From Vicodin to Suboxone, help me get there

Hi single mom of 3, father died. ready to get off pain meds and try and manage back pain other ways. Vicodin interfers with my anxiety, and so i want to try and get off it. I have a prescription for suboxone. I am worried about how long I will feel like crap as I have no one to help me with the kids. As far as I understand, i wil have to be vicodin free for 24 hours then start suboxone. Is this true??? Just trying to figure out when exactly to start which has least impact on my kids. HELP> Get anxious about withdrawals.

Hi, Breathe12,
I also want to welcome you to the chronic pain forum of Healing Well. I'm not on suboxone, and there are a few threads dealing with it here, but I would be careful about changing your doctor's orders based on anything you read here. If you are unsure, I'd call your doctor's office back. If you pharmacist is familiar with suboxone use, they could be of help also.

BionicWoman posted some information on another thread recently. Hopefully she'll see this and perhaps give you some good websites to consult for information.

We're not doctors here and can't give medical advice, but this is the best support group on the web, iMHO!

Again, welcome.

PaLady
I'm also very sorry about your loss - was that your father or the children's father? Either way, perhaps some grief counseling could also help in all of this. Your screen name also is a great way to help get through tough times - one breathe at a time. Sometimes that's all we can do.

You'll want to follow the COWS (Clinical Opiate Withdrawal Scale) list to start Suboxone. Here's the list-

Resting Pulse Rate: Record beats per Minute:
0=pulse rate 80 or below
1=pulse rate 81-100
2=pulse rate 101-120
4=pulse rate greater then 120

Sweating: over past 1/2 hour not accounted for by room tempature or patient activity
0=no report of chills or flushing
1=subjective report of chills or flushing
2=flushed observable moistness on face
3=beads of sweat on brow or face
4=sweat streaming off face

Restlessness
0=able to sit still
1=difficulty sitting still, but is able to do so
3=frequent shifting or extraneous movements of legs/arms
5=unable to sit still form ore then a few seconds

pupil size
0=pupils pinned or normal for room light
1=pupils possibly larger then normal for room light
2=pupils moderatly dilated
5=pupils so dialated that only the rim of the iris is visible

bone or joint aches
0=not present
1=mild diffuse discomfort
2=patient reports severe aching of joints/muscles
4=patient is rubbing joints or muscles and is unable to sit still cause of discomfort

runny nose or tearing not accounted for cold or allergies
0=not present
1=nasal stuffiness or unuaully moist eyes
2=nose running or tearing
4=nose constantly running or tearing streaming down cheeks

GI upset: over last 1/2 hour
0=no symptoms
1=stomach cramps
2=nausea or loose stool
3=vomiting or diarrhea
5=multiple episodes or diarrhea or vomiting

Tremor observation of outstretched hands
0=no tremor
1=tremor can be felt, but no observed
2=slight tremor observable
4=gross tremor or muscle twitching

yawning observation during assessment
0=no yawning
1=yawning once or twice during assessment
2=yawning 3 or more times during assessment
4=yawning several times/minutes

Anxiety or Irritability
0=none
1=patient reports increasing irritability or anxiousness
2=patient obviously irritable/anxious
4=patient so irritable or anxious that participation in the assessment is difficult

Gooseflesh Skin
0=skin is smooth
3=piloerection of skin can be felt or hairs standing up on arms
5=prominent piloerection

Score-
5-12=Mild
13-24=Moderate
25-36=Moderatly Severe
More then 36=Severe Withdrawal

To start Suboxone they usually recommend that the person be in moderate to moderatly severe Withdrawals. Is their a reason why your doctor didnt do this in his office?? It can be dangerous if you start the Suboxone to early cause it will cause Precipitated Withdrawal, and that's some of the worse withdrawals you'll ever feel. My doctor even had a guy go into seizures cause he lied about when the last time he had an opiate. And being in withdrawals is diffrent for everyone. This list I gave you is the same one that doctor's use, but I would recommend having a friend or someone you trust do the assessment for you.

IF you have any other questions about this or about Suboxone, let me know, I have been tkaing Suboxone for over a year. And I'm a single mother of 2 kids and had to take care of htem while being in withdrawals, and I was on Methaodne so I had to be in withdrawals for even longer.

