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PostPosted: Fri Feb 17, 2012 1:55 pm 
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I am going to a methadone clinic to taper off. I asked the doctor today about switching to Suboxone for the last 20 milligrams (of methadone) I have to get off of.

He said, "We'd just switch you right over."

I said, "Don't I have to be in withdrawal in order to get on Suboxone without getting sick?"

His reply: "No, I could just start you tomorrow."

Now, this is the one and only doctor at a methadone/Suboxone clinic in town! How can he be so misinformed/uninformed/downright wrong? And how can I tactfully educate him so he will let me wait till I AM in withdrawal before I begin Sub.?

I'm just blown away by his lack of knowledge, considering this is supposed to be his field of expertise!


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PostPosted: Fri Feb 17, 2012 2:20 pm 
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I don't know- if it was me in that situation (the way that I'm understanding it)- I probably
would just agree w/him; then just take home my sub- wait til I went into w/d- and then
dose my sub. Simple (?)

"Please choose your "battles" wisely"- I was once advised- by a very smart woman...

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 Post subject: can't take sub home
PostPosted: Fri Feb 17, 2012 4:35 pm 
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You have to take your Sub dose at the window; they don't let you take it home.


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PostPosted: Fri Feb 17, 2012 8:14 pm 
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Maybe you can do a little research online and find a reliable source indicating that you need to be in moderate withdrawal before you start suboxone - and then print it out and bring it with you? Unless they would start you on subutex which i don't think would be an issue to start the day after methodone. But i'm not sure on this either...(sorry!)
I too switched from methadone to suboxone. i was taking 45mg of methadone when i decided i wanted to switch to suboxone. Because methadone has a long half life, my doctor told me to go 3 full days without taking my methadone dose before i came back in to pick up my prescription for suboxone (in a cold sweat). And even after waiting those 3 days without methadone, it took me a full week to feel "normal" on suboxone. I think that's because i still had a good bit of methadone in my system since i had been on it for a couple years.
Also - just so you know, my urine tested positive for methadone for 2 months after I stopped it and went on suboxone. My doctor wasn't concerned about it the first month, but on the second month when my urine still tested positive for methadone, she asked if i was still using it (I totally wasn't and this was confirmed when she sent my urine off to a lab to have the levels tested). But the bottom line is that methadone stays active in your system for awhile and i'm thinking you should probably be off of it for at least a couple days before you start suboxone... I'm not a medical professional, but maybe subutex would be different because it doesn't have the naloxone in it. Check with the Doc to see if you'll be receiving subutex or suboxone - this might make a difference. I bet someone else on this forum will be able to offer you some insight on this. Good luck with everything!


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PostPosted: Fri Feb 17, 2012 8:39 pm 
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Hi all! Subutex would be the same, I've done all 3. Its not the naloxone that makes you go into precipitated withdrawal, its going from a full agonist to a partial. As my doc explained it, like an elevator. Full agonist has you on the sixth floor, partial agonist drops you to the third floor. Not all the way down, but bad enough. I've been there.


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PostPosted: Fri Feb 17, 2012 9:41 pm 
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[quote="JenW"]Maybe you can do a little research online and find a reliable source indicating that you need to be in moderate withdrawal before you start suboxone - and then print it out and bring it with you?

Yeah, I've been looking for just that. Does anyone know of a succinct little reliable scientific little description of Suboxone online that says that you must be in withdrawal?

I may just stick with the methadone and go down drop by drop. Only 20 mg. to go...

Sigh.

Thanks, everyone.


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PostPosted: Fri Feb 17, 2012 10:40 pm 
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Yep, this document is straight from the NAABT (The National Alliance of Advocates
for Buprenorphine Treatment). Buprenorphine is the active ingredient in Suboxone.

This document is actually the COWS (Clinical Opiate Wd Scale) that your doctor is SUPPOSED to use BEFORE he inducts you onto Suboxone. Scroll down the sheet and it explains Precipitated Withdrawal.


http://www.naabt.org/documents/cows_ind ... _sheet.pdf

If you have any trouble viewing it, just gooogle search NAABT and search COWS.

