Despite the recent legal hype, sublingual Bupe won't make your teeth fall out; years of addict hygiene is hard to separate out from routines of opioid maintenance that, for most of us, involved methadone at some point and last years.
A very slow buprenorphine taper is definitely the safest and most effective option. Methadone is inferior to Buprenorphine on many levels: As an agonist It doesn't block opiates (making you vulnerable to relapse), it's a weight gainer, it rots your teeth and, depending on how committed to your recovery, the clinic routine can be tedious and expose you to active addicts daily. Once on Methadone, the Buprenorphine option will quickly disappear unless you
really can wait 3 days. Methadone's only advantage over Suboxone is ease of induction.
Methadone induction is painless, but tapering down from the clinics' industry standard of 110 mg daily, plus the mandatory 3 days cold turkey before introducing any partial antagonist (Bupe) or a full antagonist, is the opposite of painless. Methadone vs Buprenorphine is really no choice after all: If you're serious about your recovery Bupe films or the Sublicade shot are objectively better options.
Suboxone induction, however, is not easy. But 3 days is a very conservative wait time estimate, I think. True, Fentanyl is short acting but long lingering biologically, so the old 24 hour/8 mg to the face and you're good philosophy is dead. Gauge your perceived level of withdrawal -- this should dictate the induction process. Use a stress-free day to sleep in as long as possible 8 -12 hours is ideal. Tell anyone who asks that you're sick because it's the truth. Even better get a hotel room. Once in moderate to severe withdrawal (take a nice shit for once) start dosing in 0.5 mg amounts, wait an hour and repeat. Everyone is very different. But the longer you wait and the less you take as you induce the better. Build up to at least 4 mg during the first day this way. It sounds as if this would be enought to relieve your withdrawal symptoms.
If you start to feel noticeably better while slowly inducing Buprenorphine, the worst thing you could possibly do is get cocky and take a large amount suddenly. Don't "cake" it. (I like this expression for taking too much Suboxone too soon. But it expresses the worst case scenario.)
By the end of the first day you should feel a very good sense that you can do this! Time is finally on your side once again!
You will have make it through one pretty bad day and night most likely. 24 hours after first inducting, you can likely make your way to 8 mg quickly. I can take a full 8 mg strip the morning after induction, precips the day before or not. Then take another 8 mg strip 36 hours after first induction. From here, you can make your way down to 4 mg comfortably -- within a few days if you don't need a blocking dose or you don't require maintenance.
I want to stress that induction is the hard part, especially if you don't know how your body responds to Suboxone. My first few inductions, when I was much younger, were a cakewalk. Having become dependent on Percocet, I'd wake sick, take a strip (4-8 mg), and I was out the door. In 2012, assuming use of Rx opiates and east coast Fent/Heroin street powder, 24 hours, 8 mg, and you were straight and strong. Straight Fentanyl requires a more careful induction. From what you've written, I assume this is your first experience with Bupe induction. That's good, because it seems to get harder and harder each time. The younger you are the better, too.
Kratom, while it does take away opiate withdrawal, is problematic for a few reasons. Quality Kratom is expensive and probably not quality. Headshop and gas station Kratom may or may not be poison. If you. must, Bali is better than Meng da. Suboxone, Methadone, and Kratom all represent trading one addiction for another. But the amount of Kratom you need to consume, the horrible taste, and the probability that you'll experience a GI event that makes you never take it again, makes it a poor alternative. If you know the supply is legit it could be used as part of a taper, I guess. Kratom maks you feel a little high. FYI: People who take Kratom daily usually die from health complications in their 50s no matter how in shape they are.
https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/kratom/art-20402171
Gabapentin is a great all around detox medication. 800 mg or more will ease RLS and serve as a nice sleep med. But Gaba should only be used at the end of a long taper -- when you're staggering days between 0 mg intervals. Grams of it are what we like and what really eases a Suboxone detox, but tolerance, physical dependency, and -- as I learned last night -- withdrawals, similar to those of opiates (restlessness and anxiety), can occur and will be unpleasant and counterproductive. So don't stop taking large amounts of Gaba willy nilly while you're attention should be on your primary detox.
What I'm trying to say is the best way to get off of street opiates is Suboxone maintenance followed by a long, slow, and responsible taper. Under 2 mg it's all about your own bodily chemistry. Everything is mental, but I would get down to 1/8 mg as slowely as possible ~ 1 year with little maintenance at higher doses (avoid taking more than 8 mg daily as your dose). Then start skipping days when you feel good. Skip one day, dose (1/4, 1/8, or 1/16 mg); skip two days, dose ... Skip four days, dose and you're done. You'll probably be surprised by how manageable your symptoms are on the dreaded drop to 0 mg day. I'm on day 10 without any bupe after a three week staggering situation, which didn't seem to work for me because I felt like it put me back at square one (even though I was only taking 1/8 mg every 3 days). Listen to your body and go slow; avoid methadone; don't take to Kratom. Of course Ativan is good. If the med's name ends with 'pam,' you're no detox gam? I just made that up. Do you like it?
That's a penny's worth of my thoughts on the subject. Congratulations on your nascent recovery! And the best of luck to you. You will get through this.
