Opioids Subutex to Methadone

[Mad Dash]

As most of you know I am on Subutex and zanaflex for PM. I dose in the AM and the PM. As time has gone on my ability to deal with the pain has become less and less manageable. With out medication I am at a 7-8/10 at pretty much all times. With the Subutex and zanaflex I am at a 5-6/10 most of the time. For a while I just figured I would deal with it. Just man up. But it is just not working anymore. I feel so completely sober (no pain relief) on them it really feels like I am taking nothing.

And the part that scares me the most is that lately I have been going to meetings a lot more often, calling people on my sober network far more often, having more panic attacks, and all around depression is getting worse. It has been in the back of my head had me thinking about how easy it would be to say fuck it and relapse on some oxy just so I could get some effective pain relief. I don't do it because I know that is just the pain talking and if I went back on oxy I would be in trouble very quickly. The pain is taking the small amount of joy in my life almost completely away.

I had seen that for this reason people often will switch to Methadone b/c it is not a partial agonist yet it still is a great tool for people who are in active recovery but are CPPs as well. I was wondering if I talk to my doctor about this do you think he will think I am just seeking? I can't imagine that would be the case as he is a PM doctor and he would know that if I was trying to make the switch to abuse I would just stop seeing him and go to a methadone clinic. Since I am out of pocket it would actually save me money by doing that but I would rather do it through PM so I don't have to do the daily grind of going to the clinic and I really have a great relationship with my PM doctor.

What are everyone's thoughts on this. Most of you know my story, know how I feel about a lot of things, and know my stance on recovery. All advice is appreciated

Please scroll down to post #26 for updated info

 

[Screaming_Skull]

Are you on Sub maintaince for pain or maintaince? If for maintaince a clinic will take ya in a heartbeat, I've called before and the lady at the clinic switch because Subs just don't cut it for them. If your talking about seeing if your doctor will write you done for pain you could give it a shot, but I dunno, worse he could do is say no, then just stick with this tilll you can get into a clinic. Try to get split dosing at clinic to.

 

[Mad Dash]

I am on it for pain management, but also because I know I am an addict so I know I can not be on regular opiates, the first day I went in there I asked to be put on subutex because I did not want to be on anything too addicting. I am hoping to go through my PM doctor because we have a great relationship and being able to have a RX for it and not drive to the clinic daily would be so much easier, but the subutex is not cutting it anymore. I don't want him to put me on oxy, or hydro, or dilaudid, or anything short acting that is easy to abuse. Since Methadone is often used in both ORT and PM I figure it is my best bet. I also wonder if he agreed would he put me on an equivalent dose? I would imagine 40 to 60 mg twice a day would be the dose I should be looking for. If he does not agree, I fear I might just have to go to the methadone clinic regardless just to get some effective pain management. I just don't know what to do sometimes, so I am just hoping for others experience.

 

[RetiredMedic]

You know brother I was in the same place. Life can be a bitch when in pain. I went from being able to do the dishes for only 15 min at a time to being completely pain free. It was due to a outstanding back surgeon. You also know that if you got back on oxy your lvls needed for pain relief will shoot through the roof, as did mine. It all ends in same place my friend. May I ask what is the source of your pain? Me personally I tend to offer to much information and tell the truth. Id expect if you have a good relationship with your PM talk about options. At least he will know you are being forthright.

 

[Screaming_Skull]

Ya can ask, it can't hurt, I thought you were on it for ORT.. I mean just tell them your pain is at a 7 even when you take the Subtex like you just told us is there anything else you could try.. If she mentions something you don't want mention methadone. Trust, it will help your pain waaaaaayy more that bupe, I know bupe helps some people for pain but it sucks ass. Methadone is one of the best painkilers, just ask.

 

[Mad Dash]

You know brother I was in the same place. Life can be a bitch when in pain. I went from being able to do the dishes for only 15 min at a time to being completely pain free. It was due to a outstanding back surgeon. You also know that if you got back on oxy your lvls needed for pain relief will shoot through the roof, as did mine. It all ends in same place my friend. May I ask what is the source of your pain? Me personally I tend to offer to much information and tell the truth. Id expect if you have a good relationship with your PM talk about options. At least he will know you are being forthright.

