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PostPosted: Mon Sep 06, 2010 4:24 pm 
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Desperately need some help, and I’m afraid the only ones who can help will be those who went straight from Methadone to Subutex. I have been on Suboxone since January 22 of this year, and am one of those for whom it has been a miracle. I am having to help my Mother through some neck surgery and it still stuns me that I can hand her Lortab 10”s every day and in my eyes it’s like an aspirin. No racing heart, no watering mouth, no lovebirds swirling above my head…just a stone cold miracle. This email involves my friend Marie , who wants off as badly as I did. She is currently on Methadone, and hates it. I took her to my Suboxone Doc, who I have never, ever liked, but at the time I did not know the importance of a good relationship with your Subox Doc. I have no insurance, and managed to get the last spot in a Free Meds program, so I have managed to hide my distaste for him. Apparently it’s just me, everyone else loves him. I’ve also come to find out I am the only one who questions him on anything, which is why I think we don’t get along. But I digress. I get Marie all set up to go, and the Doc tells her to just “have the Methadone out of her system for 24 hours”, before she gets inducted, just like me with the Lortab (are you shuddering yet?). See, *I* knew nothing about Methadone. In hindsight, having read the Suboxone insert, it basically says if you are not COMPLETELY off of methadone you will go into INTENSE withdrawal, and that is EXACTLY what happened. This Doctor gave her EIGHT milligrams of Suboxone after she had taken her last methadone tablet barely 24 hours earlier. Within an hour she was in severe withdrawal. The Doctor just watched her, like it was no big deal. Thrashing, writhing, shaking, screaming….Marie had never been thru withdrawal before, and thought she was going crazy and was going to die. It was the most difficult thing I have ever had to witness and I wanted to kill that Doctor, who kept saying “This only happens to one in a hundred people” (which I now know is bullshi*t). After about 5 hours, he shrugged his shoulders and said, “Would you feel better if you went to the Emergency Room?” and we said YES. The ER had no idea what Suboxone even WAS (I have found this with many physicians since taking it, by the way) who gave her like 2 mgs of Valium. We are still getting thousands of dollars in bills for that whole fiasco, (THAT whole situation is for another topic). Needless to say this whole experience has absolutely terrified her to the whole Subox idea. Her sleep Doctor is willing to prescribe Subutex for her “Restless Legs”, and she is willing to take it, IF, I can convince her that THE SAME THING WONT HAPPEN. I have told her all about the Naloxone factor, and that Naloxone isn’t IN Subutex, but she is still terrified. Quite honestly, *I’m* not all that hip to the difference between Subutex and Suboxone, except that it has something to do with shooting up (not a problem for her). She just needs to get off the Methadone, which she got on from a severe pain pill addiction. So I come to you, not for a debate or further questioning, but for anyone who has gone specifically from Methadone from Subutex, so that I can print it out and show it to her. She hates Methadone, and wants to get off of it so badly, and does NOT want to get back on the pain pills, which will very likely happen without something in place. She recently lost EVERYTHING in the Nashville flood, and desperately wants to get on the Subox, which has completely changed MY life. I figure if she can get on the Subutex, then she can jump over to Suboxone, or maybe she can stay on Subutex, if indeed it has the same power to null-and-void all cravings for pain pills. Anyone who can write a paragraph or two, to tell her that she will NOT have the same experience with the Subutex, I would be deeply indebted to you. Thank you SO MUCH in advance……


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PostPosted: Mon Sep 06, 2010 5:12 pm 
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First, I don't have the experience you're looking for, but maybe I can tell you a couple of things. Marie STILL needs to get the methadone out of her system and be in w/d before going through her induction - it shouldn't matter whether its' suboxone or subutex. The only difference is the naloxone, like you said, which is in suboxone in an effort to prevent shooting it up. There's no other difference. Methadone is very long-acting, which is, I believe, the reason for the increased number of people having precipitated w/d from that particular induction/transition. It takes longer for it to leave the receptors.

I've heard about many doctors who will actually put the person back on full agonist/regular pain meds for a week or so before their sub induction. I'm not saying this is what she should do, but it's what's done sometimes. I think it's great that her doctor is willing to prescribe it off-label for her, but it's my opinion that she needs a doctor who has the medical knowledge and experience to guide her through a painless induction.

There are some people on this forum who have made the transition from methadone to suboxone. If they don't respond you might just have to go through some of the older posts. You might also try a Google search.

I wish you and Marie and very best. Please let us know how it goes. I'm sorry I can't help more.

