Switching from bupe to methadone - differences?

[Båtmannen]

Hello. I know the significant difference between the two medications, with methadone being a full agonist and bupe a partial, and that bupe has lower (as in stronger) affinity for the opioid-receptors than most drugs and therefore blocks other opiates, such as heroin, better than methadone.

I'm more interested in how the difference will be noticeable? I IV 20 g bupe per day, and that's the main reason I want to change. With methadone I don't every day "have to" inject it, since it's barely possible, if at all. I tell the doctor it's general drug craving, which is also a factor, but in reality it's primarily about me keeping my needle fixation alive by nourishing it every day.

The biggest con with switching is that I can save bupe for later, and not always take it in the morning, but keep it until afternoon or night. This won't be the case with methadone as long as I live in a treatment home/center. And I'm thinking perhaps this deficit of freedom will make me regret the switch ... but it's not impossible to switch back - just tiring.


If you have been on both: which of the medications did you prefer and what dose did you have? I understand the dosage is more important when on methadone, as with bupe there's really no difference between shooting 16 and 32 mg, while swallowing 200 mg methadone instead of 100 might leave you unconscious.


Another con is that if I miss the time (if I come later than 1030 AM), I will feel the withdrawal at a significant level during the next 24 hours before my next dose, whereas on bupe I can go about three days without a problem except inreased craving.


Is there a significant difference in the subjective feeling depending on which of these two you use, or is it pretty much the same except one not blocking the receptors nearly as good as the other?


best regards

PS. I also hope that methadone will keep my heart cooler/slower when I use stimulants, and perhaps keep some of the anxiety at bay. I know this is not the purpose of methadone, but it might be a good side effect.

 

[Keif' Richards]

Hey Batmannen! I'm glad to see that you're alive and posting. I haven't forgotten your trials and tribulations in dealing with the complications of Buprenorphine injection. As you know, Buprenorphine is a strong Opioid, sure, but at the end of the day, it's only a partial agonist. This is okay for some people. It gives them that little boost that they need and they're able to fix their lives. For folks who have had serious, chronic addictions, a partial agonist is sometimes just not enough to end the cravings. I know cravings probably seem like no big deal to those who have not experienced them, but cravings for Opioids is like an extreme form of anxiety and the constant pull interferes with your ability to think and reason.

So, given your history and what you have described, I think that you're probably a good candidate for Methadone. I know that I tried Buprenorphine maintenance and aside from making me sick, it didn't end my cravings. When I got on Methadone, I found that my cravings for Opioids were very minimal. So, I think Methadone, being a full Opioid agonist, will probably do the same for you. You're in a decent position too, because the switch from Buprenorphine to Methadone is significantly less traumatic than vice versa. You may experience some withdrawal at first, but that's only because regulations prevent clinics from starting patients at anything over 30mg. Your dose will be raised each consecutive day, but there will probably be some discomfort.

In the end, especially with your complications from Buprenorphine use in mind, Methadone as a drug and the structure that it forces you into, might actually be a very good fit. There's no way to feasibly abuse the medication, as you are observed consuming it. I really think that it's likely that Methadone will improve the quality of your life. Your hijinx with Buprenorphine is serious business. I totally support your decision and I can say that it definitely worked for me.

 

[Lorne???]

^ Have they gotten tighter on regulations? My old clinic progressively gave more take-homes, can't remember exact time frame, though if you could pass most drug screens, within a year it wiuld be a once or twice weekly thing, eventually once a month; It's still hard, and somewhat pointless to abuse, though, they even stopped giving wafers( though at least one person would inject 30mg at a time using a BD syringe; multiple injections didn't seem worth it, unless doing something crazy like mixing it)

Back in point, it eventually eliminates MOST cravings, and at a point, even occasional recreational use of other opioids becomes pointless, because your tolerance is just so high, you would beep something like oxymorphone or ultra-strong(yet less recreational, generally) opioids to feel anything, and it just ends up being a waste of money.

And you really can function 100% on MD, even a lot of IV users adjust.

Unfortunately some things are hard to change; however if you are banging 20mg of buprenorphine per day,(which you even said was pointless) then MMT would likely be an improvement to your health, and more satisfactory, even without a needle.

