Methadone vs Bupre

[RubyeJack]

Need advice from those who have been on both Methadone and Buprenorphine.
I have an appointment in a week to signup for Methadone. I’ve done maintenance before but it wasn’t really my thing. However, I’ve been clean for years now except for Codeine and am thinking a very small dose, 10 mg, might be ok for the rest of my life. I’m already 73 and am only looking for pain relief.
But I keep hearing good things about Bupe.
Does Bupe work well for physical pain, neuropathy?

Which would you choose?
Also, I have minor arrhythmia and have heard they do an ekg nowadays. Would that stop my getting on either?
Thanks!

 

[Nurse Ratched]

I have never been on either one but I hear that methadone controls pain better than buprenorphine. And if your pain can be controlled with as little as 10 mgs that's wonderful. And congrats on the clean time.

So you are just looking at these 2 meds for pain control and not MMT right? Codeine not working anymore? Surprised the Dr.s wanted to bump you from codeine all the way to methadone without trying oxy or morphine first but that's Dr.s for ya nowadays.

The bupe would also work for pain. Think it has a few more side effects than the m'done. Not sure if it helps neuropathy .

My choice would probably be the m'done. And since you want to take it for the rest of your life I guess you won't have to go through the trainwreck of m'done withdrawl. Either way I hope you get some relief. You can try both and see which one works better for you. Good Luck

 

[JessFR]

Your heart condition may be an issue with methadone.

Methadone is associated with a condition called long QT syndrome. It's basically where the hearts electrical activity isn't functioning exactly right.

If they EKG you and your QT interval is already longer than normal, I wouldn't be surprised if they wouldn't want you to be in methadone.

Now fair disclaimer, I've only been on methadone. Known lots of people on bupe but like many people I've only been on one.

Ok now that aside, here's the big issue that I'm seeing.

What, if I may ask, are you getting on either drug for? Both are used as painkillers in various contexts, but you're talking about a substitution program.

I don't know of any opioid treatment program anywhere that will let you get on it unless you're already opioid dependant. If you've been on it before you're probably aware that they will drug test you to check that you're positive for opioids first.

So here's the thing, 10mg of codeine is nothing. Even 100mg of codeine is pretty much nothing compared to methadone. If codeine is your only current opioid, I would be looking at buprenorphine, if either. It has less strict rules and it doesn't seem like you'd need anything stronger.

If you're only on codeine, I probably wouldn't wanna be getting on either. Your tolerance would already be very low.

Are you taking anything else? It might help if we have a better idea of what your current use looks like. Your previous use might also shed some light on your situation if you're comfortable telling us.

BTW just also to say what the above poster said, congrats on your clean time.

 

[Jabberwocky]

what is your motivation for looking for a maintenence plan rather than a traditional pain doc route? with the heart issue you do definitely need to speak about this with your doctor, who will also be better suited to advise on your specific pain needs, as its different for neuropathic.

whatever you choose i hope you get some appropriate help.

 

[RubyeJack]

Your heart condition may be an issue with methadone.

Methadone is associated with a condition called long QT syndrome. It's basically where the hearts electrical activity isn't functioning exactly right.

If they EKG you and your QT interval is already longer than normal, I wouldn't be surprised if they wouldn't want you to be in methadone.

Now fair disclaimer, I've only been on methadone. Known lots of people on bupe but like many people I've only been on one.

Ok now that aside, here's the big issue that I'm seeing.

What, if I may ask, are you getting on either drug for? Both are used as painkillers in various contexts, but you're talking about a substitution program.

I don't know of any opioid treatment program anywhere that will let you get on it unless you're already opioid dependant. If you've been on it before you're probably aware that they will drug test you to check that you're positive for opioids first.

So here's the thing, 10mg of codeine is nothing. Even 100mg of codeine is pretty much nothing compared to methadone. If codeine is your only current opioid, I would be looking at buprenorphine, if either. It has less strict rules and it doesn't seem like you'd need anything stronger.

If you're only on codeine, I probably wouldn't wanna be getting on either. Your tolerance would already be very low.

Are you taking anything else? It might help if we have a better idea of what your current use looks like. Your previous use might also shed some light on your situation if you're comfortable telling us.

BTW just also to say what the above poster said, congrats on your clean time.

