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Starting Suboxone and Preventing Precipitated Withdrawal

sup guys alright I am dr. Chris Park and

family physician and addiction doctor

and we're talking about suboxone okay

specifically we're gonna be talking

about the suboxone induction so the

induction is when you start suboxone now

this is a disclaimer what I'm not saying

is not medical advice for you everyone

is different and please get inducted by

a doctor in their office okay don't take

it from Joe Bob down the street alright

you don't know what he's given you it's

just I say if you don't know what your

blood pressure you don't know you know

you just don't know where you're at guys

so so get into a doctor's office I know

you've probably had trouble with doctors

before maybe you don't trust them maybe

you're gonna say you can't afford it

whatever listen go see a doctor and get

inducted the right way and get the help

you need okay so that's my disclaimer

now there's three main things you want

to consider if you're having trouble

with the induction and you say well why

would anyone have trouble so sometimes

if you start suboxone it can actually

make you feel worse initially and I get

this a lot of times people come to me

saying well I've tried it you know and

it just didn't work or I had horrible

headaches or I got so nauseated and it's

almost always someone who we're taking

off the street okay and the the problem

is if you take suboxone okay and you've

got opiates in your system you can have

precipitated withdrawal okay so that

means you're forced into withdrawal all

right and that's not what you want right

the whole reason you're taking is

probably cuz the withdrawal systems are

so severe you just can't seem to get

through it by yourself and so you're

looking for help alright so you don't

want that but the answer to that is

giving yourself more time because when

you start suboxone you should be in

withdrawal already now 24 hours is kind

of a general guideline or

rule that we follow 24 hours since your

last opiates since your last pill or

heroin now if it's methadone we're gonna

say typically 48 hours maybe 72 hours

but let's say it was just hydrocodone

you were taking and 24 hours you're in

withdrawal you know you're having runny

nose you're having restless legs body

aches diarrhea you're irritable etc

right you start some Bach something you

feel horrible well it may be that you

need you need it more time so even

something like a short-acting OB you you

may need longer in withdrawal okay but

at least step number two which so maybe

you can't lasting longer withdrawal

maybe 24 hours is like you have zero

willpower right now and you're lucky to

be able to make it 24 hours so what you

might need is well almost everyone needs

to do this anyway when starting and

inducting is micro dose so you take a

very small amount this may be one

milligram two milligrams 0.5 milligrams

whatever take a small amount and then

you wait okay you see what happens over

the next hour the next two hours you

know how much benefit did you get do you

feel worse if you're feeling worse all

immediately after you need to wait a

little while longer right but but after

that dose then you can take it in a

couple hours maybe you take another

micro dose you know if you're still

having withdrawal but you don't feel

necessarily worth maybe felt a little

better and then it seemed to wear off

and so you can kind of micro dose it

every few hours and figure out your

total 24 hour needs okay and I do this

with a lot of my patients so then I'll

have them you know will induct them in

the office we'll make sure they're safe

we'll let them go home and kind of tell

them what to do and then they come back

and they say okay well you know what I

only needed 8 milligrams for about 24

hours or they may say look yeah my

withdrawal is controlled with 8

milligrams but I'm thinking about using

every day

in that case I may bump up their dose

okay so there's a lot going on when

we're trying to decide the doses of

medication now a patient may say hey I

can get by on that four milligrams a day

or two milligrams today that's good

because you want to get by on the least

effective dose as possible that's just

gonna be better for you all around long

run okay so that was two so we said you

know you want to be able to roll when

you start and you may have to push that

out further and the next is the kind of

the micro dosing of the induction to

figure out exactly what you dose is and

once you figure that out you don't have

to take you know once you figure that

out you're past that induction phase and

you're not having any kind of

precipitate withdrawal etc you don't

have to split your dose up throughout

the days you can just divide it into two

doses a day or even one dose today if

you want okay

so the first step is are the third issue

that some people have so like if you're

still having precipitate withdrawal

every time he starts the boxing you feel

horrible well you may need subutex

instead of suboxone are just straight

buprenorphine

in other words suboxone we mean two

medications one being a blocker but the

blocker and suboxone actually helps to

curb cravings as well so it is a good

medicine where it's not just in there to

keep you from shooting it up okay it's

doing more than just that so I don't

have refers a box of but if you just

cannot then you may need subutex okay

it's gonna be eating cuz it just has to

be preneur Fenian so it's not gonna have

the the severity of the precipitated

withdrawal that's a box of wood now it

still could have some so you you still

have to apply all the general you know

guidelines and rules but it may be more

effective for you than suboxone now that

being said there is you know subutex

some people just don't like it

some doctors won't prescribe it at all

some pharmacies won't fill it I disagree

with that mentality but I understand

where they're coming

right because there is some misuse of it

and you always get nervous prescribing

something to an addict who could misuse

it but look I don't know it works well

for people and if people are generally

trying to get help

it works well I don't understand keeping

a medication that could be life-saving

away from somebody but hey that's just

me so and so I'm just warning that

because if you go to the doctor saying

hey I watched this video and I'm the

doctor said I need to take subutex not

suboxone hi well I'm sorry that doctor

just gonna think you're up to something

so don't do that but if your doctor is

you know knowledgeable and caring I mean

they're gonna kind of weigh all the

options and discuss it now I've had

people sometimes come to me who had

trouble but it was because they were

taking it off the street and I just

don't trust what happened there so I may

try suboxone again okay and I may even

push them to to give it a good a good

trial okay before we just change over

something else so everything just has to

be kind of weighed out you know pros and

cons and that's why I keep telling you

guys that look these videos are not

advice for you because you are

everybody's different man everybody's

got different needs different

backgrounds different stories and that

has that just takes more than just

watching some weird dude on a YouTube

video telling you what to do okay so

please get a doctor find a good one

they're out there I promise and you know

live happy live healthy live clean guys