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BDD Moderators: Keif’ Richards | negrogesic
Bupe Which is better for long term maintenance, Suboxone or methadone?
- Thread starter ovo1024
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radiationman
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I would have to go with the methadone. I say that only because I have seen people come off both and it seems, to me, that methadone is “easier”.
Dextro .45
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I’m been on Methadone 80mg for 10-15 years due to medical condition/chronic pain
Originally short acting opioids….Percocet (Oxy 5mg / 325). Then….
Oxy-IR 5mg x 4
OxyContin 10mg x 2
Dilaudid 2mg x 4
Hydromorph-Contin 9mg x 2
Then finally Methadone 30mg…..increased to 80mg throughout a year or so until stable and chronic pain under control. Always taken in morning with breakfast 7am …..home at 3/4pm ish I take an additional 20mg if needed
Although Methadone has a very long half life of 24h approximately, it’s true analgesic “pain-killing” effects lasts only 6-10 hours depending on dose, liver enzyme (genetic makeup) DDI’s, fast or slow metabolizers or taking inhibitors/inducers/competitive substrates of same liver enzyme responsible for metabolizing Methadone hcl
In Germany, mostly Levo-Methadone is prescribed (40mg is equal to Racemic Methadone 80mg)
Methadone has a relatively fast onset of action and excellent oral bioavailability 80% and when taken for long term (chronic) is becomes more potent as it accumulates due to its long half life
Methadone 2.5-5mg would be very effective for an opioid naive patient (like Oxycodone 5mg & oral Morphine 10mg)
Methadone 80mg is a VERY effective dose for an opioid tolerant patient with long term chronic pain. You will not be able to use any other mu-agonist opioid medication while on Methadone…..as it’ll have zero effect.
Because hi-dose Methadone binds / occupies most of the mu-receptors in the CNS, taking a moderate to hi dose of Hydromorphone, Oxycodone, Diacetylmorphine, Oxymorphone, etc will be mostly useless and a waste……only thing that works is more Methadone lol, but be cautious while using other CNS depressants like benzodiazepines
Oxycodone is the most pleasurable, potent, effective, euphoric opioid analgesic if a short acting opioid is needed.
Methadone is an amazingly potent and effective long acting full mu-opioid receptor agonist. I like it
Originally short acting opioids….Percocet (Oxy 5mg / 325). Then….
Oxy-IR 5mg x 4
OxyContin 10mg x 2
Dilaudid 2mg x 4
Hydromorph-Contin 9mg x 2
Then finally Methadone 30mg…..increased to 80mg throughout a year or so until stable and chronic pain under control. Always taken in morning with breakfast 7am …..home at 3/4pm ish I take an additional 20mg if needed
Although Methadone has a very long half life of 24h approximately, it’s true analgesic “pain-killing” effects lasts only 6-10 hours depending on dose, liver enzyme (genetic makeup) DDI’s, fast or slow metabolizers or taking inhibitors/inducers/competitive substrates of same liver enzyme responsible for metabolizing Methadone hcl
In Germany, mostly Levo-Methadone is prescribed (40mg is equal to Racemic Methadone 80mg)
Methadone has a relatively fast onset of action and excellent oral bioavailability 80% and when taken for long term (chronic) is becomes more potent as it accumulates due to its long half life
Methadone 2.5-5mg would be very effective for an opioid naive patient (like Oxycodone 5mg & oral Morphine 10mg)
Methadone 80mg is a VERY effective dose for an opioid tolerant patient with long term chronic pain. You will not be able to use any other mu-agonist opioid medication while on Methadone…..as it’ll have zero effect.
Because hi-dose Methadone binds / occupies most of the mu-receptors in the CNS, taking a moderate to hi dose of Hydromorphone, Oxycodone, Diacetylmorphine, Oxymorphone, etc will be mostly useless and a waste……only thing that works is more Methadone lol, but be cautious while using other CNS depressants like benzodiazepines
Oxycodone is the most pleasurable, potent, effective, euphoric opioid analgesic if a short acting opioid is needed.
