Very Important - Taking Suboxone the Right Way
Topic: Week #2
Girlfriend and I went to the doctor on Monday and we go back again on Friday. Monday was our first drug test. When the nurse came into the exam room to give us the little bottles, I picked up my backpack and headed for the bathroom at the end of the hall. But before I could leave, the nurse stopped me and said I couldn't bring the backpack with me. Apparently, it's not unusual for people to sneak in a bottle of borrowed or synthetic (synthetic??) urine to use for the urinalysis. Such interesting things I've been learning...

Since we're now past the sickness phase, we're working on adjusting our dosage to take care of the cravings. When I first experienced the cravings, I was scared. Because I'm so happy and relieved not to have to take the Vicodin, I didn't think I'd feel cravings. How can I crave something I don't want?

The doctor says the cravings are another physical symptom. Just because I've made up my mind to stop using it doesn't mean that my body agrees. It's just along for the ride.

So we talked about how we'd been doing since we last met on the previous Thursday. We'd just gone through our first weekend since starting Suboxone and he'd told us in advance that that we might feel different. He was right. Although I had a fantastic time with my friends, I noticed the cravings more than I had during the week.

When he asked how I handled it, I told him that when it got to a point that it was bugging me, that's when I'd take my next dose. If I was still feeling it a little later, I'd take a half a pill. But that the most I'd taken in a single day was 3-1/2 pills. He understood what I was saying and why I had taken the pills that way, but that it in order for Suboxone to be effective in the long term, I couldn't take them like that.

He said that what I was doing was okay during the sickness days because taking a pill when I felt shaky or sweaty would ease those symptoms. The main reason people don't make it when they try to go cold-turkey is that the withdrawals send them running for the Vicodin. So when you start taking the pills (I think it's called the induction period) it's all about getting past that point. Now that we'd made it over that hump, we had to determine a therapeutic dose.

Using the Suboxone to get through the withdrawals was the easy part because I pretty much took it the same way I took Vicodin - only in much, much smaller quantities. Ideally he wanted us to use only three pills a day with a fourth pill allowed if we were crawling out of our skin. Using Suboxone to combat cravings is very different.

I'm assuming we're all alike in the way we took our Vicodin (or whatever was/it was you took/take). The first pills are taken soon after getting out of bed and, throughout the day as soon as you felt their effects being to diminish, you took more. We became accustomed physically and psychologically to eat pills every time we felt the slightest craving.

With Suboxone then, it's very important that you do not take it when you have cravings. While the narcotic in Suboxone is there specifically to alleviate cravings, you don't want to directly associate taking a Suboxone with eliminating those feelings. For Suboxone to be most effective, you need to maintain a consistent level of buprenorphine in your system.



This top picture shows my current dosage as an example of a therapeutic treatment. A single dose for me is two-8mg pills and I take this dose twice daily. Each triangle represents two pills, so the picture on top shows what I'd take in two days.

The black bar is my maintenance level (that's what I call it, I don't know what the medical term is). Each time I take a dose, the amount of buprenorphine in my system is elevated and I apparently experience a limited euphoria. I haven't experienced anything I'd call euphoric after taking a Suboxone, but it definitely makes me feel better when the craving starts.

The red bar shows what I was trying to achieve with Vicodin. As soon as I started on the downslope (blue arwow), when the effect began to wear off, I'd take more pills to try and get back to the peak. Before long I had to take more pills more often to reach that point. Eventually, I couldn't get back to that point and I was taking the pills just to feel normal.

The black bar, the maintenance level, is the point where I still feel normal on the Suboxone. I still feel some cravings, but not scary run-to-the-urgent-care cravings. Most of the time, it's more like just an awareness that it's there. The important thing is that I don't immediately take the the second dose of Suboxone as soon as I have the awareness. Doing that would reinforce the pattern I need to break: feel different = take a pill.

The bottom picture shows why taking Suboxone when you feel cravings doesn't work. If you take a pill and then maybe half a pill later to take the edge off, then a whole pill, etc., you can't reach a maintenance level. If you try to extend the number of pills you're allowed to take by using single pills and partial pills randomly throughout the day, you actually make your cravings worse. The effect of the buprenorphine is wearing off more quickly and the cravings return. Basically, you're taking the Suboxone as a substitute for Vicodin instead of a treatment for dependence.

If I take the Suboxone every 6 to 7 hours, I maintain a more consistent level of buprenorphine during the day. That's also helping me break the pattern of taking something at a certain time of day. As far as cravings go, the toughest part of my day is when it's time to go home from work. When I was taking the Vicodin, I'd bring some to work with me and purposely leave the rest at home to keep myself from eating my whole supply in one day.

But toward the end of the day, I lost all focus and concentration. All I could think about was getting home and getting more pills. I didn't even want to stop and put gas in my car before I got on the freeway. I'd take my chances with the needle hovering on "E" just to get to my pills as fast as I could.

Now I take my second dose about an hour before I leave work. That was I'm not feeding the habit of taking something as soon as I walk in the door. By the time I get home, I'm already on the downslope, but I've taken the pills recently enough that they're still going strong.

Now I'm beginning to see where all the confusion about switching one addition for another may be coming from. Used correctly, Suboxone does exactly what it's supposed to do, which is allow you to function normally without Vicodin. Your Suboxone dose is gradually reduced over a period of time and, during that time, you're finding ways to live a live without Vicodin and realizing that it's going to be alright. You're distancing yourself from the pills and from the patterns and triggers associated with them.

When I read about people becoming just as addicted to Subjoin as they were to Vicodin, I have to wonder if they're using it correctly. If they treat the Suboxone like Vicodin, I have to assume they're not really ready to stop. They may be tired of the expense, effort and withdrawals, but they still want to feel the effects of it; or, maybe they're doing it because of outside pressure (court-ordered detox/rehab, threats of divorce, fear of job loss, etc.) and wouldn't be using Suboxone if the choice were up to them. I think that if you're still trying to reach some kind of altered state, you're going to have a tough time.

I was ready to give it all up. There were times I tried to taper off Vicodin, but my intent was never to really stop. I just wanted to get to a place where I wouldn't have withdrawals and I could take fewer pills so my supply would last longer. I wasn't ready then, I wanted it both ways; I didn't want all of the bad things that went along with the Vicodin, but I still wanted the Vicodin.

I don't like the cravings, but I don't worry about them because it's not like I'm craving Vicodin-vicodin, it's just that awareness. At fisrt they surprised me and I was also actually a little offended. I was so done, so ready to quit, why were they coming after me? I guess I've trained my brain very well to not give up with out a fight.

That part is like the guy who doesn't know when it's time to leave the party. Apparently, the craving part in my brain can't take a hint, either.