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Old 05-17-2009, 01:28 PM   #1 (permalink)
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Starting Suboxone- help w/ the clinical opiate w/d scale?

As some might know, I have a prescription for Suboxone, and over the last month have tried numerous times to start, but have been having a REALLY hard time getting through the first day you're supposed to wait before starting the pills. I've tried over and over to do it, but I've failed every single time. The longest I've gone, was today when I waited 27 hours before giving up, and going out to get high. BTW, I'm an IV H user with a moderate habit (4-5 bags/day).

My main problem is that twice in the past, when starting on Suboxone, I've taken it too early, and (obviously) went into precipitated withdrawals. It's the biggest reason I've failed every time I've tried to get on the Sub now, because I'm so scared of taking it too early. I have printed out a copy of the Clinical Opiate Withdrawal Scale (COWS) and have been using it to guage my w/d, and several times have been in "moderate" w/d according to the scale, but it's still not enough, I'm still too afraid to take the pill.

I have a couple questions for anyone that knows anything about the COWS, or used it themselves when starting Sub. First of all, does it work? If the COWS says that I'm in "moderate" w/d, can I trust it? According to the scale, 13-24 is moderate and I've been scoring about a 15-16. Secondly, there are two portions of the COWS that I don't get. It gives you points if your pulse is above 80 bpm, but no matter how sick I seem to get, my pulse seems to never above 80 bpm. In fact, it's usully 80 exactly. Also, it gives points if you have "hand tremors", and again, no matter how sick I get, I've never gotten "hand tremors." So do I just leave out these questions when scoring myself on the COWS? And what about the w/d symptoms I get that aren't covered in the COWS? When I get really sick, I start sneezing uncontrollably, and yet, there's no way for me to score that on the COWS.

Sorry this is long, but I'm really desperate and confused. Just today I was probably ready to take my first pill, but I was so scared of taking it too early, I gave up. I guess my main question, is, can I trust the COWS? Am I being too paranoid about going into precipitated w/d's? And also, do you w/d slower when you're asleep? Would using Xanax to sleep through the first day just prolong everything (and yes, I know about the dangers of mixing Xanax with Sub)?

Any help would be greatly appreciated. I really want this, but I'm just so scared of going into precipitated w/d again, and thats been hindering my sobriety. Thanks so much.
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Old 05-17-2009, 03:13 PM   #2 (permalink)
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I started mine in the morning did my stuff went to sleep when i woke at 7 or 8 i waited two more hours and started the subs no problem at all with precipataded W/Ds. Im no Doctor but 27 hours should be plenty
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Old 05-17-2009, 03:32 PM   #3 (permalink)
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jay, while you were able to do your DOC (which is pain pills i believe) and then later on that night take the subs and be fine it is different for heroin addicts like marvel. Heroin stays in the system much longer than opiods like oxycodone, hydrocodone etc.

First let me say im glad you finally started posting again marvel!! I was worried about ya. As for this whole COWS scale thing, my own opinon would be to throw it out. Reason being is that opiate withdrawal effects each individual differently and with different symptoms. My buddy used to get so ancy that he wouldnt be able to sit still longer than 30 seconds while I would be so out of energy I could barely walk up the stairs. I wouldnt be able to stop throwing up while his stomach was completely fine during w/d. He would get terrible pains in his back and legs while I had very little aches unless I was laying down trying to go to bed[you get the picture]. I also got the sneezes like you, 4 or 5 in succession every 40 minutes or so right? classic dope sneezes ;\

To answer your question, yes withdrawal will hit you faster and the dope wears off at a much faster rate if you are asleep. The reason I know this is because when I was actively using and did my last shot the night before if I slept like 12 -14 hours I would immediately wake up in bad withdrawals however if I only got 8 hours of sleep I would be fine and the sicknesss wouldnt hit until late that night (around the 20 hour mark)

So if you could make yourself sleep most of the day after using your last shot you wont have to wait as long. As for worrying about precipiated w/d....you would have been fine taking the subs after waiting 27 hours. Being that you are only doing 4-5 bags a day (i used to live in NYC also so I know what the bags are like) after about 22 hours you should be more than fine to take the suboxone.

My own measuring system that I used to know when I was in strong enough withdrawal to take subs was when the first episode of dry heaving / throwing up took place (when that strong metallic taste in the back of your throat gets to be unbearable, i know you know what taste im talking about)

Hope to hear back from you soon and good luck on getting sober marvel, I am rooting for you
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Old 05-17-2009, 03:55 PM   #4 (permalink)
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Sorry Marvel girl my doc was pills not heroien Scotty will be able to help much more than I.
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Old 05-17-2009, 04:02 PM   #5 (permalink)
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I don't have any experience with Suboxone, I'm on Methadone in a MMT Program. But the title of your thread grabbed me. I just want to say that if the Dr.'s say wait 24 hours, then wait 24 hours. If they wanted you to use the COWS scale, they would have given you a copy. I would just throw it away. I think us dope fiends can get too much information and our minds start churning and grinding more than usual when we're trying to get clean and/or dope sick. Besides, wasn't it our own doing, thinking we know what's best for us that got us into this in the first place? As addicts, we are terrified of any withdrawl symptoms but I don't think there is anything that can truly take away every single symptom. IMO, I think we need to experience some of it to remember. After all, if withdrawls were a piece of cake, I think some of us would have relapsed many times if this were the case.