And if your bupe wd's aren't bad/delayed, then the transition should be quite painless. You could reduce your bupe dose over a couple of days, then go to the clinic. As mentioned above, there will likely be brief transition. as 20-30mg seems to be a typical starting point, though in no time you will be on more than a satisfactory dose

Don't know your story, just make sure you are dedicated

Good Luck

 

[Lorne???]

Oh, most clinics should let you split dose; mine charged an extra $2 bill per diem, they did 2/3rds there(roughly; like with 85mg think they split it 55/30 or something), on days you dosed at clinic, and rest to take home. So you could have a portion to save. In theory if 80-90mgs held you, you could go up a bit, to have a security dose, though don't really recommend it unless you genuinely have pain or insomnia, or prefer a split dose; reason being that methadone is stronger than many people think, especially at high doses (100mg md is stronger than half a gram of morphine(oral, NOT IV, please don't Iv that much Morphine, although even with a 5ml syringe doubt you could fit that much)

So careful, wouldn't go over 120mg of methadone unless it is simply necessary and beneficial for patient

(One case report notes a man on like 300-400mg of md per day, had torsades de points and eventually needed a pacemaker; yet refused a dose reduction;

That is one case where a Dr should have stepped in and done something, IMO

Just my 2 cents

 

[JessFR]

I've only been on methadone not bupe. But in my experience it takes at least 24-48 hours to feel any withdrawal provided you haven't already missed it recently.

I'm not sure they this will prevent you IVIng it in the long run since at some point you'll likely get takeaways.

And for switching, that should be fairly easy. Much easier to go from bupe to methadone than the other way around.

 

[Båtmannen]

Hey Batmannen! I'm glad to see that you're alive and posting. I haven't forgotten your trials and tribulations in dealing with the complications of Buprenorphine injection. As you know, Buprenorphine is a strong Opioid, sure, but at the end of the day, it's only a partial agonist. This is okay for some people. It gives them that little boost that they need and they're able to fix their lives. For folks who have had serious, chronic addictions, a partial agonist is sometimes just not enough to end the cravings. I know cravings probably seem like no big deal to those who have not experienced them, but cravings for Opioids is like an extreme form of anxiety and the constant pull interferes with your ability to think and reason.

So, given your history and what you have described, I think that you're probably a good candidate for Methadone. I know that I tried Buprenorphine maintenance and aside from making me sick, it didn't end my cravings. When I got on Methadone, I found that my cravings for Opioids were very minimal. So, I think Methadone, being a full Opioid agonist, will probably do the same for you. You're in a decent position too, because the switch from Buprenorphine to Methadone is significantly less traumatic than vice versa. You may experience some withdrawal at first, but that's only because regulations prevent clinics from starting patients at anything over 30mg. Your dose will be raised each consecutive day, but there will probably be some discomfort.

In the end, especially with your complications from Buprenorphine use in mind, Methadone as a drug and the structure that it forces you into, might actually be a very good fit. There's no way to feasibly abuse the medication, as you are observed consuming it. I really think that it's likely that Methadone will improve the quality of your life. Your hijinx with Buprenorphine is serious business. I totally support your decision and I can say that it definitely worked for me.

Thank you, mr Moderator.

^ Have they gotten tighter on regulations? My old clinic progressively gave more take-homes, can't remember exact time frame, though if you could pass most drug screens, within a year it wiuld be a once or twice weekly thing, eventually once a month; It's still hard, and somewhat pointless to abuse, though, they even stopped giving wafers( though at least one person would inject 30mg at a time using a BD syringe; multiple injections didn't seem worth it, unless doing something crazy like mixing it)

[<

Oh, most clinics should let you split dose; mine charged an extra $2 bill per diem, they did 2/3rds there(roughly; like with 85mg think they split it 55/30 or something), on days you dosed at clinic, and rest to take home. So you could have a portion to save. In theory if 80-90mgs held you, you could go up a bit, to have a security dose, though don't really recommend it unless you genuinely have pain or insomnia, or prefer a split dose;s

I was somewhat inexplicit: if it were up to my doctor and clinic, I would be allowed to start go getting the medication at the drug store (first 3 x / week, than gradually decreases the frequency) ... but as I have no choice but to remain in this treatment center (the direct-translation would be treatment-home, but idk which word is really correct), I have to take it between 0730 and 1030 am during weekdays and 0800 - 1100 during holidays.

