Looks like this doctor is being at best manipulative and at worst entirely unethical (I vote unethical - there is no reason for treating a patient like this).
The doctor canceled your dose Sunday and Monday because they want you to get as much of the methadone out of your system before they induce you on buprenorphine. The idea is to avoid precipitated withdrawal. Those two days shouldn't be too horrible given methadone's long half life (it takes a couple days for withdrawal to really set in).
That all said, I have to call bullshit on this "professional."
Seems to me like your doctor is telling you what's best for you, as opposed to working with you to accomplish goals you identify as important.
Dude would do good to take a motivational interviewing training... Doctor's might know what is best for their patients (in some instances at least), but with something like addiction that means very, very little. It's far more important to actually empower the patient (not just make them feel empowered, but actually support them cultivating skills that allow them to independently become so for themselves).
Showing someone what it's like to become empowered doesn't happen when they're being led around their early recovery on a leash.
OP, do
YOU want to get off methadone? Do you want to transition to Suboxone like this?
I see a lot of read flags with what you described in your post, but I hope it works out well for you. Please do let us know how you're doing.
[below is a bunch of stuff I misread from the post - so a lot of info but kinda besides the point]
Hello,
i am currently on 32mg methadone daily and due to severe, severe constipation my doctor wants to switch me over to suboxone next week. He lowered my dose to 29mg methadone today. He wants me to stop dosing on Sunday. He cancelled my dose for Sunday and Monday. He set an appointment for me to get suboxone on Tuesday morning.
Im afraid of the withdrawals. Has anyone ever switched from methadone to suboxone before? What should I be aware of. What will help with withdrawals. I have a Med cabinet full of medications that I?m willing to take if it will help.
I have never ever heard of someone jumping from methadone to suboxone like this before. Especially at this dose. Please share your experiences. Thank you.
Jumps from methadone to buprenorphine like that aren't very uncommon. It's generally recommended to transition people off methadone using Subutex (only buprenorphine) and not Subuxone (buprenorphine+naloxone), but that's not the biggest issue with what you may be doing.
Would you share a bit more about taking methadone?
- What was your habit like before starting methadone?
- How long have you been taking methadone?
- What was the highest dose you went up to and what (if any) taper have you been doing?
- Has constipation only been an issue recently?
- Have you tried anything else to deal with the constipation?
- The most important question: Do you want to get off methadone right now?
As a general rule constipation would have to be really severe to necessitate a quick transition off the medication. Generally it can be managed with fiber, diet, in some cases medication (yes there is a medication specifically prescribed for opioid induced constipation) and by lowering you dose of methadone.
Unless you're really motivated to get off methadone NOW, or there is serious concerns about your GI system/bowls, I'm not sure rushing to get off methadone is the best idea.
That said, if you are highly motivated to get off and have a plan for how you'll manage with things post methadone, go for it! ~30mg of methadone should be fairly manageable with standard comfort medication (buprenorphine, diazepam, gabapentin, clonidine and a non-habit forming sleeping pill).
What are your plans post methadone? I spent about two years preparing for getting off methadone prior to making the jump and it made things so, so much more manageable. I did taper to a lower dose than you, but unless you've only recently tapered down to your current dose you shouldn't be in for too much discomfort. With the right comfort meds, the two weeks or so of acute withdrawal should be pretty manageable.
It may be a good idea to consider using Suboxone/buprenorphine for an extended period of time while you get oriented with not taking methadone. An extended detox of six months on buprenorphine (most of that is spent tapering the buprenorphine) is generally recommended for long term methadone patients, and is becoming more common with people coming off methadone more generally (and from what folks can tell it seems to do nothing but increase long term success rates).
Why would he cancel your doses for two days before starting the subs? Maybe there is a medical reason for this but surely he could have communicated that if there is. Did he offer anything for WDs?
The issue is precisely a medical one. Buprenorphine is a opioid partial agonist. That mean's it acts in various ways as both an agonist and an antagonist. Other opioid agonists (not partial, but full agonists) are drugs like heroin, morphine, oxycodone and codeine - e.g. traditional opioids of use. Opioids like naltrexone and naloxone, which can block the effects of opioid agonists and reverse opioid overdose respectively, are full antagonists.
Methadone is a powerful opioid agonist. It has a long half life. Maintenance use saturates the body's opioid receptors. Buprenorphine is an effective medication used to manage the acute withdrawal of opioid agonists, however as a partial agonist it has the potential to interact with any full agonist opioids attached to opioid receptors. Administering buprenorphine prior to full agonists leaving the system results in an extremely uncomfortable phenomena called "precipitated withdrawal." Acute withdrawal to the Nth power.
The issue with using buprenorphine to detox someone coming off methadone is that methadone has a long ass half life. It takes about five days for methadone to fully leave someone's system who has been using it long term. For most people the majority of the methadone will be out of one's system by the 48-72hr point, but it depends on specifics. If buprenorphine is administered prior to the methadone leaving one's system precipitated withdrawal results (the more the methadone in one's system at the time of administering buprenorphine, the nastier the precipitated withdrawal will be).
The minimum wait time between discontinuing methadone and starting buprenorphine is 2-3 days. In some cases it requires 5-7 days before it's safe to induce on buprenorphine. Those 2-7 days of withdrawal can be comfortably managed with non-opioid comfort meds. It's also safe to use a short acting opioid like codeine or tramadol to manage the early acute withdrawal before getting onto buprenorphine for the rest of the detox, just as long as one waits 24hrs between the last dose of short acting full agonist opioid and starting buprenorphine (again, the issue of precipitated withdrawal, though it's less an issue with shorting acting opioids in terms of the time required to safely induce).
