Missing the Point of Buprenorphine Treatment

A forum reader wrote about concerns over a partner on buprenorphine.  Her concerns pointed out a common misperception about the goals of treatment of opioid use disorder using buprenorphine, or using methadone for that matter.
Her question, amended for privacy:
I married the love of my life.  He is still he love of my life but has been an addict for 15 of them. Our children have been greatly affected by his addiction.  He made promise after promise that he was clean, and I dove back in with complete faith time after time only to get burned.
His addiction started with recreational pills increasing over time, but now he is abusing Suboxone.   He was taking up to 12 mg depending on the day, but no pain pills for the last year. I suggested a Suboxone doctor and a plan to get off, and my husband called one and was able to get right in.
At the visit the doctor did a half ass intake and called in a prescription for an 8 mg tab for induction.   After induction they called in prescription for 20 mg/day.   My husband stayed with 4 mg once a day and was “blah” in the afternoon and irritable but not physically sick.  On his next visit to the doctor he was proud, but when he told the doctor he had only take 4mg in the mornings she got angry. She told him she wouldn’t see him anymore if that’s what he was going to do. He asked how long he would be on it and she wouldn’t give any kind of answer. I asked again before we left and she snapped at me.
I see a profound change in him after each time we see her and she tells him to take more. We walked away last time with another prescription for 16 mg a day which is just about double what he’s been taking for the last year and a half. So my question is, how does it make sense to treat someone taking 8 mg as their addiction with the same medication at double the dosage? Since seeing her he has decided he needs to take it more than once a day as well as up the dosage.  Is this right? Is it right to treat Suboxone addiction with Suboxone? A heroin addict isn’t treated with more heroin and a pill addict isn’t treated with more pills.  While I understand the concept of treating his original pill addiction with Suboxone, I am having a very hard time wrapping my head around what’s happening.
Me again… 
The writer raises interesting questions.  Regarding the ‘drug for a drug’ questions, buprenorphine has significant pharmacologic differences from heroin or pain pills. Those differences, including the long half-life and ceiling on agonist effects, allow the medication to create a level degree of mu-receptor agonism across the dosing interval.  Tolerance to that level mu agonism allows patients on the medication to feel ‘normal’ throughout the day, or at least normal from an opioid standpoint.
But her broader point provides an example of the basic misunderstanding many people have about medication assisted treatment, in focusing on the same short-term goals that their addicted loved ones have focused on: controlling the dose of opioid and tapering off.  That goal is natural, of course;  anyone who loves a person addicted to opioids wishes and hopes that the person will reverse the using behavior and climb down from opioid use.  Those hopes are bolstered by ads for rapid detox, even as studies show that detox is mostly useless.
My response:
I would not be concerned about increasing the dose of buprenorphine, because there is no increase in effect after a dose of about 8 mg per day.  A higher dose might reduce mild withdrawal symptoms at the end of the dosing interval, and sometimes provides a reduction in cravings through a placebo effect.
So why increase? Because the goal with buprenorphine treatment is to put cravings into remission for a considerable length of time. If your husband is still having cravings as he gets by on 8 mg, then his dose is not high enough. Buprenorphine is a safe medication that is used as a tool to extinguish the conditioning that was part of your husband’s addiction.
One of my patients saw a different buprenorphine physician for years, and her dose was constantly lowered over the past year. She would run out of medication after 24 days each month and then go without for 6 days, craving opioids and experiencing wtihdrawal during that time.  In some ways, her entire time in treatment was a waste.  She could boast, I suppose, that she was prescribed less buprenorphine over time. But in most ways she is just as far from stopping opioids as when she entered treatment, still lying to her husband, lying to her doctor, and feeling ashamed of herself.   All of those things  keep her addiction in the dark, where it stays active.
When I started treating her my goal was to promote legitimate behavior. I increased her dose to 12 mg per day, from 8 mg.   After a month she still ran out early, So I raised the dose to 24 mg per day. Now, after 6 months, she has taken the medication as prescribed. Her focus on buprenorphine is going down, as we want it to do. She isn’t lying, and she isn’t craving pain pills or buprenorphine. My goal is for her to take the medication like she would take a vitamin or blood pressure pill, without any special attention or interest.
How long will we do this? I can’t say now. We know from research that the longer a person stays on medication, the less risk of relapse after stopping. I don’t like to push anyone off buprenorphine, because I’ve seen so many people who have relapsed after being pushed off by their former doctors.  I find that many people eventually decide that the time has come to taper off buprenorphine, and those efforts are usually successful.  From my perspective, people forced to taper off buprenorphine do not generally do well.  That perspective is just an opinion, but an opinion based on treating 800 people with buprenorphine over the past 11 years.
Opinions aside, the goal is not about getting off opioids as fast as possible. Your husband can accomplish that in a couple weeks with a remote hotel room and a bottle of clonidine, or a couple weeks in jail. But those experiences rarely lead to prolonged abstinence, and they sometimes precede overdose, when people return to using with a lower tolerance.
I can’t tell whether your husband’s doc is on the right track or not– but she might be. She is a better doctor telling you that she can’t give a time estimate, than a doctor telling you he will be off in 3 months.  Ideally, your husband will be in a state of ‘remission’– on a dose of buprenorphine that virtually eliminates interest in opioids– for a year or more. He can taper for some of that time, but the taper should be slow enough that he doesn’t return to using.  If he returns to active use, he starts over in many ways.
Try to drop the focus on ‘how much’ or ‘how long’. Those things are not important; what is important is to get his interest back on you and the family, not on buprenorphine or other opioids. That will be easier if you let him know that he has your support, even if he takes a medication, and even if he needs that medication for a long time. You would want the same from him if you ever needed a medication for hypertension, diabetes, or anything else.

