These guys are all forces in the recovery community but together WOW, you can expect lots of inspiration, differences of opinions and thanks to Bobble every topic will be explained so that everyone will understand completely.
December 1st RECOVERYRADIO.FM went live out of Palm Beach, Florida. Three huge names in recovery are hosting the show, RJ Vied, James Sweasy and Bobble. These guys are all forces in the recovery community but together WOW, you can expect lots of inspiration, differences of opinions and thanks to Bobble every topic will be explained so that everyone will understand completely.
The show runs for three hours every Tuesday and Thursday from 9 pm to 11 pm on
96.1FM for Pompano to West Palm / 97.5FM for West Palm to Jupiter/ 1340AM for all of West Palm County. You can also watch the show live on RECOVERYRADIO.FM OR on Facebook at www.facebook.com/recoveryradio.fm
If you aren’t familiar with these guys, let me tell you a little about them from my perspective.
RJ Vied is a Recovery Advocate who is a talented writer, speaker and all around genuine guy. I guess you could say he is the eye candy of the show…at least that’s what all the ladies are saying but don’t take my word for it, check him out yourself. You can follow RJ Vied on Facebook at www.facebook.com/rjvied. Don’t think that means he is just pretty to look at, this guy has a genuine passion for reaching the addict still suffering and supporting those in recovery. RJ Vied is a triple threat, intelligent, talented and honorable. The eye candy part is just a bonus.
James Sweasy is one of those magnetic guys that when they talk you just know you need to listen. Sweasy is from my hometown Louisville, KY and his no-nonsense approach to recovery has made him one of the most followed Public Persona’s in Recovery, and he is just getting started. Sweasy’s fans are die hard and with Sweasy’s creative video angles and call it like it is approach this guy going to be HUGE…ok he already is huge so how about Enormous. Relatable is Sweasy’s middle name. If you aren’t a Sweasy Fan, you need to hope on over to www.facebook.com/jamessweasy and learn you a thing or two. That’s what us Kentuckiana’s like to say.
Last but not least is Bobble. Bobble is a musician that is rocking the recovery world with his relatable rhythms and hip hop recovery music. I don’t know a bunch about Bobbleother than thank goodness for him being on this show. Sure enough, when I am scratching my head about some odd term, idea or recovery approach Bobble is quick to say, HUH? Please explain that so we all can understand it. You can follow Bobble at www.facebook.com/bobblemuzikRAW
Over the past year anyone following the heroin epidemic has heard people making statements like, “The only reason the news is using the phrase epidemic with the word heroin is that white kids are dying, now.” or ” When we were in the midst of the Crack explosion in the 80’s the crimes committed by black addicts were given heftier sentences. No one cared that they were addicts.”
It’s not about who is dying but the amount of people who are dying that make it an epidemic. The definition of epidemic is:
a widespread occurrence of an infectious disease in a community at a particular time.
It’s absolutely true that we have been wrong in how our government and society has treated drug related crimes and addiction in general.
My heart breaks for the families that have suffered under the cruel drug sentences handed out in the name of the three strikes law. Most that fell into the three strikes category were addicts. Life in prison for drug charges is deplorable. Knowing what we know now about addiction makes thinking of the treatment of individuals with Substance Use Disorder in the past cringe worthy.
In the 80’s when crack cocaine became huge in the urban black communities, we all failed. Just the word crack in a courtroom made the sentence longer. The worst part is that those people were suffering from Substance Use Disorder and are no different than those who today use heroin because of the same disorder. The families that had loved ones who were using crack were forced to face these things without, support, and suffocating stigma.
The problem is that they were villainized while today we are pushing for courts, police officers and doctors to soften their approach to drug related crime. Now we don’t even want people to use the word addict or addiction. The term that should be used has even changed.
If we could travel back in time and stop “The War on Drugs” we would. Unfortunately, we don’t have that option. The good news is that we are waking up to the truth about addiction and slowly seeing a shift in the treatment of addicts. Social Media has moved mountains in fighting the views of addiction.
