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  • BDD Moderators: Keif’ Richards | negrogesic

NEED HELP RECOMMENDING SAFE DOSE OF MORPHINE TO PREVENT WITHDRAWALS. SWITCHING SUBUTEX TO METHADONE

Opiatelover7423

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Joined
Jan 5, 2019
Messages
15
So I’m after a bit of advice. Used to use Oxycodone with an average daily dose of 400mg for approximately 7 years. I ended up going to prison and was put onto methadone which I was stable on at 50mg for the last 17 months. Just before release that was switched to 8mg Buprenorphine/ Subutex (Espranor). I have not got on with it at all as it makes me feel weird and does not control the pain which led me to oxy in the first place. They tried increasing it up to 16mg which I’ve been on for about 5 weeks but still not got on with it so am switching back to methadone. They are leaving a 2 day gap between the buprenorphine and methadone so yesterday was my last dose of 16mg buprenorphine and I will start 30mg of methadone the day after tomorrow which will be increased by 10mg every 3 days to 50mg then be reviewed. Everywhere online says methadone should be started 24hrs after last buprenorphine dose. I don’t want to have really bad withdrawals and don’t want to be in pain. I have some SR Morphine but don’t know what dose to take. I want to be as comfortable as possible while I wait to start methadone but don’t want to OD myself. Any help would be appreciated!
 
Probably like 50mg methadone. I would recommend staying on buprenorphine though, methadone is objectively worse in every way
 
Probably like 50mg methadone. I would recommend staying on buprenorphine though, methadone is objectively worse in every way
They will be putting me up to 50 ml but I need to know how much morphine i should take as I’m not starting my methadone script until tomorrow. And am feeling really rough now as haven’t had any buprenorphine for 2 days. I know the methadone is considered worse and really didn’t wanna go back on it but buprenorphine just does not agree with me
 
Honestly I don't know why they're making you wait to induct back onto the methadone, the need is only present the other way around, switching from methadone to bupe. I recently switched from 20mg bupe over to methadone, I'm on a much higher dose now but I switched straight from 20mg bupe to 40mg methadone without missing any days. You only need to clear your system when inducting to bupe from methadone to avoid precipitated withdrawal.
 
Honestly I don't know why they're making you wait to induct back onto the methadone, the need is only present the other way around, switching from methadone to bupe. I recently switched from 20mg bupe over to methadone, I'm on a much higher dose now but I switched straight from 20mg bupe to 40mg methadone without missing any days. You only need to clear your system when inducting to bupe from methadone to avoid precipitated withdrawal.
That’s exactly how I understood it to be too but the doc (a cover dr that I don’t think knew much about it) insisted that I needed 48hrs off, so I accepted her advice then researched it when I got home and found she was totally wrong. You have any ideas on the dose of morphine to take? Basically I need to know either methadone-morphine or buprenorphine-morphine conversion but answers aren’t straight forward online for them 2
 
Well, my understanding, just as a guy on an internet drug forum, I'm not a doctor, but my understanding is that bupe has an MME ratio of 1:75, meaning 1mg buccal bupe is equal to 75mg oral morphine. That said, these conversions are kinda like translating languages, sometimes the nuance gets lost in translation.
 
Well, my understanding, just as a guy on an internet drug forum, I'm not a doctor, but my understanding is that bupe has an MME ratio of 1:75, meaning 1mg buccal bupe is equal to 75mg oral morphine. That said, these conversions are kinda like translating languages, sometimes the nuance gets lost in translation.
Yes I have seen 1:75 and 1:40 but that seems incredibly high. I think I’ll take 30mg morphine (crushed) for now and see how I get on and if anyone else can shed some more light on it. Thanks for your help
 
Careful @Seeaceme I respect your own experience/opinion regarding Methadone. I don't think it's good to say that it is objectively worse. Buprenorphine and Methadone are different things. They each have their own advantages and disadvantages. For a lot of people, especially heavier users like our OP with a previous habit of 400mg Oxycodone, Buprenorphine (Suboxone/Subutex) is just not enough. Buprenorphine was a much more effective drug when people were still using pharmaceutical Opioids and Heroin was the most potent thing around. People who use Fentanyl for instance, I've never met a person for whom Buprenorphine was enough to do what it was supposed to do. For these same people, sometimes even Methadone isn't enough.

Besides, our guy has had success with Methadone in the past. Let's not put ideas in his head that there's anything wrong with it. I'm not really sure why the prison would switch you to a different medication directly before release. That's not really important right now.

