Bupe Switching to Subs from Methadone; just how long to wait?

[blackjesus]

Hi guys, I'll try and keep this short and sweet.

I'm on 30MG Methadone, stable, have been for about a year now, but I'm sick and tired of methadone.
I want to switch to subs but I have the lingering fears about precipitating myself into WD.

30MG Methadone only really lasts me 24 hours, by the end of the day I'm sniffling, tearing, yawning and stretching constantly with leg pain, ~20% on a "WD scale" but thing is i get NO rest. edit: but i have a job i need to attend daily, which is my main concern about all this.

I'm going to take as little methadone from now until I get my subs as possible to stave off WD.
My plan is to get the suboxone then take as LITTLE as possible to start, so i dont send myself into a bad withdrawal.

I understand the ingredients in subs have high affinity and low activity. I have sent myself into Precip WD in the past (twice i think) using Subs, so I'm trying to avoid all of that if at all possible.

Can someone who has been thru this please let me know my expectations?

 

[LucidSDreamr]

They recommend switching to oxy first then sub...this is done by doctors so it's a legit tactic

 

[Beargrr73]

My experience

When I switched I tapered down to 20 mg but I've seen people do it at 40/60 ...wait at least 48 hours ,try to make it 72, take some benzos or something tp kill that awful feeling...then start with 8mg strip ...heres the hard part , if the methadone isnt out of your system yoyre going to start feeling really weird and sweating, blurred vision, cold chills...you will NOT want to take anymore suboxone bevause you will be terrified to...but trust me take another 2 to 4mg or like me another 8mg...you have to flood your system witn the bupe for it to start working...the protocol is like 2mg evety hour it until it starts to help but its scary...if your tolerance was like mine I ended up taking 3 12mg subs and within 8 hours I felt fine...either way theres going to be some discomfort for a few hours

 

[Beargrr73]

My experience

Methadone is a full antagonist and bupe is a partial if I remember right...if I ever have to do it again ill know from the start what to do...i had to force myself to take more suboxone but when I finally.got to my suboxone doctor she applauded me for my switch over home style by just reading stuff off the web

 

[Beargrr73]

Don't start with just a little , flood your system and receptors ,it'll be quicker than the hell I went thru...if you're scared look up the protocol and its like 2mg evety hour until symptoms subside

 

[tacodude]

I'd recommend like the oxygen recommendation to switch to something short acting for two weeks than transition.

 

[blackjesus]

Thanks for the good info guys

So y'all are saying that even with my low-ish dose and when I start to feel some wd symptoms I Will still put myself into precip wds from taking subs?

This is what I'm having trouble grasping...if I'm in a low/mid methadone withdrawal & take a small or even large sub dose it will make wds even worse?

 

[tacodude]

Very likely... I think you're supposed to wait 72 hours at least going from methadone to bupe.

 

[Jabberwocky]

Methadone withdrawal doesn't begin to peak until about day five off it. You will probably feel uncomfortable during the transition period, but you need to wait until you're in full withdrawal from it (3-7 days) to avoid precipitating withdrawal.

The wait from methadone to buprenorphine should be a minimum of 72hrs. Five days is ideal for a dose of 30mg or anything over 15mg.

Using a short acting opioid like codeine, DHC or the pseudo opioid tramadol to transition is ideal. Tramadol is the best out of those three because it willl not interact with buprenorphine' partial antagonism like full agonist opioids will. With using a short acting opioid like codeine to transition only requires you wait about 24hrs since your last dose of codeine before you can safely take buprenorphine.

Gabapentin and clonidine are also useful for the transition, especially if short acting opioids or tramadol isn't available. As is baclofen.

Why are you transitioning to buprenorphine OP? For managing the acute withdrawal from methadone or as ORT?

