So tired...too low of a dose?

Hi everyone,

I had my induction yesterday and I (with the help from a few friends on this site) am trying to figure out why I feel so tired. It seems to me that I am experiencing withdrawl symptoms. I went from at least 40 mg of perc/day to a total of 2 mg of suboxone on my first day. The dose the doc gave me at the office was .5mg that was at 830a. At 430p I took 1mg and then when I just couldn't stand it anymore I took the other half around 9p. After each dose I was OK for maybe 20 minutes, and then OUT...good night!

I am very disappointment because I hoped to be out working in the garden, taking my dog for a walk...things I have done, but not really enjoyed in a long time. Certainly not without taking a pill before doing so. So why do I feel so bad? It seems this is torture that my doctor is inflicting...why such a low dose? Today I was suppose to start out with a quarter of 2mg pill again, but I took half instead. I have got horrible indigestion (opposite effect of what you expect from pain meds, if you know what I mean) I am sore from head to toe, pins and needles feeling in my neck, and already getting sleepy from the pill I took 20 minutes ago.

I am hoping for some help in dealing with my doc....as in what I can say to him when he says this is not only normal but "good" because that's what he told me in the office. I called this morning and the nurse sent a note back for him to call me. He's a pretty confident guy, but told me that he's usually pretty good with guessing where a patient should be for their dosing. I am not upset about that, I know there is no formula, however, I think somethings gotta change for me.

Thanks

I have only been on it for about a week and a half. My first dose was 1/2 of 8. I felt great after 20 minutes and still feeling awesome. The girls on here are great about helping out. I think they should of put you on 8 instead of 2. If I was you and its possible, be on here thomight at 7:30 so you can join in the live chat. You will get pleanty of advise then. Monica has been such an amazing help for me. Try to send her a private message with your number. She will call you and try to help you out. I never had the first w/d. I had one bad day on day 3 but I stayed clean and made it through the day. Hope you can join at 7:30.

naturelover,
Before I say anything I do want to point out that I am not a doctor. I am an advocate and can only share my own experience and what I have learned through my own research using the different references and tools available to me.


Every doctor is different in how they do the induction for each patient. Some go high dosing and some go low. It has been my experience that a low dose is often better.

With that said, the idea is to get you to a place where you are not feeling any withdrawal or cravings.
For patients taking short acting opioids:
The protocol for Suboxone induction as written is that on day one if the patient is in moderate withdrawal the doctor should give the patient a starting dose of 2mg.

If the symptoms subside but return after 2 hours the patient can be instructed to take an additional 2mg of medication

The total amount given to the patient on day one should not exceed 8mg.
For patients who do not experience any difficulties with the first day of buprenorphine dosing, and who are not experiencing any withdrawal symptoms on the second day, the daily buprenorphine/naloxone dose is established as equivalent to the total amount of buprenorphine/naloxone (or buprenorphine) that was administered on the first day.
Patients who on day two are experiencing withdrawal should receive an initial dose of Suboxone equivalent to the total amount of Suboxone given on day one.

I am not in by no means telling you that your doctor is wrong in what or how he is inducting you. He probably wants to keep you at the lowest dose possible.
If I were you, I would start writing down how you feel throughout the day. When you start to feel symptoms of withdrawal write it down along with the time so that you can show it to or tell your doctor so your dose can be adjusted.

Did he send you home with a prescription of Suboxone. How much did he tell you he wanted you to be taking at the end of the day, the total amount?
Don't be afraid to call him and tell him how you are feeling. He can't get you on the right dose unless he knows how you are feeling.
When are you supposed to go back and see him?
We can tell you to increase your dose because personally that is what it sounds like should happen. But if you do increase it without his permission you could run out and we don't want that either.

Has he called you back yet? Let us know when he does and how you are feeling. We are here for you anytime.
Dee

Yes, he sent me home with a script that I filled yesterday. So it was .5mg in his office, then the rest came from my script which is for 60 of the 2mg pills. Written as "take 1/2 pill 3 to 4 times daily as needed for pain". I have not heard back from him yet, I called several hours ago. I have had to advocate myself pretty strongly with this doctor in the past, so I have a feeling this is what I will have to do again. I appreicate him wanting to keep me at the lowest dose but I know that I should be feeling better than this. I have told him for months that I wanted to time this with having enough time to feel as normal as possible before school starts in 2 weeks. He said I would feel great one the first day, then when I got there yesterday he changed his story and said, I should by the 1st week, hoping wd would be gone by the end of day one. I will let you know what I hear from him. I am going to strongly suggest that I slowly increase...nothing huge but for sure something to help relieve the symptoms I am going through.

