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PostPosted: Mon Dec 14, 2009 5:52 pm 
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Hi all, I apologize because I am sure the answer I need is in here somewhere but I am just too wore out to look any longer. I have been taking some form of narcotic for 10 years for chronic pain. For the last 5 years it's been methadone and vicodin, as much as 80mgs daily of methadone but for the last two years 40 mgs of Methadone and 3x 10/500 vicodin. I made the choice 2 years ago to not go above 40mgs of methadone because I knew I wanted to stop taking it so I could find out if the pain was real or phantom from the pills.

Anyways I did some research and asked my doc for Suboxone. He also checked on it and after a few weeks let me know he could prescribe it and gave me an Rx for 24mg's a day but told me to try 16mgs first. He also said to make sure it had been at least 4 hours since my last dose of methadone/vicodin. I took my first dose yesterday morning about 7 hours after my last dose of methadone and vicodin AND about an hour later I was starting the withdrawals and withing 90 minutes they were full blown. Stupidly I took some methadone and vicodin after about 2 hours of withdrawals, at least I think I did, and took my normal dose of them today.

I need to know what is the normal/recommended waiting period to take Suboxone after my last dose of Methadone? I am trying to do this and keep working which I can't do tapering off methadone even at 2.5 mgs a month.[font=Arial] [/font


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 Post subject: Well...
PostPosted: Mon Dec 14, 2009 7:05 pm 
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First welcome to the forum. I am fairly new here, but love it and am also fairly new to suboxone (almost 6 months) but love that as well. I am by no means a doctor and these are just my personal opinions and some insight which I have found researching suboxone and related matter.

I am also chronic pain patient for over 10 years, narcotic treated as well. I never was perscribed methadone for pain relief but have personal experienece with that as well. I am not going to get into it because different time/place for that..... But put it this way, very 1st script of pain killers was for tylenol 3's, that progressed into the strongest painkillers we have available in the good 'ole usa. After that didnt cut it I even used herion for "pain relief", not in any controlled way tho, I am an addict, and do not mistake that.

According to the pharm company of suboxone, (SPELLING!!!! sucks, i know :? ) Reckitt Beckniser, the first dose of suboxone should be given about 12-24 hours after immediate release agoinists (herion, oxycodone IR, hydrocodone, morphine, anything quick acting with very short half life or "short legs"), for oxycontin, ms contin, and other extended release drugs or ones with "long legs" 24-36 hours, and for methadone, 36-72 or more. Even as much as 96 hours for methadone. I think some of these numbers are cutting it close or are too short in many cases. But they are MORE than enough for others. DON'T quote me on the exact hours for each last dose of pain killer to 1st dose of suboxone. IF I WERE YOU, being on a steady amount, and realativley large amount of methadone (or relatively small, depends how you look at it I guess), I would wait as many DAYS as possible, 3, 4, 5 days.....I don't know... Basically, once you know for a fact that you are in moderate withdrawals, is usaully the safest way to gauge if it is time for suboxone.

IF someone is say on percocets or even vicodin, they usually start to feel the W/D in as little as 4 or 6 hours after the last dose of narcotic. If someone only takes oxycontin for a week or so, but knows they will be sick if they stop, they can prob use suboxone in as little as 8 or 12 hours after last dose....please dont quote me as I said. BUT if someone is a chronic pain killer user, especially the longer acting ones, those times can be much longer. That same person using oxycontin for 3 years straight might not be ready for the 1st dose in 8-12 hours, they may need 24 hours or more. This is so much more true with methadone since the half life is especially long. I guess to as you take painkillers more and more, they keep building up in your system, especially the long half life drugs. If you dose once or twice a day, but the half life is a day and a half, you can see how it will build up in one's body. Suboxone's half life is also very long, this is another issue I guess.

Sorry to ramble....answer to your question: Wait as LONG AS POSSIBLE since you are on methadone. I know 3, 4, 5 days sounds ridiculious. But I am just letting you know what makes sense and if you google a bit or search sites like suboxforum, you will find others who say the same. Good luck , and if I can help in any way just gimme a shout.....keep us posted.

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"Have no fear of perfection - you'll never reach it." ---Salvador Dali


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 Post subject: RE:well
PostPosted: Mon Dec 14, 2009 7:21 pm 
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Thanks Big Red. I tend to start to feel withdrawals within 16 hours though mild and hate to think about going 3 days or more. I can do it but will have to take leave from work which is already down to 4 work days a week. Unfortunately I'm a recruiting manager in a market with no jobs but that's another issue to deal with.

I knew about the long half life of methadone which is why I have had so much trouble dropping the dose. I have gotten down to 15 mgs a day (something I did every 18 months or so to help keep my dose low but working) but I can't seem to get lower and continue working and be a father and husband worth being around.

