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H&R Moderators: VerbalTruist
Starting methadone maintenance
- Thread starter IDied
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Jabberwocky
Frumious Bandersnatch
Thanks for the feedback Lynn. That is basically my plan. I went down from 90mg to 20mg doing 5mg drops each week without any problem or discomfort. In fact I have felt a lot better overall each drop, like now I have way more energy, focus and general alertness than I had at 30mg or any higher dose. In fact I think I actually enjoy the buzz my dose gives me now more at 20mg than at any higher dose.
I'm planning to stay at 20mg for a few months, at least two or three I think. The thing is, as much as I really really want to get off methadone so I don't have to deal with the whole clinic environment and deal with their rules and limitations on my life such as with travel and takehomes, I just know I'm not ready to stop taking opioids. I don't have enough fulfillment materially speaking in my life yet, and I mean on a super basic level. I don't need a Ferrari to quit, but I do need to be fully self sufficient before I feel I can realistically be able to handle the stresses of life without my opioid crutches.
I may drop down to like 10 or 12mg before I start my final taper, but I'm still concerned about my dose losing its magic if I continue reducing it much more before I'm ready to start getting off. Do this make sense to you, or do you understand what I mean? I can't wait to get off though like I said, but I refuse to do so until I feel I'm ready and have enough support to maximize my chances for success. I will do anything to avoid getting back on illicit opioids.
Anyways, I plan in dropping no more than 1mg each week, possibly 1mg every other week. Once I get to 10mg I will definitely not be dropping faster than 1mg every other week. Once I hit 5mg I'll probably drop 1mg every month. I plan on staying at 5mg for at least two or three months, and 3mg for the same amount of time. My goal and tentative plan, assuming I'm able to do this as expected without significant discomfort (considering my slow conservative final taper and the comfort mess I'll be supplementing my dose with, namely pregabalinx possibly clonidine at night if absoliyrly necessary, and having 150mg of trazodone and 30mg of temazepam avaliable if/when extreme measures are necessary as i respond very well to those mess and have never had a problem controlling my use of them to avoid dependency or tolerance) is to go all the way down to 1mg and stay there for a number of months, at least three, so that when I finally jump off my body will truly only be acclimated to a daily dose as low as possible. I may take a low dose of buprenorphine for the first month off methadone, in combo with clonidine at night and pregabalin during the day, again to maximize my chances of a successful, sustainable detox from methadone.
Your thoughts Lynn? I'm so sorry for hijacking this thread everyone. I'm just really excited and interested in getting some fairly objective feedback on my plans from someone who's done this recently I respect. Thank you all and especially OP for bearing with me on this. And thanks again Lynn for your feedback again!!!
IDied
Bluelighter
For some reason I don't feel any kind of buzz at all besides I have a lot of energy! I dosed almost 12 hours ago.i am starting to have a little bit of cravings at the moment.i sort of feel like 30mg wasn't a adequate dose for my tolerance.but...I am going to stay on 30mg until Monday and then I go up to 40.i would like to have a little sedation because I am a VERY hyper guy as it is! Is this normal that I have a lot of energy? I would like to relax at some point tonight lol
Erikmen
Bluelight Crew
- Joined
- May 3, 2014
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Try to adapt yourself to the right dose but keep in mind that the lower you stay the easier it becomes to get out if it comes to that.
I've been on methadone for years and when I stopped I had wished I'd stayed on lower dosages. Find your comfort zone and soon you'll see the distance you are getting from your previous addiction issues.
Erik
I've been on methadone for years and when I stopped I had wished I'd stayed on lower dosages. Find your comfort zone and soon you'll see the distance you are getting from your previous addiction issues.
Erik
IDied
Bluelighter
I was just reading somewhere on bluelight that it takes time during the induction period for the methadone to actually build up in your system? So that being said will tomorrow's dose pretty much add to today's given the half life of methadone? Guess I'll find out lol one day at a time I keep trying to tell myself
Yes that is correct. . Stable levels are reached for most between 3-5 days. I would not worry if you go into a bit of mild withdrawl in the next couple nights as that should go away.
