Saturday, August 18, 2012

Life in general & more about suboxone therapy

Greetings, everybody.
Once again, another celebrity has died, of a suspected overdose. "Joey" from celebrity rehab, was found dead the other day, in chicago I think. Its sad just to see ANYone, lose a family member to this deasise. I watched the show(s) and I sure feel bad for his mother, you could tell just from how supportive she was, that she really loved/care/wished the best for him.
I cant believe its raining, again. Already!!!
Hopefully, it doesn't last. Im definitely not ready for fall already. Not that we get much of a 'fall' here, its more like cold mornings, occasional rain showers and the very occasional nice day out.
I wish I would have been able to take Sam swimming more this summer. It just hasn't been warm enough out to do it.
We did go a few times, and it was really fun. Especially the last two times, when our new family member, Fritz was able to come, too. Now that was alot more fun for sam, since he had someone to play with other than me and his dad.

Fritz is definitely a happy dog. He goes to work with me everyday. Sometimes when Mike gets off early he comes and gets him, and then Sam and they go to the dog park or the beach. Hes such a good dog. He's never jumped on Sam or anything. He doesn't take his food when he's walking around eating, or even jump on him, when sam is playing fetch with him. Fritz just waits, patiently, or as patient as he can!! For sam to throw the ball/frisbee for hm.  Sam has learned a lot too, about how every living thing has 'feelings' since we got him also. That's one of the reasons I wanted to get a dog.  Im so happy I waited, for the right one to come along. Its unbelievable, how much we all love him so much, already.

Mike hasn't heard a thing from the trash company yet. There hasn't been a letter in the mail, either. So who knows. I sort of think, if he would have got the job, he'd know by now. Either way, its okay, he knew it was (is) a hard job to get, especially around here. He's stayed really positive since he was able to keep the other job, and last week he was super busy. Went to portland and back, twice almost every day. Since he makes a percentage,
I cannot remember if I mentioned that I got a "soft reline" at the dentist two weeks ago. I looked thru (skimmed) my blogs for a moment, trying to find it, but I didn't find anything. That doesn't mean it wasnt there!!!!
At any rate, I did get a soft reline done. Which is where thy fill your top plate with this sorta soft material, it fills any 'voids' or air space between the denture and the roof of your mouth. It takes a minute to harden, then they 'trim' it up. Things sure fit better now, that's ALL I got to say!! Guess I didnt realize just how bad it really was, until I got this done. Its a 'temporary' fix, until the 'hard reline' gets done.  They like to do the hard one, at almost a year, or around there. If I need another soft reline, he said to just come in, and get it done. Since it's not the actual material the denture is made out of, I guess it kinda 'wears off' over time. I hope I didnt already say all this, then I'd feel like a dumbass. :-)

I've had an overwhelming couple of days. . . . . . . . . . .
First off, we got a 'notice' from the old landlord from our apartments. Which says they are 'holding' the deposit. It only counts the deposits from when we first moved in, and says NOTHING about the rent that was paid three days or so, before we sent our thirty day notice.
I wrote an email back, and copied the section of the laws that states 'prepaid rent' needs to be accounted for in a totally different statement, within 31 DAYS of them accepting the property back. They 'accepted' the property back on July 17th. It also says, they must pay DOUBLE what they owe the renter, of prepaid rent. They cannot 'withold' the prepaid rent, for deposit, if you have already left a deposit, which we did. I knew this was going to be a fight, because Ive heard it from everyone else that has moved out of there. And of course I'd like to consult a lawyer, because they haven't (won't) email/call me back about any of it. Uggh.
And, the previous owner, here at the trailer, did not pay the last of their water bill. So we got a 'door hanger' notice on Thursday. So, on my lunch break I had to go up and pay it yesterday, or it was going to be shut off Monday. THAT makes me pretty pissed, it was $231, that I was NOT expecting to have to pay out of my check. With that, and daycare (preschool) and the phone/cable bill; its the day after payday, and I'm pretty much broke!!! But on the other hand, the bills are paid, and Mike gets paid on Wednesday.
The power co also wrote us a letter stating that in the apartment, we had to leave a deposit with them, of $190. It says that because our bill is sometimes paid after the due date, they are keeping it 'towards' our NEW deposit, of $342. Im like ,,, are you KIDDING ME????? we havent ever had our electricity SHUT off, so who the hell cares if its late sometimes? We are talking about a time span of 6 and half years afterall!!!!!
Now, we have an electic bill, with a disconnect notice for the 31st, of $345.
Wonderful news.