I’ve been on 150 mg Codeine for over a year. Lower amounts of Codeine for many years. I don’t like the uncertainty of doctors. The doctor who does the codeine script recommended Suboxone last visit. My original reaction was no way but then the more thought I gave it, the more I came to like the idea and to be honest it is with the idea of being able to be high again. But also the pain keeps getting worse and Codeine no longer works after around 150 mg. Taking more only causes respiratory distress and lethargy.
Morphine scares me. I would want more. Oxy’s I hate after 3 days.
The clinic here let’s you on maintenance for pain and the codeine will show as opiates in UA.
I used heroin for years starting out in college as a garbage can junkie. Got off the heroin with rehab. And by leaving the state. I would have never stayed clean if I had stayed in the same town where I used.

To tell you the truth Buvial sounds really good to me. Less heart rhythm stuff and no bad teeth from Suboxone created acid. But the idea of a gel moving through the body is not so appetizing. :;
Mostly I’m curious as to how people who have tried both M and B did with them.

 

[RubyeJack]

Your heart condition may be an issue with methadone.

Methadone is associated with a condition called long QT syndrome. It's basically where the hearts electrical activity isn't functioning exactly right.

If they EKG you and your QT interval is already longer than normal, I wouldn't be surprised if they wouldn't want you to be in methadone.

Now fair disclaimer, I've only been on methadone. Known lots of people on bupe but like many people I've only been on one.

Ok now that aside, here's the big issue that I'm seeing.

What, if I may ask, are you getting on either drug for? Both are used as painkillers in various contexts, but you're talking about a substitution program.

I don't know of any opioid treatment program anywhere that will let you get on it unless you're already opioid dependant. If you've been on it before you're probably aware that they will drug test you to check that you're positive for opioids first.

So here's the thing, 10mg of codeine is nothing. Even 100mg of codeine is pretty much nothing compared to methadone. If codeine is your only current opioid, I would be looking at buprenorphine, if either. It has less strict rules and it doesn't seem like you'd need anything stronger.

If you're only on codeine, I probably wouldn't wanna be getting on either. Your tolerance would already be very low.

Are you taking anything else? It might help if we have a better idea of what your current use looks like. Your previous use might also shed some light on your situation if you're comfortable telling us.

BTW just also to say what the above poster said, congrats on your clean time.

Seems I’m one of those people who make more morphine from the codeine than the average person. I take a month of oxy every 6 months. Nothing else. It’s just these no longer work and the nature of neuropathy and arthritis is it only gets worse. There’s dmards for the arthritis but I’d rather just take one drug.

 

[JessFR]

I’ve been on 150 mg Codeine for over a year. Lower amounts of Codeine for many years. I don’t like the uncertainty of doctors. The doctor who does the codeine script recommended Suboxone last visit. My original reaction was no way but then the more thought I gave it, the more I came to like the idea and to be honest it is with the idea of being able to be high again. But also the pain keeps getting worse and Codeine no longer works after around 150 mg. Taking more only causes respiratory distress and lethargy.
Morphine scares me. I would want more. Oxy’s I hate after 3 days.
The clinic here let’s you on maintenance for pain and the codeine will show as opiates in UA.
I used heroin for years starting out in college as a garbage can junkie. Got off the heroin with rehab. And by leaving the state. I would have never stayed clean if I had stayed in the same town where I used.

To tell you the truth Buvial sounds really good to me. Less heart rhythm stuff and no bad teeth from Suboxone created acid. But the idea of a gel moving through the body is not so appetizing. :;
Mostly I’m curious as to how people who have tried both M and B did with them.

Ok. I don't say this lightly, but I would rule out methadone right now.

150mg of codeine isn't a big habit all in all, I'd generally consider that a very mild tolerance. So I strongly think methadone would be way too strong for that. Even a tiny amount would probably have you too impaired to function.

Subuxone is a lot less powerful, so it might be an option, I suspect it'll still be a lot stronger than 150mg of codeine even at lower doses, but not quite to such extremes.

As I said I haven't been on subuxone, but I know from my own experience just how crazy more powerful heroin is than codeine, and just how much more powerful methadone can be than heroin.

As for your teeth, this may or may not be something you need to watch out for regardless. Opioids can cause dry mouth and different people are more or less prone to different opioids. It's not a deal breaker but it's something to keep in mind is all.

Seems I’m one of those people who make more morphine from the codeine than the average person. I take a month of oxy every 6 months. Nothing else. It’s just these no longer work and the nature of neuropathy and arthritis is it only gets worse. There’s dmards for the arthritis but I’d rather just take one drug.

Perhaps. What's your oxy use look like?

A problem here is this is likely to keep being an issue. Right now even if you metabolize it very well I can't see you having much of a tolerance if you're getting much out of 150mg of codeine.

