Does it matter how heavy your habit is before induction....?

Will methadone and buprenorphine together cause withdrawal? How do I stop precipitated withdrawal? What dose of buprenorphine is best? Do I have to be in withdrawal to start Suboxone?
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zon
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Does it matter how heavy your habit is before induction....?

Post by zon » Fri Jun 28, 2019 12:37 pm

I mean like in the days and weeks before you start Suboxone.

Or is the important thing making sure you've stopped for 24 hours and are in withdrawals before the first dose?

Reason I ask if that I was told to come down to 6 pills (dihydrocodeine) per day before I take my first dose of Suboxone (obviously with the requirement I still stop 24 before the dose).

Unfortunately I haven't managed to stick to the 6 a day, but will still only take 6 pills on the day before my dose and wait 24 hours before induction...

Am I likely to be hit with precipitated WD's due to not keeping to the 6 pills a day on the run-up to induction?

Thanks in advance for any replies!

owlcrow
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Re: Does it matter how heavy your habit is before induction.

Post by owlcrow » Fri Jun 28, 2019 2:14 pm

Hi Zon,

Just wanted to tell you that precipitated withdrawal is nothing to play around with. I am in a bit of a different situation right now but have had experience with suboxone inductions more than once. If done correctly the induction will give you relief rather quickly.
I would definitely take as few pills the days before as possible. The longer you wait the better it works. I know it will suck to be ill while waiting but you don't want to chance precipitated withdrawal by no means.
I know how hard it is to stay away from your doc but if you really want to kick this thing I would taper the pills as much as I could the two to three days before hand. It's not the amount of time as much as it is how you rate on the cows scale (if you don't know what that is please google it and read about it).
Some people can induct much sooner say 12 to 18 hours after using but this is all depending on the individual circumstances per person.
I am not one for sticking to the book lately but in my early days of suboxone I would read read read and found that going by the cows scale is the best advice I can give you. Be honest when evaluating your symptoms. And remember the induction is something you only need to do once, provided you wait and all goes well. Once again hold off from taking pills as much as possible the two days before induction, I know it will suck to be sick but trust me it will be well worth not getting precipitated withdrawal and relief will come quickly when done properly.
I hope all goes well for you and welcome to the forum. I hope others way in for you there are some really good people on this forum. Hang around and share people do care.
If you have any other questions I may have stirred up or have not answered, just ask either myself or someone else should reply and try to help out.

zon
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Re: Does it matter how heavy your habit is before induction.

Post by zon » Fri Jun 28, 2019 3:04 pm

Hey owlcrow,

Really appreciate the reply there, thanks. I am definitely going to leave it the full 24 hours since my last dose, was thinking a little longer, around 26/27h...but should I have tapered before this cessation period prior to the induction dose?

My induction dose is in 60-ish hours, I'm planning to take as little as possible up to the cessation period and then obviously nothing for the minimum 24h. It's the heavier use the couple of days prior (yesterday and today) that I'm now starting to get worried about.

Cheers!

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Re: Does it matter how heavy your habit is before induction.

Post by owlcrow » Fri Jun 28, 2019 3:51 pm

Zon,
I would definitely law low till your induction at this point. I wouldn't worry too much about what you have taken already what's done is done. Moving forward however I would try to take as little as possible even if it means you have to not feel well. The time will go slow and suck but we've all been through that and before you know it , it will be nothing more than a memory. Geez I wish I could think this clearly for myself dah!
I read your other post concerning the 16 mg dose. I am guessing that after some trust builds you will no longer have to go to the pharmacy to dose anymore. Where I live they are easy to get both from clinics (cash docs) or on the streets. Things are different in the UK it seems. Anyway if after some time passes you are able to have control of your meds. at that point you can adjust to the lowest possible dose where you meet the ceiling affect. Basically it means that taking more than your ceiling dose is not doing anything. I have had some pretty bad habits and never needed more than 8 mg for a week or two then cut back to the 4 mg range and slowly began to reduce over time listening to your body and going very slowly. I guess I am getting ahead of the situation. I wouldn't worry about the dose though or time period either just work on yourself and it should sort itself out as time goes on.
Once again best of luck with your induction, lay low try to occupy your mind with something else during the dreaded waiting period and just remember it will pass very quickly if you get to the induction in the proper state. Upon your first dose you could pull back to feeling normal in as little as 20 minutes and I am guessing no longer than an hour and a half.
Let us know how this goes for you, you have 2 whole days to cut back I'd shoot for say 120 mg day 2 and nothing the day prior, doing that you should be pretty well set. I am wondering after I said that if your pills are immediate release or extended. Extended relief pills have a tendency to take a bit longer to clear out of your system. Keep that in mind if that is the case. Try to drink plenty of water that can never hurt.