It also doesn’t hurt the cause that people in high places have been forced to look at addiction in a different light. People of all walks of life have been rocked by the Opioid Epidemic and maybe that is why things are changing. We must take the good with the bad. No matter what, the ideas of yesterday needed to be history. Let’s all fight to ensure that the ideas of today and tomorrow are correct for all of our communities
Placing blame does not change the destruction that unethical drug laws, did in black communities. It does, however, make people think of hate instead of change. So if you hear someone making the argument that we only care now because white people are dying just explain to them that no, we care because the way it was handled in the past was wrong. The only thing we can do now is to make sure it never happens again. In order for us to fix the issues that have and will continue to hurt people of all races, is by working together. So, let’s do it! Let’s make sure this doesn’t happen to any community ever again. After all, isn’t that the best that we can do anyway?
Her thoughts have been so jumbled since Tom died. So shaky. It’s the little things that give her the most trouble. Like earlier Thursday at the Flourtown Farmers Market. She needed sandwiches for the guests that would be attending her son’s memorial Sunday. But at the counter, her mind went blank.
“I need help,” Annie Reynolds told the clerk. “I can’t even think straight.”
She is angry. She knows it’s irrational, but she’s angry at Tom. She’s angry that she and Bob couldn’t save him. She’s angry at the dealer who sold him the heroin, whoever that might be.
She’s angry about what Tom had told her that Sunday before he died. That he often had heroin delivered to his apartment, right there across from Bredenbeck’s Bakery in Chestnut Hill. That he could just call. It was that easy.
She sat down Thursday at her dining room table filled with photos and condolence cards. It had been nearly six weeks since Tom died from a heroin overdose in the bathroom of the Trolley Car Diner on Germantown Avenue. He was 27.
Annie Reynolds had wanted to talk to me about her son. Then, she didn’t. Then, she woke up one-morning last week feeling she had to talk about his death for what it was: another casualty of heroin’s insidious reach. Maybe that could bring some small dose of healing. Help her think straight. Help some other family.
“It’s not out there anymore,” she said of the heroin and opioid crisis tearing away at the small towns and suburbs across the nation. “It’s here and it has hit us really hard. By ‘us,’ I mean the community.”
Tom was the second member of the 2008 graduating class of Springfield Township High lost in the last 14 months from an overdose. A classmate died last summer. Fentanyl-laced heroin, same as Tom. Annie and the man’s mother now talk – about the four more young people they know from that class battling heroin. A girl in town who was the same age as their sons and recently Oded.
Annie, a retired Catholic school librarian, picked up a stack of photos from the table. “Scanned and ordered,” read a post-it. Molly Reynolds, who is 25, had meticulously organized the photos for a video for her older brother’s memorial.
“No one could make her laugh like him,” Annie said, showing a photo of Molly near tears from one of Tom’s jokes. He made so many laughs.
It was only weeks before Tom’s death that Annie learned about Tom’s devout Twitter audience of nearly 8,000 followers. Bob had tried to keep it from her; it could get raunchy.
A lot has been written about Tom’s Twitter account, @tombrodude. It was delightfully weird and absurdist, sometimes cutting and very often very raw. It was undeniably hilarious. Much of it was far better suited for Twitter than a Sunday newspaper, but it was undercut with sincerity and sweetness and vulnerability.
(“You know what today is. that’s right its Monday baby!,” his final tweet read, written hours before his death, on a Saturday. “let’s get out there and work our hardest and the weekend will be here before we know it.”)
He tweeted about his addiction. His openness made a lot of people who never met him love him. Now they mourn him. A “Tom Bro Dude Memorial Twitter Meet-Up” is scheduled for Saturday at Lucky Strike in Center City.
Those parallel rails of grief – between those who knew him in person and those who knew him online – shows how it is with heroin now. It could be the guy you love on Twitter. The guy who lives above a bakery and makes his sister laugh, who was raking leaves with his father at his church the day he died.
After leaving his father, he met a dealer near the World War I Memorial on Mermaid Lane. Tom rode his bike the few blocks to the Trolley Car and walked the winding hallway to the bathroom, past the old-timey trolley photos and the Cat on the Tin Roof poster to a corner stall. His heart gave out. A cook found him.
At the table Thursday, Annie’s braced herself for her son’s memorial. For what she might say. Maybe a Shel Silverstein poem, she said. Something funny and pithy and intelligent. Like, Tom.
Then, she went back to preparing for the guests who were coming to help her bury her son. Tried to make her way through the little things.