My spine is totally fucked. I have a bunch of herniated disks with some bone on bone contact, degenerative disk disease, damaged nerves, etc... it is mostly in my lower back and it came from an airborne jump gone wrong. We were doing a ramp blast out the back of a C-130 at night and it was so dark I couldn't see where I was landing, that mixed with a strong wind put me into the trees and then into a ditch, couldn't feel my legs at first, but that didn't last for too long, but as I sat there screaming for 45 minutes so far away from everyone else that nobody even knew I was missing until they had all rallied and noticed I was missing on the opposite side of friar drop zone. Like I said it took them 45 minutes to find me, so I was alone with a broken right leg just above the ankle that did not hurt at first because I couldn't feel my legs they were kind of numb/tingling. I kept screaming for help, I was freaking out that they wouldn't find me, I had no Idea how far into the woods I had drifted because it was so dark outside. I just kept screaming and crying because I couldn't move. It was so bad... took months of rehab and pool PT after that, lots of pain meds, and then eventually I had to get out of the army because I just wasn't recovering. This plus all of the damage my body had been through with deployments and shit I was just done for. The oxy became a problem after I got out so I got the army to agree to pay for rehab got on suboxone strips in rehab (they barely helped with anything at all but I was determined). Then when I got to Florida I went to a PM doctor because he was also certified to write bupe and he put me on subutex, that helped immensely (I found out I was allergic/highly sensitive to naloxone and that is why I got zero relief). So at first they were actually pretty good for the pain. But since my dose of the strips was 8 mg, of course that is what he put me on. So I kind of missed out on the pain relieving doses (under 2 mg). And went straight to 8 twice a day which meant as soon as my body got use to it I hit the accumulation point rather quickly. Now it keeps me from feeling sick VERY well, but the pain relief is nearly non-existent now.The good new is no matter what happens with him I can go on methadone, I will just go to the methadone clinic. Too easy, I would just rather him agree with me or at least give me a month to try it and if it works, I can just get an RX for the 40 mg wafers. I know 8 mg subutex is equal to like 40 - 60 mg Methadone right?

 

[manboychef]

I was on subutex for a long time. You might want to try a slow taper and use a little kratom in the meantime. The kratom helps with my pain. I tore my acl. I didn't do physical therapy or surgery. just let it ride. Now it hurts quite a bit a lot of the time. I had the same problem as you. I was taking my subutex 16mg a day, but the pain led me to shoot 2mg in the morning, and 1mg at night.

Whatever you do, do not give in, and fall into the same hole I did. I would most definitely talk to your doctor about ways to manage pain. Personally, as long as you can have some standard of life that you can be comfortable with and maintain your sobriety, then I am in your corner. We both no sobriety isn't just not using drugs, its a state of mind, and a belief structure. From the original post it seems like you really have this down.

Lastly, meditate on it. I hate to be cliched and sound like I'm just spouting rhetoric, but play the tape forward. What do you hope to gain? Is this just the addict brain talking? I have a very good feeling you are going to make a sound decision.

Good Luck

 

[Fire&Water]

I dont see why he'd have a problem w/ it, but you need always remember to never wax that slope...

PM docs' can write for the 5mg. tabs Once you get the bupre out of your system
10 mg Methadone is much better than 8mg subutex for pain.

 

[SKR]

I'm wondering if methadone is my future also for PM. I'm barely managing on 240mgs of oxy per day which is outrageous but that's where I'm at. If I didn't have a wife and young son I think I would prefer to check out of this life by my own hand. Eat a couple of grams of oxy and leap off my favourite waterfall up the mountains at a spot that figures largely in my childhood, happiest days of my life really.

 

[Mad Dash]

So an update I went in and told him I was in awful pain and he was sure that it was just muscle spasms getting worse and worse. I couldn't even get a word in. I was like doc this doesn't feel right I have never been in so much pain and I... and then he would cut me off, and I would start talking again and he would cut me off. I feel like he could tell a question was coming he offered me xanax because he could see my anxiety and pain, and I said no that I was currently getting off of valium at the VA and they are going to have me on just PRN use of Ativan from then on. Then he started offering me muscle relaxers on top of that, which I am already on.

Then he offered trigger point injections had me schedule an appointment with the front desk lady and told me he would be back. So I went to go set up the appointment and then wait to ask him about making the switch but he was already in with another patient... I was dumbfounded, it all happened so fast I was like wtf. I have to admit it was 6:45 and he still had two more patients to see because he has these patients that will take up his entire day trying to argue with him about getting more, stronger, and better pills. I literally had a 3 minute appointment. So I walked out to a RX for 90 fucking 8 mg subutex! I mean WTF... I don't think he gets how it works, because I could take 32 mg of it right now and feel NO different. I can't just take more to feel better. It is already accumulated in my system by taking it daily for the past 5 months since I got to Florida (before that I was on zubsolv which did NOTHING because of my naloxone allergy/sensitivity)

