A few quick answers to questions before I take on the heckler on the sidelines.  First, a question about Fiorinal:
Is suboxone ever used for fioricet (without codeine) abuse? I take too much butalbital with acetaminophen. It does not contain codeine. I’ve tried to cut down, but am having a hard time. Thanks, d.
I’m sorry but no, Suboxone would not help for that substance.  Butalbital is a ‘barbiturate’, and works completely independently of opiate receptors.  A special comment:  Barbiturate withdrawal is very dangerous– much more dangerous than opiate withdrawal.  It can be fatal.  So you might need to just bite the bullet and go to a hospital for detox, followed by treatment.  I can guarantee that you will feel better eventually if you get off that drug– but it might take some time to get there.  Please get help and let us know how things work out.
Hi ~
This is my first time for speaking out so, please bare with me. I’m a mom with three kids, a husband, a good job, beautiful home etc….the perfect life right, yeah whatever! Until of course I got caught up in the zone of taking pills. First started out with percocet 5’s, 10s and then oxycontin 40’s and then 80’s; doing this for over year, getting them from my doctor, my husband who needs them spending money I didn’t have, the only thing I haven’t done yet is steal from friends or family to obtain money to buy them. I’m on the seat of loosing everything. I WANTED HELP! I turned to a doctor who has given me a prescription for Suboxone. Today is my first day and I took (1) pill of 8mil, waited an hour and felt okay and then took a half of one. As advised, I could take up to (2) pills a day. I have been fine except I have been sweating on and off, feel a little achy and have low energy. Can someone tell me if this is normal? Is my dose that I have taken to high or should I take another half? Thanks for listening! Response: Thanks for writing!  I usually start people on either 8 or 16 mg the first day– either one is fine.  Hopefully the doc had you go through a bit of abstinence first, so that you had some withdrawal– otherwise there is some risk of precipitated withdrawal.  As for how you are feeling now, your symptoms will depend on your level of tolerance for opiates.  A person who takes a few vicodin per day will actually get ‘high’ from Suboxone at first; a person used to 240 mg of oxycodone will have minor withdrawal from Suboxone even if he/she waits 24 hours before taking it.  In the latter case, the tolerance is so high that it must come down and equal the tolerance level caused by Suboxone.  Anytime tolerance is moving down, the person feels withdrawal… anytime the tolerance is moving up the person feels a ‘buzz’. Just continue to take the same dose– I would recommend taking two tabs per day, BOTH IN THE MORNING for reasons I have described before and will describe again one of these days.  Make sure you take it right– I get into that in some prior posts as well.  Three things increase absorption in the mouth– 1. high concentration of buprenorphine (so a low volume of saliva), 2. high surface area (spread it all around in your mouth– NOT just under the tongue), and 3. Time– keep swishing it around for a good 10-15 minutes.  If you are doing those things, you are on the right track.  Good luck! Finally, an exchange with a person who was considering Suboxone: Dear Subox Doc remember me, I wrote to you a month in a half ago about suboxone not helping me because I was I was still using oxy in the evening and you told me just surrender making me feel hopeless! well now I understand I decided to go to rehab I have been clean 29 days but still feel weak. I was wondering with your expertise how long before i start to feel normal again? and how long is the average length of time for my receptors to start working on there own again? I am positive I want to be clean after almost 7 years of constant opiate abuse starting with vicodin ending in a oxycontin nightmare. I remember being so angry with you thinking what the hell does he mean surrender? I can’t function, just quit how do i do that? well I did it and it has been hell but I would like some inspiring words on healing time and I would like to know since your last relapse are you taking suboxone? I choose not to and I am attending NA I never want to go through this type of painful withdraw again but if I start feeling a relapse I will definitely use suboxone since I am clean it should work the way it is supposed to.In your personal experience when did your energy come back? Thank you Response: Hey!  Yes, I remember you—I was just thinking of you yesterday and wondering how you were doing.  I e-mailed you a few days ago and didn’t hear back, so I feared that you were ‘out there’ again. First of all… Congratulations!  I would like to write ‘wonderful!’ and ‘good for you!’ but nothing quite captures or expresses the credit you deserve.  On one hand it was harder back when I got clean because Suboxone was not around… on the other hand it is much harder now, for you, BECAUSE Suboxone is around.  I can assure you though, 101%, without reservation, that if you can make it without Suboxone you are BETTER OFF.  So please, please, do your best to ‘stick to your guns’ and do it the old fashioned way—you are 90% there. (note to readers: yes, I think Suboxone is a wonderful medication and the best option for most people.  In order to get clean ‘the old fashioned way’ you need two things– the first is desperation– not just the ‘crying in the office’ desperation but the kind of desperation you get when you have lost your house, your career, your spouse, your health…  it takes that much desperation to ‘get it’, and even then many people don’t get it.  The second thing you need is desire, because it takes hard work.  You need to go to meetings, and more meetings.  Every day, even several times per day.  You have to go to meetings as long as you are an addict– meaning forever!  I can’t say that our writer will get there, but she has gone a month so she deserves a shot at it!) back to my response: As for the fatigue…. That is the last to go.  That and insomnia.  There is a ‘cure’ for the fatigue in the form of another drug—I can’t prescribe it from far away because it is a ‘schedule II’ meaning it is closely regulated…. I’m referring to Vyvanse, a new med for ADD.  I DON’T recommend any of the other ADD meds—it is too dangerous to take them in early sobriety as they are very addictive.  Vyvanse is amphetamine, but it is inactive if snorted or injected.  It has no rush to it, and if you take too much you can’t get a rush—I won’t explain the details right now but it has to do with how the drug gets activated in the intestines. (note to readers: they bound amphetamine to the amino acid lysine, and the complex doesn’t bind to the receptor for amphetamine.  The drug is inactive… until it hits the intestine, where a peptidase, an enzyme that breaks down proteins, cleaves the bond and frees the amphetamine.  The amphetamine then enters the bloodstream in a slow, gradual way, so that it lasts all day long.  There is no rush, and if the person takes a bunch of it the peptidase becomes overloaded and doesn’t produce any greater amount of amphetamine.  Totally cool!) It is a bit expensive, although it is now the first choice in WI on Medicaid and more states will do the same.  You would have a hard time getting it for the indication you describe, but if you have ADD, it is a great drug for both.  It lasts 16 hours—probably even longer.  I want to be clear—other stimulants are way too risky at this point.  I would recommend the Vyvanse for about 3-6 months, then get off of it.  It is only an option, though, if you have ADD.
As far as the Vyvanse and ADD talk,  I don’t mean to sound ‘all about drugs’—I didn’t use any of these things and I did survive.  Meetings are the key—even bad meetings.  People who go to meetings stay clean—it is truly as simple as that.
Back to my earlier posts, and the idea of ‘surrender’ and ‘letting go’—it is hard to explain, but hopefully you are seeing my point a bit. There is a daily reflections book called ‘the language of letting go’ that you can buy from Hazelden that helps one think in that frame of mind—I used it myself 8 years ago and recommend it. If you use the link in this post for Hazelden I think I make about a dime—so please click on the Hazelden ad to buy it! I also STRONGLY recommend the ’12 and 12’—the official name is ‘twelve steps and twelve traditions’. It is a must read for everybody who chooses the path of total sobriety. You will find that through the same Hazelden link.
I’m very happy for you.  It will get better—I promise.  MUCH better than you even can imagine.  I can’t say when, but I can say that it will—for sure.  Hang in there, and keep ‘letting go’.


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