University of Wisconsin Colleges Prevention Programs director1
October 28, 2016
As director of Alcohol and Other Drug Education Program for UW Colleges, including UW-Manitowoc, I’m frequently asked about the growing problem of heroin addiction and what can be done.
Since I am a prevention educator, I often frame my response in terms of what each of us can do as individuals, family members and friends to prevent the evolution of addiction from happening to those we care about.
Heroin addiction doesn’t happen overnight. For many users, the journey to addiction starts with a legitimate prescription for opiate pain medication and evolves from there. If we understand what this evolution looks like, we are more equipped to notice warning signs, ask questions and get help sooner.
If a patient uses pain medication for a short period of time, as prescribed by a doctor, the likelihood of developing an addiction remains fairly low. Over time, however, people who use opiate pain medication start to develop tolerance. If patients begin to notice their prescribed amount of medication doesn’t seem to work as well anymore, they should speak to their doctor. Many alternatives to pain management besides long-term opiate use are available.
Warning Sign 1 — The individual starts taking larger amounts of pain medication on their own, without consulting a doctor. This is drug abuse. Now is the best time to intervene to prevent further progression toward addiction.
When individuals are taking more than prescribed, they need to increase their supply. That can include getting refills legally at first but often involves finding alternative ways to maintain their supply.
Most prescription drug abusers report getting additional supply from friends and family by asking for it, buying it or stealing it. Sharing prescription drugs is illegal and can contribute to addiction.
You can reduce the risk of drug abuse by dropping off unused prescription medications to a drug drop box. Manitowoc and Two Rivers police departments have permanent drop boxes available at their stations. If you have medications at home, keep them hidden or locked in a safe location.
Warning Sign 2 — The individual is taking prescription drugs that are not prescribed to them.
As the needed dose increases, costs go up and availability of supply can become challenging for individuals. Users also experience withdrawal symptoms if they go too long without opiates.
Warning Sign 3 — Feeling sick when not using opiates.
When experiencing painful withdrawal or pill supply issues, individuals are at high risk for turning to heroin, which is often cheaper and more potent.
Initially, users who turn to heroin may experience a rush in a way they haven’t experienced with prescription drugs for a while. This can be very appealing and increases their desire to continue using heroin.
Warning Sign 4 — Heroin is typically not a recreational drug. If someone is using heroin, it is often an indicator of opiate addiction.
The sooner we — as individuals, parents, family members and friends — recognize warning signs and admit what they are, the more likely early intervention can happen.
Thankfully, growing numbers of multi-agency efforts are happening across our communities and throughout the state. Positive changes are happening legislatively as well as with prevention, intervention, and after-care support services.
Hello, you don’t know me but I am an addict. I am one of the “junkies” you love to bash whenever someone mentions addiction on Social Media or hear it in conversation. I know it’s hard to forgive the things we sometimes do because of our addiction but I have a question for you.
WHAT IS THE WORST THING YOU HAVE EVER DONE?
Obviously, I won’t get an answer to this question but think about it. The thing that you hate that you did. You know, that one thing that not too many people even know about. Well, what if everyone knew about it. What if for the rest of your life you were labeled by that one act that you would erase in a second if you had the chance?
That is what being an addict is like, kind of. Now I don’t feel like being an addict is the worst thing a person can be or do. You, however, feel like it’s a terrible thing. Don’t get me wrong, if I could erase it from my life I would. In an instant, it would be gone, but I don’t have that option. I can’t even do what you do and pretend that this thing I did, didn’t happen. In order for me to ensure it never happens again I have to work hard on making sure it doesn’t. If I don’t my disease will tell me I can have a drink or do a line and not fall back into full-blown addiction, but I will.
DO YOU WORK HARD TO MAKE SURE YOUR WORST THING NEVER HAPPENS AGAIN?
Let me guess, you are thinking, addiction is not a disease…it’s a choice, right?
Yes, all addiction starts with a choice.
The same damn choice you made when you were young and hanging out with friends.
You drank the same beer I drank.
The same pot I smoked.
You even tried the same line of white stuff someone put in front of you at a party.
You were able to walk away and not take it to the extreme.
Since I have the disease, I will spend the rest of my life either struggling to stay high or fighting to stay clean.
As children, we don’t decide we would rather be an addict instead of a cop.
You don’t see children pretending that their dolls and stuffed animals are dope sick.
