Sammi - could you explain the sub situation to me?
(Banker too - could you respond if have the time this week? Any other people with information re sub?)

When your doctor prescribed the sub for you - what were his instructions?

I had previously understood that the correct way to use sub was to take it every day at a specific dosage eg I think Banker took/takes 12 mg every day?

But EVERY SINGLE DAY - AS PRESCRIBED?

Now - the reason I ask - is that it seems to me that treatment by sub for opiate addicts may be like treatment by valium for benzo addicts.

Let me explain:

There is absolutely no doubt that anyone withdrawing from long-term benzodiazepines must reduce the dosage slowly. Slow withdrawal means tapering dosage gradually, usually over a period of some months. The aim is to obtain a smooth, steady and slow decline in blood and tissue concentrations of benzodiazepines so that the natural systems in the brain can recover their normal state. A sufficiently slow, and smooth, departure of benzodiazepines from the body permits the natural systems to regain control of the functions which have been damped down by their presence. There is scientific evidence that reinstatement of brain function takes a long time. Recovery after long-term benzodiazepine use is not unlike the gradual recuperation of the body after a major surgical operation. Healing, of body or mind, is a slow process.

Switching to a long-acting benzodiazepine:

With relatively short-acting benzodiazepines such as Xanax and Ativan, it is not possible to achieve a smooth decline in blood and tissue concentrations. These drugs are eliminated fairly rapidly with the result that concentrations fluctuate with peaks and troughs between each dose. It is necessary to take the tablets several times a day and many people experience a "mini-withdrawal", sometimes a craving, between each dose.

For people withdrawing from these potent, short-acting drugs it is advisable to switch to a long-acting, slowly metabolised benzodiazepine such as diazepam. Diazepam (Valium) is one of the most slowly eliminated benzodiazepines. It has a half-life of up to 200 hours, which means that the blood level for each dose falls by only half in about 8.3 days. The slow elimination of diazepam allows a smooth, gradual fall in blood level, allowing the body to adjust slowly to a decreasing concentration of the benzodiazepines.

For a valium taper a patient MUST take the full prescribed amount of valium every day to achieve smooth blood concentrations. Only reducing every few weeks by about 10%

Now - I understand that sub is a long acting opiate - so - if the logic behind prescribing sub is much the same as prescribing valium - the sub MUST be taken every day to achieve this smooth level in blood serum concentrations. So - if a patient does not take his sub as prescibed regularly every day then he will - more than likely - be see-sawing in and out of withdrawal on a sort of roller coaster way? Feeling good (dont take sub), feeling bad (take sub) and so the blood levels never become smooth - always up and down ......... with accompanying mood swings/feelings/withdrawal symptoms/cravings in the patient.

So - it would seem that sub must be taken every day until the patient is "stable" and when the time is right then a 10% reduction can be introduced............ held then at this level for some time (eg three weeks?), and then another 10%......... gradually weaning off the sub - very very slowly in this way.

So - if this is a similar working model - then a patient can't c/t sub as he would codeine.......he must do a lengthy slow taper ......... and this hopefully keeping the withdrawal symptoms to a mimimum so that the patient can continue to live and function as near to normal as possible.

Do you think this is anything like the situation? Or have I got it all wrong?

I would appreciate anyone's/everyone's comments?

Y