If you read the link I posted in the info I gave you.. the one whos title is about neropathic pain it tells what a complex interaction methadone has and may give you insights about your new found energy.
If you read the link I posted in the info I gave you.. the one whos title is about neropathic pain it tells what a complex interaction methadone has and may give you insights about your new found energy.
Toothpaste- your plan sounds good to me. I noticed I felt a lot better at 20mg than I ever did at 70. Once you get to 15mg, I suggest dropping 2mg/ biweekly & if that is too uncomfortable, try 1mg/week. It equals the same but gives your body time to adjust. Remember, the lower your dose gets to take into account the percentage dropped. If you're on 100mg and drop 5 that's only a 5% decrease. If you are at 10mg and drop 5, that's a 50% decrease and you'll feel it. Try to keep the percentage drop as steady as you can.
Also, I suggest you drop all the way down to 1mg before you quit if you can. Hopefully that'll make it easier. After a decrease, don't drop again until you feel stable. That might take longer than a week or it might not- just try not to go back up. It's better to stay where u are as long as you need than to increase again.
You can do this. Lyrica or Gabapentin helped me the most with the physical withdrawals.
Erik- yes I'm completely off of methadone. I haven't touched it since I quit. I don't take anything anymore- no drugs except my narcolepsy medication which is obviously non narcotic lol
IDied- IMO, being sleepy on methadone means the dose is higher than you need. If you don't have any withdrawals, try to keep it as low as possible.. I wish someone had told me that when I started. It does have a half life so if you take 30mg today, tomorrow there will still be 15mg left in your system. That's how it was explained to me anyway.
Also, I suggest you drop all the way down to 1mg before you quit if you can. Hopefully that'll make it easier. After a decrease, don't drop again until you feel stable. That might take longer than a week or it might not- just try not to go back up. It's better to stay where u are as long as you need than to increase again.
You can do this. Lyrica or Gabapentin helped me the most with the physical withdrawals.
Erik- yes I'm completely off of methadone. I haven't touched it since I quit. I don't take anything anymore- no drugs except my narcolepsy medication which is obviously non narcotic lol
IDied- IMO, being sleepy on methadone means the dose is higher than you need. If you don't have any withdrawals, try to keep it as low as possible.. I wish someone had told me that when I started. It does have a half life so if you take 30mg today, tomorrow there will still be 15mg left in your system. That's how it was explained to me anyway.
what about switching from methadone to subutex or suboxone? I'm on 60 mgs for 10 days now, and I feel great with it, I've adjusted well. But i am a musician who goes on tour, and probably will have a US tour coming up in mid-2016.... My plan is to switch to buprenorphine 8mg a day, and tour with that, and then either go back to the methadone, or continue with bupe, with plans to eventually quit, tapering off bupe.
I was addicted to heroin when i was 19, and then I got on suboxone, and started tapering over the course of about a year and a half, and it was basically painless to quit after I decreased my dose from 16 mg everyday, to 2 mg every other day... and thats where I made the jump, from 2 mg every other day, to nothing was simple, I felt completely withdrawn after 8 days of cold turkey.
I was addicted to heroin when i was 19, and then I got on suboxone, and started tapering over the course of about a year and a half, and it was basically painless to quit after I decreased my dose from 16 mg everyday, to 2 mg every other day... and thats where I made the jump, from 2 mg every other day, to nothing was simple, I felt completely withdrawn after 8 days of cold turkey.
Hey Motiv! The hard part about switching from methadone to suboxone is methadone half life and annoying habit to stick in your system. To avoid precipitated withdrawals, most clinics want you be off methadone and any other opioid for 5 days. That's pretty tough.. They would probably taper you down to at least 30mg, and then you'd need to stop completely.