Take Care.

zon
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Re: Does it matter how heavy your habit is before induction.

Post by zon » Sat Jun 29, 2019 4:47 am

Thanks again for the reply owlcrow, gonna take your advice and lay very low now. As you say there is no point worrying about what is done, I just have to focus on getting these receptors as clear as possibly so I don't get a whole heap of residual opioid goo stripped off them.

It's 48 hours until induction and my last dose of opioids was about 17 hours ago - they are instant release pills but I'm not in WDs yet which just shows my tolerance is still high and much higher than I realised, simply due to the amount being taken I assume. Need to get this down (I'm sure I will be in full blown WDs by this evening).

Instead of taking 6 pills today and 6 pills tomorrow morning when the 24h period begins, I'm gonna take no more than 3 or 4 pills total and leave about 28h before induction (so about 6am tomorrow morning). I have no choice at this point if I want to give myself a fair start on the Suboxone.

I read something about not going on Suboxone when in severe withdrawals, is this true?

As for the 16mg dose, not sure if this is just a day one thing or what, I'll just go with it and get it cut down as immediately as possible. I think it's 8mg at the clinic then 8mg to take home for later.

The supervised use period is for a couple of weeks I believe, provided I give continual clean urine tests. Around here there is a huge heroin issue, the the point they haven't really treated anyone who solely uses painkillers, so I think it's a one-size-fits-all regimen. Methadone is also the preferred treatment to start with here.

Thanks again for the advice, I'll be sure to advise how it went :)

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Re: Does it matter how heavy your habit is before induction.

Post by razor55 » Sat Jun 29, 2019 7:21 am

Hey Zon, I too had large pill problem, was started on 4mg up to 12 mgs the first few day and weeks. The reason for the higher doses it that you must feel well and have zero cravings . You can always go lower later, that is easly done. I dropped my mg intake of pills to around 40 mgs the last 3 days before induction. It worked very well. i had a 150 to 250 mg pill addiction so getting down was important. Do your best to get it low, it ll pay off later man.. Best of luck and welcome to forum..... Razor 60

zon
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Re: Does it matter how heavy your habit is before induction.

Post by zon » Sat Jun 29, 2019 9:24 am

razor55 wrote:Hey Zon, I too had large pill problem, was started on 4mg up to 12 mgs the first few day and weeks. The reason for the higher doses it that you must feel well and have zero cravings . You can always go lower later, that is easly done. I dropped my mg intake of pills to around 40 mgs the last 3 days before induction. It worked very well. i had a 150 to 250 mg pill addiction so getting down was important. Do your best to get it low, it ll pay off later man.. Best of luck and welcome to forum..... Razor 60
Hi Razor, thanks for sharing your experience, these replies have kept me motivated to keep the pills as low as possible. Glad I didn't have my pre-planned "final blow-out" today.

Not long to go anyway, cheers for the well-wishes!

zon
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Re: Does it matter how heavy your habit is before induction.

Post by zon » Sun Jun 30, 2019 3:31 am

25h until the induction - yesterday I had 3 pills at about 1pm, instead of the 15-20 I'd normally have throughout the day. That kept me from going into physical withdrawals all day (apart from chronic yawning and eye watering) so I was worried my receptors were too saturated with built up dihydrocodeine from years of habitual use, as I was expecting to withdraw from such a small dose. This had me worried I wouldn't be ready or able to start the Suboxone on Monday morning.

This morning (19h after last dose) I woke up with the liquid guts that have always plagued my comedowns, so I think my fears of my receptors being oversaturated, or me magically no longer being physically dependent for some reason were unfounded - it's the first time I've ever been relieved to be withdrawing! I got up at 8am and had a small dose (the clinic told me to have this dose no later than 10am) so I'll have 26h from the dose to be feeling withdrawals by the appointment time. Hopefully this is enough.

The clinic suggested 6 pills on day one and 6 pills on day two - I've gone a good bit under that taking 3 and 4 instead, bearing in mind dihydrocdeine is a much weaker opiate than the pills outside Europe - it's just a waiting and hoping game now.

The very worst case scenario, short of allergic reaction, is precipitated withdrawals which I know would be brutal but I have a week off work to stabilise.

zon
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Re: Does it matter how heavy your habit is before induction.

Post by zon » Mon Jul 01, 2019 7:57 am

Thanks again for getting back to me on this again folks, I had worked myself into a panic for no reason as the induction was successful! Very happy with it.

Was inducted on 4mg, with 4mg more to take home at about 5pm - a lot more sensible than the 16mg I thought I'd be taking.

I do start on 16mg tomorrow as a single daily dose but the doctor is happy to reduce this whenever I want to - too soon to say if I'll actually need it reduced, but based on how I feel just now (clear-headed and comfortable) I'll likely try to get it down to 8mg a day within a week.

Cheers!

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