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Switching from methadone to suboxone

OverDone

OverDone

Bluelight Crew
Joined
Apr 14, 2008
Messages
5,404
Hey guys, I went through 7 pages of Search Results but didn't find anything solid.

I'm unfamiliar with dosages and terminology regarding this so please bear with me.

A friend of mine was taking suboxone (3 of the 8/2's) a day for pain. Her insurance company started goofing up on authorizing scripts by only covering 2 a day as opposed to 3. She got fed up with this and switched to methadone.

After 3 weeks of methadone (4 of the 10mgs/day) she has now started to notice extreme mood swings, anxiety and panic attacks that, from her past experience, she has attributed to the methadone. Because of this (and her insurance being sorted properly now) she has decided to go back on subs.

What is the best way to make this switch? I believe that both have similar half lives but I'm guessing that this does not mean she can just take methadone one day and simply switch to subs the next day.

Is there a suggested method to make this transition from 40mg methadone/day to 3 of the 8/2's of subs per day?

Thanks in advance!
 
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Someone is going to chime in with way better advice than mine but here's my 2 cents.

I know that suboxone blocks other opiates like oxy, heroin, etc because bupe has such a high affinity for the receptors that it knocks everything else off. That's why taking suboxone while your high will send you into precipitated withdrawl which is no fun. Been there, done that it's hell on earth.

Methadone is an interesting question though because I think it also has a high affinity similar to suboxone? (not 100% sure). The only thing is suboxone also has naloxone in it, the stuff they give for overdose. It will knock everything off in a high enough dose.

My advice, the above is just me rambling so this would be a question for a doctor. My only fear would be precipitated withdrawl.
 
OverDone said:
What is the best way to make this switch? I believe that both have similar half lives but I'm guessing that this does not mean she can just take methadone one day and simply switch to subs the next day.
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No, this can induce precipitated withdrawal. No opiate user should ever have to experience PW. It's as close to being in Hell as a person can come in this existence.

Methadone has a very long half-life (mean of around 22h), meaning that one needs to wait a long time so that the amount not yet eliminated is sufficiently small so as to not lead to PW. Everybody metabolises every drug differently, so the best rule for avoiding PW is essentially 'wait as long as you possibly can before you dose Suboxone.' The person should wait until s/he is feeling moderate-to-strong withdrawal from the methadone and then try and wait some more. 'An hour in normal WD is better than an hour in PW' was always my feeling.

When she is ready to dose, start low. 2mg under the tongue, wait 30-45minutes to make sure that PW does not occur (if it does, she will know). Then give her 2mg every few hours until she feels comfortable. You want to gradually bring Suboxone on the patient in a situation like this; giving her a full strip to begin the transition would not be wise. Just please take it slow. Not calling your friend an addict, but as opiates do create a sense of more, sooner in people's minds, this feeling MUST be disciplined away by doing whatever it takes to let the patient wait long enough to factor PW out of the picture.

24mg of Suboxone a day is a LOT of Suboxone, and most of the people around here would suggest that once she's stablised on Subs that she try and get this down into the single digits (though if this is for pain, more might be better - ask a good doctor).

I hope this makes some sense. I don't want to get too 'prescribing' here because of the whole sentiment that TDS shouldn't be used as a venue for us to play doctor. Posing this question in one of the Suboxone megathreads in OD, OD, would probably get you more detailed answers (or maybe a move by one of those mods to a thread for this thing, which they could find by memory).

I wish your friend the best. Methadone to Suboxone is one of the more difficult ones.
 
The best way to do this is under the care of her physician. But I don't know why anyone would prescribe twenty-four mg of Suboxone for chronic pain. People really have NO CLUE how this drug works.
 
Hi. I WILL ADD SOMETHING YOU NEED TO KNOW.

She is opiate dependent RIGHT?

Now Subutex is bupe which blocks.

Now Suboxone is bupe AND naltraxone which may DOUBLE block

Methadone lasts awhile. IN general 20mg-30mg of Methadone you need to be at for 3 days then stop for 2-3 days (so wd's hit) then move to bupe.

When she switches the bupe alone will tear all opis out and slip into the receptor this causes PRE-WD's. Now naltraxone in the suboxone may make the pre-wds WORSER AGAIN.

OK YMMV:

MDONE MG - BUPE MG
20-30 = 8
40-60 = 16
70-90 = 24
90-120 = 32-36

THESE DOSAGES are for MAINTENCE so 40mg of done is 12-16mg bupe however Methadone kills pain better, bupe only does it so much (same with the high). If she's stable but in pain then Tramadol maybe, other opiates will be numbed so it may be a case of dropping the bupe to 4-8mg and use an opiate ontop so it works enough.