With bupe there's no problem putting it buccaly and then sit there for 3 minutes, and then take it out, but with methadone there's no choice here but to take it in the morning.

reason being that methadone is stronger than many people think, especially at high doses (100mg md is stronger than half a gram of morphine(oral, NOT IV, please don't Iv that much Morphine, although even with a 5ml syringe doubt you could fit that much)

So careful, wouldn't go over 120mg of methadone unless it is simply necessary and beneficial for patient

(One case report notes a man on like 300-400mg of md per day, had torsades de points and eventually needed a pacemaker; yet refused a dose reduction;

That is one case where a Dr should have stepped in and done something, IMO

Just my 2 cent

I assume you exaggerated somewhat, but even in that case that's alot of morphine.

The 300-400 mg guy wasn't doing it legally, right?

I've only been on methadone not bupe. But in my experience it takes at least 24-48 hours to feel any withdrawal provided you haven't already missed it recently.

I'm not sure they this will prevent you IVIng it in the long run since at some point you'll likely get takeaways.

And for switching, that should be fairly easy. Much easier to go from bupe to methadone than the other way around.

Yeah, when I start getting take-aways, I will most certainly try to IV it, but what kind of needle would one need to IV that thick solution?

Pills are very rare in my country, even on the street.

 

[Lorne???]

^ No man they continued giving him his sane dose after the pacemaker was put in! Don't know how he ever got on so much, though at that point he refused to lower his dose, despite heart problems, and they continued administering it.

I am ultra-liberal, though even U would have said "you can make it without 3-400mg methadone, let's slowly take it down, to say a quarter gram and go from there" unless they were terminal anyway.

And no, not exaggerating; remember methadone becomes more potent with repeat dosing; it is already more potent than Oxycodone and longer lasting, with chronic use it is roughly triple the potency of Oxycodone; oxycodone is usually described as 1.5x as potent as oral morphine, so 100mg chronic methadone=~300mg oxy=450mg morphine as an example

Of course it is complicated and varies, however their are sources that claim with escalating methadone doses, the conversion ratio changes, so morphine becomes less potent in relation with high doses, and supposedly a conversion of 4:1, and even 8:1 with a certain dose. Although this is more based upon analgesic potency, as methadone is excellent for chronic pain in most cases

Sorry about you're situation, though methadone is probably still better if you are pulling bupe out of you're mouth man.

Is it Bunavail out of curiosity? It has less nalaxone, though it is slightly more troublesome to inject with an insulin syringe, and don't like that it thickens up

Surprised they don't offer split dosing, even so; if it's a treatment center or long term treatment housing, it should have nightly dosing, people in severe pain would need two doses of methadone per day, it is more effective, and giving most benzodiazepines (and other anti-epileptic medications, even gabapentin) would be downright atrocious.

Don't know your story as said earlier, though it seems this is going to likely be a big decision, since switching back to bupe would be a lot more difficult as you mentioned. There are other co-medications of course, just use best judgement and plenty of people here will help/offer advice, as you know.

Good luck man, will try and check back(whatever that is worth)

Maybe post those crazy morphine-methadone conversions

 

[Lorne???]

Thank you, mr Moderator


Yeah, when I start getting take-aways, I will most certainly try to IV it, but what kind of needle would one need to IV that thick solution?

Pills are very rare in my country, even on the street.

The problem is it most likely 10mg/ml, so even with a BD 3ml syringe and large gauge needle, the most you could inject would be 30mg; with an insulin syringe, it's pretty much useless, 5-10mg; now with a low tolerance 30mg IV methadone is a nice pick me up, and you can technically get a 5ml syringe and inject 50mg(slowly), however on maintainence you're tolerance gets so high this is pointless.

And, not to give speeches, as I came to know these things through my own (ridiculous) experiences; however the stuff is not made to be injected, and the return on frequent injecting of modest doses if you are on even 80-90mg per day, not worth it.

If you can fight the needle fixation, though, at least to an extent, eventually methadone will be so satisfactory it won't matter most of the time

 

[Båtmannen]

The problem is it most likely 10mg/ml, so even with a BD 3ml syringe and large gauge needle, the most you could inject would be 30mg; with an insulin syringe, it's pretty much useless, 5-10mg; now with a low tolerance 30mg IV methadone is a nice pick me up, and you can technically get a 5ml syringe and inject 50mg(slowly), however on maintainence you're tolerance gets so high this is pointless.

