Opioids Need advice please. Stranded out of country.

[Glayce]

Hey folks,

I am on methadone (130mg 13ml methadose Solution) a day. I am currently out of my home country and I am stuck here for 6 days longer than I expected.

I am already going into withdrawal as I had taken my last 130mg at around 11pm on Thursday.

I cannot get any methadone here, but I can get some Suboxone (I have never been on it before). I am absolutely terrified of pricepitated withdrawal.

They are sublingual tablets at
2.5mg / 0.5mg respectively and I have 6 of them.

Language barrier is making things even more difficult. When can I safely take these? Pharmacy says that 2 of these (5mg beup should be around the equivalent of 60mg methadone or thereabouts. Which should make things manageable, and I intend to take it proper so the naloxone should be inert. But I'm still terrified of PW.)

Thanks so much for any advice offered.

 

[OpiateKiller]

When I came off methadone I took 2 mg at 100 hours off methadone. You need to be extremely careful. You could die in my opinion. I would wait past 4 days, when I took mine at 100 hours I went into a tiny bout of PWD for an hour but it was nothing like I’ve had with fentanyl.

Start small, take 2 mg, if you get worse, wait it out. If you feel OK take another 2 mg. 4 mg bupe will hold you for the day or so. It won’t be rainbows and sunshine but it will be helpful.

Best of luck. If your last dose was Thursday you can probably take it tomorrow night.

 

[OpiateKiller]

A lot of clinics want you off methadone for a week.. so just tread lightly.

 

[OpiateKiller]

I’d go to the doctor or pharmacist and demand Codeine, hydrocodome.. Oxycodone.. anything but subutex. A good doctor would understand your situation.

Some countries have Tylenol 3s which you can extract the Tylenol out with cold water and coffee filters to get the codeine.. you’d be much better off

 

[Conky]

Yeah and get a translation app on your phone if you'll be there for 6 days

 

[Jabberwocky]

When I came off methadone I took 2 mg at 100 hours off methadone. You need to be extremely careful. You could die in my opinion.

Except for possible heart failure due to hyponatremia from excessive vomiting AND diarrhea, opiate withdrawal is not life threatening.

And that is extremely extremely rare.

 

[negrogesic]

You might be able to microdose the buprenorphine:

Microdose induction of buprenorphine-naloxone in a patient using high dose methadone: A case report

Buprenorphine is a partial mu-opioid receptor agonist approved for the treatment of opioid dependence. The risk of withdrawal symptoms and wait time required to safely initiate buprenorphine provides challenges to both patients and providers. Microdose ...

www.ncbi.nlm.nih.gov

And gradually increase. But it is a bit of a gamble. I once got hit with an injection of narcan by an asshole EMT when I was fully awake, while I was maintained on 380mg/day of methadone, so I know the horrors of precipitated withdrawal. Fortunately for me naloxone wears off pretty fast. Buprenorphine doesn't however so proceed with extreme caution.

I would try again and see if you can get other opioids.

I actually had your situation happen to me when I ran out of methadone as a visitor in australia, and actually was able to get into one of their clinics. The most they would give me was 180mg/day, so that was an overnight drop of 200mg/day. That was rough, but better than 380mg to 0mg. But I was there for while so it made sense in my case. But the remainder of my time in Australia wasn't too comfortable.

 

[Glayce]

Thanks so much for all your advice.

I have not yet taken any of the sub. They issued me 6 2.5mg 0.5mg sublingual tablets

I am going to hold off until tonight as recommend which should put me close to 100 hours.

I managed to get some gabapentin to help a bit until then.

Will update after I take the sub, will take only one tablet

 

[OpiateKiller]

Except for possible heart failure due to hyponatremia from excessive vomiting AND diarrhea, opiate withdrawal is not life threatening.

And that is extremely extremely rare.

That is incorrect information I almost died from precipitated withdrawal

Precipitated Withdrawal, Delirium, and Cerebellar Stroke: The Pharmacology of Buprenorphine Induction in Non-pharmaceutical Fentanyl and the Neuropsychiatric Manifestations of Cerebellar Stroke - PubMed

Precipitated Withdrawal, Delirium, and Cerebellar Stroke: The Pharmacology of Buprenorphine Induction in Non-pharmaceutical Fentanyl and the Neuropsychiatric Manifestations of Cerebellar Stroke

pubmed.ncbi.nlm.nih.gov

Using Suboxone when a heavy fentanyl user can cause a major stroke, ie… death. It almost happened to me.