Methadone is an amazingly potent and effective long acting full mu-opioid receptor agonist. I like it
jasperkent
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I've been on both and I much prefer methadone. It gives me more of a comfortable sense of well-being. For me, suboxone feels a little edgy and dirty.
There's a study of medically-assisted treatment which concluded that there was a much higher retention rate for patients on methadone. Makes sense to me.
YMMV
There's a study of medically-assisted treatment which concluded that there was a much higher retention rate for patients on methadone. Makes sense to me.
YMMV
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I vastly prefer methadone as far as effects go. With methadone, I feel high every day, at least for a while. But for that reason, I find suboxone to be a better maintenance drug. With suboxone, I pretty quickly stop feeling anything at all (except lack of withdrawal). So after a while I stop really thinking about getting high on opiates. There is no desire to take more than my daily dose, because if I do, it doesn't make any difference. So I feel that it helps me transition away from the life of getting high on opiates easier.
In fact, without massive tolerance, methadone is possibly my favorite recreational opiate. It lasts so long, and the quality of the high is just what I like, a heavy, long lasting, stable euphoria. Whenever I have methadone, I am tempted to try to take more so I can get just a little higher.
Also, suboxone 100% blocks me from feeling other opiates, so even if I want to, I can't get high on opiates. This makes it a good maintenance drug, but only if I'm serious about it. If I'm trying to take it sometimes and get high other times, it is awful for that.
In fact, without massive tolerance, methadone is possibly my favorite recreational opiate. It lasts so long, and the quality of the high is just what I like, a heavy, long lasting, stable euphoria. Whenever I have methadone, I am tempted to try to take more so I can get just a little higher.
Also, suboxone 100% blocks me from feeling other opiates, so even if I want to, I can't get high on opiates. This makes it a good maintenance drug, but only if I'm serious about it. If I'm trying to take it sometimes and get high other times, it is awful for that.
Jabberwocky
Frumious Bandersnatch
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I'm giving this advice as an outsider but a very close family member.
She was a long-term heroin and opiate addict. When I say long-term I mean four plus decades.
Suboxone never worked.
The times when she was clean, working, invested in her life with her children and grandchildren were times she was on methadone.
This is not to say that she was always clean on methadone but it worked pretty well.
That said, it was the devil for her to get off of.
She passed away clean. In the end she got clean. She was clean from everything, dope, pills, methadone, Suboxone. She had gotten completely clean.
plumbus-nine
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Yeah, the difference is that methadone is intoxicating (calming, anxiolytic, sense of wellbeing etc) while bupe primarily suppresses withdrawal and nothing more even though it seems to work as an anti-depressant for some and I might indeed have had less depressive thought patterns while on it but it doesn't actually feel like a drug at all.
Jabberwocky
Frumious Bandersnatch
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The taper off of methadone took over 2 years.
plumbus-nine
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You can greatly accelerate this by using the power of dissociatives like memantine. I quit 600mg/d morphine in less than a month with little suffering that way. But yeah I do acknowledge that methadone causes heavy dependence, more than bupe or also morphine, forgot to mention that.
Las Veghost grower
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Simply put methadone is a full ago and suboxone is a partial, obviously another full ago will make you feel 1000x better but I imagine getting off it would also be 1000x harder, also with subs there will be a adjustment period where your just gonna feel off for a week or so , not the case with methadone
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Yeah, methadone will make you feel fully good. I find it very recreational in fact (though dosing it daily will make it start to just feel normal, but you still get a little high when it comes on). it's one of my favorite recreational opioids. On the other hand, suboxone will quickly feel like nothing, except lack of withdrawal. And if you're coming off a heavy full agonist addiction, you will not feel very good until you get past the full agonist dependence.
However, if you are dependent on a partial agonist (like kratom), or not dependent on any opiates, suboxone can be quite recreational and nice to take occasionally.