When I decided after 32 years of using, 25 of those fighting this disease, that I was going to get clean and sober, I decided that from this point on I had to be 100% honest with my doctors and follow their advice to a T. And much to my surprise, they do know what they are talking about! lol

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Old 05-17-2009, 07:32 PM   #6 (permalink)
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Thanks everyone. I just want to say that I'm not really "scared" of w/d, I just don't want to go into precipitated withdrawal. After trying to get on the Subs like a million times over the last months or two, I've gotten VERY used to being in withdrawal. Not that it makes it that much better, but I know that I have to go into withdrawal, and I know it's going to be ******, and wocka wocka wocka... But thanks everyone. I'm just so paranoid about taking it too early. I'm just going to have to force myself to do it and hope for the best...
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Old 05-19-2009, 11:02 AM   #7 (permalink)
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how are things going today for you marvel?? i sent you a PM but you had logged off before receiving it I think.
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Old 05-19-2009, 08:29 PM   #8 (permalink)
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Suboxone

i took the same class my doc did so he could prescribe suboxone and have been able to help others in the transition period. I think suboxone is a wonder medication. I was taking 160mg of oxy 3 times daily and had no problems with suboxone. this is the first time i have been in a forum and posted anything on line. to all of you who want to take this med and get your life back, it worked for me and i am very happy today.
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Old 05-22-2009, 09:49 PM   #9 (permalink)
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First I ain't a Dr.. Big D boy has explained it well. H is not a long acting opiate the issue is more receptor coverage as I understand it, both the bup and the nax knock the H from the receptors and the bup replaces the H. If you don't have enough bup. to replace the H you will experience the prec. WDs, it has also do with you total length of use because your body over time produces more receptors hence tolerance to H or nicotine or whatever. Also how you introduce the sub. a lot of Dr.s will do induction in there office to make sure that your dose get all the receptors covered. So if your doing 4-5 bags of H and the Dr. gave you a 2mg pill to take for induction it doesn't matter how long you wait your not going to stop the H WDs. Also if methadone is mixed in at all I hear thats almost impossible to make the transition because it is a sticky op..

What were your induction instructions besides follow the cows. Dosage and such? Like I said I'm not a doc just speaking anecdotally.
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Old 05-23-2009, 12:09 PM   #10 (permalink)
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Im glad you started posting again marvel!! all i know is my experence...i waited 2 days 48 hours before taking my first dose!maybe longer so far so good the suboxone treatment my doctor has me on works for me! again you have to be ready to stop! you have to have that desire!

keep posting



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Old 05-23-2009, 12:23 PM   #11 (permalink)
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BTW, I want to say that the reason I've been using the COWS is that the first time I saw a Dr. to get on Subs, she used the COWS in the induction. Also, I'm SOOO paranoid about taking the Subs too early, since I have done so in the past, and want to be extra sure when I take the Subs thats I'm ready.
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Old 05-23-2009, 12:39 PM   #12 (permalink)
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@Jimba: My Dr. told me to use the COWS, and that "when I feel like I can't take it any longer, wait two more hours", and told me that given my habit, I'd probably have to wait about 36 hours. I really doubt thats true, and think he's just trying to cover his own ass, and be sure nothing goes wrong. Then I was told to take an 8mg pill, and then if I'm still feeling ****** in a few hours, take as needed.

The longest I've made it so far is 27hours, and now that I can look back on it, I really feel like I was ready to take it then. I'm just so paranoid of precipitated w/d since it's happened to me before. In fact, I'm doing this with my partner, and while trying the other day he took the subs too early (waited 20hours, his habit is 2x the size of mine), and now he finally understands why I'm so paranoid.

But yeah, basically, my biggest problem is being sure, and knowing when I'm ready to take my first pill. And re: doing induction in the Dr's office, b/c he'll know for sure when I'm ready, thats not necessarily true. The first time I went into prec. w/d from taking the Subs too early was under the care of a Dr. She was so intent on getting me through the process and out of her office, she gave me the Subs too early.

