a day, with refills and tells her he will increase her dose if she feels she needs more.
The thing is, SHE DOESN"T WANT TO TAKE IT. SHe's very anti-narcotics and "doesn't want to be a junkie." Also, I foolishly warned her that if she takes it and screws up driving she could face a DUI even if she hadn't taken any that day. So, instead of taking her little bit of methdone everyday she skips it unless she is in rea pain.
No we here all know that 5 or 10 mg of methdone ain't shit. BUt this docoris ready to give her s much as she wants/needs to feel OK and enjoy life. And, she is in no immediate danger.
In my own opinion she should take the methadone just to help with the aches and pains and to lift her mood a bit (I heard opiates do that) but chnaces are she is going to take a pill or two a week for a long time.
I told her that IF SHE DIDN"T TAKE THEM she COULD give them to me and get her doctor to give her a bigger (and also refillable 'script) at the end of the month. At a minimum she will get 150mg/mo and that could easily become 300, 450, 600 mg/mo in just a few months.
Here's my idea, once she has serveral hundred mg's of methadone tablets if I could quickly taper my buprenorphine to ZERO (get into full-blown bupe w/d) then start using the methadone in as small a dose as it takes to stop the w/d then quickly taper down on the done, (not build up a methdone habit) do you guys think I can shake the bupe habit and avoid a methadone withdrawal?
Ideally, I'd have an even weaker drug, like Vicodin or Percodan to get through the last leg of the process and given my relative's's doctor's willingness to give her pain meds this might happen. I'd just have to coach her on how to describe and ask for something for "breakthrough pain."
Maybe this is all a pipe dream, I donon;t know. MY bupe docotor won't taper me using weaker and weaker full agonist opiates becaues he believes that it would "trigger" full-blown H use but I have no H connection and I have been doing well (opiate-wise anyway) fr over 10 years. All I am doing is using the bupe to avoid w/d from it because it does NOTHING for me as far s getting a good opiate glow going.
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Terrible idea all around. For one, you're asking your close family member with cancer to commit a crime. That really doesn't need to be commited. Kicking bupe will be far easier than done. Especially if one of the reasons you want to switch to the done is for an opiate glow.
You're prescribed 16mg bup a day, but you're taking less, what dose are you currently using?
Since you have plenty of stock, you'll be able to take as long as you need to taper off the bupe. A slow taper can be pretty much painless. It just takes time.
In theory it does sound like a good IDE, especially if you'll get some glow here and there. I just don't ser it working out very well. Just my opinion
I'd rather be working for a paycheck than waiting to win the lottery.
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Dude use the methadone to dt, are they the dissolve able pills or oral ones? If they are dissolve able you can titration the doses down to 1 mg or so and u know how to do it from there. Starts at 10mg a day (5 x 2) then 2.5 x 2 and so on....
I wouldn't personally bother with trying to get her to get vikes or percs.... Just my opinion....
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I'm with Taytoechip-your whole plan makes me nervous.
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If this is something you really want, maybe consider doing ibogaine while in SA.
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Iboga is overkill for buprenorphine. Id never do Ibo for anything short of a full blown dope habit or serious methadone intake.
However, I do agree with tay on the coaching cancer patient to get breakthrough meds from her doctor. I just think that's a bad idea all around.
Now if she's/he's already got a shotload of done at home and willing to help out, the. There's no harm in that I suppose....
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IME it's much easier to taper off bup than 'done; unless the methadone course is really short, like less than 6 weeks MAX, I suspect you'd probably just wind up jacking up your tolerance..
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Iboga is overkill for buprenorphine.
In my experience, I don't think it really is. When I did it, there were people doing it after being clean for more than a month. Part of it is to help with withdrawals, but an even bigger aspect of it is spiritual. To help you reset your thoughts and get past addiction mentally. It also helps a lot with depression which can be the difference between getting clean and staying clean. Small boosters are used to help with that.
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Iboga is overkill for buprenorphine. Id never do Ibo for anything short of a full blown dope habit or serious methadone intake.