So, this all overwhelms me. I just try not to think about it too much.

My patient assistance program, that pays for my suboxone, will end at the end of September. That'll be a challenge since its about $700 a month, the cash price. BUT Oregon has a prescription discount card, free for anyone with no insurance. That makes it about $550 a month. Then there is a coupon, you can use once a month from the manufacturer, worth $50.
So $500 a month, is what it costs me, all said and done.
Now, some people think this is just WAY too much money, and why don't I just stop and all sorts of stuff like that.
Well, the 'flipside' of the coin, is a habit, which towards the end, was costing me  $100-200 a DAY. So, I'll take the $500 a month any day of the week.
Im not ready to leave suboxone yet. I don't know when, if ever, I will be. Sometimes I still think about getting high, for one thing. When I do think about it, or come across someone that offers, it only takes a second for me to realize, that I have all my opiate receptors blocked anyways and it would take at least two weeks, of using before I felt anything anyways. And you know, I'd come to my senses by then, or at least I hope so!!! Thats just part of how it works.
Im posting an ariticle on HOW suboxone/buprenorphine works, at the end of my entry here. Now I know the writer seems a little "pro suboxone" but probably only because of all the good he's seen thru treating the "unfixable" addict over the years.
If you think about it for a moment, and all the medications that are in your cabinet right now, the ones you take on a daily basis just to be 'normal'. Well, thats how I feel taking suboxone.
And if I didnt, Im pretty sure it wouldn't be long before the monster inside me was trying to convince me I could take 'just one' pill.
Sometimes I think, well , youve got "X" amount of months now, your cured!! You could taper off and be fine. But the truth of the matter is, I tried for years to be free, of everything. I failed miserably.
Ive already talked about that, so I wont go into detail agian.

I'm going to try and apply for this "here to help" program again, with my doctors help I may be able to get 'approved' for another year. If not, Im still absolutely grateful for the year that I did get. I probably would have given up already, because it was just so expensive, when I started and had just started working.
As far as buprenorphine making you 'high' in small doses, I dont know about that. Even when I first took it, all it did was take the EDGE of the withdrawl symptoms. It didnt make everything peachy, like opiates always did. But, I guess for an "opiate nieve" person, it probably would. On the flip side, it would probably just make them sick. Like when I first started chasing the 'rush' of opiates, you get sick when you 'overdo' it.
Okay, heres the article, feel free to skip if you want to, I just thought it was a good idea to post it, for people who dont have any idea what the heck Im talking about sometimes!!!
And THANKS
for your continued support
