Once I got down to 8mg on methadone I considered switching to subs but I figured I'd come this far, might as well just finish. I've heard suboxone wd lasts weeks but I only took a sub once. It's always worth a try!
Once I got down to 8mg on methadone I considered switching to subs but I figured I'd come this far, might as well just finish. I've heard suboxone wd lasts weeks but I only took a sub once. It's always worth a try!
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I have not heard from anyone that ended up in precipitated withdrawl going from methadone to suboxone. From my exspierience and what I have read frpm others I do not think this is something to worry about with this transition.
NSA, when I wanted to switch I got several opinions and spoke to 2 clinics. They all agreed the person has to be tapered to around 30mg (lower is better) and the minimum wait time is 72 hours- my clinic insisted on 5 days.
I could be wrong but I never wanted to take the chance. I had PW before and they were TERRIBLE.
I could be wrong but I never wanted to take the chance. I had PW before and they were TERRIBLE.
cj
Bluelight Crew
I have heard of a few people having major problems making the switch. I think I would wait at least 100 hours after my last methadone dose before I started with a small dose of sub. I have also read that being under 60mg of methadone is recommended before switching as well.
Must be dependent on the individual then. I remember having my methadone swiped one time and took a suboxone strip a little over 24 hours after my last dose of methadone (150 mgpd) and I was golden.
I have also seen quite a few people chime in, when this subject was being discussed previously, starting they also had no problems switch really soon after taking their last dose of methadone.
EDIT: Five days would have put you off the short acting opiates. Should not go into much if any withdrawls for two to three days from the methadone.
I have also seen quite a few people chime in, when this subject was being discussed previously, starting they also had no problems switch really soon after taking their last dose of methadone.
EDIT: Five days would have put you off the short acting opiates. Should not go into much if any withdrawls for two to three days from the methadone.
It probably is different for some people. Before you start subs you are supposed to be in moderate withdrawal. Since methadone can take 3-4 days before that even happens, I think that's why you're expected to wait longer. The bupenorphine will kick out and replace any opioids on the opioid receptors but it leaves the bupe weaker- causing pwd.
Sounds like you & some other people were pretty fortunate. I'm sure dosage, length of time taken & body weight play a part too. I just wouldn't wish PWD on anyone. Uggh.
I was told if it does happen, you can take more suboxone and it might help get past it sooner. Not sure though.. Sounds like a hit or miss to me lol
Oh, and you can always find a copy of the COWS sheet that calculates if you're in zero, mild, moderate or severe withdrawal. Most doctors use it before giving suboxone- or the doctor I used to work for used it. It's free online too.
Sounds like you & some other people were pretty fortunate. I'm sure dosage, length of time taken & body weight play a part too. I just wouldn't wish PWD on anyone. Uggh.
I was told if it does happen, you can take more suboxone and it might help get past it sooner. Not sure though.. Sounds like a hit or miss to me lol
Oh, and you can always find a copy of the COWS sheet that calculates if you're in zero, mild, moderate or severe withdrawal. Most doctors use it before giving suboxone- or the doctor I used to work for used it. It's free online too.
Another way to look at is there have been a low percentage of unlucky people who ended up with negative exspieriences. I believe what CJ is claiming, but its the first I have heard of this and I still have yet to hear from a first hand account. Maybee this thread will generate one.
Please don't take this wrong, I respect your opinion and believe your experience completely, but are you suggesting that taking a sub the day after taking methadone would be fine?
Just wondering why doctors and clinics insist on tapering and waiting if there was no need. Am I misunderstanding? I think my clinics policy of 5 days was excessive considering I was on a low dose, but I saw patients get prescribed subs but didn't wait until moderate wd as directed who were back by the end of the day very sick.
My husband on the other hand, has a unique reaction with methadone. He can take 80mgs and still feel the high of an oxy. I could never feel a single bit of oxy on any amount of methadone. Lol it's just a tricky drug I guess.