By the way, that's 150 a day yeah? Because of the short half life I assume that a divided up, how often do you take it per day?

In your case if you're gonna start on maintenance I'd start of subuxone. Your tolerance doesn't sound that high, honestly it doesn't sound high enough for methadone to be safe unless codeine is crazy stronger for you than I've ever seen it.

Also it's far easier to go from subuxone to methadone later than the other way around. And since tolerance will continue to be an issue you don't wanna increase your tolerance too fast.

Regarding people comparing the two, it's gonna be hard to equate their experiences with yours unless they had similar habits. Some people have difficulty getting stable in subuxone because their tolerance is too high for what it provides. I doubt that'd be the case for you though.

 

[RubyeJack]

Yes, relatively 150 mg codeine is not much at all. However I have seizures trying to go down. No big deal.
The reason I am considering Methadone is I know it well.
Also am interested in pain control. Not detox.

 

[Nurse Ratched]

Yes, relatively 150 mg codeine is not much at all. However I have seizures trying to go down. No big deal.
The reason I am considering Methadone is I know it well.
Also am interested in pain control. Not detox.

Let us know how you make out Ruby. Controlling your pain is your first priority so that you can have what's rest of your life as comfortable as possible. You are 73, My Mom is 86 and I am 62 so I know where you are coming from. I think it will be fantastic if you can get relief from 10 mgs daily. What is that like 2 times 5 mg pill? You are going to get the pills correct? They won't make you daily dose the liquid right? I hear more GP's are scripting m'done pills for pain. The 5 mg ones.

Be sure to let us know how you are coming along.

 

[Jabberwocky]

I have been on both and have chronic pain issues. I would always try buprenorphine first. Crossing over to methadone from buprenorphine is fairly simple while going the other way around can be tricky if your doctor does not know his stuff (usually it would be best to stop methadone and go on some short-acting opioid for a week and then make an induction on buprenorphine). Considering you have concerns about your heart then this should be no brainer. This is just my opinion based on experience and some info I learned by myself, but I don't think you will make a mistake if you try buprenorphine first.

 

[RubyeJack]

Let us know how you make out Ruby. Controlling your pain is your first priority so that you can have what's rest of your life as comfortable as possible. You are 73, My Mom is 86 and I am 62 so I know where you are coming from. I think it will be fantastic if you can get relief from 10 mgs daily. What is that like 2 times 5 mg pill? You are going to get the pills correct? They won't make you daily dose the liquid right? I hear more GP's are scripting m'done pills for pain. The 5 mg ones.

Be sure to let us know how you are coming along.

Thanks Pumpkin!
I think people in general don’t understand the difference in maintenance and pain relief with Methadone. I’m going to try and get on maintenance at a clinic because I don’t know of any doctors in my area prescribing Methadone. They all push Bupe.
Evidently 5 mg of M works well and 10-12 for severe dying type pain. It’s the kind of thing where you just have to get in there to find out for sure.
This is a really good article on Methadone pain relief for the elderly if anyone is interested.

Methadone: An Effective, Safe Drug of First Choice for Pain Management in Frail Older Adults

Abstract. Objective. Frail older adults have a high prevalence of chronic pain with major effects on function and quality of life. Many analgesics, includi

academic.oup.com

 

[JessFR]

Yes, relatively 150 mg codeine is not much at all. However I have seizures trying to go down. No big deal.
The reason I am considering Methadone is I know it well.
Also am interested in pain control. Not detox.

Yeah but your tolerance was probably a lot higher when you were on methadone.

Heroin blows codeine out of the water in strength.

I'm sorry for your chronic pain, I've never experienced chronic physical pain so I won't pretend to understand what it's like. But buprenorphine is used as a painkiller too and if your body is only tolerate to 150mg of codeine methadone sounds way too strong.

 

[VerbalTruist]

I would almost never recommend methadone over bupe. Buprenorphine is a better drug for so many reasons. There are a lot of articles as to why it is preferable, but I would say that the two biggest for me are 1)Mental Clarity & 2)It totally eliminated the craving for opiates for me.

 

[RubyeJack]

Yeah but your tolerance was probably a lot higher when you were on methadone.

Heroin blows codeine out of the water in strength.

I'm sorry for your chronic pain, I've never experienced chronic physical pain so I won't pretend to understand what it's like. But buprenorphine is used as a painkiller too and if your body is only tolerate to 150mg of codeine methadone sounds way too strong.

