Opioids Suboxone (licit) to Methadone (illicit) to Suboxone (hopefully for good, this time!)

[socio]

The Bad News:
I'd been "cleanish" a year or so (Rx supply from legit doctors only for legit reasons, but occasional recreational dosing, or IVing Suboxone, that kind of thing). Then roughly 4 months ago, got a friend who started providing Methadone regularly enough for me to sustain 40-60mg daily, with quite a few days much higher, over 100, maybe 200 once or twice.

But now I want to get back on my legit-prescribed 8mg/day of Suboxone and take it the way I should. My situation is untenable and would require too much legal violation for my level of risk tolerance for me to continue.

The Good News:
I anticipated this and never fully quit Suboxone. (Something I learned to do over the past decade + of being prescribed Subs). I dropped from 8mg daily (either SL or IV/SC) and I continued to take 0.5 - 2mg, average over this period. Sometimes I went a week without any, sometimes I got as high as 4mg-6mg SL of Suboxone.

I really started upping the Suboxone while dropping the Methadone simultaneously over the past 4-6 weeks.

That hurt, but I got down to 20-30mg of Methadone and up to 0.5-2mg of Suboxone. According to "the Protocols" I'm probably good to take a "withdrawal holiday" and sweat it out for 48 or 72 hours, then just continue on Suboxone. I have a feeling, though, that I could end up in a world of (prolonged) hurt. I don't really know for sure, since these "holidays" away from Suboxone have gotten harder over the years.

I'm down to 20mg/day oral Methadone and have stopped resupplying, with only 100 left. I feel fine most of the time, and I can even handle a 1mg or 2 of SL Suboxone most days (it feels shitty, but I do it anyway cuz I gotta).

But now it's time to jump off the Methadone train and all the way back onto legit Suboxone and other Rx meds.

I'm in a much better spot than a lot of people running out of illicit Methadone, so I can't complain too much.

Not only do I have suboxone already floating around my system and a relatively low dose of Methadone (I still feel it and get sick without it, within a day), I have Rx comfort meds: as much Clonidine, Gabapentin/Neurontin, and (for sleep) Remeron, as I need. Plus a modest prescription of daily Clonazepam and access to plenty of etizolam. Oh, and about 12 x 200mg Ultrams for emergencies/smoothing the switch (I know -- of questionable value).

I always lived by the motto, "Withdrawal's all in the game, if you wanna be a real junkie," but I may be getting soft as I get older and as I have to be doing things actively on a near-daily basis. I guess I'm getting to be a lot less of a "hard-core true junkie" nowadays (not that it was ever a title to be proud of, but I did get a sense of satisfaction in being able to routinely endure misery and suffering that I'm just not capable of anymore!).

Any thoughts on the smoothest way to do this?

I see three main options (based on past experience).

(1) Continue upping the Suboxone until it reaches saturation and I don't feel the Methadone anymore, and don't really feel too sick. That's worked very well in the past, but with larger supplies of the illicit substance. Questionable strategy now, but might work.

(2) Up the Suboxone to highest comfortable level while finishing Methadone at the lowest comfortable dose. Then cease both. Wait a day. Take the Ultrams (carefully to avoid lowering seizure threshold, though mitigated by my benzos and Gabap.) and comfort meds for about a day and try to keep reasonable well. Wait at least 12-24 hours after last Ultram/Tramadol and start upping my Suboxone dose gradually until I hit near-saturation levels (~8mg SL daily; I'll still have a few mg's floating around, so it won't be a big shock). Probably a moderately uncomfortable ride, but not too bad.

(3) Just do it old school: Finish the Done and Ultram and then just take an 8mg Suboxone strip or two and brace for the pain! Writhe and sweat in delirium-pain for 12-24 hours, maybe 36-48, and get back up standing tall, if a bit raggedy. That's the least pleasant, but I know what to expect, and it wouldn't be as bad as it could be (I've had numerous "Narcan & Naltrexone Wake-up Calls" at the ER as well as been on various Precipitated WD escapades that I've mentioned in other forums; I'll take it if gets me over the hump before the weekend ends and I'm back to work/daily responsibilities).