Good luck
-Carmen

Since your taking just vicodin, that's a short acting med, so I would take a dose maybe in early evening or late afternoon, so your withdrawals start that night, and hopefully your kids will be asleep. Get some movies together (as you wont be sleeping that night more hten likely) and lots of water or gatorade. And take lots of hot baths or showers to help the sysmptoms, and hopefully by morning, if you feel like your in enough withdrawals, start by taking 1-2 mgs. then wait an hour and see how you feel, and take naother 2mgs if you still feel terrible. ALSO keep looking at your eyes in normal light, if they're huge (dialated)then your still in withdrawals and take a little bit more til your eyes are normal sized. Alays start off by tkaing very small doses and going up frm their.

When I started Suboxone, I had to be in withdrawals for 48 hours cause I was on methaodne which takes forever to leave the body, and the doctor dosed me in his office. I really feel that your doctor should of had you ocme back in withdrawals so he could do it in his office to keep an eye on you. But I hear lots of doctors also just send the patient home with an RX to do at home, but too many people seem to start too early. I did throw up that first day a few hours after dosing at the doctor's office, but that was because withdrawals gives me migraines, and migraines make me vomit. The next day I felt WONDERFUL, and have since. Other people have a harder time starting it, and heard it can take up to week for your body to adjust to it, but I felt absoutly normal the next day, so it's diffrent for all of us.

If I where you, I would make easy meals already made for the kids, and get some movies to keep them busy and just stick it out, I did and I made it. I warned my kids that I would be sick so they knew ahead of time I wasnt going to be feeling well for a few days.

Also their are some forums for people taking suboxone and they have people on their that can give you some better advise, it's addictionsurvivors. org Also check out NAABT.org for some good information on Subuxone.

-Carmen

I'm sorry you've had to go through such difficult circumstances. You'll fit in perfectly with the CP community. You're almost like our own Dr. House! Anyways, I agree with the others that you should contact your doctor so you have a very structured schedule of weening off vicodin and starting the suboxone. Any questions or unknowns are not something you want to have in the midst of withdrawal. Hope all goes well!

btw, i wrote a list of questions to call and ask the Dr, I do not know him well, he was referred by my psychiatrist, and I wasn't sure what to ask. Also so much to say about why I get anxious about weaning, trying meds, felt like he was rushing. I will be strong and call him with my questions. I guess I have trust issues with Dr's lately, since my ex died.I have had some scarey things happen, and being all alone and present for my kids takes all my strength.

Thank you, i need support and am glad I found this website.

Thanks. I too wonder why my Dr doesnt see patients when they take it??? I talked to my therapist about it. She said some do and some don't Also, I feel like in a way I am getting judged because I said I do not take a lot of pain meds. But it does not matter, that is because my tolerance goes up slowly and I have been psycho about not taking too many. So, I talked to the phamacist, and I wll call my Dr to let him know I am starting tomorrow, 24 hours after my last vicodin. I was told to take 2 mg first, so that is what I will do. I will not start the suboxone for twenty four hours no matter how crappy I feel, and If I have any questions about being ready, I will call the Dr tomorrow. Thanks again. Still nervous, but I am hopeful. Thanks thanks thanks.

Thank you, I am already feeling a little sick. Very achey, partly due to my back crap, but sure becuz no meds. Popped two advil I also got a friend to drive my daughter to school, becuz I am sure I will feel worse at the close to 24 hour mark. Let two friends know I am starting a new med, one is the one who had to drive me to the hospital last year when I had a reaction to a mood stablizer. At least it is snowy and It feels like a good day to be in the house doing nothing. I will be in touch. Again, thanks, keep logging on to see if any of you are there.

I thought that the doctors you can find via the suboxone website are only for addiction/abuse management?

Breathe,
Wish I could help with the suboxone issue. Maybe Kitty will see this post and gives you some help. Or maybe your pharmacist can?

GCoin - That may be a good point. I don't know. Maybe Kitty does. Because treating for pain and treating for addiction are two different things, I would think re: dosing, but I don't know. I do know there are different dosing issuing for methadone when used for pain vs. addiciton. Kitty, if you see this maybe you know the answer?

Keep at it, breathe, I know you'll get through. Sometimes our fear gets the best of us.