However, I do agree with tay on the coaching cancer patient to get breakthrough meds from her doctor. I just think that's a bad idea all around.
Now if she's/he's already got a shotload of done at home and willing to help out, the. There's no harm in that I suppose....
That's how the idea came about. SHe doesnt't want the methadone but they are writing her refillable prescriptions with the option to increse doe and quantity.
I would NOT divert any medication that would be otherwise used. The isdea for getting some weaker plates "for breakthrough" was from past experience with CPP they are frequently given them along with long-acting pain meds. My thinking was if they were going to do this a few of them would make a good last step down after using methadone for (a week?) then be done.
I know people who quit bupe and methadone go through much longer acute AND post-acute w/d than short-ating opiates, including H.
THe other person is not symptomatic. She refuses chemo and doctors dont see malignancy. And she is really wary of taking ANY drugs so they are either going to pile up or get flushed so me usuing them to help detox from bupe isn't going to negatively affect her and she is for me trying it.
It's a pretty good opportunity because of those factors. What I wonder is HOW to best go about it. I average maybe 12 mg of bupe a day which is way more than I want to be taking . I took 2mg/day for years until I got insurance and a new door who wrote for 16mg day which I took in ordr to have a back-up stash and I am glad I did.
More than once my bupe supply has been interrupted; insurance problems, lost some once, cops saw them and arrested me for psosession because I was travelling and kept my travel supply in a small factory botle that had all the right information (name, script number, etc) but was from an old fill so he said it was illegal....it was laughed out of court but I still had to go to jail and get released, then flay back and forth to fight it and show my pharmacy records and even then the cops "lost" them when I asked for my property back. Plus only a few doctors CAN write for it and they are often at their maximum patient load (by law) so if you and your bupe doctor part ways you can go weeks or more w/o geting a new prescription.
That was a tangent sorry, but that's why I now make sure I have extra's stashed away. The downside is it is now easy to take more than I intend to when I feel shitty or think I'm starting w/d.
So don't worry about the person who is getting the prescription. What I'm unsure of at what leel of bupe use can I use methadone to stave off w/d and then how much methadone do I use and at what rate do I reduce that to zero? You know, the stpe by step procedure.
Also, if it DOESN'T work I still have shitloads of bupe and a monthly doctor's visit for more.
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IME it's much easier to taper off bup than 'done; unless the methadone course is really short, like less than 6 weeks MAX, I suspect you'd probably just wind up jacking up your tolerance..
That's what I was thinking: get as low on the bupe as I can until wd starts. Then, use the 'done at the minimum effective dose and start titrating down right away.
Also, there is no danger of developing a real methadone habit. The supply would be limited.
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I dont know what you want us to say
you realize how little 150mg of done is a month right? You want to come off 12mg of bupe a day, which you have plenty of, to use 5mg of done a day to taper?
If you want to get high, just get high. dont try to trick yourself into believing its for the best. Just go off your bupe a few days, do what you want to do, then go back on the bupe.
" BUt this docoris ready to give her s much as she wants/needs to feel OK and enjoy life. And, she is in no immediate danger."
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That's how the idea came about. SHe doesnt't want the methadone but they are writing her refillable prescriptions with the option to increse doe and quantity."
There are people here who take 150mg in one swig. Thats not even close to appearing on the scale of "a shitload"
Even if you dont plan on "coaching" her into weaker opiates for breakthrough, you're still planning on coaching her to ask for more done, over and over again. and that in itself is fucked up that you see that as perfectly fine and harmless. Because honestly, its not. Nothing about this plan is a good idea. If she doesnt want the done then sure, by all means let her give it to you if she wants. But just get high once or twice and go back to real life
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Also, there is no danger of developing a real methadone habit. The supply would be limited.
Which is exactly why you shouldnt even involve someone else, there is no doubt 100% that you will be right back on the bupe. Which is fine. But what would you have accomplished?