Maybe itll be painless for him as it was for you. I hope so, that would be awesome!
Just wondering why doctors and clinics insist on tapering and waiting if there was no need. Am I misunderstanding? I think my clinics policy of 5 days was excessive considering I was on a low dose, but I saw patients get prescribed subs but didn't wait until moderate wd as directed who were back by the end of the day very sick.
My husband on the other hand, has a unique reaction with methadone. He can take 80mgs and still feel the high of an oxy. I could never feel a single bit of oxy on any amount of methadone. Lol it's just a tricky drug I guess.
Maybe itll be painless for him as it was for you. I hope so, that would be awesome!
I respect you and your opinion as well.
If you stick around (which I most certainly hope you do) and continue to share your valuable support and hard won wisdom, that you may find yourself doing a ton of research in so many fields. In doing this you may find, as I have, that there are ocean liners full of total BS out there. Trouble is we need to grab the bits of trueth out of all the nonsense.
Why would a clinic ask a dependent person to wait five days?
Its no skin off their back and even if they were following nonsense.
Im not sure how unique your husband's exspierience with oxy and methadone were as my pain Dr prescribed both to me and I aslo clearly felt the effects of both.
Not to challenge you, but just to try and show the extent of misinformation... why does suboxone have nalaxone in it?
Will spell check later.. phone
If you stick around (which I most certainly hope you do) and continue to share your valuable support and hard won wisdom, that you may find yourself doing a ton of research in so many fields. In doing this you may find, as I have, that there are ocean liners full of total BS out there. Trouble is we need to grab the bits of trueth out of all the nonsense.
Why would a clinic ask a dependent person to wait five days?
Its no skin off their back and even if they were following nonsense.
Im not sure how unique your husband's exspierience with oxy and methadone were as my pain Dr prescribed both to me and I aslo clearly felt the effects of both.
Not to challenge you, but just to try and show the extent of misinformation... why does suboxone have nalaxone in it?
Will spell check later.. phone
I'm always open to learn new things. I've witnessed people react to medication combinations completely differently. Naloxone blocks the euphoria I think.. I know methadone doesn't contain naloxone but while on methadone, my friends and I, excluding my husband, were all unable to feel the euphoria of oxy. It was like I didn't even take it- no euphoria for us. I guess that's the difference in each person as we've said.
I guess I'm just looking at it from someone who has felt pwd. My guess for the clinics where I live enforcing a taper & 5 day detox is to be on the safe side. We both know methadone withdrawals have only just gotten started by day 5. The clinic I went to administered suboxone and methadone. The subs were actually more expensive so if it's not a risk, I don't understand why they would enforce waiting. The option to go back to methadone was never off the table with them.
The majority of people might be fine, I don't know, but the pwd I went through was so intense I've been afraid of suboxone ever since. I respect it, but it scares me. Methadone does too of course which is why I'll never touch either again lol.
Even with short acting opioids you need to be in mild-mod withdrawal before you start suboxone. Do you disagree? I'm just going from personal experience and what I've witnessed firsthand. I 100% believe that you were fine without waiting, I just don't think I'd feel right suggesting that when I've felt and seen what could happen.
I hope I haven't offended you. You've always been a great help in my recovery.
I guess I'm just looking at it from someone who has felt pwd. My guess for the clinics where I live enforcing a taper & 5 day detox is to be on the safe side. We both know methadone withdrawals have only just gotten started by day 5. The clinic I went to administered suboxone and methadone. The subs were actually more expensive so if it's not a risk, I don't understand why they would enforce waiting. The option to go back to methadone was never off the table with them.
The majority of people might be fine, I don't know, but the pwd I went through was so intense I've been afraid of suboxone ever since. I respect it, but it scares me. Methadone does too of course which is why I'll never touch either again lol.
