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Thread: Methadone and subutex.

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    Bupe the next day after methadone (not opiate dependant atm). 
    #1
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    Hello fellow bluelighters.

    I have not used any opiates recreationally for the last three months and thus I'm currently not physically addicted to opiates. For the last six days (with one day off in between) I have been taking 30 mgs of methadone every morning. My psychiatrist whom is an addicition and OCD and specialist wants to put me on a subutex maintance program for my severe OCD and to help me stay off other opiates. For reasons I'd rather not get into right now I can not tell him I have been useing methadone for the last six days (although he does know that I did take 30 mgs last thursday).

    My question is basically: since I'm not physically addicted to opiates at the moment, can I take my first subutex dose 24 hours (or potentially even 12) after my last methadone one?

    I figure that since subutex is both an opiate antagonist and agonist it would just cancel the effects of the methadone and give me the subutex effects. I know that if I was physically addicted to methadone it would send me into withdrawls but since I'm not I was wondering if it would be safe. Though I'm not really worried about this since my opiate tolerance is rather high, will the risk of respatory arrest be any higher?

    Also, I was thinking of taking 2mgs of sub the first day and afterwards raise my dose to 4mgs since I figure that that is roughly equivalent to 30mgs of methadone. Would you suggest a diffrent dosage?

    Thanks for reading my thread and I hope you can answer my questions quickly since I'm probably going to start my subutex program tommarow and if not then in the next 2-3 days.

    P.S.
    I plan to continue takeing 30mgs of meth every morning until I start the bupe unless told otherwise.
    Last edited by a5l6o5n2; 14-02-2011 at 17:01. Reason: Poor English.
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    #2
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    Buprenorphine has higher affinity (attraction) to the opiate receptors than methadone (and also more affinity than all or most opiates). This means that it will kick any opiates off of your receptors and you will be left with the buprenorphine.

    So Subutex and Suboxone are the same in that respect, as it is the buprenorphine that puts you into withdrawals by kicking every other opiate off the receptors and hogging the receptor for itself. The naloxone part of the Suboxone will induce withdrawals if injected but not when taken orally or sublingually "as directed."

    Once the buprenorphine takes over the opioid receptors, it is only a partial agonist, meaning it is strong enough to grab on and block the receptors from anything else, but it doesn't ACTIVATE the receptors fully. For this reason, (as well as dosage conversion between buprenorphine and x opiate), the receptors may not be activated to the level your body requires and there is no way to increase the opiate load until the buprenorphine releases it's grip on the receptors.

    You say you are not physically addicted to methadone but you say you have a high tolerance to opiates and that you are taking methadone each day. If you were to stop all opiates right now, would you go through withdrawals? If so, you want to wait at least (AT LEAST!) 36 hours after taking methadone before taking buprenorphine or you will be put into precipitated withdrawals. Whether you are physically dependent on opiates or methadone this will be the case as you have now swapped over onto methadone.

    So my answer would be to be really sure that you have no physical addiction to opiates before you take the buprenorphine because precipitated withdrawals are not fun. If this is the case, why are you continuing to take the methadone each day until swapping onto bupe, if not to prevent sickness?

    I do not think respiratory depression would be a problem as buprenorphine has less of these effects and it would not be bupe + methadone as the methadone is removed from the receptors.

    As for dosage, someone else might be able to answer that. It really depends on your habit, and seeing as you are taking it for OCD and not for opiate maintenance, your psychiatrist would know more about the correct dosage.
    Last edited by AuraLee; 15-02-2011 at 11:00. Reason: typo and clarity
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    #3
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    Please do let us know what the effects are from taking buprenorphine after methadone when not physically addicted (that's if you're brave enough to try it!) I assume it would be fine. You may just get snapped out of the "methadone haze" as the bupe comes on.
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    #4
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    Quote Originally Posted by AuraLee View Post
    Buprenorphine has higher affinity (attraction) to the opiate receptors than methadone (and also more affinity than all or most opiates). This means that it will kick any opiates off of your receptors and you will be left with the buprenorphine.

    So Subutex and Suboxone are the same in that respect, as it is the buprenorphine that puts you into withdrawals by kicking every other opiate off the receptors and hogging the receptor for itself. The naloxone part of the Suboxone will induce withdrawals if injected but not when taken orally or sublingually "as directed."