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PostPosted: Fri Feb 17, 2012 11:59 pm 
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Romeo wrote:
Yep, this document is straight from the NAABT (The National Alliance of Advocates
for Buprenorphine Treatment). Buprenorphine is the active ingredient in Suboxone.

This document is actually the COWS (Clinical Opiate Wd Scale) that your doctor is SUPPOSED to use BEFORE he inducts you onto Suboxone. Scroll down the sheet and it explains Precipitated Withdrawal.


http://www.naabt.org/documents/cows_ind ... _sheet.pdf

If you have any trouble viewing it, just gooogle search NAABT and search COWS.


Romeo, thank you very much!


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PostPosted: Sat Feb 18, 2012 12:04 am 
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No problemo!! :D

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PostPosted: Sat Feb 18, 2012 1:03 am 
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From my experience, the term mild withdrawal could have numerous meanings. I think it's a term used loosely for suboxone, but for most cases one would only be taking it coming off of an opiate resulting in withdrawal. If someone was to take suboxone without having any experience with opiates then they would most likely get sick or feel 'off' from the buprenorphine. In your scenario I think you would be fine considering you have been taking methadone. Personally I would be shocked if you had any sort of negative side effects from suboxone as long as the methadone is out of your system.


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PostPosted: Sat Feb 18, 2012 10:30 am 
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Fireman wrote:
From my experience, the term mild withdrawal could have numerous meanings. I think it's a term used loosely for suboxone, but for most cases one would only be taking it coming off of an opiate resulting in withdrawal. If someone was to take suboxone without having any experience with opiates then they would most likely get sick or feel 'off' from the buprenorphine. In your scenario I think you would be fine considering you have been taking methadone. Personally I would be shocked if you had any sort of negative side effects from suboxone as long as the methadone is out of your system.


I guess I don't understand your point. The methadone would only be out of my system, or at least the Sub would not cause precipitated withdrawal, if I waited until I was in withdrawal from the methadone, as I am on 20 mgs. The doctor had said I wouldn't have to wait at all, that I could just start the Sub immediately.


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PostPosted: Sat Feb 18, 2012 10:59 am 
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marilynj55 wrote:
Fireman wrote:
From my experience, the term mild withdrawal could have numerous meanings. I think it's a term used loosely for suboxone, but for most cases one would only be taking it coming off of an opiate resulting in withdrawal. If someone was to take suboxone without having any experience with opiates then they would most likely get sick or feel 'off' from the buprenorphine. In your scenario I think you would be fine considering you have been taking methadone. Personally I would be shocked if you had any sort of negative side effects from suboxone as long as the methadone is out of your system.


I guess I don't understand your point. The methadone would only be out of my system, or at least the Sub would not cause precipitated withdrawal, if I waited until I was in withdrawal from the methadone, as I am on 20 mgs. The doctor had said I wouldn't have to wait at all, that I could just start the Sub immediately.


Am I wrong, or is methadone not a full opiate agonist? I know Suboxone is a partial opiod agonist...but I'm not sure if methadone is a partial agonist or not. You shouldn't have to be in withdrawals from methadone to switch to Suboxone...therefore, that would be why the doctor said what he did...

I could be wrong though...I don't take methadone, only ever been on Suboxone.


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PostPosted: Sat Feb 18, 2012 12:40 pm 
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jonathanm1978 wrote:
marilynj55 wrote:
Fireman wrote:
From my experience, the term mild withdrawal could have numerous meanings. I think it's a term used loosely for suboxone, but for most cases one would only be taking it coming off of an opiate resulting in withdrawal. If someone was to take suboxone without having any experience with opiates then they would most likely get sick or feel 'off' from the buprenorphine. In your scenario I think you would be fine considering you have been taking methadone. Personally I would be shocked if you had any sort of negative side effects from suboxone as long as the methadone is out of your system.


