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>Once you've plateaued, then the doctor can start tapering you down
>about 2 mg (or less) every two weeks

To all, especially Very Lucky/Mr Hope: (incl. message to Oldtimer)

I have been reading several threads re Bup with major interest, as I do not have a dr with either experience or patience with questions and a complicated situation to which his training does not apply, as he keeps reminding me (did I listen? Nooo; he was so gung-ho at first that I did not appreciate the significane of "I have NO experience.") In any case, I was an intractable pain pt for the better part of the last 30 yrs. But the source of this symptom of my disorder regresses as women enter middle age & estrogen decreases. So, I am now trying to get completely off the MS Contin I've used to treat my pain since '97, ultimately by way of Subutex. And I've been tapering for the last 6 months and am down to 105 mgs, the equivalent of about 35 mgs of methadone, maybe 60 mgs Oxy & 10.5 Vicodin, so far. I began at several hundreds of mgs more, at first just to see if/how far my pain had regressed. Now it appears I can go all the way, but time is of the essence, for reasons including, but by far not limited to surgery both desparately needed & funded by a group insurance plan likely to be terminated at the end of this calendar year. And I had planned to switch to the Buprenex, now Subutex when I got down to the equivalent of 30 mgs methadone (90 mgs MS) and then just stop that within a week since I thought it did not build physical dependence, especially in such a short time.

However, last week, the dr I consulted specifically for this purpose, offhandedly mentioned the need to taper from Bup itself, at a rate of 10%. But he was on call and even more unavailable for follow-up questions than usual. Since I have been reading the same story here, especially VeryLucky's comment excerpted above, I have begun to urgently wonder whether I could taper the MS itself just as quickly (or slowly) and perhaps even experience less withdrawal, something I have yet to do, than if I used the Subutex for the final 100 mgs as planned. It is difficult to taper below that point because the lowest dosage is 15 mgs, and, as a % of total dosage, each reduction after 105 to 90 (30 mgs meth) respectively represents 20%, 25%, 30%, 50% and then 100% from 15 mgs to zip. Yet, I dropped from 150 to 135 to 120 and, as of last night, 105 with just 4-5 days on each dosage w/ little or no problem. I also used to stop around the clock vicodin (5 mgs) every month for the days my pain was bearable with hardly noticeable symptoms. If I am able to get down to 60 mgs by my September appt., then I will be also at the same dosage. (60 mgs hydrocodone, also 25 mgs meth, etc.) Would the long-acting nature of morphine make a big difference? Or the nature of the substance itself?

So, long story short, my primary question concenrs whether I will have to taper from the Subutex as well, and if so, how long will THAT take? 10% every day, week, more? And is that a physical issue or psychological one or both? Another complication is that I still have pain requiring medication 5-8 days per month at the moment, so I had scheduled the Bup or Sub switch for the first week of it. But if I am not off of IT by the end of that month, I will be in big trouble. And there is just so much needing doing between totally finishing the taper and surgery, which involves 6 weeks of IV antibiotics and tons of tests. All that & more, including the need to make plane and motel reservations for my Dad, who is coming in to help me thru whatever, all combine to make my need to decide what to do and exactly when to do it all the more urgent.

In short, HELP!!!

VeryLucky, I am directing my message primarily to you because I trust your information and experience, plus we share something else very important in common. Clue: "including, but not limited to." As a professional nitpicker, I also feel compelled to point out that Suboxone contains naloxone, not naltrexone, a BIG difference. And Oldtimer, if you are reading, why do you think you are an addict, rather than a pain pt? Because you will never legally qualify for Suboxone maintenance unless you meet the DSM criteria for opioid dependence and it certainly does not sound as if you do from reading your posts. Some people need meds; it does not mean that you are a failure or "relapsing'" because you keep taking them. Addiction is a whole different beast than appropriate treatment of pain, anxiety, depression or fear of withdrawal due to physical dependence. Just in case, it is also not misplaced shame about taking/needing meds, something I know all too well. Or did.

In any event, any and all input desired regarding my dilemma and the details of a Bup taper. Thanks much in advance.

[This message has been edited by Grinolla (edited 08-06-2003).]

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