Is pain a big concern for you? I know a lot of people on pain killers have been on them so long that they haven't established their pain level off of the pain killers. Usually they start wtihdrawals which cause even pain free people to have back pains etc.., and they think their pain is coming back strong as fuck. But you really need to wait till after you detox to determine that.
many might not agree with me, but unless you really are ready to quit, which it doesn't sound like, I would see a different doctor, not sign any releases or mention affiliation with another doc.
Your insurance might have issue with you filling these contradicting scripts. Might wanna pay cash for bupe and make sure you get prescribed generic bupe (generic subutuex) other wise you'll be payin an arm an da leg.
It seems that either way towards ending the cycle of addiction is going to lead to a lesser amount of pain relief. As stated above a step straight to suboxone will not be comparable, and even if it's possible to find a way to try both at once, even a small dose of the suboxone is going to inhibit the other opiates action to an extent.
That being said, I think your best option, if you are really ready in your mind, is just to tell your PM doctor that the concept of how addicting opiates over a long span of usage can be scares you, and that you'd like to try suboxone. As others have said, I'm sure he's going to have no problem with that.
Best of luck to you.
If you even managed it there would be zero benefit from taking bupe and a full agonist at the same time. First of all it's really playing with fire, 2nd of all the two simply don't complement one another in any way. Aside from how you will feel mentally and physically, you will end up wasting one or the other because if the full agonist takes affect (if your on a low enough sub dose) thats all you feel. It's not as if you has 20mg methadone in you and added more opiates. You had a partial agonist and now added a full with a dopamine release, something bupe alone lacked.
But if you have ever experienced moderate to severe withdrawals you cringe at the thought of a full blown almost instant fall into the peak of those withdrawals. If you are heavily physically dependent bupe is nothing to play around with. Anyone who has experienced precipitated withdrawals knows how debilitating they are (and I don't mean a minor case, I mean instant dry heaving, shitting. cold sweats, rls. You would do just about anything to get off sick. If you were even physically able. It's tough to go cop when your lying in sweat piss shit throwup naked on a tile floor lol. Thats when you end up making the worst decisions.
But all that aside thats clearly not his intention. I can't speak for him, but personally I think he wants to stay using full agonists and have suboxone for when he runs out of meds early. He stated he clearly has a problem with his pain meds, and wants them to fall back on etc.. Honestly if I was in his position, I would be in the same situation as him. Even though I do want to quit I am just not fully ready, and it wasn't easy to get on this pain clinic, but how do I cope with running out early? Bupe. I'll tell my self I plan to detox etc.. make all these plans to quit, but it simply becomes a tool to bridge the gap.
Honestly I often wonder where I would be right now if I didn't get on bupe. I wonder if I would have quit dope from constantly being in withdrawals after binges, or maybe I would be in a worse spot. Honestly if I used as often as I do now, but took nothing the days I didnt use (about 4 days a week im on bupe, 2 or 3 on dope), my tolerance would be drastically different. For me it's been so long and bupe is like this cushion to fall back on. You can decide to use for just one more weekend or whatever because you won't have to face greuling withdrawals.
Some would say you should just try and make your meds last all month. If it were me, it would be impossible. Once I am at a certain level every road I travel ends up bringing me there. I can start chipping once a month and soon im back using just as bad. I take every approach like a psychopath thinking that somehow I will get different results from essentially doing the same shit lol.
One good thing about bupe especially in contrast to methadone, is tapering is seriously cake. You have absolutely no compulsion to taek extra. Ask a meth clinic patient how mayn times theyve doubled up on their weekend dose of meth, then ask a bupe patient how mayn times they doubled up their bupe dose. Unless your in bupe honeymoon phase, there is literally nothing to be had from a larger dose. Mdone dont get you way high but its still a full agonist. When you taper depending how gentle you are, you do have the impulse to take more, or wait a bit longer etc.. Tapering with any full agonist is hard.
Bupe is something you can actually taper on your own without needing it dispensed. If you go slow and proper and down to like 0.25mg evey other day, you can walk off bupe and not even miss a days work. Walking off 2mg+ is a WHOLE idfferent story. For me every time Ive gotten to like .5mg daily, I end up making a really stupid decision to use, and only god knows when i'll make it back on track IF I will.
Once you get that low on bupe if you stabalize over a few months, you actually get a really big pick me up from dosing.