38 thoughts on “Missing the Point of Buprenorphine Treatment”

  1. Thank you Dr. for your explanation to this issue. I have been on the same dosage for a time period that the LCDC or AA sponsor would just say “you’re just addicted to a different drug” or “what is the difference between what you were taking before and now?” But my behavior has changed dramatically for the better. My experience has been defined by everything you said and I agree with it 100%. Thank you for explaining the difference between long term suboxone use vs. opiate addict behavior. I work in a profession that deals with many addicts and I always recommend they get off methadone and go see a suboxone doctor. Your response was truly enlightening.

  2. This is truly an amazing article period I have been on Suboxone for 10 years and every attempt made to get off of it was forced by either a 12-step program or my husband which have been nearly fatal. I have come to accept that sobriety for me has nothing to do with medication I take as prescribed and everything to do with the way I live my life today. I am an active mother of two teenage boys, wife, employee and take care of our home. I’m not just active I am loving kind giving and helpful in all areas of my life and it is because of a 12-step program coupled with the medication assistance. The last time I relapsed I had overdosed and I finally made a decision that I didn’t care who in the 12-step program or my husband thought about me taking Suboxone. When I pointed out to my husband who didn’t know I was on Suboxone for the first 5 years and made him make a list of the difference between before I was taking Suboxone and after he could not argue the amazing changes that took place. I work really hard at my recovery I cannot just depend on the medication and I don’t know if I will ever be off of Suboxone maybe one day but it will be when I am clearly ready not when someone else thanks I am.

    1. I feel your pain! I myself have been on an off suboxone several times in my lifetime, more on than off.
      I am in dire need of a serious surgery to repair pelvic organ prolapse but cannot commit to a surgery date because I can’t quit freaking out because I cannot get past this last dose of .5 to .75. I am scared to death of the pre and post op pain meds not working.
      If anyone can help I would appreciate it.

      1. I can’t believe someone with the same exact story. I went on Suboxone in 2007 and every attempt to come off has been pressure from 12 step people and my husband however since the last fatal experience where I overdosed in my home my husband gladly accept that I have to take Suboxone. I have never relapsed while on Suboxone however I have relapsed when I have come off of it every single time within days or weeks it has always been catastrophic… I can’t really be a part of a 12-step program because of their beliefs it has been truly harmful to find connection with other people and Recovery face to face. I can find it online but that is just not the same.
        Regarding other comment….I have had several surgeries.. I did not take suboxone 2 days before surgery and resumed Suboxone two days after I was released from hospital. Talk to your doctor…

        1. We have a medication available that for many people, makes opioid use a non-issue. Overdose is virtually impossible in patients who are fully tolerant to buprenorphine. Yet even in a time of record deaths, people ask ‘how long will you be on that stuff’? Ridiculous.
          Thanks for sharing!