I guess I don't understand your point. The methadone would only be out of my system, or at least the Sub would not cause precipitated withdrawal, if I waited until I was in withdrawal from the methadone, as I am on 20 mgs. The doctor had said I wouldn't have to wait at all, that I could just start the Sub immediately.


Am I wrong, or is methadone not a full opiate agonist? I know Suboxone is a partial opiod agonist...but I'm not sure if methadone is a partial agonist or not. You shouldn't have to be in withdrawals from methadone to switch to Suboxone...therefore, that would be why the doctor said what he did...
]

No, you DO have to be in withdrawal from methadone in order to get on to Sub without getting extremely ill. Do a simple Google search or look on the forums and the horror stories of people who have been on methadone and started the Sub too soon -- deathly ill.
I could be wrong though...I don't take methadone, only ever been on Suboxone.


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PostPosted: Sat Feb 18, 2012 5:30 pm 
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Methadone is a full agonist. A long acting one. It stays in your system alot longer than morphine, vicodin, etc., that is why the wait is longer for the switch. Again, the elevator theory: clean is the first floor, partial agonist(buprenorphine)would be the third floor. A full agonist(methadone) is the sixth floor. By not using, your system naturally goes down to the third floor. If you don't wait for this to happen naturally, the buprenorphine will slam you to the third floor, which is precipitated withdrawal. Wait at least 48 hours after your last methadone dose. And yes, switching is so worth it! I know all of this is confusing and frustrating, but I wish I would've had this knowledge when I switched, not after. Good luck, you're on the right path!


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PostPosted: Wed Mar 14, 2012 6:33 pm 
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Finally got in to see the doc and, though he advised I should start Sub today, even though I dosed (10 mg.) yesterday, when I balked at that and started quoting sources (he didn't like that; made him look uninformed, which he is!), he said, "Okay, you can start tomorrow," which would be 48 hours from my last methadone dose. I just hope to God I'll be okay.

Next question: He wants me on it for 3-4 weeks (4 mg. -- I finally talked him down to 2). I can't afford that at $25 a day, and my secret plan was to take it just long enough to get the worst of the methadone w/drawal done with and not long enough to get addicted to Sub. Do you think I can accomplish that in 10-12 days? I could then skip a day or two and go back and get another dose if I needed to.

Thoughts? Thank you, everyone.

PS I'm thinking or reporting this doctor to the authorities, the medical board or something. He doesn't know anything about precipitated w/drawal and is actually taking quite a chance with me starting tomorrow, I think.


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PostPosted: Wed Mar 14, 2012 9:34 pm 
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Normally when people are transitioning from methadone to suboxone, the best way to do that is for the doc to switch the patient over to a short-acting full opiate agonist for a week or two before the sub induction. This way there's plenty of time to get that methadone with it's long-half life out of your system.

Now that said, you have other options that transitioning from methadone to suboxone. You could continue tapering off the methadone or you could just switch to a short acting opiate and taper down from one of those. A straight transition from methadone to suboxone isn't always smooth. It can be, but at times it's a struggle for some people.

What you choose to do depends on some things though, such as was methadone your opiate replacement therapy or was it your DOC? Why is it you think that switching to suboxone for a very brief taper is best for you? Your brain doesn't know the difference between one opiate or another. It's addicted to OPIATES in general and what you'll be doing essentially is using the suboxone to taper off the methadone, not tapering off the suboxone. Do you see the difference?

That's why I'm thinking you might want to consider switching to a short acting full agonist and tapering off those. That will of course depend on your addiction history is and what is best for you and your unique needs.

But I did want to point out your options and fill in some of the blanks here. I hope this helps a bit.

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PostPosted: Wed Mar 14, 2012 9:53 pm 
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hatmaker510 wrote:
Normally when people are transitioning from methadone to suboxone, the best way to do that is for the doc to switch the patient over to a short-acting full opiate agonist for a week or two before the sub induction. This way there's plenty of time to get that methadone with it's long-half life out of your system.

