Switching from Methadone to Suboxone taper? need advice

[Seasick]

Hello, my mother is on 20mg of methadone (10mg twice a day) and when she went to the Dr. a few days ago, they told her the Dr. was on vacation for 10 days and there was no backup Dr. or anything, meaning there was no way to get her prescription refilled (this seems almost unbelievable that a Dr. would allow this to happen). So because she has had a terrible experience before where she was without her methadone for 3 days, and had terrible withdrawls, she obviously does not want to go into withdrawls now, but has no access to any alternative opiates. So she was sitting in a parking lot crying about the situation and a guy came up and asked if she was ok, and she explained the situation and asked what she should do, and the guys response was "smoke heroin". She was open to the idea, and the guy helped her buy 2 grams of black tar (a bit excessive, she admits!). She then called me and said she would prefer to not smoke the H, and would prefer to switch to Suboxone. Why Suboxone? Well I have been on Suboxone for about 1 year, so she associates Suboxone with being an effective way to lower your dose of/get off of opiates. I am honestly not very educated with the difference between Methadone and Suboxone, so I couldn't tell her that was a good or bad idea. The reason she thought Suboxone was a good idea was because I always have extra because i take 1/4 of what is prescribed to me (prescribed 8mg, i take 2mg) so she could obtain them thru me. But my big question is, should she switch from methadone to heroin for a few days before she switches to Suboxone? Or can she just switch directly from Methadone to Suboxone. I think I remember reading here before someone suggesting something similar. What do you guys think? She has an appointment with her Methadone dr. when they return in a week, but she is absolutely determined not to have any withdrawls. So I guess I have a few questions but the most importantly, if she wanted to get off opiates completely, is tapering off suboxone any different/easier than tapering off methadone? Because I have a friend who just tapered off methadone (like 2mg less per month i think) and he said his taper was easy. But I have heard also that tapering off methadone is harder, is that true? My mom actually had just gone to another Dr. and he told her the methadone was probably doing more harm than good and should of never been prescribed it for her issue (rheumatoid arthritis) and that she should taper off over 6 months. So she was planning on telling her methadone Dr. that she wanted to start tapering. So she was planning on tapering with methadone, but now she is angry with her Dr. and she thinks switching to Suboxone and then tapering the Suboxone is the answer. What should she do? Also, if she did switch to Subs, would 2mg of Bupe be enough to make her feel normal if shes on 20mg methadone? Any advice is much appreciated, Thank you.

 

[RaizdByWolvz]

In my course of using/recovery over the years I have had my time on both methadone and Buprenorphine maintenance. A very unfortunate circumstance put me in the situation where I was unable to continue going to the methadone clinic and I had to cold turkey off 130 mg. 2 years later I started buperenorphine maintenance and over the course of the last 6-8 months I tapered down from 8 mg to .25 mg suboxone, it was extremely difficult for me to jump off of even so low as .25 mg, i finally was able to jump off the subs 3 weeks ago today with Kratom. My point is that tapering off of suboxone is just as irritating as tapering off methadone as they are both long acting agents. Be very careful if ever switching onto Suboxone from methadone, as one would need to be sure you are in full on withdrawal, that could take anywhere from 36-72 hours after last methadone dose as you must avoid precipitated withdrawal. Unlike methadone, Suboxone is a partial opioid agonist with partial opioid effects, so to feel better from taking suboxone after methadone you would need to be in absolute withdrawal and like I said that could take up to 3/4 days. I wouldn’t suggest at all for your mother to use heroin as we all know where that goes, with that being said it would help in making a transition from methadone over to suboxone a little easier, again you would have to make sure you are in full withdrawal off the Heroin before inducting suboxone.

 

[Keif' Richards]

First off, switching from Methadone to Buprenorphine (Suboxone/Subutex) is especially tricky due to Methadone's long duration of action. As you're probably aware, the use of Buprenorphine when currently dependent upon Opioids can provoke a severe and immediate sickness known as Precipitated Withdrawal. The same withdrawal that creeps up slowly over the course of days for your Mother could occur immediately. It is not a fun situation, so you always need to plan appropriately.

Switching from Methadone to Buprenorphine is something that should only be done (in my opinion) if one intends to remain on Buprenorphine. It's very difficult to accurately determine when to begin dosing Buprenorphine, but to be safe, one should wait at least 48 hours and probably 72 hours after their last dose of Methadone. Being that your Mother's issue would be resolved in a matter of days, I don't think it makes good sense to throw Buprenorphine into the mix. Truthfully, if remaining on Methadone as you have been is your ultimate goal, you're probably better off to maintain with full-agonists like you are doing.

It's very shitty that your Mother has to resort to using Heroin, but it really sounds like it's her prescriber's fault and not hers, so she really shouldn't feel bad about having to turn to the streets.