Even with short acting opioids you need to be in mild-mod withdrawal before you start suboxone. Do you disagree? I'm just going from personal experience and what I've witnessed firsthand. I 100% believe that you were fine without waiting, I just don't think I'd feel right suggesting that when I've felt and seen what could happen.
I hope I haven't offended you. You've always been a great help in my recovery.
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Everytime ive gone from opiates to suboxone strips, I always just waited a few extra hours to dose the suboxone and I was always fine... Never had Precipitated withdrawals in all my tens years of messing around with opiates and suboxone.... I always just dosed my suboxone the day after and i was golden , thats just me though... I have other friends who mix heroin and suboxone basically on top of each other and never have any probelsm either
Jabberwocky
Frumious Bandersnatch
It's pretty easy to go from methadone to buprenorphine/Suboxone/Subutex, it just requires one wait a little longer than going from another full agonist that isn't as long acting to it. Most medical professionals, ESPECIALLY in clinic settings (where the general state of medical knowledge is extremely impoverished), have an extremely poor knowledge of what methadone and buprenorphine/Suboxone do, not to mention how they actually work (and prescribing doctors generally aren't much better). The extent of most professionals' knowledge when it comes to methadone (in the US) is from legal and bureaucratic guidelines surrounding it. When it comes to buprenorphine it's even worse, most of what they know is a product of pharm sales reps and their companies. Neither source is known for the transparent public dissemination of accurate medical information.
A side note before I continue: the naloxone in Suboxone essentially does nothing. For some people its addition in the medication leads to side effects. For the rest of us it essentially doesn't do anything. Its oral and sublingual BA is so low it doesn't get into one's system for all intensive purposes when you take the medication properly. It was only added to help it get approved by the FDA for the treatment of addiction in a primary care office setting (as opposed to a clinic setting like methadone). The idea is thrown around my its manufacturers, sales reps, and consequently doctors who prescribe it, that the naloxone will "block" or prevent the misuse of Suboxone and keep people from taking it intranasal, IM or IV.
However the naloxone still has essentially no practical effect when taken intranasal/IM/IV. In the case that the ROA has a high enough BA for the drug to actually get into your system, buprenorphine significantly outcompetes naloxone in terms of binding affinity (this is where opioid receptors come into play). For the same reason, because buprenorphine has a much higher binding affinity than almost any other opioid (certainly all commonly/normally misused ones), it will prevent those other opioids from binding to the opioid receptor systems if buprenorphine is already in the system OR cause precipitated withdrawal if an individual already has opioids in their system by knocking the previously taken opioids off the body's opioid receptors, causing a very intense, short lived withdrawal effect.
Methadone's "blockade" effects are de facto similar to this, in that it will prevent one from getting high off other opioids due to the opioid receptor systems being flooded with methadone, which has a higher affinity at higher concentrations than most other opioids as well, but the blockade effect of methadone is totally dose dependent where as with buprenorphine it is not (it's easy to get high on other opioids when taking lower doses of methadone whereas it's more difficult to get high on other opioids when taking lower doses of buprenorphine - a little bupe produces the same kind of blockade effect that a little methadone will not).
Precipitated withdrawal has nothing to do with naloxone when it comes to Suboxone. The reason some people emphasis you should wait ridiculously long periods of time when switching from methadone to buprenoprhine is because, when taken at really high doses (60mg or more) and for long periods of time (six months or more) the dose of methadone has build up in your system such that for some people it actually takes about five days for the methadone withdrawals to even begin. Now, the vast majority of people don't need to wait that long for methadone withdrawal to begin. But if you were taking a high dose or oxycodone for long long periods of time, you'd also have to wait much longer than if you'd just been taking a few Percocets every day for the last couple months. Same deal.
Also, medical providers like to make opioid addicts suffer, and I believe this does come into play. Plus precipitated withdrawal will happen at different times given different people and different circumstances such that it would be difficult for a medical professional to say, "Okay at X amount of hours you'll be okay to go," instead of the much easier, much more generalized guideline that is based on the logic that no one should have to wait longer than Y time so that is going to be the baseline applied to all inductees.
