PunchThomas
Greenlighter
- Joined
- Dec 20, 2011
- Messages
- 10
I'm attempting to help a friend quit a daily heroin habit. He's turned to me for advice because I enjoy studying things like this, whereas he doesn't, as he has a daily heroin habit. So the situation is this:
Take as a given he has sufficient motivation to quit, but can't because of the physical dependency. To help him, he has 2 suboxone strips, plus a dozen methadones (at his tolerance level, it takes 2-3 methadones/day to feel normal).
So question (1): what is the best way to utilize these medications? Since transitioning from methadone to suboxone is out of the question, is it worthwhile to go through the standard suboxone induction process first, then transitioning to methadone (using the timeline below), or is he better off forgetting about the subs for now and just using methadone?
My initial feeling is that there is a benefit to using the subs first, provided that he can force himself to wait long enough after his last heroin dose to transition safely. So let's say he takes one strip 24 hours after the last dose of heroin, and the second 24 hours after that. At this point the danger of precipitated withdrawal is past, and the only penalty for starting methadone too early is possibly wasting a pill that doesn't do anything. Correct? 16mg isn't an especially high dose, and I believe he can begin taking methadone as soon as he enters withdrawal, which I expect between 36 and 48 hours after his second suboxone dose. By that point, enough should be processed that there are enough open receptors for the methadone to have an effect. Am I still thinking along the right lines here?
After that point, he will begin a short taper using the remaining methadones. This final stretch won't be without some withdrawal symptoms he'll just have to suffer through, but as I see it, it's the easiest route considering the resources at his disposal. It's not exactly easy but I believe it's doable.
I'm advocating the suboxone to methadone transition partly due to the idea that suboxone, even at low dosages, will ultimately make quitting easier. Anecdotally this seems to be true, though I wonder whether the underlying idea is that going into withdrawal, then dosing out of it, will make thw next episode of withdrawal easier, whether suboxone was used or not. Again, anecdotally this seems to be the case, but is there any actual basis for this belief?
I couldn't find much info at all about these questions. If my friend is going to be the guinea pig, so be it (someone has to be), but I don't believe for a second no one has tried something like this before. So if you have knowledge or experience, pleae share!
Take as a given he has sufficient motivation to quit, but can't because of the physical dependency. To help him, he has 2 suboxone strips, plus a dozen methadones (at his tolerance level, it takes 2-3 methadones/day to feel normal).
So question (1): what is the best way to utilize these medications? Since transitioning from methadone to suboxone is out of the question, is it worthwhile to go through the standard suboxone induction process first, then transitioning to methadone (using the timeline below), or is he better off forgetting about the subs for now and just using methadone?
My initial feeling is that there is a benefit to using the subs first, provided that he can force himself to wait long enough after his last heroin dose to transition safely. So let's say he takes one strip 24 hours after the last dose of heroin, and the second 24 hours after that. At this point the danger of precipitated withdrawal is past, and the only penalty for starting methadone too early is possibly wasting a pill that doesn't do anything. Correct? 16mg isn't an especially high dose, and I believe he can begin taking methadone as soon as he enters withdrawal, which I expect between 36 and 48 hours after his second suboxone dose. By that point, enough should be processed that there are enough open receptors for the methadone to have an effect. Am I still thinking along the right lines here?
After that point, he will begin a short taper using the remaining methadones. This final stretch won't be without some withdrawal symptoms he'll just have to suffer through, but as I see it, it's the easiest route considering the resources at his disposal. It's not exactly easy but I believe it's doable.
I'm advocating the suboxone to methadone transition partly due to the idea that suboxone, even at low dosages, will ultimately make quitting easier. Anecdotally this seems to be true, though I wonder whether the underlying idea is that going into withdrawal, then dosing out of it, will make thw next episode of withdrawal easier, whether suboxone was used or not. Again, anecdotally this seems to be the case, but is there any actual basis for this belief?
I couldn't find much info at all about these questions. If my friend is going to be the guinea pig, so be it (someone has to be), but I don't believe for a second no one has tried something like this before. So if you have knowledge or experience, pleae share!