 

[Jabberwocky]

That is incorrect information I almost died from precipitated withdrawal

Precipitated Withdrawal, Delirium, and Cerebellar Stroke: The Pharmacology of Buprenorphine Induction in Non-pharmaceutical Fentanyl and the Neuropsychiatric Manifestations of Cerebellar Stroke - PubMed

Precipitated Withdrawal, Delirium, and Cerebellar Stroke: The Pharmacology of Buprenorphine Induction in Non-pharmaceutical Fentanyl and the Neuropsychiatric Manifestations of Cerebellar Stroke

pubmed.ncbi.nlm.nih.gov

Using Suboxone when a heavy fentanyl user can cause a major stroke, ie… death. It almost happened to me.

Extremely unlikely to occur without underlying medical issues and probably not from opiate withdrawal anyway. I can't talk to your personal situation but I can certainly talk to the citation that you presented.

The single person cited in the article was 61 years old, homeless, long time alcohol abuser, had hypertension, atherosclerosis, and had last used alcohol 48 hours before he presented to the emergency room.

It wasn't precipitated withdrawal from opiates that gave him the stroke. It was alcohol withdrawal.

Read the actual article.

Precipitated Withdrawal, Delirium, and Cerebellar Stroke:... : Harvard Review of Psychiatry

An abstract is unavailable.

journals.lww.com

 

[Delmonte421]

You might be able to microdose the buprenorphine:

Microdose induction of buprenorphine-naloxone in a patient using high dose methadone: A case report

Buprenorphine is a partial mu-opioid receptor agonist approved for the treatment of opioid dependence. The risk of withdrawal symptoms and wait time required to safely initiate buprenorphine provides challenges to both patients and providers. Microdose ...

www.ncbi.nlm.nih.gov

And gradually increase. But it is a bit of a gamble. I once got hit with an injection of narcan by an asshole EMT when I was fully awake, while I was maintained on 380mg/day of methadone, so I know the horrors of precipitated withdrawal. Fortunately for me naloxone wears off pretty fast. Buprenorphine doesn't however so proceed with extreme caution.

I would try again and see if you can get other opioids.

I actually had your situation happen to me when I ran out of methadone as a visitor in australia, and actually was able to get into one of their clinics. The most they would give me was 180mg/day, so that was an overnight drop of 200mg/day. That was rough, but better than 380mg to 0mg. But I was there for while so it made sense in my case. But the remainder of my time in Australia wasn't too comfortable.

how did you do it? would you take a couple days off and be in hell then go back to work if you couldn't get anything?
Im lucky, lol im addicted to oxy and have a stock pile of subs so when I wanna quit, I fall asleep and wake up and take a sub, I feel bad for long lived half life people

 

[OpiateKiller]

Extremely unlikely to occur without underlying medical issues and probably not from opiate withdrawal anyway. I can't talk to your personal situation but I can certainly talk to the citation that you presented.

The single person cited in the article was 61 years old, homeless, long time alcohol abuser, had hypertension, atherosclerosis, and had last used alcohol 48 hours before he presented to the emergency room.

It wasn't precipitated withdrawal from opiates that gave him the stroke. It was alcohol withdrawal.

Read the actual article.

Precipitated Withdrawal, Delirium, and Cerebellar Stroke:... : Harvard Review of Psychiatry

An abstract is unavailable.

journals.lww.com

I injected a 8 mg Suboxone approximately 20 hours after my last shot of fentanyl / Tramadol which I had been shooting for 3 months straight and went into a 6 hour coma basically woke up in complete psychosis and ended up in an ambulance at 5 am with a body temp of 95. I had crazy visions I believe to be DMT visions and haven’t really been the same since that night my balance and coordination had to basically be relearned and I still deal with panic attacks and numbness in my feet and face.

Yes very unlikely and it was my fault but I should have died that night I believe.

 

[Delmonte421]

I injected a 8 mg Suboxone approximately 20 hours after my last shot of fentanyl / Tramadol which I had been shooting for 3 months straight and went into a 6 hour coma basically woke up in complete psychosis and ended up in an ambulance at 5 am with a body temp of 95. I had crazy visions I believe to be DMT visions and haven’t really been the same since that night my balance and coordination had to basically be relearned and I still deal with panic attacks and numbness in my feet and face.

Yes very unlikely and it was my fault but I should have died that night I believe.

wait you shoot subs and you got put into a coma, instead of PW?

 

[OpiateKiller]

wait you shoot subs and you got put into a coma, instead of PW?

PWD is why I went into a coma. I stripped my brain of all the fentanyl and Tramadol and think I had a giant seizure / stroke.

 

[Delmonte421]

PWD is why I went into a coma. I stripped my brain of all the fentanyl and Tramadol and think I had a giant seizure / stroke.

holy shit dude I didn't know you could do that. Explain to me what that was like if you can?