When is the last time you talked to a little girl that told you she couldn’t wait to grow up so she could turn tricks to feed the insatiable hunger of her drug addiction?
My best friend didn’t tell me about exciting plans to become homeless.
My Dad, not one time, told my Mother to think twice before marrying him because he had high hopes of becoming an angry drunk.
My sister in law didn’t blow out her candles as a child wishing for an S.U.D. ( Substance Use Disorder ) because she couldn’t wait for the day her children were taken into foster care.
Nobody WANTS to have Substance Use Disorder.
Some of us just do.
So always remember –
YOU MADE THOSE
SAME CHOICES TOO
YOU JUST GOT LUCKY
IT WAS ME
AND NOT YOU.
If you still have doubts you can take those up with the Center for Disease Control ( CDC ) or the United States Surgeon General. Since they have classified addiction as a disease, but then again I am sure you know more about it than they do, right
So to you, I pray that you don’t have to reevaluate these opinions because you find out your child or parent is an addict. If you do, just know that we will accept you into our community. We will help your loved one. Do you know why we would do that? Because we are good people that just want the chance to live like everyone else.
So please, before you post another post bashing people who are suffering think about it. Not only are you hurting the people who, have the disease, you could be hurting everyone that loves them. You have people on your friend’s lists or that overhear you at work who have children who are suffering right this moment from addiction. What did they do to deserve the awful things you put out into the universe, that does nothing but perpetuate hate and judgment?
You have a right to your opinion, but no matter what, hurting people is wrong.
This is the best information I can find about tapering off of Suboxone. Please if you have tapered from Suboxone and had success send us a message so we can share your story. When I came off of Suboxone I didn’t taper. I went to a three-day medical detox where they gave me a cocktail of nonnarcotic meds to help with the withdrawal from the Suboxone and 20 years of Xanax ( benzo ) use. The withdrawal was very tough and lasted for months. I was successful though and you can be too.
Summary: The purpose of a taper (instead of just stopping) is to gradually reduce tolerance, thus distributing withdrawal symptoms over a longer period of time minimizing the discomfort experienced on any single day.
Ending the taper at the manufacturer’s lowest available dose (2mgs for Suboxone Film® and generics or 1.4mgs for Zubsolv®) can still result in significant withdrawal.1,6 Here we lay out the rationale for tapering to much lower doses. As the data will show 2mgs/day is closer to the midpoint of a typical taper than it is to the end.
General rule: Pace the taper with the body’s ability to adapt to each decrease. Dose decreases of 25% separated by at least 10 days has been reported to be tolerable by many.1
The whole point of buprenorphine treatment is to suppress cravings and withdrawal so that you can make big changes in behavior, routine, living situation and thinking. It’s these changes which, in effect, rewire the brain and reverse some of the craving-causing brain adaptations. If this is not done first the taper will likely be shortly followed by relapse.
Have you made significant changes in behavior and had a period of time to gain experience with those behaviors? Have you been able to deal with stress, anxiety, and depression without craving drugs? This takes time and doesn’t happen on its own, it is a deliberate effort. If you have been in stable treatment less than six months, tapering is NOT advised.
Buprenorphine is NOT a detox medication, it is a treatment medication. If you are not clear on this distinction go to the treatment page and understand it before tapering. But assuming you are ready to taper there are some things to consider.
Tapering to very low doses minimizes withdrawal
Before we continue, it should be noted that the following is a detailed explanation for those interested in the nuances of tapering and not necessary to conduct a taper. It does however, help make sense of why certain protocols are likely to be more effective than others.
Cut pieces of film
Fig. 1. Suboxone Film can be cut into small pieces. Accuracy is not that important when cutting the dose. Blood levels will average out over a few days. Also, it is not a certainty that the medication is evenly distributed throughout the film or tablet, so super-precision in cutting isn’t warranted.
To understand the tapering process there are a few concepts you should understand:
The Ceiling Effect of Buprenorphine:
In short, at a certain dose of buprenorphine, nearly all available opioid receptors become occupied with buprenorphine.3 Each helps induce a small opioid effect.4 The cumulative effect created from all receptors is the maximum effect or the ceiling effect.4 The minimum dose to reach this point is the ceiling dose. Taking more than the ceiling dose involves so few additional opioid receptors that patients are unable to detect any additional opioid effect.4 Whether the patient’s dose is at, near or above the ceiling dose, they experience virtually the same opioid effect. For this reason, tapering can be more aggressive (per mg.) at higher doses than at lower doses when more receptors are affected by dose decreases.2
Fig. 2. PET scan showing available opiate receptors at various doses.