      2. I had surgery in March 2016. I was (and still am) on 1,2 to 1,6 mg a day (3 or 4 times a day I take 0,4 mg – I have to order them here in France since no one seems to take less then 2 mg per dose). I cut down several years ago from 4 to 6 mg a day to 1,6 mg since I don’t need more, I’m on it for 12 years now. Before that, 25 years of heroin and methadone.
        Before surgery I just warned them that I take Subutex, and when I woke up, they wanted to give me morphine (as they do with normal patients) but when I said “no morphin, I’m on Subutex” they gave me Tramadol IV and pills after.
        All went well !
        So don’t let them tell you that you can’t have surgery because you’re on Subutex. Post operative pain treatment like morphine just has to be switched for Tramadol, for example. Wishing you the best !

    2. I have just found this site today . I realize your post was older as we r in August but, I could have written ur post. I’m so happy to have found this site . Feeling alone with thoughts stink, reading everyone’s posts help me tremendously. I thank the Dr and all of u wonderful people and the honesty here !

  3. I can’t agree with this enough. Suboxone is a miracle drug for many people and is not like heroin or pain medication containing true opiates. I have been prescribing Suboxone since 2003 and most people remain on it but get back to work and get back to their lives. Why take away a med that is working? I have had about 4 people taper off completely but most will remain on it indefinitely. There will be a right time and a right place in their lives for them to taper and they will!!!

  4. There are other worlds than these…..
    Here was much that was lost in words so I will simply ask your counsel Sai Junig and Sai who’s name I’ve not had the honor to learn.
    I speak with respect and with deepest sincerity for unlike you I did not see with eyes unclouded. May God bless you both on many long days and pleasant nights. I had forgotten the face of my father, I learned something in this world that was only Truth and that Truth is that the world has moved on, I’d set my watch and warrant on it.
    I cry your pardon, You both are my Ka-Tet, You both bring light to a world that is weary, the Breakers will succeed, they always do in time. In those like me you I was trapped, some are trapped within their minds, pain, cages, Devar, but you follow the path of the Beam and allowed me me to see, allowed me to remember the face of my Father. Thankee, Sais, We are and will forever remain Well-Met in The Clearing at the End of the Path.
    One of the Great Old letters if ever there were.
    Zn
    Zn
    Zn
    As The Great Old Ones Say
    Saecula Saeculorum

      1. Lol, thank you for your posts i am greatly encouraged to use suboxone. I have been on methidone for 20 years and have now tapered to 24 mils and going to switch to suboxone. I have not been a user of anything beyond my prescription for methidone for years, i hope this isnt too painful.

        1. Just go as long as you can without methadone– at least 3 days– and you should be OK. If you DO have precipitated withdrawal, it never lasts very long. The quickest way to feeling better, if it does happen, is to take a full dose of buprenorphine each day. By 24 hours you will be feeling much, much better– and by 48 hours you will be fine. But again– wait at least 3 days after stopping the methadone before taking your first dose of buprenorphine.
          Good luck!

  5. Thank you for all your experiences and information you share. I recently received my x waiver and am learning much from you.

    1. Hey, thanks for introducing yourself! Be sure to use the forum, suboxforum.com, to learn what your patients have issues with. If you send me a ‘personal message’ from there– I go by ‘suboxdoc’ on that forum– I’ll exchange emails with you. Or just link up at LinkedIN.

  6. I’m sorry but I beg to differ regarding the “no increase in effects above 8mg a day” claim. I was relapsing non-stop and my doctor upped me to two zubsolv’s per day instead of one, and that did it for me, and I really don’t think it was all psychological either. I get it, anecdotal evidence and all…still, I would probably not be alive right now if it wasn’t for that increase in dosage working.

    1. When I say ‘no increase in effect’, I mean that people feel essentially the same at higher doses. Did it stop your cravings? I don’t know. You’re in a better position than me to judge. But the power of the placebo effect is strong– and by definition, the people who get a placebo effect get a REAL effect (i.e. it feels every bit as real as any other effect). When you look at binding studies, more receptors are occupied at 16 mg than at 8 mg, and maybe some people benefit from that extra binding and get greater reduction in cravings. For most people, though, they ‘feel’ the same as far as opioid effect goes. They don’t get more drowsy, or more narcotized. That’s what I was thinking when I wrote that comment.

