From Suboxone to Methadone

[ChaosControl]

How long does suboxone block opioids? How soon after my last suboxone dose can I take methadone?

 

[opiatekrzy]

My rule of thumb is this: use Suboxone today, dont take any other opiate until the next day. Depending on dose...2-4mg doses in a day you may. Be able to pull off taking methadone with minimum opiate withdrawal blockage

 

[Keif' Richards]

It depends heavily upon how long you have been taking Buprenorphine (Subutex). If you were on maintenance at a common dosage of say 8mg, I would expect 72 hours minimum before you would experience any Opioid effects from Methadone. If you're simply trying to switch, I would recommend biting the bullet and begin taking the Methadone irrelevant of the Bupe. The ideal scenario would leave you with:

Buprenorphine leaving the body -> Methadone entering the body = relatively smooth transition. More information would allow us to help you more effectively Chaos.

 

[ChaosControl]

It depends heavily upon how long you have been taking Buprenorphine (Subutex). If you were on maintenance at a common dosage of say 8mg, I would expect 72 hours minimum before you would experience any Opioid effects from Methadone. If you're simply trying to switch, I would recommend biting the bullet and begin taking the Methadone irrelevant of the Bupe. The ideal scenario would leave you with:

Buprenorphine leaving the body -> Methadone entering the body = relatively smooth transition. More information would allow us to help you more effectively Chaos.

Thanks for your help! So, my situation here is a bit different than what you might have suspected. I'm actually a methadone patient, recently managed down to a prescribed dose of 20 mg methadone a day (10 mg taken twice daily).

That said, I missd my doctor's appointment last week & they weren't able to fit me back in until a few days ago. So, I had ended up staring at a four-day dry period ahead of me (bc I had to see the dr before I could get my script called in). Luckily, I had a last-resort backup strip of 8mg Bupe (specifically for this kind of unforeseeable occurence). Given the relatively low dose of methadone I was on, I was able to start the bupe after only having been off of methadone for less than 24 hours (I had taken a 10mg methadone the day before taking the bupe). Risky, perhaps. (Save the whole "methadone stays in your system for 3 days--why'd you put yourself at risk of a precip w/d" spill pls; chalk it up to a psychological side effect of addiction, but I was already feeling minimal w/d the next day.)

So, after having read that 8mg bupe is roughly equivalent to 60mg of methadone, I split the strip into fourths (intent on using even less than was suggested, so as to both be safe *and* stretch it out), taking one piece a day for the following 3 days. Today is my first day without using the bupe (I had taken my last piece around 6pm yesterday). I have one 1/4 piece of the strip remaining. I also have my methadone script. I'm wondering whether I should start taking my methadone tonight, or use the final piece from my bupe strip and ride that out until whenever is an appropriate time to start back on my methadone regimen. Because it must be one or the other.

Thanks again!

 

[ChaosControl]

My rule of thumb is this: use Suboxone today, dont take any other opiate until the next day. Depending on dose...2-4mg doses in a day you may. Be able to pull off taking methadone with minimum opiate withdrawal blockage

Duly noted! Thanks for the response

 

[Keif' Richards]

And Opiatekrzy definitely does have a good rule of thumb going there, but you situation is a little less straightforward than many others'. Methadone makes things tricky. Please don't ever assume that you are "safe" from precipitated withdrawal. I know in the context of maintenance dosages 20mg per day seems like small potatoes, but in the context of pain management, you are just short of what is considered the maximum prescribable dosage; this dosage being 30mg.

I personally think that you shouldn't mess with the Buprenorphine if you are dealing with a clearly defined and relatively short absence of Methadone. I'm just saying this is what I would do if I were in your shoes. Another option that I might go for would be a microdose. A "micro" dose would be something a lot smaller than 2mg. I'm thinking more along the lines of .25mg or something like that. This is not easy to eyeball, but you really would just be taking minute crumbs of the strip to mitigate some of the symptoms without putting you at risk of severe precipitated withdrawal. That's just my opinion.

 

[ChaosControl]

And Opiatekrzy definitely does have a good rule of thumb going there, but you situation is a little less straightforward than many others'. Methadone makes things tricky. Please don't ever assume that you are "safe" from precipitated withdrawal. I know in the context of maintenance dosages 20mg per day seems like small potatoes, but in the context of pain management, you are just short of what is considered the maximum prescribable dosage; this dosage being 30mg.

I personally think that you shouldn't mess with the Buprenorphine if you are dealing with a clearly defined and relatively short absence of Methadone. I'm just saying this is what I would do if I were in your shoes. Another option that I might go for would be a microdose. A "micro" dose would be something a lot smaller than 2mg. I'm thinking more along the lines of .25mg or something like that. This is not easy to eyeball, but you really would just be taking minute crumbs of the strip to mitigate some of the symptoms without putting you at risk of severe precipitated withdrawal. That's just my opinion.

Well, by the time I had posted the OP, I had already taken the bupe for the prior 3 days. What I couldn't decide, however, was whether or not I should take the final 2mg of bupe on day 4, or to just go ahead and switch back to methadone since I'd been able to get my script earlier that day. I wasn't sure how long the 2mg bupe strips would block opioids or when was ideal to make the transition back into my daily methadone doses.

Ultimately, I ended up taking the methadone, and I have transitioned back onto it seamlessly.

I appreciate all the help!

 

[CfZrx]

How long does suboxone block opioids? How soon after my last suboxone dose can I take methadone?

I take 10mg/day of sub, and recently took 10 to 15mg methadone/day to help pain relief, and I certainly felt it, although it was of course less than if I were not on Sub. So no need to wait in my opinion, I took both on the same day.

 

[JessFR]

It's always been my understanding that there isn't a risk of precipitated withdrawal from switching purely from subs to methadone. Only the other way around.

Though taking subs then methadone the subs again could be a very different story.

All that said, my personal experience with subuxone is zero, so I don't feel at all confident saying any of the above. I'm mainly putting this out there so someone can correct me if I'm wrong.

 

[Nicomorphinist]

The long metabolic half life of methadone helps here, especially the fact that it is lipid soluble and it and its metabolites build up to have maximum effect, so it does seem that there is nothing to lose by starting the methadone right away, so at the very least the metabolic and endocrine systems can get working on it so that when the opioid receptors become available and the CNS ready for it again, serum methadone levels are higher, more stable, and well under way to the longer term maintenance level . . . since there is still buprenorphine in the system at the beginning, have people in this situation had success with starting the methadone right away at 25 per cent of the intended dose, 50 the next day, 75 the next, then the intended dose on Day 4?

 

[CfZrx]

starting the methadone right away at 25 per cent of the intended dose, 50 the next day, 75 the next, then then intended dose on Day 4?

Perfect prescription imho.

 

[Keif' Richards]

If I was just confused, I apologize. There's nothing extreme to worry about when switching from Buprenorphine to Methadone, especially if you are able to work with folks who can adjust your dosage accordingly.