Fig 2 is a PET scan showing the amount of available opioid receptors at various doses.3 From this evidence it is clear that, for this particular patient, at some dose above 2 mgs. and below 16 mgs. the ceiling dose is reached, as the amount of available receptors have diminished to insignificant levels.3 If we extrapolate this admittedly very limited dataset and apply a curve shape common in biology, we can estimate approximate receptor involvement at various doses. Fig 2a illustrates this concept. It should be noted that there is great variability in reality and liberties have been taken with this particular graph, but it is meant to illustrate the point that the amount of receptors involved is not a linear relationship with dose. Therefore cutting the dose in half from 32mgs to 16mgs doesn’t mean that half as many receptors are affected, in fact due to the ceiling effect there would be no discernible difference.
involved receptor graph
Fig 2a. Approximate amount of buprenorphine-occupied mu receptors/dose
If a taper should follow a steady and gradual decrease of involved opioid receptors, then 2mgs would be about the midpoint of the taper. In one of the few taper studies, both long and short tapers ending at 2mgs resulted in very low success rates.6 The researchers concluded: “For individuals terminating buprenorphine pharmacotherapy for opioid dependence, there appears to be no advantage in prolonging the duration of taper”. They apparently gave no consideration to the possibility that maybe 2mgs is too high of dose to stop at. We will show it is and suggest their conclusion is wrong in that extending the taper well below 2mgs for a much longer period of time is beneficial.
Buprenorphine doesn’t completely metabolize between doses. It typically takes between 24-42 hours to metabolize half of it, but could range as much as 20-70 hours.9,10,11 We use 37 hours as an average in our calculations, but be aware of the range if your results don’t meet expectations. Therefore, after the first 37 hours, only about ½ of the buprenorphine has been metabolized, while half remains to continue to elicit an effect. After another 37 hours half of that remains and so on. At typical maintenance doses, previous doses can contribute to the overall blood levels for 5-12 days (depending on actual metabolic elimination rate). At very low doses, by day three the amount of buprenorphine still un-metabolized is so small its effects are negligible.
Although this graph starts at 16mgs., the curve would be the same for any dose.
Buprenorphine Blood Level Buildup, Stabilization
As patients take subsequent doses of buprenorphine before the prior dose has completely metabolized, a buildup occurs in blood levels. (Fig 3) The buildup continues for approximately 5-12 days at which time the dose taken 5-12 days prior has nearly fully metabolized. This is the stabilization period. When dose is decreased the effects of this build up should be considered before the effects of the new lower dose can be evaluated.
11 day half-life graph
Fig. 3. Blood levels build up until stabilization
Putting It All Together
We now know that doses at or above the ceiling dose can be decreased more aggressively than lower doses. We know that 2mgs/day is not the end of the taper but closer to the midpoint. We know that due to the half-life, buprenorphine builds up in the blood and may still produce effects 5-12 days later, particularly at higher doses. Armed with these considerations we can construct a taper plan which will minimize discomfort.
Buprenorphine Taper Plan
By coupling what we learned above with anecdotal taper testament found online, we can estimate that dose decreases of 25% with 10 days between drops should be tolerable.1 Furthermore, if our initial dose is at, near, or above our estimated ceiling dose we can taper more aggressive initially, maybe as much as 50% drops. As we approach 2mgs and below, we should expect more noticeable differences between each dose decrease and may need to slow down the pace. Once at a very low dose (less than 0.5mgs) we can speed up the pace once again as the buprenorphine is metabolized down to insignificant levels in just a few days.
Emergency Buprenorphine Taper
If you find yourself in a situation where you must taper off immediately for some reason and don’t have the time or enough buprenorphine for a planned taper, you can try an emergency taper. With the emergency taper you stop all buprenorphine until the onset of withdrawal. At that time you take small doses (<= 1mg) every hour until withdrawal is tolerable. Then, take buprenorphine only when symptoms become intolerable and only enough to stop the withdrawal. Although this method minimizes withdrawal intensity for a given amount of available buprenorphine, there could still be considerable withdrawal depending on tolerance and the amount of buprenorphine available.