Using buprenorphine before the methadone has sufficiently left your system will lead to very uncomfortable precipitated withdrawal. The most effective way

 

[LucidSDreamr]

Methadone is a full antagonist and bupe is a partial if I remember right...if I ever have to do it again ill know from the start what to do...i had to force myself to take more suboxone but when I finally.got to my suboxone doctor she applauded me for my switch over home style by just reading stuff off the web

Agonist not antagonist

 

[Beargrr73]

Google methadone to sub protocol, to make sure I was telling you right, i read after 24 hours the transition can start..i was on 115mg of done for 6 years , i tapered down to 15 ,last dose thursday 5am...Sunday about 1 I couldn't stand it i took 8 mg.. Felt weird , sweaty , so an hour later I took 8mg , then I started to feel better ...if your initial dose is high enough youll be fine

Thank you LucidSDreamr for the correction, my phone dictionary has so many misspelled words saved because of the same mistakes from texting and being on steel beams at work

 

[Keif' Richards]

I know this is an old thread, but the method that has always worked best for me has been waiting for a decent amount of agony to appear. This has generally entailed 2-3 sleepless nights with extreme symptoms such as persistent nausea/vomiting and liquid diarrhea appearing around the 72 hour mark. Now, the key, I've found, is to start with miniscule pieces of the strip/pill; I'm talking like 1/16th under the tongue every 30-45 minutes. If you are too early, consuming the small portions of Buprenorphine will cause some general discomfort, but should not be sufficient to cause a full-on precipitated withdrawal syndrome.

In short, go slow. There' no rush. I know we all want relief, but you need to keep in mind how terrible Precipitated Withdrawal can be.

 

[tacodude]

I know this is an old thread, but the method that has always worked best for me has been waiting for a decent amount of agony to appear. This has generally entailed 2-3 sleepless nights with extreme symptoms such as persistent nausea/vomiting and liquid diarrhea appearing around the 72 hour mark. Now, the key, I've found, is to start with miniscule pieces of the strip/pill; I'm talking like 1/16th under the tongue every 30-45 minutes. If you are too early, consuming the small portions of Buprenorphine will cause some general discomfort, but should not be sufficient to cause a full-on precipitated withdrawal syndrome.

In short, go slow. There' no rush. I know we all want relief, but you need to keep in mind how terrible Precipitated Withdrawal can be.

You should say mg dose... 1/16th of an 8 mg strip would be 0.5 mg or 500 ug. I would recommend even starting with less like 100 ug. I found after 1 mg somewhere is were precipitated withdrawals got bad definitely by 2 mg. It is different for everyone, but throwing oneself into precipitated withdrawals I found led to me never stabilizing where the one time I started without precipitated withdrawals I had some level of relief at least. It was like I never could come out of withdrawals after initiating precipitated w/d even if I used a full agonist to pull me out then go back in, waiting for them to end and redose, or just adding more and more. As keif said do not rush it, but go slow. I HIGHLY suggest switching to a shorter acting compound. Codeine if you can... I don't want to suggest poppy seed tea as the blend of opiates in the opium might make it harder to figure out when to transition, but it might be easier than methadone if you measure your doses carefully. Like 1-6 oz is good enough the less the better as lbs of seeds is just a ridiculous waste.

 

[Jabberwocky]

Google methadone to sub protocol, to make sure I was telling you right, i read after 24 hours the transition can start..i was on 115mg of done for 6 years , i tapered down to 15 ,last dose thursday 5am...Sunday about 1 I couldn't stand it i took 8 mg.. Felt weird , sweaty , so an hour later I took 8mg , then I started to feel better ...if your initial dose is high enough youll be fine

This is incredibly tricky and generally speaking a horrible idea. For the most people 24hrs after the last dose of methadone, particularly with a high dose of methadone like that, is pretty much a guarantee for precipitating withdrawal.

If the transition between methadone and buprenorphine is too uncomfortable, short acting opioids can be used (not to mention other comfort meds) while the methadone has sufficient time to leave the system.

Taking more buprenorphine after precipitating withdrawal seems to help some, others not so much. It is a situation best avoided for a lot of reasons.

It's great that you were easily able to transition from such a high dose of methadone directly to buprenorphine after just 24hrs, but for most this isn't a very wise plan of action.

 

[DrugOmen]

Its different for everyone. When I switched years ago I made it 48 hours. I was so fucking sick by that point, I knew I would be fine. I was on about 120 a day.

You just have to listen to your body and be a hundred percent honest with yourself with how you feel. If you know that you arent feeling the peak of withdrawal but you just feel like shit then just wait longer.

I took 2 mg every hour for a few hours then started taking it every half hour or so until I felt stable, which was at 20 mg.

The doc actually gave me 52, 2 mg subutex to titrate my dose from Friday to Sunday by myself. Honestly though I dont think it matters if its suboxone or subutex because bupe is bupe.

 

[keeping]

i waited a day and half and was fine but everybody is different, ymmv etc
48 hours is recommended