Now that said, you have other options that transitioning from methadone to suboxone. You could continue tapering off the methadone or you could just switch to a short acting opiate and taper down from one of those. A straight transition from methadone to suboxone isn't always smooth. It can be, but at times it's a struggle for some people.

What you choose to do depends on some things though, such as was methadone your opiate replacement therapy or was it your DOC? Why is it you think that switching to suboxone for a very brief taper is best for you? Your brain doesn't know the difference between one opiate or another. It's addicted to OPIATES in general and what you'll be doing essentially is using the suboxone to taper off the methadone, not tapering off the suboxone. Do you see the difference?

That's why I'm thinking you might want to consider switching to a short acting full agonist and tapering off those. That will of course depend on your addiction history is and what is best for you and your unique needs.

But I did want to point out your options and fill in some of the blanks here. I hope this helps a bit.


Thank you, Hat. Yes, methadone was my DOC. I am doing a brief taper because I cannot afford to stay on Suboxone (nor do I want to) for longer than it takes to get over the worst of the methadone w/drawals. My clinic doesn't offer anything in between (like, say, a week or so with percocets or something) and I don't have money nor insurance to go to a private doctor at this point to get that set up. In my city, all my medical info is plastered with "Drug abuser," so I'm not able to get anything.

I do know that I will be tapering off the methadone and not the suboxone. I was just wondering if 10-12 days was long enough to accomplish that without getting addicted to the subox, realizing that to mitigate that possibility of becoming addicted to the Subox that I can not go to the clinic for a couple of days at a time, if I choose.

I'm entrenched in this clinic, kind of came here in desperation, so dealing with the hand I dealt myself, perhaps too hastily.


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PostPosted: Wed Mar 14, 2012 10:26 pm 
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If you use suboxone short term (10-12 days) to taper off methadone, any withdrawals you suffer should still be those from the methadone, not the suboxone. Not that it will make much difference, they both have very long half-lives, which can make tapering more difficult. That's why I mentioned about tapering off a short acting opiate, in case that was an option for you.

Everyone who does a short term taper does it in their own way. Just do the best you can to taper down evenly over the period of time that you have, lowering your dose every day or two. Everyone has a different amount of films/tablets and does their taper in a different amount of time. But you should be fine to attempt a taper over 10-12 days. With any luck, if you taper down consistently, your acute w/d will be lessened. Now depending on how slowly you tapered your methadone over the last few months, you may or may not get a break from the post-acute w/d symptoms.

I've never done a short term taper myself (I'm still on suboxone), so maybe someone who has done a short term taper will come by and chime in with their experience.

Good luck to you!

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PostPosted: Wed Mar 14, 2012 10:42 pm 
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hatmaker510 wrote:
If you use suboxone short term (10-12 days) to taper off methadone, any withdrawals you suffer should still be those from the methadone, not the suboxone. Not that it will make much difference, they both have very long half-lives, which can make tapering more difficult. That's why I mentioned about tapering off a short acting opiate, in case that was an option for you.

Everyone who does a short term taper does it in their own way. Just do the best you can to taper down evenly over the period of time that you have, lowering your dose every day or two. Everyone has a different amount of films/tablets and does their taper in a different amount of time. But you should be fine to attempt a taper over 10-12 days. With any luck, if you taper down consistently, your acute w/d will be lessened. Now depending on how slowly you tapered your methadone over the last few months, you may or may not get a break from the post-acute w/d symptoms.

I've never done a short term taper myself (I'm still on suboxone), so maybe someone who has done a short term taper will come by and chime in with their experience.

Good luck to you!


Thank you again, Hat. The lowest dose my clinic goes to is 2 mg., so it's totally up to me. They have a very generous policy of allowing you to skip up to 15 days before they drop you so I can take the Subs according to my plan of 10-12 days, throwing in days in between here and there, and then at the end if I am still suffering, I can go back every third, fourth or fifth day. So there is a backup. I just wish they had it in .25 increments, etc. This clinic makes me crazy!!


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