Now HEED my advice. 'done to bupe can hurt bad!!! I wanted off mdone so 40mg methdone to 30mg 5 days then 2 days off (now I wanted off as my addiction was so bad I needed 70-90mg - being on 40mg was NOT enough so I dropped to 30mg+used gear, then near the end I ran dry of gear and was only on 30mg so wd'ed BAD - never cared and did 40mg ontop making my 4/5th day 70mg) and jump onto bupe 4mg, now the guy was in the DDU was clueless but I went the chemist and back to DDU and did there for some reason - I wasn't in WD so didn't want to take it as I know it'd be bad, if I refuse I don't start bupe so I swallowed them. I went home okish. Later that night felt crappy (I swallowed so 1/3rd as good as subbing - like taking 1mg subbed) that night I used Heroin as I was to be going out, it fixed the wd's. The day after, I was ok I went to the pharmacy and fully subbed 8mg - hours later I was AWEFUL, SWEATING, NOT ABLE TO STAY STILL - IT GREW WORSE MY MUM SAW ME IN AN AWEFUL PREWD STATE. Now I did something STUPID, I DROVE!!! in full blown wd!! It was 2mins away and I waited AGGGGES (probs 10mins) sweating, freezing, kids came with gear. I snorted 2bags and laid back (5mins later) I feel straight, I drove home "sober", the rest of the bags I shot that day and the next. I missed the day after (16mg) and went the day after that (16mg) and swallowed one and subbed the other so it's more like 10mg and it was good, day after 16mg.

Now my problem is moving about meds, I had I get a bus to town for the DDU script then come home, then I went the pharmacy and I had to do that every day - which I am ok with but NOT when you're wding.

If you can get subs or get them given to you do this

Done drop 20-30mg and 5 day then 2-3 day off then 4mg(6mg if you really feel bad), next day 8mg, then 16, 16,16,16,16 or what you decide. Another tip DROP Methadone say it's 20-30mg then 2-3 days or 40-60 maybe 4-6 days. It's so hard without the 'done so swap to Heroin/Oxy or another opiateand use that till the done is out now with the others you can use bupe near enough the day after.

Also if she's given her subs and they say take 4mg tomorrow. When tomorrow come if you wake rough SNORT 2mg and see how that is - then another 2mg 2hr later. I say that as you can snort a little dose and it works 15mins and peaks 45min when subbed 45mins it starts then 2-3hr peak.

This is advice based on my experience with opiates and addiction. BE DAM SURE you're starting to rattle before thinking of using bupe.

Again that prewd I reckon would be worse with Suboxone so ask for Subutex for a week then swap.
 
In my personal oppinion, the best course of action when switching from methadone to buprenorphine, is to switch from methadone first to a short acting full agonist like morphine or hydrocodone for a few days, and then wait the 24 hours and switch to the bupe. This allows time for the methadone to clear from your receptors, without the person experience grueling withdrawal, and the transition should be much easier. Luckily your friend is also not on a very high dosage of methadone.
 
RedLeader said:
No, this can induce precipitated withdrawal. No opiate user should ever have to experience PW. It's as close to being in Hell as a person can come in this existence.
Click to expand...

I have had it rough once, lucky I could get Heroin which numbed it back - God knows what I would of done, probably hospital or LOADS of benzos :(

RedLeader said:
Methadone has a very long half-life (mean of around 22h), meaning that one needs to wait a long time so that the amount not yet eliminated is sufficiently small so as to not lead to PW. Everybody metabolises every drug differently, so the best rule for avoiding PW is essentially 'wait as long as you possibly can before you dose Suboxone.' The person should wait until s/he is feeling moderate-to-strong withdrawal from the methadone and then try and wait some more. 'An hour in normal WD is better than an hour in PW' was always my feeling.
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I will resay what I did before. Backing what RED said. jumping from meth to bupe can be done.

Option #1 Get the mdone stable 20-30mg and wait 2-3 days and you SHOULD be good to do 4mg bupe.
Option #2 stop mdone completely even 60-70mg and work out how long it takes to be removed (3x times as long) BUT hold yourself with morphine/h/oxy or a short opi then jump off them to bupe that way mdone is OUT you then that morning start,

Now 2 points:

I WOULD ASK FOR SUBUTEX. The Naltraxone in SUBOXONE will make pre'wds WORSE as 2 things are pushing the 'done. A week on it, over to Suboxone.
and when you dose 4mg for the first day or whatever, maybe try snorting it - when I GOT AWEFUL WDs from subbing 8mg it took 2ish hr then 3-4hr got unbarable - if you SUB it do 2mg and wait 5hrthen 2mg more if you snort it 2mg 2hr 2mg.