Which brand of buprenorphine to use
As of early 2016 there are 3 name brand and at least 5 generic buprenorphine products to choose from. For ongoing treatment something can be said for the newer brands; with their better bioavailability side effects may be fewer and some dose and copay card combinations make it the least expensive option (including generics). (see cost page) But when tapering, particularly at doses below 2mgs, Suboxone Film (as pictured above) offers the advantage of being larger thus easier to cut into the fractional doses necessary for the taper. Pieces of film left over between doses should be stored in a childproof pharmacy bottle with a silica gel pack to absorb humidity and prevent the opened film from becoming sticky. (see storage section)
When to take your taper dose
Taking your buprenorphine first thing in the morning is best. There is good reason for this. By taking your dose in the morning, buprenorphine blood levels are lowest while you are asleep. Therefore, when the buprenorphine is providing the lowest level of craving and withdrawal suppression you are asleep and aren’t dealing with it. Another reason is, you want to avoid anticipation of taking the dose, because this is the type of brain activity you want to eliminate. Anticipating the dose then receiving the reward of the dose, may be reinforcing the behavioral patterns you have worked so hard to eliminate. By taking it early in the morning, there is no need to think about it for the rest of the day. Exception: If insomnia becomes acute, you may benefit from taking your daily dose at night.
Take your full day’s dose all at once
Don’t split up the day’s taper dose. As mentioned above, taking it early prevents you from thinking about and anticipating your dose. Also, once you finally stop, it is an easier transition from taking something once a day to zero times a day, than it is from taking something 2-4 times a day, to zero times a day. Also, avoid complicated rituals like dissolving the medication in water and metering out portions for the taper. Simply cutting the film or tablet is all you need to do. Exception: Again, if insomnia becomes acute, splitting the dose up by taking some in the morning and some at night might help.
Remember, the taper schedule is not etched in stone. Individuals will respond differently to the same taper schedule. It is meant as a rough guide which must be tailored to match an individual’s body and circumstance. The main concept is to pace taper rate with the individual’s ability to adjust to each decrease. However, it can be helpful to have a guide to loosely follow and to estimate about how long it will take and how much buprenorphine will be required.
Buprenorphine and Pain
Buprenorphine is a painkiller. A return of minor aches and pains is to be expected when you stop taking a painkiller. This is not withdrawal, it’s the pain the painkiller was killing but isn’t killing anymore. Aleve® or some other OTC painkiller might help but only when and if you need it. Hyland’s® Restful legs tablets have also been reported to be effective especially, at night. For sleep, patients have suggested Valerian root and Melatonin. Maintaining good overall nutrition and keeping well hydrated is also important. But maybe the most important thing is to keep busy, preferably away from home. Sitting home waiting for symptoms to appear is a sure way to fail.
Pain is progress
The discomfort you feel while tapering can be thought of as an indication of your tolerance diminishing. The necessary discomfort stimulates the body to produce endorphins. If you can possibly motivate yourself to exercise, even brisk walking, the pain will be less noticeable and you benefit form the exercise. It might also help you sleep better.
Depression and Tapering
Along with being a painkiller, buprenorphine has been recognized as an anti-depressant.7,8 Just as when you stop taking a painkiller, pain comes back, when you stop an anti-depressant, depression may come back too. The severity of the depression could determine the success or failure of the taper. Be prepared to deal with the reemergence of depression, particularly if you suffered from it before starting buprenorphine treatment. This might entail working with a psychiatrist and having antidepressant medication on the ready, before concluding the taper.
Pausing the Taper
If you hit a dose level which produces unacceptable levels of withdrawal discomfort, it is acceptable to go back up in dose, one step, for a few more days. Alternatively, you can hold at that dose for a longer period of time than indicated on the taper schedule. Since everyone’s body and brain is unique, the generic taper schedule may need to be tweaked slightly. Once your body adjusts to the dose level the taper can be resumed.
It’s okay to take a break from the taper if you need to, as long as it is minimal and infrequent. An example would be if you have been at 0.5mgs/ day for a week and still feel withdrawal discomfort, taking up to 1-2mgs one day will remove all withdrawal symptoms for that day and possibly the next, giving you time to refocus, get things done, and prepare for the final leg of the taper. One day at a higher dose will not increase your tolerance, thus reversing your progress, as long as you limit such higher doses to once or twice during the taper. If you can, try and not take any the following day. This may not be that difficult since about half will still be present the next day. Then resume the taper schedule.