    Once the buprenorphine takes over the opioid receptors, it is only a partial agonist, meaning it is strong enough to grab on and block the receptors from anything else, but it doesn't ACTIVATE the receptors fully. For this reason, (as well as dosage conversion between buprenorphine and x opiate), the receptors may not be activated to the level your body requires and there is no way to increase the opiate load until the buprenorphine releases it's grip on the receptors.

    You say you are not physically addicted to methadone but you say you have a high tolerance to opiates and that you are taking methadone each day. If you were to stop all opiates right now, would you go through withdrawals? If so, you want to wait at least (AT LEAST!) 36 hours after taking methadone before taking buprenorphine or you will be put into precipitated withdrawals. Whether you are physically dependent on opiates or methadone this will be the case as you have now swapped over onto methadone.

    So my answer would be to be really sure that you have no physical addiction to opiates before you take the buprenorphine because precipitated withdrawals are not fun. If this is the case, why are you continuing to take the methadone each day until swapping onto bupe, if not to prevent sickness?

    I do not think respiratory depression would be a problem as buprenorphine has less of these effects and it would not be bupe + methadone as the methadone is removed from the receptors.

    As for dosage, someone else might be able to answer that. It really depends on your habit, and seeing as you are taking it for OCD and not for opiate maintenance, your psychiatrist would know more about the correct dosage.


    Thank you for your detailed answer. I'm currently taking the methadone because I enjoy the very mild "high" I get from it and because it's also really helping my OCD.
    I'm currently institutionalized in a mental hospital as my OCD has became so bad that I haven't been able to leave my house nor my room for the past few months (also the reason why I have stopped useing opiates as I can't go score any, before that though I was useing pretty often and that's why my tolerance is pretty high). I can't tell my psychiatrist I'm taking it, because one of the patients here who is on MMT is giving me 30mgs every morning (he gets 240 and says he doesn't really feel the difference) in exchange for my pregablin and some cigarettes. I have told my psychiatrist once that I have taken the methadone and he told me that if I don't stop he will have to report it; so while I do want to be as honest as possible with him I don't want to get myself or the patient with whom I'm swaping kicked. I've considered getting on MMT instead but my psychiatrist doesn't like the idea nor will my parents considering the stigma meth has.

    I still don't understand wether I will still get precipitated withdrawals when switching from the meth to the sub despite not being physically addicted to the meth. I don't really know which day my doctor is going start my giveing me the subutex and since he thinks I have stopped taking the methadone it will look suspicious if I ask him to wait a day or two considering how long I have been begging him to start me on it. I really enjoy the mood lifting effects of the methadone and how bearable it makes my OCD and thus don't want to quit.

    I know you can't really compare bupe to meth as they are quite diffrent, but say I was taking it for pain managment, would 30mgs of meth be roughly equal to 4mgs of sub? Most opiate conversion charts don't include bupe but I just want a rough estimate?

    Despite not getting high of my methadone, it's really giving me a mood lift. Should I expect the same from the subutex? I'm not really looking to get high, I just want my life to become bearable but A small buzz won't hurt.

    tl;dr: Will I get precipitated withdrawals when swapping the meth for bupe despite not being physcially addicted to opiates?
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    #5
    I switched from methadone to subutex a while ago successfully, and it's made things so much better. I took 4 mg of subutex about 12hrs after my last hit of methadone then next day went up another 4 and another 4 the day after that.. Don't think you should have any problems at all.. I do know people who hate it though and swear by methadone, it's just personal choice as far as I can see and of course some things agree with some people where as other things don't. I would strongly suggest to anyone taking methadone who hasn't tried subbutex to give it a go, it might really help you. I totally got my habit under control after changing over (a few other things happened to fall into place as well). You are warned about the precipitated withdrawal that can happen if you use on top of the subutex, I have had no problem with this though, admittedly because you can quickly work out how to mess around with your script, but often the timing and the hassle doesn't make it worth it, and once the buperenorphine is in you, you won't get the same hit off opiates, you have to be well into wd's and even then a couple of days clear from your last subutex i've found..
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    #6
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    you want to wait anywhere from 18 to 48 hours after doing methadone before doing subutex but most painkillers don't last as long as methadone with other painkillers you want to wait 12 to 30 hours before taking subutex
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    #7
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    Yeah when switching from methadone to subutex, I would wait ATLEAST 48 hours, more like 72. You really do not want to experience precipitated withdrawals. Since you are in a hospital, if you get precipitated withdrawals, they will know something is up, and probably cut you off completely. Why not just stop fucking around with the methadone, since you will be starting subutex in a couple days, anyways? I have been on 75mg methadone daily for 1.5 years or so, and I can go 72 hours without feeling any major withdrawal..
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    #8
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    Brokendownpalace is correct. Wait at Least 2 days before switching to suboxone. Once you are in withdrawl and feeling very sick, thats a sign you can take Suboxone. The key is you have to be in Withdrawl , (Youll know when you are)
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    #9
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    Quote Originally Posted by AuraLee View Post
    Buprenorphine has higher affinity (attraction) to the opiate receptors than methadone (and also more affinity than all or most opiates). This means that it will kick any opiates off of your receptors and you will be left with the buprenorphine.