I guess I will wait until I have the time to deal with the withdrawals for a few days before I try again.


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 Post subject: Gotcha
PostPosted: Mon Dec 14, 2009 7:52 pm 
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I understand you on that....I really do. You could, if you have the means, try to switch temporarily over to a short acting pain killer, well even oxy or ms contin is shorter than methadone. But ideally something like 30mg oxycodone immediate release, or maybe something parentally (spelling). Also I think the fentanyl "lolli pops" are a very short acting anagelsic. The fent patch is for 3 days, but the rasberry lolli pop is for break thru pain and I think is only like 3 hour half life. OR maybe goto oxy or ms contin for couple weeks at equivalent or less equivalent but comfortable dose than switch to the immediate releases. That might be an easier transition from methadone compare to going directly from methadone to oxy IR. Allthough, I suppose if you had the correct dose, this could be accomplished with relatively little side effects with doctor's supervision.

SO hypothetically (SP), if you went to oxycodone 30mg immediate release 4 times per day equaling 120mg per day total, that might not even hold you over. But ther are other stregnths, so a 30mg and a 15 mg, making total dose 45mg 4 times a day, thats 180mg of oxycodone. I think that would be more than enough to take care of the methadone and hydrocodone you take now. If not, you can take 2 - 30mg's 4 times a day......240mg oxycodone. All immediate release. This way, you can take your last dose before suboxone treatment, and then the next 12-24 hours you will be ready for the suboxone, if you took the immediate releases for say a few weeks and no methadone. Just a suggestion and I realize that this may not be at all possible one bit for you and you just must wait.

Do what you need to do, but I know that if I knew about suboxone a while ago, I would have been on it. As a matter a fact, I went about a week without suboxone in the middle of my current treatment (doctor problems, had to get new one, had him for few months now and great) and during that week without suboxone I noticed my back pain and leg pain from nerve damage much more intense. Once I got back on suboxone I have noticed that it does help with my pain. It does not make me 100% but it makes it tolerable and now I dont need to keep increasing my pain med dosage because I am steady with the suboxone and that is my pain med. I know that methadone and other full agoinists will produce more "numbing" of pain, but with that comes the opiate "fog". I have a very clear head on suboxone and not in that fog so to speak.

Once again, just some suggestions and some of my experience with the matter at hand. Good luck with what ever you choose to do. But I know I had no choice when It came to suboxone or not, maybe that is why the decision and switch was so easy. It was something that had to be done. But if you can do this now and you do benefit from suboxone then the sooner the better right? Best of luck to ya and I hope everything works out. This a great forum. Suboxone is a great tool.

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"The past is finished. There is nothing to be gained by going over it. Whatever it gave us in the experiences it brought us was something we had to know."----Rebecca Beard

"Have no fear of perfection - you'll never reach it." ---Salvador Dali


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PostPosted: Tue Dec 15, 2009 1:11 pm 
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Hi GSquared! and welcome!

You have survived something most of us here are quite concerned about. That is called precipitated withdrawal.

Since you are in a pain management situation with your doctor (but wasn't suboxone wise) - I wanted to give you some short rules of thumb. Please, understand you and your doctor (TEAM) are the authority. If you hang around the forum a while, you will see most all of this site is spot on with good information - often you can take it to you doctor for discussion.

First, make some time to really research suboxone (buprenorphine). Dr. Junig (suboxodoc) has some excellent clips on youtube, and the manufacturer also has good information.

Points to consider (generally) .

. Suboxone is a partial agonist opioid with buprenorphine - and an anti-abuse drug naloxone for abuse prevention (IV, etc.).

. Suboxone has a ceiling effect probably around 8-16mg's. In Layman's terms that means you won't get any more relief by taking 24mg, or 32 mg than less.

. Suboxone has a stronger affinity to the opioid receptors than full agonist opiates (codiene, hydrocodone, oxycodone, methadone, heroin, etc.) Again, in layman's terms that means if you take suboxone - it will displace any other drug on your pain receptors. In your case, methadone was still in it's first half life in your system- and so when you took suboxone it kicked the methadone, and percocet off - leaving you in precipitated withdrawal - which has been mentioned here to be 'un-fun'.

. Suboxone only works sublingually. We have had some folks who thought they took suboxone like methadone - just swallow them. It doesn't work that way.

. Suboxone will render methadone, and other opiates useless while in your system (within 5 half-lives).

. Suboxone has a 37 hour average half life. Taking any opiate (methadone, percocet, oxycodone, ...) when on Suboxone will not help pain - as it can't attach to the pain/opioid receptor in your body.