  7. I have a huge dilemma and I need help. My doctor could not give me any advice. She was totally not helpful. I am having to have surgery for anow ectopic pregnancy. Unfortunately, this is my husband and i’s second miscarriage. I currently take 24mg of suboxone per day. How do I handle that with a planned surgery and pain meds. Having withdrawalunch is not an option as that can cause life threatening issues with the pregnancy. How do I stopened and start the meds again before and after surgery? When I had my csection with our son they had to give me morphine, hydrocodone, and oxycodone all at the same time just to control pain. However, back then I was on subutex not suboxone. It did not have naloxone in it. I was also in the hospital where they could administer iv meds. I will be sent home this time instead of kept. Should they plan on keeping me a night or two just to control painot adequately without withdrawals. I look forward to hearing from you as you seem extremely knowledgeable on this topic and in general. Thank you for taking time to respond!!!
    Lauren T.

    1. I’m sorry for taking so long. I give my patients this info: http://suboxonetalkzone.com/surgery.pdf
      I continue buprenorphine or suboxone at a dose of 8 mg or less. It doesn’t matter which, because the naloxone is irrelevant unless injected. I find that 15 mg of oxycodone every 3-4 hours provides pain relief in patients on 8 mg or less of buprenorphine. Interestingly, they say it doesn’t ‘feel’ like anything; they don’t feel warm or ‘buzzed’, but it does provide pain relief. When it is time to stop taking pain pills, simply stop them and resume the full dose of buprenorphine or Suboxone. As long as you’ve taken 8 mg every day, you’ll have no problem with precipitated withdrawal.
      Good luck!

  8. Quick summary so you know what I’m asking:
    1. How to stop/start the suboxone before/after my surgery and subsequent pain meds
    2. Can I be sent home the same day or should I be admitted to control painot
    3. If I’m sent home will oral meds control painot
    Again,I’m on 24mg/day and have been for over 3 years. I have had zero lapses, relapses, etc during the 3+ years.
    THANKS SO MUCH for answering my questions. I GREATLY APPRECIATE you taking time out to respond as I don’t have anyone to advise me.
    Lauren T.

    1. See my other post, and this link: http://suboxonetalkzone.com/surgery.pdf
      I recommend NOT stopping buprenorphine, but reduce the dose to 8 mg or less. The opioid agonist will out-compete buprenorphine if given in high-enough doses, usually 15-20 mg oxycodone every 3-4 hours will do it. Morphine is NOT a good drug, as it does not compete well against buprenorphine. But oxycodone, dilaudid, or fentanyl work well.
      You can go home, as long as you can urinate. All opioids can block the ability to urinate, and you would need a catheter in that case.
      I’ve treated people at home after very significant operations. I get nervous when patients are on large doses of benzos, or when people live alone. I’ll often ask them to have a sibling, parent, or friend stay over the first night in those cases. The BEST way to get pain control, if you had great doctors and endless money, would be to be in an ICU, on a monitor, getting an infusion of fentanyl while on buprenorphine. But in those cases they are often afraid to give high-enough doses of fentanyl, The way to monitor for respiratory depression from opioids is to monitor respiratory rate, not dose. Respiratory rate below 16 is a sign of good analgesia, and a rate below 14 means to stop giving pain meds. A rate of 20 means that the person is hurting, and needs more narcotic. The whole issue is pretty straightforward; just competition at the receptor between buprenorphine and the opioid agonist. But doctors sometimes pay too much attention to the dose, and not to the patient. The WORST thing to do is to use one pain med, get to a high dose, and then give up and use a different pain med. In that way people end up on a bunch of non-therapeutic pain meds. The goal is to choose the drug, and stick with it until pain is relieved, stopping if respiratory rate is below 14 or 16.
      How to measure respiratory rate without accidentally impacting it? You feel the patient’s pulse, as if counting pulse– but you watch the chest rise and fall and count that instead.