I'm telling you man, you have the shit you need to get off the bupe. focus on that. Long term goals. No pipe dreams of being clean by next month, be realistic with your taper. Plan it out, stick to it. It can be painless i promise
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I dont know what you want us to say
you realize how little 150mg of done is a month right? You want to come off 12mg of bupe a day, which you have plenty of, to use 5mg of done a day to taper?
If you want to get high, just get high. dont try to trick yourself into believing its for the best. Just go off your bupe a few days, do what you want to do, then go back on the bupe.
" BUt this docoris ready to give her s much as she wants/needs to feel OK and enjoy life. And, she is in no immediate danger."
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That's how the idea came about. SHe doesnt't want the methadone but they are writing her refillable prescriptions with the option to increse doe and quantity."
There are people here who take 150mg in one swig. Thats not even close to appearing on the scale of "a shitload"
Even if you dont plan on "coaching" her into weaker opiates for breakthrough, you're still planning on coaching her to ask for more done, over and over again. and that in itself is fucked up that you see that as perfectly fine and harmless. Because honestly, its not. Nothing about this plan is a good idea. If she doesnt want the done then sure, by all means let her give it to you if she wants. But just get high once or twice and go back to real life
I probably didn't explain it clearly enough for you. Right now the prescription is for 5mg/day with a refill. The doctor will increase it s needed. I doubt more than 5 or 10 mg a week will be used. So in a couple months there will be a few hundred mg of methdone sitting here. When I have gone to mehadone detox from H they started us at 40mg/day and dropped it by 5mg/day. (OR close, it was 40 down to 0 in a week).
I will agree that "coaching" to ask for a weaker "breakthrough" opiate probably is'nt worth it.
The thinking is that after tapering to as low as possible a short course of methadone will ease the w/d that occours even after you taper down to a fraction of a mg of bupe. But it wouldn't be enough in dose or length of use to develop a methadone habit, just ease the acute w/d from bupe.
Remember, this is an idea for an experiment. Franly I am very tired of needing bupe like a junkie without the reward of a full agonist but I don't want the junkie life either so the short case of methodone might ease the transition.
What I would find MORE helpful than speculation why I shouldn't try it is someone with IRL experience or from someone who is professionally qualified in the biology of opiate dependence and the actions of different opiates.
And to be clear, none of this is "to get high" my statement was that I am going through the mechanics I did to get high but now I do it just not to be sick.
I'm not pushing anyone into doing anything. They are going to keep writing it for her and telling her to take more (in fact, they just called to tell her to take more) but it is her way to say "OK" and then just leave it on the shelf.
Tattoo, I don't think I can explain this all fully or to your satisfaction. THe bottom line is in a month or two there will be a few hundred mgs of unused, never gonna be used methadone here and I was specualting as to if it could be helpful in getting off the bupe. IT's nothing to freak out about.
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Tattoo, I don't think I can explain this all fully or to your satisfaction. THe bottom line is in a month or two there will be a few hundred mgs of unused, never gonna be used methadone here and I was specualting as to if it could be helpful in getting off the bupe. IT's nothing to freak out about.
Theres really no need to explain anything to my satisfaction. I'm just trying to help you realize what a terrible idea this is. But you're right, I'm not professionally qualified in the biology of opiate dependence. I did however just finish a year long suboxone taper that was more or less painless, but hey fuck me.
Good luck with your endeavor
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I guess what I'm not understanding is why you want to taper after switching to methadone instead of just simply tapering from the bupe...seems like alot of trouble. Sorry but I'm not seeing the point in this. Either way, good luck man! Kat
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Without going into too much detail I have what may be an opportunity for kicking buprenorphine (Suboxone).
I've ben prescribed bupe since about 2003, from almost s soon as it becoming a prescribable drug for detox and/or maintenance. Thses days I am prescribed 16mg/day but I don't take that much. Like any experienced junkie especially with so few doctors able to prescribe it I've learned to tell my prescribing doctor that I take 2X aas much as I do so I can keep a healthy "emergency supply" stashd "just in case. Besides having to visit the doctor once a month to get my pills so that I can avoid withdrawal just rubs me the wrong way.
