Bupe Bupe to Methadone and cross tolerance

[littlebaggies]

Hi,

I was unable to find a thread exactly on point for this question in either the Bupe or Methadone Megathreads:

The background is not unique nor really important here however in essence, I am now hooked on the Bupe, can't get below 2.5 mgs/day and I'm thinking about methadone to taper off the subs. I've seen a lot on the topic of cross tolerance and also a lot of info about how a short term user of methadone will not end up (typically) physically dependent. So, the theory is, 30 mgs/daily of methadone for a couple days, then rapidly cutting that down by 5mgs every couple of days should enable me to titrate down off the sub without too much w/ds. Note: I withdraw pretty hard after 18 hours of no sub.

Question: Does the fact that there is a degree of cross tolerance for any opiate/opioid tolerant individual mean that I'll develop a tolerance faster for methadone than an opioid naive person? Put another way, while it does take some time for users of methadone to develop physical dependence, won't any opioid tolerant individual develop it faster (or already have some on the initial dose)?

Any thoughts would be great

Baggie

 

[Cane2theLeft]

You are already tolerant to methadone. There is substantial cross-tolerance between ALL opioids so if you are tolerant to one you are tolerant to them all essentially. Think of it this way, you are tolerant to opioid agonists, not any individual one.

 

[Znegative]

I think the confusing thing regarding bupe conversions, is that no one can really say at what dose the agonist effects of buprenorphine really plateaus. It's generally accepted that somewhere under or at 32mg will hold a person tolerant to 30mg of methadone, so I would say its safe to say that switching from 2.5mg of bupe to 30mg of methadone would most likely end up raising your tolerance. If you're going to switch to methadone out of preference, than I would start off with 10mg and see how that treats you. Make sure to give it a full three hours to kick in, as it's notorious for having a slow onset, especially in people who do not use it everyday. You probably will not find tapering with methadone any easier than doing so with bupe, as they both are super potent, long lasting opioids. However, I do understand a need to get off of one drug, even if it's to switch to one that is similar. Sometimes it can make a psychological difference.

 

[muskolo]

I was able to get off an 8mg a day sub habit by using kratom for a little over a month. Little to no withdrawal, especially in comparison of what I would of been in for or what methadone w/d's are like.

Take it once you are in withdrawal and do it for the length of time you are in sub w/d then taper off the kratom. Honestly, I take kratom to this day and a few days off have barely any w/d symptoms aside from insomnia and a little anxiety. Although, I take a far less amount than I did while getting off sub.

Just a thought from my own experience.


EDIT: I haven't had sub in over year now; or any other opioid aside from kratom. Don't know if it's just me or if a lot of people are pussies, but I have never had a bad "withdrawal" (if you can call it that) from kratom.

 

[adder]

It's generally accepted that somewhere under or at 32mg will hold a person tolerant to 30mg of methadone...

This would seem very strange. If this is true, then people at hospital wards being transferred from methadone to buprenorphine should be given the highest dose of buprenorphine regarded as the ceiling dose. In practice, a person is tapered down to around 20-40mg of methadone and then is given 8-16mg of buprenorphine in whatever form.

I think a better measure would be 40mg of methadone is equal to 8mg of buprenorphine. Concerning cross-tolerance, of course this is true that if a person has tolerance to one opioid, he/she will experience tolerance effects when switching to some other opioid. But buprenorphine and methadone are so different structurally that in this case it's definitely far from 1:1.

I remember myself trying to taper off using buprenorphine and I felt pretty bad at doses lower than 16mg and the dose I felt really fine at was at least 20mg. When I switched to methadone once again in my life (this time for good), I needed ~50mg of methadone to feel all right. So in my experience a higher dose of methadone was needed when transferring from buprenorphine, on a weight basis of course.

Anyway, concerning switching from buprenorphine to methadone, I don't think this is a good idea. Buprenorphine is a partial mu agonist and this guarantees weaker withdrawal symptoms after eventually tapering off it. Besides buprenorphine doesn't make your thoughts "cloudy" and it's not as dull, actually it is quite stimulating for any action. I was definitely much more motivated to do anything on buprenorphine than on methadone.