  9. Please HELP!! I’m having surgery this Thurs 14th for a hernia under general anesthesia. I’m on about 3mg of Suboxone film a day for 5 years. I’m so worried about what to take for pain. I do not want to take any type of opioid. So, is there anything else they can put in my IV that will relax me, help with pain and make me feel good/no pain? Also what prescription meds to help with pain and relax me while at home recovering?
    Weird thought but is nitrous oxide ever used post op or pre op for relaxation/pain??? I was given a script of ibuprofen 800mg. What else can be prescribed? Toradol? Tramodal? Xanax?
    What’s good for constipation? It’s really bad. Nothing ever seems to work. Its the reason I got the hernia in the first place. Ugh! I’m on Senna Plus at bedtime. But it only works sometimes and I DO NOT want to be constipated after surgery! No Way!
    Thank you for your time. Hopefully I’ll hear back before Thursday 14th/17

    1. I missed this, but maybe my response will be of interest to someone else… relaxation isn’t a problem. You will likely get midazolam, a benzo that blocks memories of the preop area and OR. At home, the doctors can give a number of different things depending on the situation. Toradol is an NSAID, like ibuprofen or naproxen. It will provide some degree of pain relief, but will NOT relax you. I think a small dose of diazepam might be useful for patients who can control that type of medication… but frankly most doctors will avoid things that have abuse potential. After 5 years I would hope that your doc has a good sense of what you can and can’t control. As for nitrous, I don’t know if any recommendations for home use. It was used in some ER’s that I’ve worked in over the years for treatment of migraine headaches, or when the doctor wanted to avoid opioids in other patients. But nitrous oxide comes in a tank that contains only nitrous oxide– so people who attach a hose to the tank and fill a bag or balloon risk hypoxia, brain damage, and death. Any device for human use must be ‘yoked’ to a tank of oxygen in a way that prevents oxygen levels less than 21%. All modern anesthesia machines are designed in that way- as are the delivery devices in the ER’s. I don’t know of any device that is considered safe for use at home. And of course beyond the oxygen issue, most people have poor control over basic functions (like walking or talking) when breathing nitrous oxide!

  10. Hi Dr. Junig! 🙂
    I have been avidly reading your blog and the subox forum and have learned so much about my truly life saving medication. So much information to take in on both sites! I am however having no luck with registering for the forum and I desperately want to! I’ve attempted registration 4x over the past few weeks but have never received an activation email. I’ve tried from my phone and tablet but not from a PC- could that be the reason it hasn’t worked? I’ve also tried using 2 different emails but neither works. I then tried emailing the admin using the address listed on the forum and it was sent back to me. Commenting here is my last ditch effort!! Please lmk if you have seen a registration request for the username “hopefulgrrl” and if so what I’m doing wrong. If need be I will post my email address here temporarily. Thank you so much for your help!

  11. Thank you so much for your insight, open mindedness and compassion for what my redundant sister calls us “sub heads.” The level of hypocrisy that this woman has, you only but have to laugh at as she runs in the closet eats 15 Norco a day, runs out and points her forked tounge of judgment. I just started suboxone three days ago, coming off of a twenty year pill habit and I do stress way too much. You are so right about people blaming the subs for all that bothers them. I have been having headaches, a couple sweating spells and a little irritability but I also got up at 6 a.m. went to work ran errands after work then til I read what you said earlier and thought why am I blaming the suboxone for how I would feel after a day like that normally..lol..thank you.

  12. Your husband needs to take whatever dosage that makes him feel comfortable.my doctor started me on 16 mg a day was wearing off around 5,6 o’clock so the doctor put me on 24 mg a day it’s been a year and a half now. This drug has changed my life for the better.

    1. I totally agree as I have come to believe that the suboxone journey is completely different for each person. So if he is comfortable on that dose then what’s the problem. I was inducted on 16 mg. I am doing an extremely slow taper. I was on 16 for two months then 12 for two months then 10 for two months now down to 8 and no cravings thus far. I have gotten a therapist, been working out again for the first time in 6 years, even quit smoking but this medication has certainly been a beneficial tool in my recovery the rest is being proactive

    1. I thought I had answered this, but I must have accidentally deleted it… Check out my site SuboxSearch.
      If you select the box to search this blog using ‘kratom’, you’ll find every thought I’ve had on the topic. If you search ‘kratom’ in the FORUM box, you will see the tens of thousands of comments in a moderated forum– i.e. a forum where the non-useful content is limited (no politics thrown in, no personal insults, and where you can get a sense about the person who is providing the opinion. Check it out– you’ll find some interesting discusions with the most-relevant ones starting at the top.