Thanks again

So what he is giving you is up to 8mg a day am I right. If I added it up right. 2mg tablets
So far today, how much have you taken? And how do you feel?

I wanted to ask you also if you were going to be attending any counseling or other therapy, meetings etc as well to help you deal with the baggage left behind by addiction. Some doctors mandate it and some don't.
I personally recommend that patients do try and attend some type of group and some one on one counseling.
We can talk about that later, let's see if we can get you to feeling better first.

No its 4mgs a day; 1/2 of a 2mg pill up to 4 times a day. Finally spoke to him because I vomitted & just demanded not to wait any longer for a call back. I am in serious w/d and he says...take another 1/2! You are in w/d & taking too little. I have also been doing other research & find that of the little bit I have been taking, I probably wasn't getting very much of it. He gave me no instructions about now swallowing saliva, not drinking right afterwards...all of which I have been doing. It was taking less than 5 mins to dissolve under my tongue & afterwards I would either swallow or spit the salvia which contained all the meds. I cannot believe he told me nothing. I feel sooooo very bad. I just want to cry and go to sleep but I am too sick. I took the other half which made my stomach feel slightly better, enough to keep me out of the bathroom. So total today: 3 doses of 1 mg.

4mg a day. I am so used to thinking in 8mg tablets or strips and that is where I messed up.
Not much at all.
If you were someone at a stable dose I would be thinking yes I can see that. But someone who is just starting their induction I am having a hard time wrapping my head around it.

Even though it doesn't take long for the Suboxone to dissolved, you need to keep it under your tongue for at least 15 minutes so that it can be absorbed.
Do not talk, smoke, eat, drink etc. If you are around people that you think are going to talk to you, leave the room, lock yourself in the bathroom if you have to and take a shower. That way if you are in the shower they are more likely to leave you alone. Try it.
This is what I have to do. It always seems like when I take my meds that is when someone is going to need something. Never fails.

As to the swallowing or spitting the excess out. I swallow. I've gotten used to the taste over the years so it doesn't bother me anymore. Hang in there please, we will get you through this.
Dee

I am trying...although I am so sick, I know I don't want to go through this again. I just have to get better. I am so sick & stressed right now that I cannot even think correctly. I feel fuzzy, sick, sleepy, agitated..it's like I feel everything at once and it's opposite. By him admitting that I am in w/d, I believe have a good leg to stand on if I chose to increase my dose until I feel better and just tell him in the morning that I had to do it because I was too sick...which is the truth.

I know you are, and you will get through this. I promise. It is so hard and it shouldn't be.
I did answer your pm, please go check it.

Hi Nature ,

How are you feeling now?
Did you speak to your doctor?

I'm glad you got to speak with Dee, like I told you, she knows her stuff !!!

I was really glad you were at chat last night. Next one is Thursday.
I think someone (Tammy) wrote that's it's tonight, which isnt the case.

Thinking of you

GOOD morning everyone!!!!

I feel so much better today! Sometime during the night my body adjusted to the last 2mg pill and I feel so good. I went to sleep around 9:30 still feeling bad, woke up several times during the middle of the night to go to the bathroom, and I felt better each time I woke up! I never got sick again, so the 2mg worked!

I changed my mind about taking the 4mg first thing this morning, and just stuck with the 2mg. I hope this is not a mistake, however, since I had so many differing doses yesterday I figured I would start with just 2mg first thing this morning and then plan to take another 2mg later today. Since it took a total of 5mg yesterday, but left me feeling too "highish" I will do the 2mg twice a day for a today or two, and then switch to just the 4mg in the morning. I hope that this good feeling doesn't go away...at least for today. I am just so happy. I am going to the grocery store, making a picnic lunch and spending the day at a local (very close) hiking park that is a special place for my daughter and I (and our dog)! We have not been there once this summer...but now we will!!!!!! It has been almost 2 hours since my morning dose and I still feel good.

Ladies, I know you that you all know just how important support is. It is clear you all are success stories, and have had your time of needing support and are experts in giving it. That being said, I hope that I can somehow express my gratitude for you, times a zillion. You don't know me, but I know you CARE about me. And I CARE about you. I would have never had to the clarity or experience to figure out what to do. And knowing (because you so kindly told me) that you are there for me whenever, is just so comforting. How could someone even think twice about changing their life from being chained to pills, when there is an answer like Suboxone and friends such as yourselves? I have new friends..YAY!