Advice is appreciated!!
Thanks

 

[Screaming_Skull]

K, I'm a little confused by the post because I haven't taken my Subs for 3 days and have taken about 100mg of Roxi IV today with 4mg of xanax, but from what I get you want to get off the Methadone and are on the dose of it they reccomend you can jump off of it wait a couple days and begin to take the Subs..Also you mentioned you have Tramadol, I would reccomend you keep those for when you get back on the Subs in case you are not confortable on that dose, because from what I understand Tramadol CAN be taken with Subs and you can still feel the effects of the Tramadol also while on the Subs...been wanting to try that myself, wish they were still available online...

 

[socio]

Thanks Screaming_S, I think the second part is one thing I wonder about, cuz I'm not sure whether to take them while going totally dry off both, or wait til I am on JUST subs, not done.

Yeah, I wanna get off methadone after a few months. Dose is pretty low (but 20mg is nothing to sneeze at for a regular human) and my suboxone dose is moderately low (0.5-2mg, which would also be high for normal humans).

Without the Done, I'm hurting, even though the dose is pretty low, and I hurt worse if I try to take Subs to solve the withdrawal. I've been upping my suboxone dose (small doses usually, 0.5mg - 1mg, sometimes 2mg or more, always SL), which still allows me to feel most of the Methadone, but slowly blocks more and more of it (ideally). I'm probably blocking about 1/2 the Done when 2mg is in my blood, maybe less, since that figure is based on heroin research (no time find citations, sorry). More blocking some days, less others. But never all the way off.

So basically if I go back on Subs alone, my opi-receptors are going to lose a bunch of happy from the Methadone (even if partially blocked since I've been trying to up the concentration of Subs in my blood). I can feel it when I take 0.5mg of Subs...grimy, sweaty, restless, diarrhea. Not bad, but not great for taking care of business in life.

They say to jump off if you're stable at 30 or 20 for 2-3 weeks or more, and then wait 72 hours to start subs. That's apparently a rough transition, but doable. Mine won't be that bad. But maybe I'll try to have 36 hours where I take nothing (plus another 8 hours of restless sleep to stretch it out if possible), then go on the Subs and add the Tramadol then.

I don't know, do you get what I'm asking?
Don't mean to be confusing.
It's just that even low dose full-agonists, if you take them for a while even on top of relatively high Suboxone doses, then stop, can cause withdrawal, especially if you've been on Suboxone a long time. I've gone off dope before because I had already "tapered up" to 12-16mg SL Subs, and wouldn't feel it for a thousand bucks. But two days after I stopped, my nose and eyes started pouring. Weird. Gotta really ease off, especially for people who've been messing with their receptors like this for a long time. (As I understand it's partly because your brain will start creating new receptors when bombarded with enough opioids for long enough, including agonists and mixed agonist-antagonists, though, again, I don't have a specific reference for that, but could probably get one or more with time,\.)

 

[The Doc.]

In my opinion I would stop the Suboxone on top of the methadone because that's jacking your tolerance up even if you can't feel the methadone its still in your body and its asking for trouble. What I would do is stop taking the Suboxone you can taper if you really want but I don't see any reason to if your on methadone. Once stopped on the Suboxone then taper your methadone by 5mgs at time MAX until down to 5 or you could go to 2mgs even 1mg if you can measure it out. Then stop the methadone for at least 72 hours, then you can dose your Suboxone at about 0.5mgs and find a dose which works for you from there once stable on a low dose. Is there any reason this wouldn't work for you?

 

[BrockLS]

I am in a very similar situation. I was on Methadone but I had drive an hour and half round trip to get it at the clinic where they treat you like a total child. I wanted to see a doctor and get a script for suboxone which I did. Unfortunately, I had a hell of time transitioning. Actually I just went back to using dope for a week then thought I could wait 12-18 hours for the withdrawals to start and begin the subs which I did get but It was in hell for 12 hours. Sweats, Chills, Vomiting, Cramping, Depression, it was rough. I was wondering if there was a better way to make the conversion from heroin to suboxone or am I better off on subutex without naltoxone. I don't want to take anything away from the original poster but I believe both of questions are closely related. I was wondering if I should save a small amount of heroin to take after I take suboxone knowing I wont get high but it will take away from the withdrawals and not last as long in the receptor's as suboxone? To the orginal poster, I would love to taper Methdone if I had that option but I don't. The clinic I went to also wanted me to come for at least six months. Any help or advice would be greatly appreciated!

 

[BrockLS]

Also, why do people slowly dose suboxone when they start? Should they increase or decrease the subs based on withdrawals?