  13. I really enjoyed your article. It gave me hope! I was on OxyContin, 240mg a day for about the last 3 years f taking opioids. It all started about 14 years ago after my 4th ACL reconstruction. My doctor started prescribing 60 Lortab 10mgs a month. Then, as restrictions got tighter, he sent me to a pain clinic. About every 3 months they increased my dosage and told me to take as prescribed. My wife encouraged me to do exactly as the pain doc said because she said she did t want to see me suffer. (I have had a LOT of surgeries. I played LB i.n college and beat my body up pretty bad. I have now had: 4 ACL recons, 7 knee scopes (both knees together), 1 knee replacement, 1 total shoulder replacement, 2 discectomies, 5 level Lumbar spinal fusion (all of my lumbar discs are fused). Yes, I have a lot of pain. I was on my way to the pain clinic a year ago next month and was Praying about what I should do. I didn’t want to be a slave to those little maroon devils (the 60mg OxyContin tablet)! Driving down the road, I typed in “opioid help” on my phone & called the first number that came up. GREAT PLACE!!! I met with a caring counselor that walked me through the process and then met with a doctor and she put me on Suboxone. I take it 3 times a day and I can honestly say I have NOT had any withdrawals or even cravings for those maroon devils!
    My problem is, my wife wants me to stop taking them. She now calls me a junkie, a pill head, and any other negative thing she can think of. She says she never wanted me to take ANY pain meds, she just went along so we wouldn’t argue. She says I am selfish because I go to group counseling monthly and to the Suboxone Doctor and it costs $250 each time. She says I am breaking us. My insurance paid almost all of the bill to the pain clinic, but will not pay anything for the counseling or Suboxone doctor. For the first time I. FOURTEEN YEARS I am proud of myself, but my wife makes me feel like a selfish ‘dope head’! My wife is a very educated woman. She has her EducTion Specialist degree in counseling. So, honestly, is she correct? I do not want to be selfish and take away from my family. I don’t want to be a junkie, a pill head, a dope head, or any of the other things she calls me. I have to decide something soon because I have 2 week before my next group meeting and doctor appointment and I have to figure out a way to come up with $250. My wife has closed our joint bank accounts out (checking and savings) and opened them up in her name only. She says it is because she refuses to let me pay that $250 any more. (Oh, I am sorry for skipping g around, but my insurance does pay for my Suboxone. It costs $5 a month) Honestly, I think my wife wants a divorce. I have been told by several people that she is seeing someone. When I asked her if that was what she doing, she said, “prove it!” I told her I didn’t want to battle in court. If she wanted someone else, I would walk away. I just want her happy. She said if I try to divorce her and bring up her seeing someone, she will destroy me. She will expose me being a drug head and I will not get to see my children.
    To be completely honest, I am so low right now, I would have to look up t see Whale Poop and it lays in the bottom of the ocean!

    1. Unfortunately it has been over a month since I viewed these comments. I hope you’re OK– and I encourage you to use my forum to get in touch with others on buprenorphine. There is so much ignorance out there… I’ll just say that it take courage to change a life, with or without the help of buprenorphine! Most people I’ve treated with the medication did NOT do well; those who do well are people who have the courage to leave their current situation and invest in a better life. That goes double for someone with a long history of injury and pain.
      I don’t know where things are with your marriage now, but I hope you have some clarity about the difference between her ‘issues’ and the facts of the situation. I’m sorry for the delay in getting this– and I hope you’re feeling better.

      1. Dr Jeffery I so thank you for your information that you are sharing with us as it has been my experience that my current sub doctor does not know what he is talking about. I recently emailed you about my bone issues that I have been having and I am soon going to have surgery on my foot and my sub doctor told me oh just quit taking the sub the day before surgery and you will be able to feel the pain meds the next day. It really scared me I have been on 16 mg for 7 months now and just started a reduction to 12 yesterday. He should know that I am not going to feel the effects of pain medication the day after i stop taking this med. I am very serious about my sobriety and want to know everything I can about what I take, But thank you for the things you emailed me even though he didnt even look at them but it makes me wanna seek out someone who knows more about suboxone other than writing a script and collecting your money..Thanks

      2. Also they didnt think I should do a reduction til after a year I see a therapist and they recommend me to go down to a level of meds that keep me sober but i think i am on to much and think I was inducted to too much. I keep the sweats all the time.