And also (I know this is getting long), but did anyone else have such problems getting on Subs, ie, having to try multiple times before finally getting on it? Though part of me feels like I want to get clean so badly, and I'm always trying to do that, part of me thinks "well if you really wanted it, you'd do it". Which is basically all I hear on this board. Did anyone else take multiple tries? Am I doomed for failure and many more years of addiction here?
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Old 05-23-2009, 02:17 PM   #13 (permalink)
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Quote:
Originally Posted by marvelgirl View Post
And also (I know this is getting long), but did anyone else have such problems getting on Subs, ie, having to try multiple times before finally getting on it? Though part of me feels like I want to get clean so badly, and I'm always trying to do that, part of me thinks "well if you really wanted it, you'd do it". Which is basically all I hear on this board. Did anyone else take multiple tries? Am I doomed for failure and many more years of addiction here?
Marvelgirl, it didn't take me multiple times to get on Sub. Regardless, I have to reply to your comment, "Well if you really wanted it..."

You're back at it again and this is after going what?? 27 hours last time??? Sure sounds to me like someone who wants it!! When I was in what I thought was PW (but now am wondering if it was just w/d due to the way Sub works on me... another subject for another post), it was not only the sickness that was horrible but the feeling of absolute helplessness. I couldn't reach my doctor and I was afraid to take my DOC (oxys) to get better and was afraid NOT to take it. I kept calling my doctor and leaving messages. My oxy habit wasn't long or large, so I was able to continue with the Suboxone. I didn't take any oxy and, after 30+ hours, I was dehydrated, but finally feeling better (hmmmm... I've since heard that PW don't last that long, but as I said... another thread topic).

Anyway, ALL this is to say, give yourself a break, sweetie. You've got enough that you're dealing with. Be kind to yourself. You sound determined to me (and not the least bit afraid of w/d). I think that you're correct when you say: "The longest I've made it so far is 27hours, and now that I can look back on it, I really feel like I was ready to take it then." You've gained a lot of experience with this. So, I agree with you... do as your doctor instructed, use the scale, but also trust your gut.

When are you looking at inducting this final time?
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Old 05-23-2009, 04:51 PM   #14 (permalink)
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Hello,
PamEla here with a bit more of my story. I have been involved in three rear-end car accidents. First one in 1992, second in 1998 and last one in 2008. I did not want to have surgery on my back so I tried every avenue I could find to make my back feel better. Finally I had had it with the pain so I elected to have back surgery in Jan of 1998. In August 1998 I was rear ended again, not healed yet from first surgery this sent me through the pain roof. In 2001 I had a bi-level fusion. Then 10 years to the month later I got rear-ended again. My Ortho in 1992 started giving me vicoden for pain, kept increasing amount and I could not stay out of pain. Then I learned about Oxycontin. My Doc started prescribing it slowly and it sure didn't take me long to get addicted to Oxycontin. I was taking 160mg three times a day and then some, when I learned about Suboxone. My doc had to take that "special" class so he could prescribe suboxone. I reached a point in my addiction where I wanted my body, mind and sprit back. I knew Suboxone was the ticket for me. I had the bottle of Suboxone in my home for about 5 weeks before taking it. I set my date and just did it. I was terrified, and had to walk to the edge of my courage and take one more step. I took my last dose of oxy in the evening and threw away all opiate drugs in my home. I left myself no option as to, do I take it today or not. Not much sleep the night before and I should have waited a bit longer before taking it, but all went well. My plan was to take Suboxone for 3 months and then get off. That is exactly what I did. I started reducing the Suboxone on the 75th day and by day 90 I was done. Currently I am in lots of pain and I use breathing and slow movements and the pool for pain relief. I had a wonderful experience getting myself back, and decided to take the same class my doctor did on Suboxone. What I learned, and wish I had know on my induction day is that one should take 2mg at a time giving one hour between doses, up to 24mg in 24 hours the first day. Taking it that way is far easier that a full 8mg at the gate. Then individually one must figure out how much is needed to stay feeling ok. I kept a journal of when and how much Suboxone I was taking. Doing that made it easier to get off and to track my intake. Having taken the class I have been able to help 6 other people make the transition on to Suboxone. I have done it on the phone with some and in person with others. I used RN assist line at Reckitt Benckiser Pharmaceuticals Inc. (the company that makes suboxone) and have found them to be very helpful. The number is (800) 444-7599. I wish I would have had that number the first day I took suboxone. They are there Mon. thru Friday during the day. They are very helpful, if you can't get through to your doc or have any questions about when or how much to take. I hope this info helps one more person to get clean. Be Well to all,
PamEla
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Old 05-23-2009, 06:09 PM   #15 (permalink)
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I'm going to be calling that # on Tues. for help with my detox, although they may not be as helpful with detox as they would be with induction. LOL.

Yeah I think your right marvel, I could call my Dr. on Tues. he's a bit of a pusher but I had tapered and my habit at the point of induction fairly minut compared and I was taking pills. My transition was smooth. I told him how much I did 150mg a day about. I waited 8 hours and he had me take 16mg and then another 16 two hours later. I actually got high after the second dose. Probably what you have to deal with more than anything else is the ceiling effect which is like 40 something mgs. Anyhow the point was he's told me he deals more with h iv users and methadone users which is supposed to be a real challenge. I have to call him anyhow so I'll try to get some info out of him.
One more opinion can't hurt.
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