Anyway, a close family meber has cancer. She's had it for some time and it isn't malignant or immediately dangerous. She opted for "pallative care" just trating her symptoms and not doing chemo. Her pallative care docor just wnts to keep he comfrotable and able to have a normal life. He prescribed her 5mg of methadone a day, with refills and tells her he will increase her dose if she feels she needs more.
The thing is, SHE DOESN"T WANT TO TAKE IT. SHe's very anti-narcotics and "doesn't want to be a junkie." Also, I foolishly warned her that if she takes it and screws up driving she could face a DUI even if she hadn't taken any that day. So, instead of taking her little bit of methdone everyday she skips it unless she is in rea pain.
No we here all know that 5 or 10 mg of methdone ain't shit. BUt this docoris ready to give her s much as she wants/needs to feel OK and enjoy life. And, she is in no immediate danger.
In my own opinion she should take the methadone just to help with the aches and pains and to lift her mood a bit (I heard opiates do that) but chnaces are she is going to take a pill or two a week for a long time.
I told her that IF SHE DIDN"T TAKE THEM she COULD give them to me and get her doctor to give her a bigger (and also refillable 'script) at the end of the month. At a minimum she will get 150mg/mo and that could easily become 300, 450, 600 mg/mo in just a few months.
Here's my idea, once she has serveral hundred mg's of methadone tablets if I could quickly taper my buprenorphine to ZERO (get into full-blown bupe w/d) then start using the methadone in as small a dose as it takes to stop the w/d then quickly taper down on the done, (not build up a methdone habit) do you guys think I can shake the bupe habit and avoid a methadone withdrawal?
Ideally, I'd have an even weaker drug, like Vicodin or Percodan to get through the last leg of the process and given my relative's's doctor's willingness to give her pain meds this might happen. I'd just have to coach her on how to describe and ask for something for "breakthrough pain."
Maybe this is all a pipe dream, I donon;t know. MY bupe docotor won't taper me using weaker and weaker full agonist opiates becaues he believes that it would "trigger" full-blown H use but I have no H connection and I have been doing well (opiate-wise anyway) fr over 10 years. All I am doing is using the bupe to avoid w/d from it because it does NOTHING for me as far s getting a good opiate glow going.
Seems really unethical and scheming to be honest. If she dies, and leaves over some medication i dont think it would be okay to take whats left over, but anything seems wrong.
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Not that it's all that relevant, but you mention several times a "refillable" methadone script -- Schedule 2 drugs cannot be written
with refills, they require a new written script every 30 days afaik.
And I get what you're thinking, it seems a shame to have a bunch of methadone sitting around, unused. But the whole thing seems like it
might be more trouble than it's worth. And I have detoxed off of both suboxone and methadone, and I don't see any advantage in trading
one for the other.
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Your family member has cancer-there are no good cancers. Only stages-and each stage is worse and closer to death- said family member will need those pain meds, and is already afraid to take them for fear of addiction.
You should persuade this person to take them when needed with no fears. Share your knowledge instead.
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I don't think this is going to be advantageous for you. If you want to get high, just go off the bupe for a few days, and take some methadone. (yeah I know you said you don't want to get high - me neither. NO NEVER!).
I feel I must warn you about being on bupe, switching to methadone, then trying to go back on bupe. Wait like a WEEK since your last methadone dose to take a dose of bupe, or you'll be in PWD HELL!
Now, if you were trying to get off methadone, by switching to a short-acting opi like oxycod or morphine, that would be something to try.
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Your family member has cancer-there are no good cancers. Only stages-and each stage is worse and closer to death- said family member will need those pain meds, and is already afraid to take them for fear of addiction.
You should persuade this person to take them when needed with no fears. Share your knowledge instead.
This 1000 times..
...im sorry your family member has cancer that sucks big time...even if its slow growing one...it will eventually spread/ metastasize etc...and she will need those pain meds...my Father was anti meds...he sure as hell took his when it got bad...