    2. Joseph, I am no therapist but I am an educated man. I have a bachelors in literature and arts and a Masters in Criminal Justice. I have worked as a paralegal for a family law firm for many years and have seen so many divorces come through my office and the question you have to ask is am I happy and if not why? You talk about the ways your wife acts toward you and what she calls you. No one that truly loves you
      would kick you like that when your down. I have been on Suboxone for 7 months now and it has really helped me. She should be thanking the gods that you took a hard look at yourself and realized that there was a problem, acknowledged it, and became proactive. Being on Suboxone does not make you a junkie, you are the only one that can do that. I know that you are afraid that she will bring your drug history up in a court battle and i am sure that she will but the judge looks more at the here and now not so much the past. If you are working a program, being proactive, doing counseling and are on Suboxone for a period of time to assist your recovery then you should not be worried about that. Your wife does not seem like a supportive person and people that love you hold you up and support you when you are doing good things not kicking you when your down. I think you have some decisions to make. Maybe go to counseling with her and then she can learn more about your condition and how it is being treated cause knowledge is power. But I have seen several divorces go through where one party had a drug history and was using a program and suboxone to get help and got standard visitation with their children. So you don’t give up hope, ok…as long as your doing the right thing the right thing will come back to you….Much wishes and success toy your future and remember the only person you can change is you…

  14. I’m stuck in a situation on the opposite spectrum and very uncomfortable. I got started off at 8mgs once a day. Even that I was thinking, “um I’ve given into the idea of suboxone finally after 13 rehabs, countless outpatients, living in rehabs for women and children, 15 years of a devastating addiction and maybe 8 isn’t enough???” But as a newbie you trust your doctors opinion. The 8mg was actually fine and believe me when I tell you, suboxone has given me a newfound hope and well being and excitement for a great life!!!!! I am thrilled. However, the outpatient required me to come to 4 appts a week and as a Stuart hormone of two kids t got impossible m, finally I was told I’d be kicked out if I missed or was late for any spots!!! So I worked so hard to did another suboxone doctor, get referenced, deal with insurance. Finally after a week off of the suboxone I had y appt with my new doc. He induced me with 10 msg (2 an hour till I felt good) the next day asked me when I started to feel good and told him I felt great withdrawal reliefs when I got to 6 msg. So guess what. That’s what he’s prescribed me. 6 a day. And I’m uncomfortable! I feel like I’ve waited so long to start this and I know it is the answer for me, but I’m starting off so low! It’s scary! After the first week I told him I’d be so much more comfortable at a higher dose and that I’m afraid that being on such a low dose, I’ll begin tapering off too soon. I mean i looked forward to 1-3 years under my belt of reestablishing a successful and beautiful life for me and my kids before getting off of it. And I’m already down to 6! It’s been 2 months! Anyway he said “yes your comfortable phsychologically with a higher dose but that’s only in your head. Your on the right path with 6 a day!” Is he wrong? He won’t give in believe me. He knows best! Should I find a new doctor? Will the new doctor even get it? Or agree with this one?

    1. Hi Lindsay,
      I see that you wrote this two weeks ago, so I hope things are OK. I would say first to try to relax… because 6 mg of buprenorphine can be enough. I usually start higher, but 6 mg is doable– but it may require that you work a little harder initially to relax and overcome your anxiety about all of this. I think that much of the 16 mg initial dose is there to help patients relax, and trust that the medication is working. Most people feel about the same on 6, 8, or 16 mg in regard to withdrawal symptoms.
      All of that said, I’d recommend having a calm discussion with your doctor about this issue. I am not always impressed by the doctors out there, and I don’t have a great answer for living in an area that doesn’t have a few good docs. Frankly, I’m not entirely happy with the choices I have in my own town! I watch my family members get bad treatment or bad advice from their doctors, and have many of the same frustrations as you.
      If your doc doesn’t handle the discussion well, and you don’t think you will be able to work together over time, then you’ll need a ‘plan B’, with or without buprenorphine. But in the meantime keep what you have, and make it work. It is definitely workable.

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