And, not to give speeches, as I came to know these things through my own (ridiculous) experiences; however the stuff is not made to be injected, and the return on frequent injecting of modest doses if you are on even 80-90mg per day, not worth it.

If you can fight the needle fixation, though, at least to an extent, eventually methadone will be so satisfactory it won't matter most of the time

I have injected about 30-50 ml two times of horrendous solutions, without filtering, so if I want to, there's no problem in IVing methadone if I wait some time and let my veins heal. But I would need help very time (most likely) since it's very impractical IVing with a 100 ml syringe.

Isn't the sugar in the Methadone a problem when IVing or is the sugar-thing a national thing here? I've heard 11 g sucrose per bottle, which is way too much for me, but I guess that problem is OK if something else compensates (both diet and the medication, bc if it's exactly the same for me, but sugar in methadone, than I'll regret my ass off).

But since BA is 85 % oral, I think I'll manage to not shoot it even when I can go get them and take-away.


I want a high dose. Won't get max but at least 120 mg. I'm a big guy.

 

[JessFR]

Ugh. I don't know why but the idea of shooting methadone grosses me out so much. I had a friend who used to do it fairly often and I hated watching it.

I've done it once myself, it wasn't actually unpleasant. I think the problem is I've drunk so much of it and it tastes so disgusting that I can't stand the thought of shooting it.

He'd use a large gauge syringe and needle. 21-23g 10ml as I recall. And he'd water it down slightly as it was too thick to start with.

 

[Lorne???]

I have injected about 30-50 ml two times of horrendous solutions, without filtering, so if I want to, there's no problem in IVing methadone if I wait some time and let my veins heal. But I would need help very time (most likely) since it's very impractical IVing with a 100 ml syringe.

Isn't the sugar in the Methadone a problem when IVing or is the sugar-thing a national thing here? I've heard 11 g sucrose per bottle, which is way too much for me, but I guess that problem is OK if something else compensates (both diet and the medication, bc if it's exactly the same for me, but sugar in methadone, than I'll regret my ass off).

But since BA is 85 % oral, I think I'll manage to not shoot it even when I can go get them and take-away.


I want a high dose. Won't get max but at least 120 mg. I'm a big guy.

Weight has nothing to do with it. I’m not a big guy, and could do enough drugs in in a day to knock out a small town.

120mg is max at some
Clinics, well to get more you have to have a “peak and trough” although that is the states, and the glass
Ceiling varies, though more than 150 seems fairly uncommon (though of
Course, the guy on nearly
half
a gram proves higher doses are certainly given)

Over 100mg,(or just a very high dose) going back to Buprenorphine, and ever having to get off, will become exponentially more difficult; remember that 80-90mg is chronic is already far stronger than a burp dose since methadone is a full agonist, and no ceiling; and it builds up your system, that is why they say go down to 40mg b4 attempting a switch.
Take what you want/need just in my IMO, aside from knowing that you need a high dose, don’t have a target in mind; just go with the flow

 

[JessFR]

Something I found interesting about when I got on methadone is that, I had a crazy high heroin habit. Waay higher than usual. But when I got on methadone I found I was fairly comfortable once I got to about 60mg over a couple weeks.

Which isn't even half of what most people I know are on.

However this is consistent with something else I've noticed, which is that cross tolerance can seem to behave in unexpected ways.

There's no question my habit was higher than most though. Me and a friend of mine we used together, did everything together and had exactly the same habit. We'd know how sick the other was by how sick we were cause we used the same amount at the same time every day.

Anyone else would be floored by smaller amounts of the same heroin we did including people who were actually on twice as much methadone.

I don't really know what to make of it. But I've found strangeness like this all too common where tolerance is concerned. I've never been able to entirely work it out.

There must be an explanation, but I'm not sure what. I've noticed it with a few things though particularly with cross tolerance. That it doesn't behave like you'd think it should.

I wonder if perhaps it's to do with different binding profiles. That the different opioids bind to different combinations of opioid receptors which results in different results in practice than what the cross tolerance charts show which are just based on smaller amounts for pain relief purposes.

 

[Lorne???]

Methadone is stronger than many would think.

Check out opioid calculators, for chronic md, and take into account it’s long duration and slow elimination.

Everyone is different though, and want/need different things, not mention differences in metabolism and such

Surprised potentiators aren’t more commonly used; you can really mess w/ methadone metabolism.