You don't need to wait at all if you're switching from Buprenorphine to Methadone. Precipitated withdrawal happens when Buprenorphine is given to an Opioid-dependent person too early, not vice versa. If you start Methadone "too early" the only issue is that some of the Methadone will be blocked by the Buprenorphine. Then you go back the next day and less will be blocked and you will begin to feel the Methadone more and more until ~5 days in at which point you'll only be feeling residual effects from the Buprenorphine. In other words, there really is no consequence to starting the Methadone "too early" and really, putting a person through withdrawal for this purpose seems unnecessary.

Obviously listen to your doctor. You'll have to play ball with him regardless.

Converting other Opioids to Methadone is complicated as their is an abnormally high variability from person to person in regard to Methadone's bioavailability. It is heavily affected by enzymatic activity, whereas OP's former DOC Oxycodone, features hardly any significant enzymatic activity. For this reason, the oral bioavailability is often quoted at figures of 40%-80%, which is a shit ton of wiggle room for such a potent drug.

You should be able to return to your previous stable dosage without a lot of issues. I'm pretty sure government regulation forbids inducting any person for any reason at above 30mg Methadone on day one. They should be able to raise you by 10mg each day though without issue. This gives you a few days at a relatively low dose, putting you at your previous stable dose around day 3 right as your Buprenorphine levels start to seriously drop. This should be fine for you. It shouldn't be too difficult mentally or physically.

Let me know if I missed anything and good luck.
 
Careful @Seeaceme I respect your own experience/opinion regarding Methadone. I don't think it's good to say that it is objectively worse. Buprenorphine and Methadone are different things. They each have their own advantages and disadvantages. For a lot of people, especially heavier users like our OP with a previous habit of 400mg Oxycodone, Buprenorphine (Suboxone/Subutex) is just not enough. Buprenorphine was a much more effective drug when people were still using pharmaceutical Opioids and Heroin was the most potent thing around. People who use Fentanyl for instance, I've never met a person for whom Buprenorphine was enough to do what it was supposed to do. For these same people, sometimes even Methadone isn't enough.

Besides, our guy has had success with Methadone in the past. Let's not put ideas in his head that there's anything wrong with it. I'm not really sure why the prison would switch you to a different medication directly before release. That's not really important right now.

You don't need to wait at all if you're switching from Buprenorphine to Methadone. Precipitated withdrawal happens when Buprenorphine is given to an Opioid-dependent person too early, not vice versa. If you start Methadone "too early" the only issue is that some of the Methadone will be blocked by the Buprenorphine. Then you go back the next day and less will be blocked and you will begin to feel the Methadone more and more until ~5 days in at which point you'll only be feeling residual effects from the Buprenorphine. In other words, there really is no consequence to starting the Methadone "too early" and really, putting a person through withdrawal for this purpose seems unnecessary.

Obviously listen to your doctor. You'll have to play ball with him regardless.

Converting other Opioids to Methadone is complicated as their is an abnormally high variability from person to person in regard to Methadone's bioavailability. It is heavily affected by enzymatic activity, whereas OP's former DOC Oxycodone, features hardly any significant enzymatic activity. For this reason, the oral bioavailability is often quoted at figures of 40%-80%, which is a shit ton of wiggle room for such a potent drug.

You should be able to return to your previous stable dosage without a lot of issues. I'm pretty sure government regulation forbids inducting any person for any reason at above 30mg Methadone on day one. They should be able to raise you by 10mg each day though without issue. This gives you a few days at a relatively low dose, putting you at your previous stable dose around day 3 right as your Buprenorphine levels start to seriously drop. This should be fine for you. It shouldn't be too difficult mentally or physically.