Now. 24mg is ALOT (I was on this for maintence but 16mg never held me - BIG TOLERENCE) - bupe is a pain killer but will only kill so much. start with 16mg(I mean as a stablise dose). Now bupe isn't well researched like mdone, heroin and Scandanavian coutries have a huge amount of people boshing bupe and getting addicted and doctors(+peoples experiences) are saying to stay at 8mg NO MORE!!!!! because Subutex has been about 5-10 years so there's nothing known long term. It works DIFFERENT from the classic opiates - now it IS possible that if someone is on 24mg for YEARS!!!!! and then taper off, they may damage thier opi receptor meaning even tapering and being clean - years later for pain or a high it's harder than it should be as bupe saturates diff parts of the receptor. I am NOT saying this is true but possible and I've heard it happen.

Bupe came out in the 80's for pain, chronic too. However it was in film strips of 200 MICROGRAM (that means your 8mg tab is 40x more!!!!!) and 300 MICROGRAM AMPULES. Now Subutex/Suboxone play on the safety profile of bupe+overdosing and I think 2001 the FDA approved these HIGH dose pills 2mg and 8mg. In NL 2006 it came out, UK 2005 (I think) so it's 5-10yr of human research. I thnik Sub* (high dose bupe tabs) are for maintence and may not help pain much - so 8-16mg go for, please don't let them tell you to live on 24-36mg for pain because it will stop working, bupe is like that. Maybe it's a case of 8-16mg bupe for a bit of pain relief but stableness+another pain med (tramadol is one).

While bupe is in you and the more that is you have a "super high tolerence" AKA blockers that is tempory (while it's in you). So if you were stable on 16mg but needed some proper pain relief then you would need alot to over power it. maybe drop to 6-8mg and opiates ontop will work alrighty. This is why people on 16mg or whatever STOP and even a week after they still notice a blockade and my worry is if she was on 24mg for years and grew tolerent and it fucked up then back on methadone/morphine to find they barely work. This MAY explain why I have such a tolerence.

Znegative said:
In my personal oppinion, the best course of action when switching from methadone to buprenorphine, is to switch from methadone first to a short acting full agonist like morphine or hydrocodone for a few days, and then wait the 24 hours and switch to the bupe. This allows time for the methadone to clear from your receptors, without the person experience grueling withdrawal, and the transition should be much easier. Luckily your friend is also not on a very high dosage of methadone.
Click to expand...

I always get shot by docs advising this but I know docs know thier shit but they have never experienced it so wont really understand - Above I mention it in option #2 - but from 4-5 yr exp this is a great method. Doctors in the UK should infact script MSCONTIN after the done and the day(s) after instant morphine, clear 'done then titrate up the bupe.

Any q's or where I am wrong please ask.
 
Tony Williams said:
I have had it rough once, lucky I could get Heroin which numbed it back - God knows what I would of done, probably hospital or LOADS of benzos :(



I will resay what I did before. Backing what RED said. jumping from meth to bupe can be done.

Option #1 Get the mdone stable 20-30mg and wait 2-3 days and you SHOULD be good to do 4mg bupe.
Option #2 stop mdone completely even 60-70mg and work out how long it takes to be removed (3x times as long) BUT hold yourself with morphine/h/oxy or a short opi then jump off them to bupe that way mdone is OUT you then that morning start,

Now 2 points:

I WOULD ASK FOR SUBUTEX. The Naltraxone in SUBOXONE will make pre'wds WORSE as 2 things are pushing the 'done. A week on it, over to Suboxone.
and when you dose 4mg for the first day or whatever, maybe try snorting it - when I GOT AWEFUL WDs from subbing 8mg it took 2ish hr then 3-4hr got unbarable - if you SUB it do 2mg and wait 5hrthen 2mg more if you snort it 2mg 2hr 2mg.

Now. 24mg is ALOT (I was on this for maintence but 16mg never held me - BIG TOLERENCE) - bupe is a pain killer but will only kill so much. start with 16mg(I mean as a stablise dose). Now bupe isn't well researched like mdone, heroin and Scandanavian coutries have a huge amount of people boshing bupe and getting addicted and doctors(+peoples experiences) are saying to stay at 8mg NO MORE!!!!! because Subutex has been about 5-10 years so there's nothing known long term. It works DIFFERENT from the classic opiates - now it IS possible that if someone is on 24mg for YEARS!!!!! and then taper off, they may damage thier opi receptor meaning even tapering and being clean - years later for pain or a high it's harder than it should be as bupe saturates diff parts of the receptor. I am NOT saying this is true but possible and I've heard it happen.