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This is just my 2 cents, but I think you should focus on doing a painless (read: slow) bupe taper. You will need to switch to the 2mg ones eventually to get as low as possible. It will take a while but it can be done painlessly if you take your time and stick to the plan. Once you get down to like .25mg or less, you can revisit this idea. But give yourself the time to do it right w bupe. Perhaps by then her situation may have changed and she may need the done and you won't hafta feel any guilt for borrowing her meds. Or. All may remain the same and you can switch over to a quick itty bitty done taper to shorten that last final leg. But I would strongly suggest just focusing now on slowly tapering down to the lowest possible bupe dose, it sounds like you're ready to get this monkey off your back.
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I guess what I'm not understanding is why you want to taper after switching to methadone instead of just simply tapering from the bupe...seems like alot of trouble. Sorry but I'm not seeing the point in this. Either way, good luck man! Kat
The idea was to use the methadone for a shot time at a low dose both low to not build a tolerance to methadone just ease the last couple weeks of post-sub detox w/d symptoms (PAWS). It ws NOT to trade one habit for another then try to quit the new habit. It's the same kind of thing detoxes do when you have a heroin habit; they give you methadone (or suboxone) for a short time while youget through the worst of the H wd. I've done this half a dozen times a different detoxes but back then I wasn't looking to really quit. Now I want to quit bupe because I still have to have a connection ( doctor) I still have to have a supply, I still am always a certain amount of time from being sick but when I do the bus, the
"reward" is just not getting sick.
Although methododne is a longer acting opiod it is a shorter acting opiod than dupe. Ideally you would do this with something very short acting and just through the worst of the kick.
At this point its all speculation because I know my family nd Iit is a safe bet that sometime after I get back from Colobia the medicine cabinit will have several nearly full bottles of methodone and I was hoping thre ws a way to put it to good use and someone here would knowi how.
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Your family member has cancer-there are no good cancers. Only stages-and each stage is worse and closer to death- said family member will need those pain meds, and is already afraid to take them for fear of addiction.
You should persuade this person to take them when needed with no fears. Share your knowledge instead.
I have tried...and tried ...and tried. THis person knew she had breast cancer (but kept it a secret) for 5 YEARS until the lumps grew then she decided to get the mastectomy. Then, she refused all chemo because they coudn't promise it would cure her.
Now some cancer cells are showing up in other places and she still refuses chemo. I am sure she is depressed and is now old and thinks it's time to die. You know and I know this is rcazy but Ive been discussing this with her for 2 years (staritng 5 years after her diagnosis)
In fact I ws the one who got her to see a pallative care doctor hoping some kid of opiate would make life easier for her but she's resisting taking the pills, even after the doctors office called her today and told her to increase her dosage.
She's "Not going to be an addict!" she says.
From what she told me they gave her a bottle of #30 5mg pills and it has a refill. They will give her more and stronger pills so she can take more. Eventually she might start taking them once she's in real pain. If so great but if not and she winds up with hundreds more pills than she can use AND they are still giving them to her at her monthly pharmacy visitshe will give them to me if I ask. If the pain really gets bad they will start giving her dilaudud I suspect.
It's just DENIAL, her daughter died of an OD so therefore all opiates are bad and she is fighting using them.
I was ONLY speculating that they might be put to good use instead of flushed. I did some research and found that doctors are detoxing people from long-acting opiates by switching them to shorter and short acting ones therefore tapering the dose until they get down low enough to finally quit completely.
It is not othodox in the US but it IS being done successfuly in other countries and it does make sense to me.
Before anyone else jumps down my throat about this just know at all times she willl always have enough painkillers.
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This could work with incredible self control, control I lack. After years of being an H addict for many years, I spent 2 years on bupe, chipped the whole time, 6 years on methadone, chipped the whole time, tapered at the end, ibogained and was clean for 6 months. Then, I took 20 Mgs methadone and it rocked my world and that fucked up everything. Be careful, methadone is no joke and very pleasurable after bupe or after nothing. The temptation becomes huge, bigger than my will power, that's for sure.
Tapering bupe sucks but it does work. Just gotta go to a tiny dose. I hope I understood the situation .