This attitude is why I despise pain doctors.
You act like I don’t know anything about opiates and tolerances and Methadone. I’ve said several times now I would be seeking a dose of 10-15 mg. Whatever!

 

[RubyeJack]

I would almost never recommend methadone over bupe. Buprenorphine is a better drug for so many reasons. There are a lot of articles as to why it is preferable, but I would say that the two biggest for me are 1)Mental Clarity & 2)It totally eliminated the craving for opiates for me.

I think Bupe scares me because there seems to be a lack of control. With Methadone you can pretty much dictate your dose yourself as long as you follow the program and I have no problem doing that.
With doses under 40 mg you can have mental clarity. It’s when people get over 70 that pretty much all they’re doing is staying well and nodding.
I was taking classes at Berkeley when on 40 mg and doing fine.
Methadone has gotten a bad reputation for a lot of people cause they think everyone is up over 100.
But thank you for your thoughts.

 

[Jabberwocky]

This attitude is why I despise pain doctors.
You act like I don’t know anything about opiates and tolerances and Methadone. I’ve said several times now I would be seeking a dose of 10-15 mg. Whatever!

I think that JessFR is just really caring. The written word can be read wrong. I don't think there was any "attitude" and for sure JessFR is not a doctor trying to belittle you and make you feel insecure. In fact, she is thinking it through the same way I do. Why not try low doses of buprenorphine to test the waters. Methadone is really potent and if you need it for pain dosing at least 2 times daily is a must. This is true for buprenorphine also. 3 x 0,5mg of buprenorphine gave me a way better pain control than 3 x 5mg methadone. 3 x 20mg methadone controlled my pain better than any other opioid, but that is quite a dose. In light of all that I think it is very good advice (you asked, that is what this thread is about) to start with buprenorphine and then if it is not good enough to transition to methadone. But if you decided that you want methadone then there is nothing wrong with that. I am, like everybody else, giving you a personal opinion and nobody can know what is best for you. You will have to feal whatever you decide. Hope your decision makes your life better!

 

[Nurse Ratched]

Yeah @RubyeJack some of us on here can be quite passionate when it comes to helping people. We all want you to just have a pain free life. And the age old question of bupe vs. m'done is gonna come down to whichever one makes YOU feel better and your Dr. is willing to prescribe. When you get your meds ( whichever one you choose ) and get a few days under your belt, so to speak, be sure to let us know how you are coming along.

 

[JessFR]

This attitude is why I despise pain doctors.
You act like I don’t know anything about opiates and tolerances and Methadone. I’ve said several times now I would be seeking a dose of 10-15 mg. Whatever!

I act like that cause for one, I don't know you and can't reliably assume what you know, and two, some things you've said have given me that impression.

You want a drug that's very likely a lot stronger than you need that can cause arrhythmias over one that's probably a lot better suited to your needs, has less restrictions, and is less associated with arrhythmia.

Because... I dunno, you've been on it before back when you were on heroin?

Then there's this...

I think Bupe scares me because there seems to be a lack of control. With Methadone you can pretty much dictate your dose yourself as long as you follow the program and I have no problem doing that.
With doses under 40 mg you can have mental clarity. It’s when people get over 70 that pretty much all they’re doing is staying well and nodding.
I was taking classes at Berkeley when on 40 mg and doing fine.
Methadone has gotten a bad reputation for a lot of people cause they think everyone is up over 100.
But thank you for your thoughts.

This gives the impression that you're not really factoring in tolerance. Cause people can definitely be so high on 40mg that they can't function.

Also, as for lack of control, I dunno how the system is where you are, but here you'd have more control on buprenorphine. You get a lot more unsupervised takeaways. And you can always transfer from one to the other if buprenorphine isn't enough, doing the reverse if methadone is too much will be a horrible experience. Bupe to methadone you can just switch, methadone to bupe you gotta go through a horrible wait for your methadone levels to drop first or you'll experience precipitated withdrawal.

I am most definitely not against methadone. I'm on methadone myself. But it's not the best choice for everyone in every situation. I was getting off a huge IV heroin habit not a 150mg codeine habit. If that were your situation too I would also be suggesting that there's a risk bupe might not be sufficient.

I'm on your side here, I'm trying to give you the best advice possible for what your stated goal is. But as a forum we have seen a lot of members die from their drug use, so I doubt I'm alone in wanting to be over cautious rather than just assuming people know or are clear on things they might not be.

But ultimately the choice isn't mine, and my understanding your reasoning is not a requirement. I wish you luck nevertheless.