Bupe came out in the 80's for pain, chronic too. However it was in film strips of 200 MICROGRAM (that means your 8mg tab is 40x more!!!!!) and 300 MICROGRAM AMPULES. Now Subutex/Suboxone play on the safety profile of bupe+overdosing and I think 2001 the FDA approved these HIGH dose pills 2mg and 8mg. In NL 2006 it came out, UK 2005 (I think) so it's 5-10yr of human research. I thnik Sub* (high dose bupe tabs) are for maintence and may not help pain much - so 8-16mg go for, please don't let them tell you to live on 24-36mg for pain because it will stop working, bupe is like that. Maybe it's a case of 8-16mg bupe for a bit of pain relief but stableness+another pain med (tramadol is one).

While bupe is in you and the more that is you have a "super high tolerence" AKA blockers that is tempory (while it's in you). So if you were stable on 16mg but needed some proper pain relief then you would need alot to over power it. maybe drop to 6-8mg and opiates ontop will work alrighty. This is why people on 16mg or whatever STOP and even a week after they still notice a blockade and my worry is if she was on 24mg for years and grew tolerent and it fucked up then back on methadone/morphine to find they barely work. This MAY explain why I have such a tolerence.



I always get shot by docs advising this but I know docs know thier shit but they have never experienced it so wont really understand - Above I mention it in option #2 - but from 4-5 yr exp this is a great method. Doctors in the UK should infact script MSCONTIN after the done and the day(s) after instant morphine, clear 'done then titrate up the bupe.

Any q's or where I am wrong please ask.
Click to expand...

With all due respect, TW, most of what you've written in your first post and this post is incorrect. First, Suboxone does not contain naltrexone. It contains naloxone, which has no oral bioavailability, so there is no "double blocking." Second, the OP cannot ask for Subutex because it is no longer available.
 
Ok the naltrax**** stuff I get mixed up - I am sorry. One thing though, with bupe I never believe txtbook standards and doctors (eg, suboxone IV puts you into the worst wd possible even if you're stable and you cannot fix it) - it's quite clear a scare thing - I aint tried but I know 3 people who have and it's either "the same" or "delay in the rush"

Everyone is different remember.

However usually when I've seen people start treatment to bupe - they normally go for Subutex, the doctors but then swap to Suboxone. 2 weeks later. Remember none of these are taken ORAL but SUBLINGALLY. - one way or another it will have SOME sort of BA even if it's quite low. I heard that nal will fight some of the bupe(and applies to other opiates_ and reverse some side effects (constipation). When you're starting treatment (meth to bupe/sub/nal) ideally you want the LEAST possiblity of pre-wds. I have one friend that gets Suboxones and claims the pre-wds were aweful (worse than pure bupe powder he used) - obviously that's one person. Also a person a not react well to the nal/combo which is the LAST thing you want when moving so plain bupe would be a smart option then suboxones.

I know it's wiki but "Because of possible side effects of naloxone in some patients, chemical detox can begin with Suboxone's sister drug, Subutex, which does not contain naloxone. It is common for Suboxone film to be used in all cases unless pregnancy is a concern."

I did not know that the OP can not get plain bupe/subutex? He never said where he is from as it's different everywhere. Even if it wasn't available to you, usually under circumstances you may get them like this or being preg. Like in the UK our Methadone is green mg per ml and sweet and made imossible (well probs poss) for IV, under some circumstances you can request another form like pills which I got when I went on holiday as I can carry on plane unlike liq. I am from the UK - my DDU writes me buprenorphine - when I fill it usually I get ARROW GENERICS BUPRENORPHINE 8mg (small 100mg pill weight tabs). Once or twice they gave brand name Subutex as the generics were out :( - however in another part of England my friends DDU I think do Subs then 2 move to Suboxone.

Ok, now you said MOST of what I had written please correct me on it because it's important to have good flow of knowledge.
 
Hey O.D...Make sure your friend is in pretty good withdrawals...With all due respect....She needs to have teary runny eyes, running nose, sweats, shakes and pupils like a saucepan! I would recommend this to avoid P.W...Methadon has such a long life O.D it will be hard to "guess" how many hrs this may take...If she has these withdrawal symptoms she will def avoid P.W....She should try to go as slow as possible with the subs...
Thats my two cents O.D...I hadnt noticed this info anywhere, though i did skip a bit of the above posts!
 