Optional Ending Kicker Dose
Once you fill out the form above and create the taper schedule, you’ll notice that on the last day of the taper is a higher dose than recent previous doses. The idea is to take advantage of the half-life property and extend the taper a few days more. The higher dose raises blood levels, without raising tolerance, and as this final dose metabolizes blood levels slowly decrease until reaching zero, thus extending the taper. That’s the theory, but we know of no studies that have looked at this, only doctors who employ this in their taper plans.1 It’s up to you whether or not to include it. Good luck.
Anecdotal evidence compiled from several social media sites over a period of several years
National Alliance of Advocates for Buprenorphine Treatment- http://www.NAABT.org
PET scans- mu receptors- Effects of Buprenorphine Maintenance Dose on mu-Opioid Receptor Availability, Plasma Concentrations, and Antagonist Blockade in Heroin-Dependent Volunteers – 2003 – http://www.nature.com
TIP-40, buprenorphine treatment clinical guidance – government document 2004
Results produced by the NAABT.org taper engine (beta)
Buprenorphine tapering schedule and illicit opioid use- Clinicaltrials.gov, Identifier: NCT00078117 -Ling – study
Buprenorphine treatment of refractory depression, Bodkin [study]
The Buprenorphine Effect on Depression, Richard Gracer, MD [article PDF]
Zubsolv full prescribing information submitted to the FDA – Zubsolv PI
Bunavail full prescribing information submitted to the FDA – Bunavail PI
Suboxone Film full prescribing information submitted to the FDA – Suboxone Film PI
Brand names for buprenorphine/naloxone (bup/nx) combination products in the US: Suboxone Film, Zubsolv, Bunavail, and generic equivalents of the discontinued Suboxone Sublingual Tablets.
Buprenorphine products in the US WITHOUT the added naloxone safeguard:
Subutex Tablets (discontinued in 2009) but the generic equivalents remain available.
Buprenex® is an injectable, FDA approved for pain NOT addiction – illegal to prescribe for opioid addiction.
Butrans® Patch, also FDA approved for pain and NOT addiction – illegal to prescribe for opioid addiction.
Pharmacy-compounded bup or bup/nx preparations – NOT FDA approved for addiction – illegal to prescribe for opioid addiction.
Probuphine® is an insertable buprenorphine rod which goes under the skin and releases bup over the course of 6 months. It was FDA approved in May of 2016, and is for the treatment of addiction.
Belbuca™ is a buprenorphine film which goes on the inside of the cheak. It was FDA approved in October of 2015, and is for the treatment of pain – NOT FDA approved for addiction – illegal to prescribe for opioid addiction.
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Nothing on this site should be confused for medical advice. The information provided here should only serve to inspire you to find out more from credible sources. We hope to help you understand the disease better so that you know what questions to ask your doctor. Never take any online medical advice over that of a healthcare professional, assume it’s all made up. Despite the links to peer reviewed studies all interpretations of said studies may be opinion, unreliable or erroneous. If some patients found something beneficial to them it’s not an indication that it will be beneficial to you, on the contrary, it may be dangerous. You, not us, are responsible for what you do with the information you get from this site or any site.
Would you like to start a Facebook page for your business or cause? Let me take you step by step through the things I found helpful and those that were a waste of time. If you follow my hints you will have a successful page before you know it.
Let’s get started.
The more you put into your page the more you and others will get out of it.
Choosing a name, obviously, if you are starting a page for your business you need to use that name. If you are starting a page for a cause or just for laughs it helps people find you if your name says what your page is about.
For instance, if I am trying to promote ribbons I would use ribbon in my name with something catchy before or after it. My page is a cause page for awareness of the heroin epidemic. That is why I used Heroin News. We share up to date news articles and even write our own articles on our blog http://www.caringbysharing.net and then I share to my facebook page. It works great.
Be sure to create the address for your page with the same name. That way people can find you easily. You can create the link in the about section of your page. See example below:
Invite all your personal friends to like your new page and encourage them to share your posts. Every time your posts are shared there is a like button attached that people will click and that means more followers.
