Bupe Advice on switching from methadone to buprenorphine

[crunched]

Hi all,

This is my first time posting, although I joined bluelight a couple of years ago.
I am in the UK and on MMT; I've been on methadone for about 3 years and have tapered down to 30ml. I am now about to switch to buprenorphine and have planned to do it over this bank holiday weekend so I have 3 days to stabilise before going back to work on Tuesday. I am still on supervised daily pick-ups at the pharmacy. My doctor has prescribed my last dose of methadone for Friday (tomorrow) and then I'll pick up the bupe on Saturday, when I'll pick up 3 day's worth (because the pharmacy are closed on Sun and Mon due to bank holiday). Obviously Saturday's dose is not supervised as I have to wait until I am rattling to take it, in order to avoid precipitated withdrawals (which I'll call PWs for short). I consider myself well informed about PWs and have read what I can find in forums on bluelight. I know my body, I have a slow metabolism; in fact I was diagnosed with an underactive thyroid this week and started taking medication for this 2 days ago. (It is very marginal- subclinical, which normally they don't treat but because I am symptomatic, the doctor gave me a low dose of levothyroxine). Anyway, this is a long-winded way of saying that I don't think I will be rattling (withdrawing) enough on Saturday - if I take methadone on Friday- to take the bupe on Saturday, and I want to have stabilised by Tuesday. So I've decided not to take the methadone on Friday as I don't want to risk PWs- I've heard they're horrendous. The doctor has recommended I just take 2mg when I'm sick, wait 30mins and then take more if I'm ok (I.e. not in PWs). I've read people on bluelight recommend switching from methadone to a short-acting opioid before moving to bupe, so I'm thinking of doing some brown (heroin) on Friday night to get me through the night and then I anticipate being ready to take the bupe on Saturday night. I took my last methadone dose this evening at about 6:30pm.

My question is, does this plan sound sensible to you guys? Does anyone have any experience or advice you could share with me?

Nice to finally post on here and meet you all. I hope to be a more active participant on here from now on. It might help to come on here over the weekend whilst I'm going through this switching process and feeling crap. I have a couple of close friends who are coming to stay with me to keep me company - one is coming on Saturday and the other is coming on Sunday and staying over til Monday. By the way, I started using heroin about 5-6 years ago and I have been very lucky that I have never experienced full-blown withdrawals. I went onto methadone as soon as I started having trouble staying well I.e. not being able to afford my habit. As I'm in the UK, we have the national health service so treatment is free and easy to access; it takes only about a week from first contact with the drugs service to get a script.

I didn't intend this post to be so long so apologies for my long-winded explanation. I look forward to hearing from you. Thanks.

 

[Larimar]

Honestly from what I have read on bl it takes a few days to feel withdrawal from methadone because it stays in system so long . I would wait as long as you can and look up the cows scale to judge your withdrawal symptoms. Don't do the herion , you are doing so well that's a step backwards . Best of luck .

 

[crunched]

Honestly from what I have read on bl it takes a few days to feel withdrawal from methadone because it stays in system so long . I would wait as long as you can and look up the cows scale to judge your withdrawal symptoms. Don't do the herion , you are doing so well that's a step backwards . Best of luck .

Thank you for your supportive words.

 

[Jabberwocky]

Generally speaking people need 3-7 days to switch from methadone to a partial agonist like buprenorphine.

Given your on 30mg of methadone I would imagine it would take at least three days of no methadone prior to induction on buprenorphine to guarantee avoiding precipitated withdrawal.

DO NOT take buprenorphine the day after taking methadone, your on too high a dose of methadone for that and you mentioned you think you have a slow metabolism.

The easiest way to transition is to use a short acting weakish opioid like codeine to get in buprenorphine. If I was in your situation and wanted to stay stable while waiting to transition I’d take codeine once to twice a day for three days, then waiting 12-24hrs after the final dose of codeine before taking any methadone. That will help you avoid precipitating withdrawal and keep you functional and well.

Tramadol works well for this, because there won’t be any issue transitioning from that to buprenorphine (it won’t precipitate withdrawal from tramadol).

You could also use comfort meds like clonidine, gabapentin and diazepam to manage withdrawal symptoms while you wait for the methadone to clear your system.

Again, I highly suggest waiting at least three days before getting on buprenorphine. It takes a while for the methadone to leave you system enough to avoid buprenorphine precipitating withdrawal. 30mg methadone is still a pretty significant dose if you’re stable on it right now, so don’t expect you can just induct on buprenorphine like you would if you were dependent on a shorter acting opioid. It takes time for methadone to clear you system; it’s a longer acting opioid.

I used codeine to transition and it worked really well. Hopefully you can get some codeine otc and CWE to manage withdrawal before starting buprenorphine, or you can get comfort meds or something.

Good luck! Buprenorphine is a great way to transition off methadone. Are you planning on staying on buprenorphine long term or are you doing a normal or extended taper off that?

And no worries about your post. We are hear precisely because we want to support folks in your situation. Please feel free to ask any questions. It’s no trouble at all

Consider starting a thread in SL if you want to get some recovery oriented support (but if anyone gives you shit for methadone or buprenorphine please let me know, because that isn’t cool and I have worked hard to cut that shit out of the SL culture).