Man, there's a lot of food for thought here.

She has three doctors that she deals with (psychiatrist, GP and I think a pain management doc). Calls were made to her psych and pain management doctors and we're expecting callbacks today. Her GP admits to not knowing anything about either drug.

An important point is that she is in recovery. Other drugs aren't an option.

I'm hearing two options to best facilitate this switch:

1) stop methadone completely. Wait as long as possible (2 or 3 days) through withdrawal and then incrementally dose subs beginning at 2mg
2) taper down on the methadone. Wait as long as possible (2 or 3 days) through withdrawal and also incrementally dose subs beginning at 2mg

Since she has only been on the methadone for three weeks, I'm of the assumption the withdrawal won't be horrible. Is this a correct assumption based on the info provided?

You guys have no idea how appreciative I am for your input based on your experiences. I guess these pains we go through have definite value. It sucks that they need to be endured but it definitely helps others
 
She has been on Methadone for 3 weeks? What about BEFORE using gear or?

Well what bupe does when you take it + are opi dependent is it enters that receptor and says "right all you'se OUT now" - all heroins, methadones will be forced out you rapidly and it SUCKS BAD worse than natual wd.

How much Methadone are you on? if it's 40mg? drop to 30 or 20 for 5 days then STOP 2-3 days and you will feel wd's if you take bupe take the smallest amount you can 2-4mg and wait and see - if it's ok then up 8mg the day after or whatever tthe doctors say.

If you STOP 40mg then theres too much in your system for taking bupe 2-3 days later would be longer.
 
Ok, we waited 72 hours and just dosed her 2mg sublingually.

According to the COWS chart she is in the area of a score of 24. A score of 13 to 24 is listed as 'moderate' withdrawal so she is in the upper end of 'moderate'.

She took the suboxone sublingually at 8:39am. I figure 5 minutes to dissolve so, at 9:30am we'll see how she is feeling. If no PW is present, we'll dose another 2mg. After that, another 2mg every hour. Sound like a plan?
 
O.D i think u have done rite thing. Now wait and redose 2mg 2hrs afta first dose. Then give her 2mg every 2hrs until she is comfey. Dont let her go to high O.D. imo 8mg shld work. U r good mate. I chek in lata n c how u 2 r going. I b online all day O.D.


Excuse the slang, was on my stupid mobile phone!...How is she going O.D?...Whats the time where you are?..I am in Australia and its heading to 1pm here..How long ago did she take the sub?...I cant tell because the clocks on the forum say a different time zone than mine!

Also O.D, If she was going into PAWS youd know long before the hour was up!
 
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Thanks, MK (you rock!)

After the 72 hours she took 2mg of subs to see if it would throw her into withdrawal (it didn't). We waited an hour and she took another 2mg. After that we waited another hour and she took the 4mg remaining from that pill. We waited another hour and she took a whole 8mg. We then waited another hour and she took the final 8mg.

Prior to methadone, she was taking 24mg of subs in the morning (this was three weeks ago).

She felt significantly better with the exception of being drained of all energy. She slept all day and most of the night. We're sitting here watching TV and she is 100% better than she was yesterday but still feels like she's been run over by a truck.

Thanks so much for your input and concern <3

Edit: it's 4:32am here in the states. You live in the future so we are one day behind you Aussies :)
 
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wow, your waking up to good friday then?....Its 10pm at night here so am off to bed soonish...Am glad your girl went ok....It seems she needed a real lot o.D...Even when i went from 600+mg oxys a day i never needed more than 16mg....She really should only take it to feel comfortable...NOT HIGH...You should really start with a dose of no more than 12mg the first day...I had no idea from your post that she might need so much..Anyway...I aint in her body so 24mg might just be what she needed...
O.D...If she dosent want another habit, make sure she takes less today....And less everyday day until in three weeks she needs nothing else...Would you like me to do a taper plan for you/her...I have done it in 10 days...Personally, your friend will need to do it over three weeks i think O.D...I will make it painless if you can make sure you follow it to the letter....
 
I appreciate it but she takes that amount as prescribed primarily for pain. She's been on that dose for quite some time. She only switched to methadone because her insurance company started making errors on the coverage for her script. That's all been sorted so it was important to get off the methadone (it was causing severe mood swings and anxiety). The suboxone doesn't do as much for pain but it's much more preferable than the mental/emotional sides that she was experiencing.

Man, that methadone is some pretty nasty shit!
 
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