I will check in throughout today. And if I start to feel "not right" I will take the 2mg. Otherwise, I will take this afternoon.

Have a beautiful day and I look forward to talking to you ladies this afternoon!

naturelover,
It is wonderful to hear from you. After talking to you on the chat last night and knowing how badly you felt I was worried. I knew you would be okay but I also knew you were still in withdrawal and was feeling the worst of the worst at the time.
I would not wish withdrawal on my worst enemy.

To read what you wrote this morning I can hearing the singing in your voice. You are on your way.
You may have some days where you don't feel up to par or a little anxiety but we can get through that together. That is what this forum is all about.

I think the 2mg is a good idea as long as you are feeling okay at that dose with the 2mg in the afternoon if you need it. See how it goes.
Take time today and enjoy your new freedom, have fun at the hiking park and notice the simple things.
I have some things to do this afternoon. We are moving an about a week and a half and I am to meet the new landlord so I can get some window measurements. That is just my excuse to take another peak at the place to see how the renovations are coming along.
Enjoy the day. I will be back on here this afternoon. Great chat last night by the way.
Dee

Whew ! I'm SO glad your feeling better.
Don't even worry about the 4mg. Let your body tell you what to do.

Im just so happy your feeling good today !

How are the park?

Stop in when you can, I'll be logged into the forum for most of the night.

And by the way, the fact that your doing better today is all the thanks we need !!!!!

we really do care and we want you to know your not alone !

Dee, you are right...last nights chat was so great. I was feeling pretty crappy, yet I had SO much fun. You all made me smile at a time when I felt like crying. So you're moving? Moving is so fun. Renovations? Do tell! I worked on doing some renovations for my parents at their home in the historical district this summer. Seeing the results is just one of the best feelings ever. So vacation will be over just in time to move? Bummer?!

So anyhow...I am going to have to rush off to bed...you see I am absolutly exhausted from ENJOYING MY DAY PAIN PILL FREE!!!!!!!! This is such a new concept, yet it just felt so right. Isn't that weird? but easy to understand at the same time? I will have to admit that my pain in my belly area is around a 7, the back pain was taken care of by a Naproxen. However, I am only on 4mg and that will just have to be addressed with the doc. I am going to tell him that I found that by taking the 2 half doses close together that it worked better, so I should just take the whole pill, however, the pain isn't controlled. My instruction sheet stated I should call if pain isnt controlled...and that I shall do! haha! So yes, Lexi and I walked the dog on our favorite trails and had a picnic of tasty cheeses, crackers and fruits. We laughed and I noticed how calm I was...wow it was just a great feeling. Three days now, and they just keep getting better. Tomorrow we are making and canning homemade marinara from veggies out of the garden....SO FUN!

Good Night Friends

I LOVE that your enjoying life now !!!
Its amazing to watch, I mean, you went from miserable to pill free happy in a few short days.

Life is good and your about to find out just how good !!


See you in the REAL chat tonight.

It is great to hear that you are doing so good. Be very proud of yourself. You did it, we were there to help you over the bumps. Keep in mind that anytime you need to reach out to anyone of us, we will be here.

Blue, thanks for the reminder. Today is a busy day but I will be at the chat most definately. I missed Monday night and felt kind of off after that so the one we had on Tuesday helped. I would like to get caught up with jelly though. How is she?

Everyone have a great day. It looks like one full of sunshine and smiles.>>> <<<
Talk to all of you this evening
Dee

Nature lover,
I'm sorry I haven't been here for a couple of days, and I posted on the other thread before I realized you were feeling better. I'm glad things are going well, and I hope to be in chat tonight. I'm glad that you were able to stabilize at such a low dose. That's really great. I hope that you continue to enjoy your life. I too was amazed at how quickly it turned around for you and I guess maybe the sub built up and now that it has you will hopefully be ok. If there is anything I can do to help you please let me know.

I'm so happy to see that people are getting their lives back. It really helped me to log back on here cause one of my sponsees just relapsed and relapsed hard and it has really affected me that's why I took a couple of days to refocus on my recovery and get my head back in the right place. I did my best not to take it personal, but she kept pushing me to help her and I couldn't do anything that she was wanting me to do so I just dropped off of the radar. My apologies to all of the wonderful people I have met here. I should have stayed plugged in and I would have felt better sooner. Lesson learned...Just b/c someone in my real world circle fails, don't drop out of my circle here.