Let me know if I missed anything and good luck.
Thanks for all that thorough information. I really don’t know why they made me miss 2 days but I got through them with the help of a little bit of morphine 30mg crushed as and when I felt I needed it totalling 120mg on the first day and less every day since. I have continued with the morphine until today as they were only willing to increase the methadone on every 4th day but I’ve only been taking 1-2X 30mg for the last couple days and plan on it being last day on the morphine today as I will be at 50mg methadone tomorrow. I feel I probably could have gone straight back to 50mg methadone without any issues but I don’t really have much experience switching to/from methadone and they said 30mg was the max I could start on. When I was taking oxy I could switch to morphine or H if I run out of oxy and I would know roughly how much to take but after 18months on nothing but methadone I have no idea how much morphine or oxy I could handle as there’s not much info about conversion to/from methadone on the internet like there is other opioids. What you say about there being such a big variation would explain why there’s so little info available about conversions. As for buprenorphine from what I understand is when converting to it from other opioids it’s considered at least 40X stronger than morphine but when converting from buprenorphine there’s no certainty on where your tolerance is at and it could be significantly lower than the conversion rates and because of this there’s no guides on switching from bupe to any other opioids except methadone which is capped at 30mg as a maximum. As for the prison switching it before release, this is something they do routinely as it is supposed to reduce your risk of overdose from street opioids after a period of abstinence. I have seen your posts on a lot of threads on here and you always seem to give good advice so you seem the best one to ask, if I decided to have occasional nights on oxy what would be a reasonable dose to start with taking in to account my previous use, a period of 18 months taking nothing but 50mg of methadone and the fact I’m going to be taking 50mg methadone regularly so that’ll be in my system along with it? Now I know it’s not wise to be taking it after being dependent on it and getting off it and onto a stable dose of methadone but I only plan on doing it now and again and regardless of if it’s stupid I know I’m going to do it at some point but I know the risks of slipping and becoming an everyday thing and I really can’t let that happen. I just wanna know what a safe starting dose that’s going to get me feeling nice would be?
 
Hey @Opiatelover7423 Thanks for the kind words. I'm glad I've been able to help.

Here is the thing. Methadone is not as subjectively "good" as Morphine. There is a whole textbook of science I'm not gonna try to unload on everyone right now. Suffice to say, there is a preference. However, Methadone itself is "good" in its own way. If I had to try to quantify it, it's like 75% as good as Morphine/Heroin. What I'm driving at, is that it is possible to stabilize on Methadone without any other Opioids.

I've been at points in my life where I've injected 3-4 grams of Heroin a day. That's extreme circumstances. Still, my lifetime use was ~2g every day for ~12 years. I tried Buprenorphine. It was not a good situation. It made me feel like I was locked in a stasis. I couldn't use Opiates due to the blocking effect. The problem was that I was still craving Opiates BAD, all day every day. I was somewhat stable, physically speaking, not dopesick. The cravings were unreal though. It did not sate my cravings. I was like a starving guy who couldn't eat food.

Methadone was different. Once I got on a high enough dose, I didn't crave Opioids so much. Cravings can be this primal, visceral feeling like sexual lust, where your whole body and mind are dragging you toward dope. My cravings now are like memories that I'm able to understand without those intense feelings. I remember it felt good. I know that I want to feel good. Basic logic tells me I should use Heroin again. When you're on the right dose of Methadone, you're satisfied. You don't want more Opioids.

That is the goal I feel you should be working towards. You might need more Methadone. There would be nothing wrong with you going up to 80mg Methadone and see how you feel. I truly believe that when you get up to the right dose, your cravings will be much easier to handle.

When I've been on Methadone maintenance, I've never actually been able to get "high". I've injected large amounts of Heroin; my nose itches for a few minutes then I take a nap. That's great if you want to take a nap, though you could get the same effect by taking a few Diphenhydramine (Benadryl) or what have you.

Basically, the effects of the Morphine will be heavily blunted by the Methadone. You are unlikely to get where you actually want to be. I consider taking other Opioids with Methadone a waste of time. I know some people use Fentanyl to "break through", though that seems to just entail an immediate, unconscious stupor for 1-2 hours followed by a return to consciousness.

You are your own man. I can't judge you for wanting to experiment. I'd start by just taking your normal dose of Morphine. If that doesn't work, you can up the dose after 45-60 minutes. I'm telling you as a friend looking out for you that this practice is a waste of time, money and doesn't help you in trying to fix your life.

Again, I understand completely. Do your experiment and see how it is. You're unlikely to overdose, especially considering your cautionary approach. I would advise trying 80mg Methadone for a week or two.
 
Hey @Opiatelover7423 Thanks for the kind words. I'm glad I've been able to help.

Here is the thing. Methadone is not as subjectively "good" as Morphine. There is a whole textbook of science I'm not gonna try to unload on everyone right now. Suffice to say, there is a preference. However, Methadone itself is "good" in its own way. If I had to try to quantify it, it's like 75% as good as Morphine/Heroin. What I'm driving at, is that it is possible to stabilize on Methadone without any other Opioids.

I've been at points in my life where I've injected 3-4 grams of Heroin a day. That's extreme circumstances. Still, my lifetime use was ~2g every day for ~12 years. I tried Buprenorphine. It was not a good situation. It made me feel like I was locked in a stasis. I couldn't use Opiates due to the blocking effect. The problem was that I was still craving Opiates BAD, all day every day. I was somewhat stable, physically speaking, not dopesick. The cravings were unreal though. It did not sate my cravings. I was like a starving guy who couldn't eat food.