    So Subutex and Suboxone are the same in that respect, as it is the buprenorphine that puts you into withdrawals by kicking every other opiate off the receptors and hogging the receptor for itself. The naloxone part of the Suboxone will induce withdrawals if injected but not when taken orally or sublingually "as directed."

    Once the buprenorphine takes over the opioid receptors, it is only a partial agonist, meaning it is strong enough to grab on and block the receptors from anything else, but it doesn't ACTIVATE the receptors fully. For this reason, (as well as dosage conversion between buprenorphine and x opiate), the receptors may not be activated to the level your body requires and there is no way to increase the opiate load until the buprenorphine releases it's grip on the receptors.

    You say you are not physically addicted to methadone but you say you have a high tolerance to opiates and that you are taking methadone each day. If you were to stop all opiates right now, would you go through withdrawals? If so, you want to wait at least (AT LEAST!) 36 hours after taking methadone before taking buprenorphine or you will be put into precipitated withdrawals. Whether you are physically dependent on opiates or methadone this will be the case as you have now swapped over onto methadone.

    So my answer would be to be really sure that you have no physical addiction to opiates before you take the buprenorphine because precipitated withdrawals are not fun. If this is the case, why are you continuing to take the methadone each day until swapping onto bupe, if not to prevent sickness?

    I do not think respiratory depression would be a problem as buprenorphine has less of these effects and it would not be bupe + methadone as the methadone is removed from the receptors.

    As for dosage, someone else might be able to answer that. It really depends on your habit, and seeing as you are taking it for OCD and not for opiate maintenance, your psychiatrist would know more about the correct dosage.
    Nice post. This is all very accurate and useful information. Do you work in the medical field, or are you just a drug nerd like the rest of us?
    You explained everything quite well. I was going to post in here but you covered everything that I could possibly say. Welcome to the board!

    Edit: Some would argue that the 1:4 ratio of naloxone to buprenorphine is not enough to cause withdrawal if IVed. Before releasing suboxone they did studies and found that at a 1:2 ratio of naloxone to bupe, patients started to feel sick when IVing so they went with a 1:4 ratio. I'm not really sure why. My theory is that it was just to make sure people who are sensitive to naloxone wouldn't experience any discomfort when taken as directed. I've never IVed sub or bupe itself, but I know plenty of people who will say that it works and is worth it to them. I think it's more about being addicted to the ritual of IVing than anything else.
    Last edited by sonic; 20-04-2012 at 03:04.
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    #10
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    So you're going to start taking buprenorphine after being on methadone, and your doctor doesn't know about it? I assume that in your hospital you are being drug screened, at least I would hope so. For your own health and well-being, you would be better off telling your psychiatrist what you're up to, or you are going to feel real lousy.

    Time is not the real important factor; you want to feel mild to moderate symptoms of withdrawal before beginning buprenorphine.
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    #11
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    Quote Originally Posted by Missykins View Post
    So you're going to start taking buprenorphine after being on methadone, and your doctor doesn't know about it? I assume that in your hospital you are being drug screened, at least I would hope so. For your own health and well-being, you would be better off telling your psychiatrist what you're up to, or you are going to feel real lousy.

    Time is not the real important factor; you want to feel mild to moderate symptoms of withdrawal before beginning buprenorphine.
    The OP claims to have zero dependency to opiates so there will never be a point where they have mild-moderate withdrawal symptoms. The OP says they are not physically dependent and have only been taking methadone for 6 days with 1 day off as well. That is not enough time to develop anything more than very mild dependency.

    If the person has no dependency then there is no risk for precipitated withdrawals.

    That being said if you really have zero dependency at the moment why don't you just wait 4 days after your last methadone dose to start the bupe? Even if precipitated withdrawals are not a risk.. I would think bupe would take effect and work better if there was nothing on the receptors for it to kick off. If you have zero depency like you claim then waiting 4 days will be easy since you will not have any withdrawals.
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