Join groups of like-minded people if you are a cause. For a business that has a physical address, you want to join groups in the area of your business address.
We post with the hope that it will be shared and seen. People sharing your posts is important. It’s the best way to get your posts in front of as many people as possible. That is why it is extremely important to always check notifications.
You need to be sure to say thank you. It will be tedious work but it will build loyalty to your brand or page. A quick comment under the post on their page simply saying, Thank you for sharing our post. You will be surprised how much it will help your page grow.
Another plus to commenting on shared posts is that every person who sees that post will see your page name and might follow your link to check out your page. I have gotten loads of new followers this way.
Read the comments on your page and respond. People like to feel important and if they are engaging in your page by sharing, commenting and/or liking your posts, they deserve your attention. This will also breed loyalty plus they ARE important.
If someone is being rude you can hide the comment after clicking the down arrow in the top right corner of the post itself. Facebook will then ask you if you wish to ban this person from your page. This is of course up to you and their offense. See example, of rude comment and the tiny arrow in the top right corner of the comment.
Find other pages that have lots of followers and as your page comment, like and share things that work with your specific page. Always comment Shared to __________. You share ethically by hitting the share button on their post. By doing these things the page itself may notice you and check out your page. With any luck, they follow your page and share a post or two. Not to mention anyone that sees the post that you engaged with will see the name of your page and may begin following you as well.
WHETHER YOU LIKE MEMES/POSTERS OR NOT FACEBOOK USERS LOVE THEM. Make your own posters/memes for your page and you will be twenty times more likely to be shared by your followers as well as other pages.
Websites/Apps to create posters/memes http://www.befunky.com http://www.picmokey.com
These can all be used free or paid. It’s all Heroin News and Holy Addiction uses. It’s also fun to experiment.
Facebook has an awesome feature that allows you to schedule your posts so they are spread out. The more you post the larger your chances of being shared, however people will get frustrated if you post twenty things in a roll because it clogs up their timeline. People will unlike your page if this happens.
You can also sit down and in one sitting schedule the posts for a few days or week ahead. You still need to check your page regularly to respond to messages, reply to comments and say thank you when you get a share. The schedule button is inside of the post button. On the right, you will see an arrow click that and you will see the schedule option.
Never make anyone an Admin on your page. Many pages have been stolen because of making this mistake. You can still get help with your page by adding them as an editor. This way they can do everything the owner of the page can but cannot make major changes to the page, like change the name or block you from your own page. Your page will show the name of the person who posted on every post. Those following the page cannot see this, it’s only visible to you or your editors. Keep this in mind so that if needed you can ask them to add their name to any messages they answer or comments on posts. That way your customers or followers will know who they spoke with. An editor has access to your messages on the page as well. There are other roles you can choose. Check them out and decide for yourself.
Celebrate with your followers when your page reaches milestones. When you reach 100 likes on your page post a poster that says Thank you for helping us reach 100 likes, we couldn’t have done it without you. Then make another every hundred after. Once you make it to one thousand start celebrating for every thousand.
When I first started my page I made a bunch of rookie mistakes. This is a list of the most important ones.
1. Memes that other people create are that person’s intellectual property. People spend time, money and thought into making these Meme’s or posters as I like to call them. Don’t make the mistake of downloading other people’s work and posting it to your page. This is why this is important. After you begin making your own memes/posters you will see how much work and love go into them. Those memes/posters are someone’s intellectual property.
a. If it is wrong, don’t do it.
b. If you do it and someone reports you for stealing their intellectual property Facebook can and will shut down your page.
c. The other pages and groups that are putting out memes that fit your page are the people you want to network with, you don’t want to piss them off.
2. Boosting posts is a complete rip-off. Don’t do it!! I wasted way too much money with little to no evidence that it got me any more followers.
3. If you join groups and begin sharing to the groups be cautious because Facebook Jail is very real and they get upset if you post too fast or too much to groups. There are two pages I know of that were made unable to share to groups for 30 days or more.
I hope this article helps. It would have been awesome for me to have had this information when I started. Helping others is a new addiction of mine so I hope this serves you well.
If you have questions about any of this or something else please comment below this article on the website and I will answer your questions. That way others will be able to use that information as well.
All these tips can be used for Twitter too, at least the basic idea. I am just now getting involved in Twitter. I will keep you posted on my progress.