I also didn't get to talk to him about going on testosterone because I think my levels have to be dropping because of the opiates.But nothing went right because he was in such a rush. Now I am even more depressed, now I am going to have to travel to California at an active 7/10 for a week for a family wedding. Like I have never felt so hopeless. I am in so much pain I can barely think. I think he kind of minimizes my pain because I am 29. I was very close to going out and buy rigs for IV so I can get some fucking relief, like I mean I was at the cash register ready to pay close before I said never mind walked out and called my sponsor. So now in the name of sobriety I sit here writhing in pain, and as some of you know I am waiting for my disability to kick in and have been trying to find a job for the past couple months, but it has been really hard ever since I got out. So my family took me in and pays for all my bills. They only agreed to pay for me (ie: food, rent, medication) If they hold on to the medication, but they are brutally regimented about giving me my meds. They will ONLY give as written on the bottle. Even though the doctors say I am going to write this, but I am going to write an extra (10,15,30) you know what I mean extra if you need them for bad days. They refuse to ever administer any extra anything. So there is a huge stockpile of extra medication that has been going un-used that could be a great help to me. As in taking an extra zanaflex or and extra valium or atarax or all of them together or something! But I am living in a true hell.

Buying those rigs would technically not be a relapse, but relapse is like manboy said, it is a mindset. I know IV crosses the line, and I can't do that. But the fact I got that close means it is going to happen soon, because before I got sober I have shot bupe and zanaflex together and I know it feel like slamming dope (maybe even a little stronger but less euphoric). So that is why I am really thinking I am going to give this one more try wait another month of agony, this time I am going to say hi doc, I think I need methadone. Like right off the bat so I can get a yes or no, and if I get a no tell him I can't deal with the pain anymore and that there is no way I can sustain this current way of life. If he still says no after that I am going to the methadone clinic. It is just not worth having a relapse. And relapse occurs way before the actual relapse happens. I know this, so I am taking measure to make sure it doesn't happen.

I don't normally get into my feeling, emotions, and pain on here. Because I try to stay positive, but the truth is I can not take the crushing weight on my chest of this anxiety and depression squeezing its way into my back and stabbing true. This pain is real, I hate what society has done to us, why do we live in such a cruel world. How can I fucking live in a world that is okay with a fellow human being living in such pain, all the time, and telling them if they go on medication that would help them to live again that they are a junkie. This is barbaric. I don;t know how much longer I can keep putting on this mask everyday. I am not there yet, but the old feelings of just thinking how much easier everything would be if I just had died overseas. I would have died a hero, with a loving life and family that was so proud of me, and missed me but would always remember me in a positive light.

Now if I die, people will remember a broken soul weighed down by the pain of losing everything and everyone he cared about due to injury, pain, depression, anxiety, and divorce. This has also made my prospects of ever finding a job I can make a lot of money or a career I can get to keep my life stable and ever find love. If I don't get 100% military disability I could be very well fucked.

 

[namnoc16]

Guys I was on methadone for nearly a decade and I can tell you from my experience it's all well and good at first but you build your tolerance and you continue taking your same dose and you just end up feeling normal and eventually no pain relief at that dose so you need to get bumped up. All opiates and opioids have diminishing returns and eventually become ineffective. But Iwill say its better for pain then bupe,bupe has little analgesic effect. If you do switch to methadone don't be in a rush to increase dose when you level off it drives your tolerance through the roof. My PM doc wants to add methadone 10's to my oxys and I really don't want it,when I cme off methadone it lasted muh longer then dope wds.
Mad Dash I feel you I have DDD,herniated l4/L5 and ruptured L/5 sr1 disc but use your support group and gather all the facts you possibly can,don't make this decision lightly(I'm sure you won't).

Us vets have to stick together!

 

[tricomb]

STRONGLY ADVISE AGAINST METHADONE!!!! my $0.02

 

[sekio]

There are lots of other things to add to Subutex/opioids before trying to switch to methadone... as many different NSAIDs as they can get their hands on (not every one of them will have the same side effects, some people can tolerate one or two of the class much better than others, so try them all before you give up), analgesic potentiators (e.g. orphenadrine), cannabinoids esp. CB2 agonists, topical anesthetics, things like memantine/ketamine etc.

 

[Mad Dash]

Roger that, thanks brother. Ya I spoke to the people closest to me and they already knew something was wrong but couldn't figure out which of the great number of things wrong with me was going on. I told them about my plight half of the people said go get on it TODAY and everyone else said don't do it is toxic you will lose your teeth! Clearly the second party was not as informed as the first group, but the reason for their concern I believe was they could feel dpression and could hear in my voice how close to relapsing I am. FML

 

[weR138]

Heros like youself do not deserve this. I wish you the best stay strong my friend.