Switching from a partial agonist to a full agonist to taper off is a weird solution. Think it over again if the problem isn't in your mind actually. The reason I switched to methadone was because I used very strong opioids (much stronger than heroin) before and also because I used methadone as a tool to stop withdrawal in the past many times. And all this was probably the reason why I needed such a high dose of buprenorphine and I was kind of pressed to taper down quicker than I could bear it as I didn't have an unlimited amount of buprenorphine.

 

[Cane2theLeft]

zneg, I did a training course with reckitt-benckiser reps and its accepted clinically that the ceiling for the agonist effects for most individuals is between 2 and 4mg. The ceiling for the blockade effect is between 16 and 32mg for individuals.

 

[Znegative]

Yeah, I personally believe the cieling (from my owne experience with bupe) to be around 4mg, I said dosages at or under 32mg (sorry, I don't want those italics to come off as sounding aggressive, I just wanted to emphasize that point), should hold a person that is stable at that dosage of methadone, which it would, even if the cieling effect occurs at four milligrams (in which case 4mg would be roughly equipotent to the 30mg of methadone).

 

[Swimmingdancer]

This would seem very strange. If this is true, then people at hospital wards being transferred from methadone to buprenorphine should be given the highest dose of buprenorphine regarded as the ceiling dose. In practice, a person is tapered down to around 20-40mg of methadone and then is given 8-16mg of buprenorphine in whatever form.

I think a better measure would be 40mg of methadone is equal to 8mg of buprenorphine.

I don't think so. Also he/she did say under (or up to) 32mg of buprenophine. Where I live doctors won't even transfer someone from methadone to bupe unless they are on under 25mg of methadone per day, preferably 20mg. The reason this is done is because bupe is known to have a ceiling effect at which a higher dose will not produce stronger effects, whereas methadone does not, and so for people taking above 25mg of methadone/day there is no guarantee that the (purported) ceiling dose of bupe of 32mg will be strong enough to keep them from experiencing withdrawal symptoms. Of course exactly where this "ceiling dose" lies is the subject of debate among some users and it does seem to vary from person to person, but most doctors say it is about 32mg. If 40mg of methadone were equivalent to 32mg of bupe then doctors wouldn't require that someone be below 30mg or 25mg or 20mg (depending on the practice where you live) of methadone before starting on bupe.

The reason that a doctor will start someone at less than the maximum dose of bupe is because they are trying to find the lowest dose possible to alleviate withdrawal symptoms. The equivalent dose when going from methadone to bupe or vice versa is not a precise science and greatly varies from person to person. If when switching from 25mg of methadone you start at 8mg of bupe and it's not enough, you can always raise your dose. Doctors don't want to risk giving someone too much bupe (or methadone) when starting out because they do not want to be responsible for a possible overdose, so they start low and titrate it up if needed. I would recommend someone do the same thing when switching from bupe to methdone. Try 10mg and if that isn't enough after 4 hours take some more. It's also important to note that the way methadone works is that it takes several days to build up to peak levels in one's system, so being a little bit sick for the first few days is very common and doesn't necessarily mean you are taking too low a dose. If the goal is to get off it as soon as possible then I would take as low a dose as you can possibly bear.

 

[littlebaggies]

Thank you all for the replies. Today was my methadone induction, 20mg about 4hrs ago. It was not enough to take me completely out of withdrawal but I knew there was going to be some discomfort, you gotta pay to play. Tomorrow it will be my option to move up 5mg, I'm thinking of doing that and no more. I can take some pain (just not a week of full blown w/d) so I'm going to start rapidly tapering the first week. My wife and kids will be out of town for 7 days, should be plenty of time to get acclimated to lower doses (I hope). I have a follow-up to my earlier question: Assuming I can get to 10mg/day, does anyone have experience with what the withdrawal (if any) from that would be after 7 to 10 days? Assume male, average height, weight, build and liver function, etc. My theory is, if I can hold myself to 10mg/day for over a week, I can jump from there. Note: I'm a total puss when it comes to w/d.