However, if you are dependent on a partial agonist (like kratom), or not dependent on any opiates, suboxone can be quite recreational and nice to take occasionally.
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A question you should ask yourself when considering bupe vs. methadone: how much do you value your freedom? With methadone, the most you'll ever be able to take home is a week's worth. If you want to travel for 10 days, you need to figure out how you're going to accommodate that. Certainly, you can locate a clinic for courtesy dosing, but that may come with it's own drawbacks. If the weather is bad, you still have to go in. If your dog is sick,you still have to go in. If your mom's plant is lonely and you said you'd keep it company, you still need to go into the clinic. If you're 5 minutes late because the universe has it out for you that day, good luck. That door is closed, locked, and not opening until tomorrow.
Bupe avoids the majority of that, though you're still tethered to a prescription, and the rules/requirements of the provider/clinic you use. I've worked in MAT programs for over ten years, and it's gotten significantly easier to find a clinic that matches what you need. Bupe also has the advantage of being able to transition onto Sublocade if you were interested in that. I've had a number of patients successfully taper off of bupe entirely using sublocade. SL buprenorphine tends to be a bit harder to come off of, especially as you reach the lower doses (4/2/1/.5mg etc.).
I will also note that buprenorphine did not work well for me when I was trying to get clean. It seems like some people just respond that way to it. The majority of patients have a good experience with it, and don't experience a ton of negative effects from it, but I guess I was just one of the lucky ones that it just made feel like shit all of the time, and this was in 2008, before fentanyl made precipitated withdrawal so much more complicated.
Additionally, as much as I believe that these are potentially life saving medications, one thing to think about is that going onto replacement therapy means you're staying connected to your active addiction, even if it's in a more passive way. You're going to have to provide urines for someone, deal with rude staff sometimes, run into insurance issues, and are going to be expected to be okay with stuff like random urines, pill counts, and someone you don't know that well holding your pharmacological relief over your head in ways that can feel shitty. In many ways, they can keep you tethered to the mindset of being an active addict. You're also more likely to be around other people who are in early recovery, potentially not doing the right thing, and potentially inviting you to not do the right thing either. Obviously, this kind of stuff can happen anywhere, and isn't exclusive to methadone or suboxone programs, but there's a higher concentration of active and quasi-active opioid users that you'll run into just by participating in those programs.
My $.02
Bupe avoids the majority of that, though you're still tethered to a prescription, and the rules/requirements of the provider/clinic you use. I've worked in MAT programs for over ten years, and it's gotten significantly easier to find a clinic that matches what you need. Bupe also has the advantage of being able to transition onto Sublocade if you were interested in that. I've had a number of patients successfully taper off of bupe entirely using sublocade. SL buprenorphine tends to be a bit harder to come off of, especially as you reach the lower doses (4/2/1/.5mg etc.).
I will also note that buprenorphine did not work well for me when I was trying to get clean. It seems like some people just respond that way to it. The majority of patients have a good experience with it, and don't experience a ton of negative effects from it, but I guess I was just one of the lucky ones that it just made feel like shit all of the time, and this was in 2008, before fentanyl made precipitated withdrawal so much more complicated.
Additionally, as much as I believe that these are potentially life saving medications, one thing to think about is that going onto replacement therapy means you're staying connected to your active addiction, even if it's in a more passive way. You're going to have to provide urines for someone, deal with rude staff sometimes, run into insurance issues, and are going to be expected to be okay with stuff like random urines, pill counts, and someone you don't know that well holding your pharmacological relief over your head in ways that can feel shitty. In many ways, they can keep you tethered to the mindset of being an active addict. You're also more likely to be around other people who are in early recovery, potentially not doing the right thing, and potentially inviting you to not do the right thing either. Obviously, this kind of stuff can happen anywhere, and isn't exclusive to methadone or suboxone programs, but there's a higher concentration of active and quasi-active opioid users that you'll run into just by participating in those programs.
My $.02