 

[Jabberwocky]

As most of you know I am on Subutex and zanaflex for PM. I dose in the AM and the PM. As time has gone on my ability to deal with the pain has become less and less manageable. With out medication I am at a 7-8/10 at pretty much all times. With the Subutex and zanaflex I am at a 5-6/10 most of the time. For a while I just figured I would deal with it. Just man up. But it is just not working anymore. I feel so completely sober (no pain relief) on them it really feels like I am taking nothing.

And the part that scares me the most is that lately I have been going to meetings a lot more often, calling people on my sober network far more often, having more panic attacks, and all around depression is getting worse. It has been in the back of my head had me thinking about how easy it would be to say fuck it and relapse on some oxy just so I could get some effective pain relief. I don't do it because I know that is just the pain talking and if I went back on oxy I would be in trouble very quickly. The pain is taking the small amount of joy in my life almost completely away.

I had seen that for this reason people often will switch to Methadone b/c it is not a partial agonist yet it still is a great tool for people who are in active recovery but are CPPs as well. I was wondering if I talk to my doctor about this do you think he will think I am just seeking? I can't imagine that would be the case as he is a PM doctor and he would know that if I was trying to make the switch to abuse I would just stop seeing him and go to a methadone clinic. Since I am out of pocket it would actually save me money by doing that but I would rather do it through PM so I don't have to do the daily grind of going to the clinic and I really have a great relationship with my PM doctor.

What are everyone's thoughts on this. Most of you know my story, know how I feel about a lot of things, and know my stance on recovery. All advice is appreciated

if you are truly in pain and need oxy, then it is not a relapse; its helping your daily life. just try to stick w/ what is scripted to you rather than abuse those pills all day long and burn through a month script in 3-5 days like I would do.

forget about sobriety, man. it seems you actually need the help.

me on the other hand, NOPE! I have no pain; I just like the feelings. so I am what they call a junkie - no you.

 

[manboychef]

I can only take ibuprofen due to chronic hep c. I'm more than halfway through the process....it goes s0-s1-s2-s3-s4. I'm at s3. I have to be very careful about certain NSAIDs because they are processed by the liver. In addition to the knee I get an insane ammount of migraines. Nearly weekly. I just pop a lot of ibuprofen, eat a little kratom, and I try not to rush things.

I know exactly what you mean about relapse mode. I never understood it before, until this time I got sober. This is the longest I have had in Fifteen years. I know it happens with romantacizing, and being stuck on something in recovery...I see those signs in myself from time to time so I talk to my sponsor. He knows how I feel about AA and he knows I only call him when I am seeing something in myself I don't like.

It seems to me that you need to call your pain management doctor today. Tell them to give him a note about how you feel. A doctor that doesn't have time for you shouldn't be your doctor. Had to drop my old psychiatrist because of that. Obviously he has too many patients and his work with you is going to get sloppy, or slowed.

there are two things that I would do if the pain becomes unbearable.
1.)call someone you can trust to tell the nurses and doctors about your situation

2.)go to the hospital with said person, because they can make you comfortable. Having that person with you will help stop you from going overboard. I'm with BBt on this. If you medically need it, than get it till you can make the switch, however, you need to have all your ducks in a row before you go. Be forthcoming about being a recovering addict, because they may be able to try certain steroids or targeted analgesics.

I popped me knee out a few months ago, pain was horrible when it popped back in. Went to hospital cos my knee was the size of a large grapefruit. They gave me a shot of lidocaine, and cortisone, and it took the pain down to a manageable level.

I don't have all the answers. I only understand where you are at, cos I have been there. If you need someone to talk to, PM me, I'm in florida too.

 

[Mad Dash]

I am calling today, and going to ask about NSAIDs (though I can not take ibufprofen because they would give you so much of that in the army for everything) I ended up with peptic ulcers so I don't know if I can take any others. And I am going to ask about the topical creams, does anyone have experience with trigger point injections? I looked them up but I don't think that is the problem... the pain comes from my spine, and I think it is pressing on my sciatica.

 

[namnoc16]

I've had the trigger point injections right in the drs office. They sprayed some kind of cold numbing topical on my back then gave me the shot(had it done twice). It didn't help me but that's not to say it won't help you. Also had the Faucet injections and they were painful(trigger point wasn't) but I'm thinking it was because the Doc I seen for that had me hold a block of ice on my back for 10 mins and then stabbed me in the back 8 times.Only injection I had that gave me relief was the epidural but I was scared shitless because everyone is telling me there's a risk you can be paralysed if they mess up(risk with any procedure).Anyway we are all different and the trigger point's might give you relief and as I said they don't hurt,you have nothing to lose!

 

[StaffWriter]

Unless you're gonna be a lifer, don't go the methadone route, for PM or Addiction (if you can avoid it). Day 14 getting off that shit and I still can't dose sub without getting Pwd's.