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PostPosted: Sat Sep 27, 2014 5:21 pm 
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im new to any type of forum so hello and thanks in advance.......I'm Putting some serious thought in to making the transition from methadone to suboxone or buprenorphine in the coming week's or months...already been reducing my dose from 110mg to current 45mg,had a brief discussion with my addictions worker who knows suboxone is available but doesn't know much about it,thus the reason I've found myself here....my main concern is the optimal finishing dose of methadone and starting doses of suboxone..... Thanks...d


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PostPosted: Sun Sep 28, 2014 4:02 pm 
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Hey, welcome to the site. Hopefully someone with more experience will come along and answer you soon. There's not a lot of people here on methadone, but there are a few and plenty that made the switch. I've never been on methadone, but this is what I know from reading others experiences here and on bluelight.

It's ideal to be stable on 30 mg of methadone or less before switching. Sub only has up to the agonist effect of 30 mg of methadone before the ceiling effect kicks in, so this will make your switch easier. It's important too, to be stable on that dose.

Precipitated withdrawals are the other big issue with methadone. When you take your first dose of sub, it will rip any other opiates in your system off. This results in a huge, sudden drop in opiate effects on your body and will cause you to instantly have very bad withdrawal symptoms. The only way to avoid this is to be sure that you are already in withdrawal before taking sub. Because methadone stays in your system much longer than short acting opiates, it is advisable to wait AT LEAST 36 hours and in most cases more like 72 hours between your last methadone dose and first sub dose. Some people bridge this gap with short acting opiates, taking those for a week or so, then waiting the recommended 12-24 hours. Whether that is an option for you, I don't know.

I would discuss all this with the doctor that will be prescribing you the suboxone, and also with your methadone doctor. Some doctors will prescribe a shorter acting opiate for a week or so to ease the transition. Others will not, but some may prescribe you comfort meds - xanax, clonidine, etc - to make the 36-72 hour wait easier.

Generally, the longer you wait, the better you will feel right off the bat. The amount of time is not as important as making sure you are already in moderate withdrawal before dosing sub.

Hopefully someone else will help out a little more, as like I said, I haven't personally taken methadone, I just read a lot on these boards...


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PostPosted: Sun Sep 28, 2014 5:44 pm 
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Fullycaffeinated's response seems pretty spot on to what I was going to say or what I think most would say to your questions. Although I didn't transition from methadone to suboxone, this is also what I've read here and at various other recovery websites.

I also wanted to mention using the Clinical Opiate Withdrawal Scale, or C.O.W.S. for short, which contains a series of classic symptoms of withdrawal, and a numbered scale to rate severity/existence of each symptom. Once a certain score is reached on the scale, it is usually considered safe to begin taking buprenorphine with the least chance of precipitating the withdrawal syndrome. In addition, I've also read many times that one should, if possible, have another person score their symptoms on this scale, as it's easy in our need for relief, to score our own symptoms too high, and risk bringing on precipitated withdrawal. If you're going to be inducting in a doctor's office, they'll likely use this scale to assess your symptoms and time your induction properly.


To be on the safe side, many people start with a relatively small dose of around 2 mgs, and if after an hour or so , no accelerated PWD symptoms occur, and you're still feeling withdrawal or craving, increase every 2 hours or so with 2 mgs until reaching a dose that stops your WD, and takes away your cravings, thus reaching your maintenance dose.

This is in no way to be considered official medical advice, just based on what I've learned and read from this and other sites. Hopefully, someone who has made this transition will be along to answer your questions. Good luck making your transition!
(Btw, you can easily find the c.o.w.s. scale by googling or some other Web search)


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PostPosted: Mon Oct 06, 2014 6:30 am 
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thanks for the reply and input...iv now spoken to my worker again who informed me that the most comman programme available to me is a 28 day rapid detox using the suboxe from a final 30 to 40 ml dose of mtdone...ill be discgussing this with the prescribing doctor in two weeks from now...after reading numerous posts on this forum i dont think the 28 day option will be the most practical route to take so im hope the doctor can extend the time and reduce the speed of the reduction of suboxone to suit my individual circimmstances..to me 28 days seems far too quick after beind dependant on opiates of one kind or another for 18 years...i do have the drive and determination to do it this time but realisticly,how am i going to feel 3/4 days after starting the crossover..i wont know until im actually in that postition and i need to keep my time off work to a minimum so being wrapped up in bed for 3/4 weeks realy isnt an option.....
ill have a better idea and understanding of my options once ive spoken to the prescribing doctor in a week or so,although i dont know how experienced he is in the prescribing and subtleties of suboxone yet,im hoping he can tailor the programme to suit....

again,thanks for the input its appriciated....D


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