. I have seen several recommendations that a methadone patient get to 30mg's of methadone initially, wait a few days at that dose, then quit methadone for 3,4,5 days (so they are in medium to moderate withdrawal symptoms [this is the hard part] ), then start the suboxone under the tongue and ramp up until your symptoms abate. It was not recommended for patients on more than 30mg's, but again - this area is a great discussion point with your doctor - or others here that have gone from methadone to suboxone.

. Suboxone has limited pain management abilities. As BigRed said - it helps, but more is not more. More is the same as far as affect on your body.

Suboxone is WONDERFUL for us who are looking to get 'clean' as there is no euphoria with it. There is just 'normal' so that the majority of us can deal with triggers and other issues that lead us to use, and then we can slowly taper off.

I hope this helps you as you consider your next moves. I personally believe anyone with 'chronic pain' should really do their homework and understand the upside/downside of using suboxone.

Please keep posting, and we look forward to your decisions/progress in the future!


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PostPosted: Tue Dec 15, 2009 2:42 pm 
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Some very good points were made by lathe. Talk with your doctor with some of the good info that you find here, youtube, or other sources. Just make sure it is reliable. I too find a lot of reliable info from suboxdoc.

I would like to say something about naloxone however. It is my understanding that yes indeed it is the bupe that displaces the oxy or morphine etc, if someone is dependent and then takes suboxone. The affinity of bupe is much stronger than I think every other narcotic (almost positive, but it is extremely strong nonetheless). Also, if you are maintained on suboxone, taking other normal doses of painkillers will not produce any anegelsic effect nor euphoric. In very high doses they may produce small effect compared to the dose but the respitory depression is not effected as much by the bupe tolereance. Meaning, when you take the large amount of say oxy or whatever, you are flirting with disaster because of breathing problems.
The naloxone is supposed to be there to prevent abuse. The only time precipated w/d happens is when someone is dependant on full agonist opiods (oxys, dope, methadone, etc...) and takes suboxone. However this is still from the bupe and not the naloxone. No matter if taken under the tongue, snorted, shot, or whatever else us addicts do to ingest drugs (dont swallow subs, extremely poor B/A orally hense the sublingually (under tongue)). I dont shoot, nor did during active addiction but others who do shoot have shot the suboxone, just like subutex, while dependant on suboxone (not full agonists) and have not gone into precip w/d. The naloxone is more or less to please the FDA and others.

I am by no means attacking anyone. LatheDude and many others have some great imformation and expereinces to share. I am just upset sometimes when other sites and other people spread so called "facts", whether it is on purpose or just their misimformation.

Keep us updated and take care!...

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"The past is finished. There is nothing to be gained by going over it. Whatever it gave us in the experiences it brought us was something we had to know."----Rebecca Beard

"Have no fear of perfection - you'll never reach it." ---Salvador Dali


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PostPosted: Tue Dec 15, 2009 4:25 pm 
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Hi All -

BigRed is right, if I left the impression that naloxone did anything other than prevent abuse, my bad.

Also, for those who want generic options, the good news is that buprenorphine (Subutex) is available generic, but suboxone is not. Suboxone has the abuse preventative medicine naloxone which is inert as BigRed said, unless IV, (I'm not a doctor - but I believe them and don't recommend trying it :) )

Also, back to the original challenge of chronic pain - it's a big and real issue. Without a ton of detail, we live in that world everyday in our family.

Methadone is a controversial medication in its own right. Personally - it has given my family a life back. There are plenty who think if you take one methadone - you will stop breathing. I also find lots of folks who don't understand suboxone. The medication 'is what it is.' The best thing you can do as a chronic pain patient is to make sure your expectations line up (hopefully with your doc) what will most likely happen with suboxone and your chronic pain.

Health Care, in my opinion, is now partially in our own hands. GSquared, I hope you continue to find information from good sources about suboxone. I do get concerned that people think they can take suboxone for pain - get on suboxone - only to find out it is not enough. Then they are stuck for a few days in agony while suboxone is eliminated from their body and they return to other pain medication. It's a balance, that only you can determine with resources here and your doctor.

In our families case, suboxone would not be enough to provide coverage - and especially in the 'break through' pain environment - where most pain doctors give something on top of methadone - that something on top of suboxone is wasted money for zero improvement (unless as BigRed said - you were on some mammoth dose of something - then you might really quit breathing).

Please let us know how you decide to proceed with this, as many people who visit are also chronic pain patients. Suboxone is straightforward for dependence (In my opinion). I don't clearly understand how to set expectations for people who have legitimate severe chronic pain with Suboxone.