But anyways I'm going a little far afield. I'm definitely going to (probably![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")
) use buprenorphine in my detox arsenal when I come off methadone, well if I need to I mean. I don't like the idea of jumping back and forth between buprenorphine and methadone really quickly, but not so much for any other reasons than that it will mess with the tolerance to each drug in major ways, fucking up their relative effectiveness. Generally it's much better for one to stick to one or the other. Switching from one to the other isn't hard at all for the vast majority when not totally fucked up by bad medical professionals, and shouldn't involve any serious suffering - even the more nuanced switch from methadone to buprenorphine.
A side note before I continue: the naloxone in Suboxone essentially does nothing. For some people its addition in the medication leads to side effects. For the rest of us it essentially doesn't do anything. Its oral and sublingual BA is so low it doesn't get into one's system for all intensive purposes when you take the medication properly. It was only added to help it get approved by the FDA for the treatment of addiction in a primary care office setting (as opposed to a clinic setting like methadone). The idea is thrown around my its manufacturers, sales reps, and consequently doctors who prescribe it, that the naloxone will "block" or prevent the misuse of Suboxone and keep people from taking it intranasal, IM or IV.
However the naloxone still has essentially no practical effect when taken intranasal/IM/IV. In the case that the ROA has a high enough BA for the drug to actually get into your system, buprenorphine significantly outcompetes naloxone in terms of binding affinity (this is where opioid receptors come into play). For the same reason, because buprenorphine has a much higher binding affinity than almost any other opioid (certainly all commonly/normally misused ones), it will prevent those other opioids from binding to the opioid receptor systems if buprenorphine is already in the system OR cause precipitated withdrawal if an individual already has opioids in their system by knocking the previously taken opioids off the body's opioid receptors, causing a very intense, short lived withdrawal effect.
Methadone's "blockade" effects are de facto similar to this, in that it will prevent one from getting high off other opioids due to the opioid receptor systems being flooded with methadone, which has a higher affinity at higher concentrations than most other opioids as well, but the blockade effect of methadone is totally dose dependent where as with buprenorphine it is not (it's easy to get high on other opioids when taking lower doses of methadone whereas it's more difficult to get high on other opioids when taking lower doses of buprenorphine - a little bupe produces the same kind of blockade effect that a little methadone will not).
Precipitated withdrawal has nothing to do with naloxone when it comes to Suboxone. The reason some people emphasis you should wait ridiculously long periods of time when switching from methadone to buprenoprhine is because, when taken at really high doses (60mg or more) and for long periods of time (six months or more) the dose of methadone has build up in your system such that for some people it actually takes about five days for the methadone withdrawals to even begin. Now, the vast majority of people don't need to wait that long for methadone withdrawal to begin. But if you were taking a high dose or oxycodone for long long periods of time, you'd also have to wait much longer than if you'd just been taking a few Percocets every day for the last couple months. Same deal.
Also, medical providers like to make opioid addicts suffer, and I believe this does come into play. Plus precipitated withdrawal will happen at different times given different people and different circumstances such that it would be difficult for a medical professional to say, "Okay at X amount of hours you'll be okay to go," instead of the much easier, much more generalized guideline that is based on the logic that no one should have to wait longer than Y time so that is going to be the baseline applied to all inductees.
But anyways I'm going a little far afield. I'm definitely going to (probably
) use buprenorphine in my detox arsenal when I come off methadone, well if I need to I mean. I don't like the idea of jumping back and forth between buprenorphine and methadone really quickly, but not so much for any other reasons than that it will mess with the tolerance to each drug in major ways, fucking up their relative effectiveness. Generally it's much better for one to stick to one or the other. Switching from one to the other isn't hard at all for the vast majority when not totally fucked up by bad medical professionals, and shouldn't involve any serious suffering - even the more nuanced switch from methadone to buprenorphine.