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I am still not getting how you have refills on a C-II drug. That is against Federal law AFAIK.
From the DEA Pharmacists Manual (which can be found at http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm)
Schedule II Controlled Substances
Schedule II controlled substances require a written prescription which must be manually signed by the practitioner or an electronic prescription that meets all DEA requirements for electronic prescriptions for controlled substances. There is no federal time limit within which a schedule II prescription must be filled after being signed by the practitioner. However, the pharmacist must determine that the prescription is still needed by the patient. While some states and many insurance carriers limit the quantity of controlled substances dispensed to a 30-day supply, there are no express federal limits with respect to the quantities of drugs dispensed via a prescription. However, the amount dispensed must be consistent with the requirement that a prescription for a controlled substance be issued only for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. For a schedule II controlled substance, an oral order is only permitted in an emergency situation (see Section X, Emergency Dispensing).
Refills
The refilling of a prescription for a controlled substance listed in schedule II is prohibited (21 U.S.C. § 829(a)).
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If she has a problem with addicts then I'm not sure you should slide into that role in her life. It will likely start out fine, but at some point you are calling for more pills and coaching her to get a larger prescription. She might start to see you as an addict using her for drugs.
Is methadone any better than bupe anyways? They both have long withdrawals and I can't really see the advantage if you are stable and happy on bupe.
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I am still not getting how you have refills on a C-II drug. That is against Federal law AFAIK.
From the DEA Pharmacists Manual (which can be found at http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm)
Schedule II Controlled Substances
Schedule II controlled substances require a written prescription which must be manually signed by the practitioner or an electronic prescription that meets all DEA requirements for electronic prescriptions for controlled substances. There is no federal time limit within which a schedule II prescription must be filled after being signed by the practitioner. However, the pharmacist must determine that the prescription is still needed by the patient. While some states and many insurance carriers limit the quantity of controlled substances dispensed to a 30-day supply, there are no express federal limits with respect to the quantities of drugs dispensed via a prescription. However, the amount dispensed must be consistent with the requirement that a prescription for a controlled substance be issued only for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. For a schedule II controlled substance, an oral order is only permitted in an emergency situation (see Section X, Emergency Dispensing).
Refills
The refilling of a prescription for a controlled substance listed in schedule II is prohibited (21 U.S.C. § 829(a)).
In this case it is easy: the pallative care and oncologists have offices in the hospital and a pharmacy downstairs, so they have the refill as independent scripts sitting there on file in the pharmacy ready to go. It's not like having them call in to the local CVS.
I think it is because they know cancer patients might run out at odd hours and can't wait for the doctor to check his messages the next day, then fax or leave for pick up a new paper 'script. Instead., there is an in-house 24 hour pharmacy. It is a specialty clinic and they know their patients are going to need regualr refills indefinitely so they found a way to cut through the usual things that slow down the process from patient request to pick-up. It may not be EXACTLY as I describe it but that's how it seems to have ben working.
Or maybe they have a system in which every time a patient picks up a fill the pharmacy alls the doctor and he immediately prepares the next script. I don't know for sure but it has ben made clear she cn pick more up whenver she wants.
Plus they are dealing with mostly seniors and peole fighting a long and ultimately losing battle so they aren't too worried about creating dependency.
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If the pain really gets bad they will start giving her dilaudud I suspect.
I suspect you wouldnt ask for those then, yes?
It's just DENIAL, her daughter died of an OD so therefore all opiates are bad and she is fighting using them.
But giving them to another addict is fine.
I was ONLY speculating that they might be put to good use instead of flushed. I did some research and found that doctors are detoxing people from long-acting opiates by switching them to shorter and short acting ones therefore tapering the dose until they get down low enough to finally quit completely.
in your research you found doctors switching people from large bupe doses to tiny methadone doses to get off shit? in what context does that even make sense?
Before anyone else jumps down my throat about this just know at all times she willl always have enough painkillers.
To avoid people from jumping down your throat about something so god damn ridiculous, use your magic mod powers and close this ignorant thread