Methadone was different. Once I got on a high enough dose, I didn't crave Opioids so much. Cravings can be this primal, visceral feeling like sexual lust, where your whole body and mind are dragging you toward dope. My cravings now are like memories that I'm able to understand without those intense feelings. I remember it felt good. I know that I want to feel good. Basic logic tells me I should use Heroin again. When you're on the right dose of Methadone, you're satisfied. You don't want more Opioids.

That is the goal I feel you should be working towards. You might need more Methadone. There would be nothing wrong with you going up to 80mg Methadone and see how you feel. I truly believe that when you get up to the right dose, your cravings will be much easier to handle.

When I've been on Methadone maintenance, I've never actually been able to get "high". I've injected large amounts of Heroin; my nose itches for a few minutes then I take a nap. That's great if you want to take a nap, though you could get the same effect by taking a few Diphenhydramine (Benadryl) or what have you.

Basically, the effects of the Morphine will be heavily blunted by the Methadone. You are unlikely to get where you actually want to be. I consider taking other Opioids with Methadone a waste of time. I know some people use Fentanyl to "break through", though that seems to just entail an immediate, unconscious stupor for 1-2 hours followed by a return to consciousness.

You are your own man. I can't judge you for wanting to experiment. I'd start by just taking your normal dose of Morphine. If that doesn't work, you can up the dose after 45-60 minutes. I'm telling you as a friend looking out for you that this practice is a waste of time, money and doesn't help you in trying to fix your life.

Again, I understand completely. Do your experiment and see how it is. You're unlikely to overdose, especially considering your cautionary approach. I would advise trying 80mg Methadone for a week or two.
To be honest I was completely fine on my 50mg a day for the last 18 months and didn’t really have any intense cravings for anything else. The short period of time on bupe has been totally different and I would’ve done anything for a bit of oxy or H but like you said, they don’t work with bupe. I fully believe when I settle back on 50mg methadone I won’t have any intense cravings but after being locked away for 18months without even a crumb of oxy I know at some point I’m gunna want to have a go. I’m confident it won’t become a problem as I am satisfied on methadone. I have heard other people saying other opioids don’t work the same while on methadone but have heard others saying other opioids they find it makes the affects stronger but I guess I’ll find out myself. I only used the morphine while switching as I was scared of facing withdrawals again and wasn’t really trying to get high. I haven’t ever actually managed to get a proper high off oral morphine, oxy on the other hand can be very enjoyable as can H and I know I’m going to want to have a little try again, although there’s no way I’ll touch H again! I’ll have a little blast on the oxy and see if I get anything out of it while on methadone, if I enjoy it then it’ll have to be a very occasional treat, heroin on the other hand I don’t believe could be an occasional treat so I’ll be staying away from that now. Thanks for all your help, much appreciated! 👍

PS apologies to anyone reading, my grammar/punctuation etc is not very good anymore and I’ve sort of rushed this post 😂
 
So you on the methadone now?

i agree a lot with what @Keif' Richards said, but with my own personal exp, you can you use H on Buprenorphine and methadone, the problem is to use enough to knock the receptors clean and so then that the H can do its job.

But yeah you can use methadone striaght after the rest as it is Buprenorphine or morphine ther will be no pcw, seeing as its a full agonist.


 
@Opiatelover7423 that feeling of "maybe I don't need Opiates when I'm on Methadone" is the universe throwing you a bone. It's giving you an opportunity to make a rational choice without fear, pain and withdrawal motivating you. Recognize this moment for what it is. It is a crossroads. You can take this small, positive improvement and cultivate it. Here you are, the universe has been nice enough to allow you to keep taking Opioids permanently, collect them from a window legally and maybe enjoy every single wonderful thing life has to offer. It is the best of both worlds for folks like you and I.

Be strong and don't give in to the cravings. Other Opioids are really a waste anyway. But, when you go buy your drugs, you're connecting with other users and just having them in your orbit will give you more and more options to fuck up. You can go buy Fentanyl from someone, but then you're connected. It's better to have distance between these things. A lot of moments in my recovery, a relapse was prevented because I didn't have active relationsihps with dealers anymore. I would have to go downtown, try to score, maybe get ripped off, freeze my ass off... compared to having a number to call that will have drugs delivered to your front door, the distance gives you some insulation. Once the cravings pass, you'll be glad you made it through.

If you ever need to talk, I'm available buddy.
 
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