Rather have a single 70mg-maybe 80-dose with proper inhibitors, than a single 100mg dose, as can make MD more potent and last longer, especially with sub chronic use

 

[Keif' Richards]

I had a habit of two grams per day of brown heroin from Masachusetts and I've never found that I truly needed more than ~80mg. This is a dosage that keeps me feeling normal without any daytime sedation. I'm not saying my case is the norm, but I do believe that patients are chronically over-medicated in the United States with both Methadone and Buprenorphine.

 

[Lorne???]

^Yes. People with modest habits thrilled at first to have over 100 mg md until they're tolerance is out of control and acute pain relief, good luck.

Even with it's low and variable ba%, bupe doses are sometimes too high as well, it's still highly potent, the original tablets were a mere 200mcg. And it has a ceiling effect.

Wasn't suggesting MMT patients use inhibitors that was off-topic example (ftr)

 

[Willthiseverend]

Dude probably had hepatitis c.. People with hep c need insane amounts of methadone because their liver processes it super fast or something like that

 

[TargetX]

Man I remember seeing a pic of a dude who got MRSA in his arms from injecting oral methadone. It nearly killed him, he got necrotizing fasciitis, spent a long time in hospital and needed some serious skin grafts all up his arms. He had a few surgeries and had a fasciotomy from all the swelling. He looked like a burn victim. The methadone he had was biodone, which only has purified water, colour and methadone hcl in it and it was from a sealed bottle, however oral solutions aren't sterile live IV solutions are. Most methadone solutions are thick and syrupy, with either sugar or sweeteners in it, thickeners, colours/dyes, preservatives and possibly alcohol or chloroform. That will fuck up your veins in short order, put you at risk of embolisms which could cause a stroke, heart attack or pulmonary embolism, you could go blind, end up with sepsis, abscesses and it really isn't that much stronger when IVed, no real rush per se either.

OST is used to reduce the damages that come with illicit opiate use. With methadone a major part of that is going from IV use to oral, another is so that you stop having to chase a high. You should really try and consider the reasons for being on methadone and if you're actually achieving anything if you start shooting it up, trying to get a high from it. Shooting methadone might be more harmful than IV heroin IMO

EDIT: Found the photos - they are graphic

NSFW:

 

[JessFR]

Dude probably had hepatitis c.. People with hep c need insane amounts of methadone because their liver processes it super fast or something like that

That makes absolutely no sense at all.

 

[Lorne???]

^ Hep C often has little or no symptoms, and it certainly wouldn’t make you metobolize MD “super-fast”

It is metabolized primarily via phase 1 metabolism, multiple P450 enzymes(3A4, and 2c19 primary?)

Injecting MD, especially large doses, is unsafe and self-defeating

 

[DynoSpec]

I take 90mg methadone every day, I came from a .4-.5g/day IV herion habit, which had loads of fentanyl cut into it. I went up to 85mg initially and I was getting sick everyday by the time I got to the clinic the next day(after months), so I went up to 90 and it changed my life. Ive never been so happy, and normal before in my life. I was abusing some drugs a little when I first went onto methadone, but in the last 18 months Ive really cleaned up my act, and now I cant even fathom how I used to live the way I did. Methadone has saved my life. Absolutely, it is a great drug. When used properly it can be a powerful tool for changing your life. I also suffer from chronic pain, I have rheumatoid arthritis and Im not currently in remission so I do deal with a fair amount of pain every day and despite my history of abuse with opiates, methadone still relieves my pain.

As for you wanting to shoot your methadone, mine personally comes pre mixed with Tang juice in the carry bottles so it would be tough to shoot. I go once a week, and when I go in I still take a "witnessed ingestion" dose at the clinic, then take my 6 carries.

I find for me, cannabis has been a great help at keeping myself positive and dealing with pain aswell. Theres a good chance I will end up on methotrexate sooner than later, so then especially I will value cannabis. I know that it isnt for everyone, and statistically cannabis use is associated with relapse so know yourself.

When I got on methadone, my goal wasnt to get totally sober, just to get off heroin but I have ended up basically totally sober by accident! I rarely get cravings anymore, and they are less strong each time. Maybe methadone could do this for you too, if you are willing to commit. There are times when the drs are going to seem like assholes, but they mean well most of the time.

I wish you the best of luck moving forward, happy new year.