A question was asked about the last post that warrants top billing:
“Buprenorphine acts similar to opioid agonists in lower doses, with the same addictive potential as oxycodone or heroin. In higher doses—doses above 8 mg or 8000 micrograms per day—the ‘ceiling effect’ eliminates interest and cravings for the drug.”
Buprenorphine Ceiling Effect
Ceiling Effect
I’m not sure I followed this. Can you explain more? What would you think about someone who is taking 1-2mg of Suboxone twice a day without a prescription, and says they want to stay on that dose once they find a prescriber? Are they better off on 8mg or more per day, or would it be ok for a prescriber to keep them at the lower dose? Is the answer the same if they hope to taper off the medication completely within a year (they don’t feel able to do this on their own right now, but hope to be able to when some life circumstances change). Thanks!
This gets a bit complicated, but I’ll do my best. A couple background issues; buprenorphine has a ‘ceiling’ to its effect, meaning that beyond a certain dose, increases in dose do not cause greater opioid effect. That is the mechanism for how buprenorphine blocks cravings.
If the blood level of buprenorphine is ABOVE that ceiling, the opioid receptors are maximally, 100% stimulated. If the person takes more buprenorphine, and the blood level increases, the opioid receptors don’t feel the increase, as they cannot be stimulated more than 100%. But more importantly: when the person takes less, and the blood level of buprenorphine goes DOWN, the receptors also sense nothing– as long as the level stays above the ‘ceiling’ level.
Read the above paragraph, and think on it until you grasp it– as it explains buprenorphine and Suboxone. If you understand that paragraph, you will know more about Suboxone than most doctors!
Below that ceiling level, the opioid effect from buprenorphine varies directly with dose—just as with oxycodone, hydrocodone, heroin, etc. Medications that have effects that increase with dose are called ‘agonists’. Buprenorphine is a ‘partial agonist;’ it acts like an agonist up to point, the ceiling effect, beyond which increases in blood level have no greater effect.
The level of this ‘ceiling’ varies from one person to the next, depending on efficiency of absorption (on average, only a third of a dose is absorbed from under the tongue), body size, liver function, differences in regional blood flow, and the presence of other medications that affect buprenorphine metabolism. In order for buprenorphine to have the unique, craving-blocking effects, the blood level of buprenorphine must stay above the ceiling level, for the reasons described above.
Lower levels (blood levels of buprenorphine below the ceiling level) still have SOME effects on cravings. Buprenorphine has a long half-life, an that alone reduces the desire to take more—especially if the medication is taken more than once per day– since the blood level drops very little between doses. For agonists or for buprenorphine below the ceiling level, drop in blood level equals drop in opioid effect, equals sense of things wearing off, equals cravings.
But the classic method for treating with Suboxone, as described in the certification course, is for it to be given at a high enough dose to stay above the ceiling level… and dosed only ONCE per day. If the blood level stays above the ceiling level, once-per-day dosing covers cravings completely. Yes, people still want to take more, especially initially, but that desire is not driven by chemical effects; the desire is instead based on psychological factors, like habit, or from being accustomed to feeling better after a dose, and getting a placebo ‘lift’ from taking a second dose.
A person can eliminate that second dose fairly easily, providing that the morning dose is high enough, i.e. usually 8-16 mg. To eliminate the second dose, the person should distract him/herself as soon as the thought about taking the second dose comes to mind. Immediately, do anything else—the dishes, call a friend, wrestle with the dogs… and the thought will pass. If the person does the distraction method for a few days, the need to take the second dose will go away—a psychological process called ‘extinguishment.’
Dosing every other day, and even every third day, has been studied; people cannot tell the difference, if the dose is raised enough to keep the blood level above the ‘ceiling’ (providing the person is given a placebo that tastes the same).
As for as the writer’s friend… I’m not a fan of any illicit use, but I am aware of the shortage of physicians. When the person has a physician, in my opinion the person should be prescribed a dose that allows for once per day dosing. Realize that buprenorphine wears off VERY slowly; it takes over three days for half of a dose to leave the body! So that ‘need’ to take more is almost always entirely learned or ‘conditioned.’ The medication does not wear off in that short period of time.
Even if the person has withdrawal symptoms, the sensations are almost surely imagined. How to tell? Use the distraction method, and note that a couple hours later, when the person remembers that the dose was skipped, note that the withdrawal went away. That doesn’t happen with ‘real’ withdrawal!
The sense of withdrawal that drives the second dose is simply a memory; a conditioned response that the body has that triggers the person to take more opioid. We become conditioned by drug use, just like the salivating dogs from science books! In the case of opioids, whenever we feel down, we think that an opioid will lift us up, as it has hundreds of times before. And even if what is taken is not a real opioid, the mind ‘feels’ a boost, just from expecting what has always happened in the past.
As for tapering, I look at many factors in order to recommend, or not recommend, stopping buprenorphine—things like age, presence/absence of using friends or contacts, physical health, mood, support network, personal motivation to stop buprenorphine, ability or lack thereof to dose once per day, consistently, number of relapses and personal ‘recovery’ plan, etc.
Realize that EVERYONE looks forward to a day when life circumstances will change for the better—but most of the time, life becomes more, not less challenging. Yes, it is nice to have a reliable job… but it is much more stressful being the sole breadwinner for a family with children, than working to pay for one’s self! Marriages settle down in some ways over time, but they also lose the intense infatuation that can gloss over personal differences.
As I have often written, it is VERY hard to stop opioids. It is a little easier to stop buprenorphine; I am convinced of that fact because I have seen opioid addicts taper off buprenorphine, but I know of no opioid addict who tapered off an agonist. But SOME people cannot taper of ANY opioids—including buprenorphine. I do not consider those people ‘addicted’ to buprenorphine, because they lack the constant obsession for opioids that is so destructive to the mind of an active addict. But they ARE physically dependent on buprenorphine— a fair trade, in my opinion, for a life of chaos, broken relationships, legal problems, and death.













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