Much love to you all. I hope to see you in chat tonight.
Monica

Hey Nature missed u at the chat to night. I only stayed on half hour. I am watching bengals play on tv. I am wore out. I am so enjoying my new life. I feel like a million dollars. How are you feeling? Its good to talk to someone who is just starting the meds. I feel we kinda relate. We can go through this together with help of our new friends. It is so weird that they care about us the way they do and dont even know us. That is true friendship right there..

K I hope this finds you well. Have a great night and if u are ever on here and wanna chat please send me a message. I love the chat and comparing stories.

GREAT TO KNOW ALL OF YOU. I have to get to learn the site and post pics and signature. Seeing as how I have so much time on my hands.

Hi Monica,

I am sorry for the confusion. I started this topic after my introduction. I was thinking about maybe starting a new one about stabilizing. I am no longer sick, which is a huge relief. However, I am trying fingure out the right dose for my pain and this great doc of my has not called me back. In another post you were wondering how he got so respectable....I believe it's more in the manner of being able to put out big numbers, research, and speaking engagments. It seems to me that he's really into this respect he gets in the medical field; being a member of an office of heros, but when it comes to being there for his patients, he is too busy and we get put on the back burner. I have thought about finding a doctor closer to me, because it is an 8 hour ordeal for me to see him, however, I know (at least I hope) that he will never pressure me to get off of the Sub. No telling with someone else. That's for another day.

I am sorry to hear about the trouble you are having in your meeting. I can tell from the many posts I have read (I have been all over this site) that you are very involved that they mean a great deal to you. I am sure it is hard to watch someone relapse and don't apologize for being gone for a few days. No need to beat yourself up, you do a lot and sometimes just checking out for a a day or 2 is what is needed. I hope you are feeling better and that your member comes back around....being sick is not worth it.

Have a great day everyone!

Nature Lover
Thank you so much. I am feeling much better now. It is hard to watch someone relapse and I've resigned myself to the fact that if I'm going to care and try to help people, part of that is going to be having to know when to back off and let them fall. My last relapse (hopefully it's the last) saved my life and all I can do now is turn it over too my higher power and pray that she finds her way back before it is too late. I've done all that I can. I can lead the horse to water, but I can't force it to drink, unless I want to drown it in the trough. She did come to our meeting last night, but I ended up having to ask her to leave when she came right out in the middle of the meeting and asked if anyone had suboxone to "loan" her. That's completely out of the realm of recovery and I can't tolerate that.

I'm glad that you are doing better physically. Unfortunately, your dr. seems to be more concerned with his reputation than with actual patient care. I hate that you are having to go through such an ordeal to see him, and from what you've described, I'm not sure he's worth the wait. You may be better off in the long run to find a different doctor, because patients should never be put on the back burner, especially during their induction phase. You seem to have adjusted well, but I wonder how many of his patients actually get on a stabilized dose since he is so unresponsive. I am so blessed with the provider I have. He is a recovering addict who was treated successfully with sub and tapered off almost 5 years ago. He has allowed me to control every aspect of my treatment and has always listened to me. Hopefully you will be able to find one like that, but many dr.s just see addiction treatment as a financial windfall and really don't know what they're doing. I wish it wasn't the case, but it is. The fact that your prescription read as needed for pain concerns me, as physicians often use prescibing for pain to get around the 100 patient limit when treating addiction. I'm not a doctor, but I have experienced just about every type of sub doctor there is out there, indirectly and I don't care for the one's that skirt the requirements. Suboxone treatment carries enough of a stigma without physicians acting irresponsibly and adding to it. Hopefully you will be able to find a provider that cares and knows what he is doing. Like I said, I'm not a dr., but I don't think he is one of the good ones.

If there is ever anything I can do for you please don't hesitate to let me know. There is a wonderful group of caring people on this site and I'm glad to have another caring person here.

Much love,
Monica

Tammy,

I sent you a PM through the "members" section, but I don't know if it showed up in there, I don't have a copy of it in my sent folders since I sent it from the other tab. I appreicate all of your support, am sorry I missed you in chat last time. Please send me a PM and I will work on rewriting mine to you now.

Thanks:)
Nature