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 Post subject: Agreed!
PostPosted: Tue Dec 15, 2009 4:55 pm 
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I agree. I might have been mis-leading in my words. I do not thing that subs is a great pain med. Nopers! In fact, I think that for someone with chronic pain and who is not in active addiction but is taking pain meds to wait on the subs, or research a bit more first. If you are having problems taking the script as directed, abusing it, cheating, lying, stealing, etc etc etc, then suboxone will be of help, especially compared to nothing.

Suboxone might help a bit with the pain, but breakthru with be hard to manage and you, for the most part, will not have a wide range of doses to control your pain if that ends up a problem. MANY points to consider on this topic, I just try and help if I can.

In any event, consult a doctor, consult two, three....I just wanted to put my .02, or .04 cents in.

Take care everybody

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"The past is finished. There is nothing to be gained by going over it. Whatever it gave us in the experiences it brought us was something we had to know."----Rebecca Beard

"Have no fear of perfection - you'll never reach it." ---Salvador Dali


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 Post subject:
PostPosted: Thu Dec 17, 2009 7:45 pm 
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Thanks everyone. As far as my chronic pain goes I have no idea if I have pain anymore of if it is now from taking painkillers for so long and that is why I need to get off the meds for a while to see where I am at. I'm 44 and someone who loved to abuse my body riding motocross and playing football without pads so I am sure I have pain but just how bad is the key. Suboxone seemed to be the best choice for me other than coma withdrawal which is a bit expensive. I have reduced my methadone intake a number of times and know how lousy it for me even dropping in very small increments so I am hoping Suboxone will be a bit better.

I am going to try taking Suboxone again on Saturday which will be after about 50-60 hours after last dose and will take small amounts of it until I feel better. I think that advice is the best I heard since it makes sense that if I can get by with 8 mg's instead of 16 or 24 I will be able to get off of it that much easier, easier being a relative term of course. If I start getting the withdrawals again is it better just to ride them out for a bit? Since my withdrawals stopped after a few hours last time do you think I would have been fine sticking with the Suboxone from then on? I have off the week of Christmas do you feel I will be ready to go back to work in 7 days after starting Suboxone?

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PostPosted: Fri Dec 18, 2009 1:23 pm 
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hey GS the others have offered wonderful advice I just wanted to point out to you that since Suboxone (buprenorphine) has a "ceiling effect" at around 2-4mgs it really doesn't matter how much you take above that in terms of opiate effect. I've been on Suboxone for about 3 years now and I've been able to easily go down to 2mg a day for a few days with no withdrawals whatsoever. If you're getting good abosrbtion of the medication then it doesn't really matter how much you take 4mgs and up in terms of eventual tapering. The reason opiate addicts are usually prescribed more Suboxone 8--24mgs is to provide a stronger antagonist effect meaning that it makes it almost impossible to get high if this isn't an issue for you then I'd talk to your doctor about what he'd think about you taking a lower dose. Again do whatever your doctor tells you but in my own personal experience and the experiences of others I know dropping from 8mgs a day to 2mgs a day even for more than a few days at a time will not cause any real physical withdrawal.

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PostPosted: Fri Dec 18, 2009 2:47 pm 
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Hey GSquared!

Thanks for the update. You asked a question about riding out wd's if they hit...

hmmm... I guess everyone is different. I wanted to use suboxone as a tool to limit the wd's initially to zero, and to slowly taper from there.

As for the ceiling effect - the dose is different for everyone. Matt is right from my understanding, but everyone's absorption ability in their mouth is different. Why do I say this? Well, I am on 8mg's right now. Initially I needed 12 mg's for no side effects, and have tapered down to 8mg's today. Maybe my mouth creates too much saliva, or maybe I don't absorb as well as others - bottom line - is it doesn't matter. I found relief and could set goals and get help. I hope you find that same relief at whatever dose it takes.

If you need more mg's - there is nothing wrong with that! If your sublingual absorbtion is not as good as someone else's - who really cares as long as you are out of withdrawals all together, and able to deal with your dependence and get ready for a successful taper.

So, my advice is use the least amount of suboxone as needed - but if you need a bathtub to handle your wd's - I personally would look to add a few mg's to find the right dose. Stabilize there, work with your doc, and make a taper plan. No judgment at how much it takes to relieve your symptoms. Anyway - you and your doctor can decide. In my own personal case, if I were not free of wd's I would be very tempted to turn to another drug for relief - and we don't want that!

Keep us posted, and thanks for the update!


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 Post subject: withdrawl
PostPosted: Tue Dec 22, 2009 3:13 am 
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you want to wait until your feeling moderate to severe withdrawal before you start the suboxone. If you take the subs too early it will remove the opiates in the receptors and throw you into withdrawl as you already know. I made that mistake too.


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