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  • BDD Moderators: Keif’ Richards | negrogesic

Buprenorphine to methadone equivalent?

A

AnythingEverything

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Oct 17, 2014
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Is there a formula for this? I can't find one anywhere.

Say if I were to change from 32mg suboxone to methadone, is there a mg to ml equivalent?

This is theoretical now I guess, I am rxd that amount of subs but using heroin now so when I do have to take it I'm only taking a few mg.

Still deciding how I want to go about getting back on track.

Don't know if this should be in sober living or somewhere else sorry..
Thanks
 
Different sites say different things, and lots say data not available for a switch that way....only for the reverse.

A couple I've found say that
8mg suboxone is 60ml methadone? Meaning my 32mg dose would be 240mg of oral done??
 
it'snot an exact science in my experience but i rememeber going from 20ml of methadone to 4mgs of subutex without any issues as susb are v v strong
 
Thanks. Yeah that seems to be why a lot of the sites don't give equivalency for methadone like they do other opiates/oids.

I'm sick today and subs aren't holding me - because I sold nearly all of them for gear, so I've had 1mg every few hours and dreading tomorrow as I only have 2mg left.

I'm so all over the place deciding my next move. Detox, methadone, abstinence and Na, ugh. I guess my heroin use is around 1/2 a gram a day after a few months now with a day or so off a week, sometimes 2...would prefer a gram a day but just can't afford it and the gear is really shite.
 
When I was Iving 4mg buprenorphine I made the switch to methadone and 40 mg had me rocked so 16mg buprenorphine sublingual equivalent and I was gassed off just 40 mg of methadone so I don't think bupe is comparable really to any full agonist truthfully bupe is a weird one that's for sure
 
Generally 1mg buprenorphine = 30mg oxycodone...and 30mg oxycodone = 5-10mg methadone(depending on cross tolerance). BUT things get complicated because after 2mg you get rapidly diminishing returns from buprenorphine...I'd go as far as to say for every 1mg increase in Bupe AFTER 2mg you'd only increase your equivalent dosage of another morphinan opioid by ~5%, so 32mg bupe = 150mg oxycodone = 20mg methadone. AND THEN morphinan opioids have an incomplete cross tolerance to methadone, so if you are new to methadone you could probably reduce that dose by ~25%.


That's leaves us, conservatively, at 15mg-25mg of methadone. I guess your decision at this point is do you want this transition to be completely pain free, or are you willing to be a little uncomfortable for a few days while you adjust. If the latter try starting at 15mg, if you want it to be as comfortable as possible(long taper) I would say 30mg, or just shoot for the middle at ~20-25mg.

If you have some control over your dose after you begin, I would start as low as I felt comfortable in your position and go up from there, but if you get kind of locked in to a range based on your first dose then I would shoot a little higher...but 40mg of methadone is a LOT of methadone for someone new to methadone(no matter what their previous habit was), I really can't see 40mg of methadone ever failing to hold someone on buprenorphine(no matter the dosage).

If you are trying to combat the cravings that come with abandoning an IV heroin habit, you need to go as high as it takes on methadone, much higher than what it would take to just stay well. But if you are already stable on bupe the main concern should just be staying well, and I can't possibly see it conceivably taking more than 40mg-60mg(30mg x2) of methadone to stay well when transitioning from bupe.


!!!EDIT!!!- I am so sorry, I'm a little drunk(just got back from the ball game, go Braves!) and did not read your post thoroughly...chances are your doc doesn't know WTF he is doing and there is NO WAY IN HELL you need 32mg of bupe. More than likely your doc used some stupid formula which says anyone who reports having a habit of greater than half a gram a day of heroin needs 32mg of bupe...but as I mentioned before bupe has a very strange dose response curve. Induction can be a little tricky, but almost NO ONE needs more than 4mg of SL bupe per day for any length of time, and the vast majority can maintain on 2mg or less after stabilizing.

Go ahead and fill your script of 32mg of bupe/day but DO NOT ingest those dosages. When your first induct, take 4mg, then 2mg(if needed) after 60 minutes, then 1mg every 30 minutes until you are well...whatever your total dose is during induction. half it right off the bat the next day(then add 1mg every ~45 minutes until well) and the third day start with 2mg adding 0.5mg every 30-45 minutes until satisfied. The amount needed during induction is largely dependent on you habit, but the amount it takes to stay well after that will be much smaller. And when inducing wait AS LONG AS YOU POSSIBLY CAN before taking any buprenorphine, this is both to avoid PWD and so you can stabilize on the smallest dose of bupe possible. Try hard to take bupe only once a day, but if fighting cravings always take bupe before caving in, if that means taking 2x a day NP.


You will get the best results from bupe at less than 4mg per day, and optimally less than 2mg per day. At first it may take more than that to keep you well, but if you keep taking doses higher than that you will suffer from negative side effects, blunted emotions, and believe it or not more cravings in the long run, the lower the dose the more like an agonist bupe acts.
 