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PostPosted: Mon Sep 06, 2010 6:21 pm 
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I went from methadone to suboxone just a few weeks ago. I did, however, taper off methadone for many weeks and jumped off at 2.5 mg a day. Even so, I experienced pretty severe w/d from methadone and subsequently took hydrocodone twice a day for several days to help with the headaches, pains in the legs, cramps, etc. When I went to the sub doc, I was still taking hydros. He advised me to start the suboxone 12 hours after the last hydro. Even so, I waited 24 hours before taking my first 8mg suboxone. I had no adverse effects. In fact, I haven't had a single craving for anything, including suboxone since. I have gone from three 8 mg subs to 1 8mg sub per day in the last few days and intend to drop that to 6mg, then 4mg over the next few weeks.

Methadone has a half life, much like suboxone, that results in the drug staying in your system for 2 or 3 days after your last dose, perhaps even longer. The first day off methadone feels like withdrawal, but after 3 days you realize the first day was most likely psychological, rather than physiological. Your friend just got that immediate 3rd day experience without the benefit of sliding into it a little at a time. She really does need to stop the methadone for 3 days or longer before taking suboxone, IMHO. If necessary and available, there are other drugs besides narcotics that can help get her through those first days off methadone, but in my experience, hydros do make it palpable. Not that I am recommending any specific course of action, it is just what worked for me. I feel like a have a new life, although I still intend to get myself off suboxone at some point, for now I am content to find the lowest dose that will allow me to function without opiates.


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PostPosted: Tue Sep 07, 2010 7:20 pm 
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I haven't but a loved one of mine has:
First off, you need to be down to 30mgs a day or less or what happened to her will happen again.
Then, it's seems like it's better to wait 2 days rather than just one, obviously just my thinking IM NOT A DR.
And it's gonna take her at least a week to feel 100%. It's wicked going from MEthadone to sub, however doing the subutex instead of suboxone would be so much better for her!!!

Also, another person who did this was my husband...except his dr put him from MEthadone to Vicodin first, then vicodin to Suboxone. So thats another option.

Im SO SORRY your friend had such a bad time :-( that sucks. I hope she finds a way. please let us know how she is doing!

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Of course there's such a thing as angels. Only sometimes they don't have wings... and we call them mothers. -Unknown


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PostPosted: Wed Sep 08, 2010 9:03 pm 
Hi bdon.... Has Marie been able to see the responses you've gotten for her? I hope so. I will add one more to other good replies you've already gotten.
First of all.....That doctor, in my humble opinion, needs to have done to him what he did to Marie! There is just no excuse that I think of for a medical professional who is 'certified' to prescribe buprenorphine to be that ignorant! That must have been pure torture to her, and to you, not to mention her bank account. Ridiculous and totally uncalled for!
Methadone is a very long-acting opiate. It stays around in the body for much, much longer than what you and I and many others have converted to Suboxone from (hydrocodone, oxycodone, dilaudid, etc) The rules for induction timelines onto Suboxone or Subutex from Methadone are way different, as you now know.
As far as Subutex being a better choice than Suboxone for her......I don't know that there's really any scientific rationale for that. In my understanding, it was not the nalaxone that put Marie into precipitated withdrawal, it was the buprenorphine (which is in both Suboxone and Subutex.) The nalaxone is essentially inactive unless it's injected. What happens is that the bupe 'knocks off' the full-agonists (in her case, Methadone) from the opiate receptors in the brain which is what threw her into such immediate and terrible withdrawals.
From what I have read and as I understand it, it is best to get the Methadone weaned down as low as possible (as RTLmom said ~30mg/day) and then wait until mild to moderate withdrawals ensue, then start the buprenorphine. That may take several days. The other option I hear which was mentioned here as well, would be the way I would want to go, if it were me and I could find a doctor to agree.....would be to wean the Methadone down to 30mg for a good week or more, then switch over to hydrocodone or oxycodone to ease off the Methadone for a week or so, then take the ~24 hour to go into the appropriate stage of w/d and then make the change over to Subutex or Suboxone under doctor supervision, preferably a NEW doctor who knows what s/he's doing! There is a chart that can be found easily by googling "COWS scale." It will help one gauge their level of withdrawal to help prevent taking bupe too soon and going into precipitated w/d.
I have never been on Methadone myself and I'm not a doctor or expert or anything, but thought I'd try to help a little bit. Good luck to Marie! Let us know what's going on when you can. And glad to hear how well you've been doing!


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