Hugs,

PaLady

I have talked to both Drs. I am extremely nauseous and dizzy, but that is normal. As far as pain, I have it, but the pain meds was screwing with my anxiety, so I have to go off them for now and get that part of my health in order. I am hoping that once my antidepressents get back on track, i can use pain meds when necessary. I am sensitive to lots of those too, but percocet and vicodin really help when my back is really bad, and everything else that goes along with that. I do not think I am going to be on Suboxone for long, but it does help your brain start producing dopamine, that will help my anxiety, and as far as pain, it sometimes helps joint pain, which is my constant right now. My pain levels go up and down, from bearable to debilitating. Too bad there is not a magic pill that helps all my physical ailments, but things are never easy, and that is ok. I am learning a lot, and I will eventually be feeling strong in all ways. Thank god for folks who actually understand that pain is real and can be so debilitating. Some people are so uneducated, they think depression is not a disease and anyone who needs narcotics is an addict. Sad.

Breathe12

Sorry I didnt see your post earlier. My son got VERY sick on me and we wher at he ER yesterday and I have been on my feet cleaning up vomit and all that fun stuff (things we do for our children is crazy lol). Remember that it can take up to aweek for Suboxone to stabalize in your system. Your suppose to stay at the same dose and take it on scheadule to get the most benifet out of it. It's not unheard of for the first week or so to be very ruff. But of course if you just cant handle it then call your doctor and explain, maybe you need a higher or lower dose or need something else completly but of course thats up to your doctor.

Also about the SUboxone websight.....It is used for people fighting addiction, but ALSO for people like me, who wasnt abusing their pain meds, but wanted off of them but couldnt handle the tapering or cold turkey that most other doctors recommed. So after I did some research, I found that addiction specialist doctors are trained to help people taper off of pain meds and sometimes they use suboxone to help with that. You dont have to be abusing your meds to see an addiction doctor, they undertand how the brain is dependent on it and rather your abusing or just dependent, both need help tapering when they need to come off of pain meds. I hope that made sense lol. My doctor knows I didnt abuse, and I explained to him how pain med wernt helping my pain and I wanted off of them and he understood completly, he hardly even drug tests me cause he's seen my history with other doctors and I have never had a dirty UA on file in the 8 years that I was a pain patient. I just have alot trouble trying to taper from high oses of pain meds, my body just couldn't handle it, some people can take it and some people cant like me.

Also doctors must take an 8 hour course online to be certified to prescribe Suboxone for opioid dependence. BUT any doctor can prescribe it off label for pain releif but lots of pharmacists dont know this and wont fill it. Doctors who are certified to prescribe it have the letter "X" at the beggening of their DEA license number. Also lots of doctor choose not to have their name listed on the Suboxone doctor list, and choose just to prescribe it to a hand full of patients or sometimes just one patient. But calling your hospital and asking, they will usually have on file if there are any other doctors who are certified.

Also for some who dont know, theirs a place on the suboxone websight where you can annoumously send your doctor a package telling them about getting certified to prescribe suboxone. Also alot of doctors are certified but dont prescribe (for reasons I dont understand) actually more then half doctors who are licensed dont prescribe. So with the help of some people with the NAABT websight, I'm trying to advocate to my local area doctors to get certified, as we have a huge problem right now in this area with addiction and their's no help. This is why I know so much about suboxone, I think it's a wonderful med thats deeply misunderstood and underused. And now that it's lost it's pantent, their's going to be generics hitting the pharmacy shelves soon, so hopefully more people can afford it who dont have insurance or for people whose insurance dont cover it.

Well anyways, if you have any other questions feel free to ask, but remember I cant replace any information from your doctor. And forgive me for being slow at responding, the flu has hit my house, and right htis moment I'm going to try and get some sleep as up all night with my sick son but I will try and read and keep up as much as possible. Usually I'm here checking the forums several times a day but for this next week I'm going to be kinda scarse.

-Carmen

Palady, what you said didnt offend me at all, you where completly right, I should of stressed more that doctor's advise is the only way to go, but some times my brain goes numb. I'm always wanting to help everyone and I dont mean to ever have anyone take my advise over their doctors, usually I'm just trying to state MY personal experience and sometimes it comes out sounding like that s what I'm telling people to do too and I dont mean for people to follow what I do. If I ever do that again, feel free to smack me back into my place lol.