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They simply cannot be easily "converted" into equivalent dosages. Buprenorphine and Methadone are so totally different. Buprenorphine actively blocks the effects of other Opioids. How long will you wait before starting the Methadone? Be aware that you could be in for a little bit of pain in this process. I'm sorry, but your prescriber shouldn't be putting people on 32mg Buprenorphine a day. It's proven to be pretty much unnecessary after dosages significantly lower than that.
 
That's really hard to do since bupe isn't even a real opioid, Talwin is more so than bupe which comes in pills so acidic that they destroy teeth due to the lime/lemon natural and artificial flavouring..brand name Suboxone and (most), the last generic brand of bupe I was on before I was transferred to the pain clinic wasn't awfully sour (Actavis suboxone generic) due to my close to 6 years on them has destroyed my dentition, which was near-perfect before I switched from Methadone (I was at 39mg, docs had me stay without anything for 48 hours then I had a supervised induction dose of 2mg, was in a room of my own at the clinic, listening to music on my mp3 player, all was fine, stayed 4 hours, repeated the same thing the next day with 4mg and there was no issue. I noticed that the methadone's mental fog disappeared and I was pretty happy about that...but knowing what I know now I would have stayed on a low methadone dosage, I was fine at 39mg (after months of reducing dosage by 1 or 2 mg from 60, the largest dose I got to).

It can't be compared as one can get euphoria from methadone, nothing great, while bupe euphoria can happen but it is extremely rare and random and needs something like promethazine or hydroxyzine and maybe a low dose of a benzo to get there, I've nodded off bupe but it never was pleasant. Now, the 2 weeks I had to be sober from 1mg suboxone to nothing before I got my reds (Oxycodone-CR 60mg, generic oxy) was another story, hence my opinion that bupe should be only for short-term 3 month detoxes, not maintenance.
 
Well, 40-50mg is the transitional "ceiling " for methadone to bupe - That us, if your dependent upon MORE than ROUGHLY ~ 40mg, or MAX DOse 60mg, you simply cannot convert directly to, or switch to, buprenorphine w/out lowering your methadone dosage to <=50mg per day (30-40 is better IMO) and still wait, near 72 hours

So it stands to reason, NO DOSE OF BUPE, especially with diminishing returns, as a partial against, shall be stronger than about 40mg, or even equal to 4-55 in full agonist effects

I think in practice is more complicated on paper, still, 30-40ng of methadone should certainly stabilize you, maybe a tad more for cravings

And 32ng a day is stupid; 8-12mg is the most 98% of people shall need, and many can get by on 4ng or less, SL!

Lucj with the (presumptive) transition
 
Agreed on pretty much everything. And yeah, they don't even allow over 24mg of Suboxone here, you can't be at 32mg. Even 24mg is stupid, I never felt the need in my worst days to take more than 16mg, and my script after those 2 inductions days, when I left the second time after a safe 4mg induction of the thing, with a script for 12mg.

It took me 2 years to go from 12 to 10mg and then 4 years of 8mg one day, 10mg another, since we don't have strips here, only pills, no 1mg reductions possible.then another year of 8mg 5 days a week, 10mg twice a week. Whenn I got to 8mg once a day all the time, it was easy thanks to a big amount of clonazolam blotter to reduce to 4mg in 6 months, 6 months at 2mg (this period of time is when i wasn't around here...it was hard as fuck but I was determined). Then the pharmacy started cutting my 2mg tablets in half so I would get 1mg doses a day, I don't know why they would not do this...I guess the pharmacists are mad that Bunavail was rejected by Health Canada, we're in dire need of other formulations, Zubsolv would be optimal and easier to get off from. With Bunavail 1mg doses would have existed. Anyway, spent 2 months on 1mg, then 2 weeks of pure hell taking nothing, the last 4 days I had to be in there as an inpatient, they fed me a bunch of Mirapax for the insane RLS and started giving me 5mg Oxy IR twice a day, then gave me Oxy IR 10mg twice a day then I met the Pain Doc that I was going to be transferred to, referred to by my ORT doc, I never was considered a junkie or drug-seeking since I had legit pain issues that led me to buying opiate painkillers from retired construction workers, who are so broken physically they are retired and are given all they want around here. Left with a generic Oxycontin 60mg script after 6 days in the inpatient facility of my ORT clinic, lol.

Dear god I'm glad that bupe bullshit is over, that thing that could be causing permanent damage to opiate receptors.....well it seems that way when you get off even off 1mg daily, but I'm good now with 120mg generic oxys that I could chew like the old brand name ones, but I don't. Well I don't, often. Still have to go every month to the pain clinic to meet with the doctor and have urine tests for a good while. I've proven myself to the ORT clinic at the hospital, I hope that part will be quicker at the pain clinic in the same hospital because of that.
 
I would ask your GP or addiction worker. They will know best. There are things online but they are all different. :)
 
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