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PostPosted: Fri Sep 20, 2013 2:46 am 
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Hi all,
If I am down to taking 1 Methadone 10mg a day for back/knee pain and I want to switch to Suboxone asap, how soon can I start taking the Suboxone? Example: Can I take it tomorrow, of course w/o my methadone? Do you have to be off methadone or other pain meds a certain amount of time before you can take Suboxone? I'm in pain but I do not want to take Methadone anymore. I go to the doctor in 4 days and was wanting to talk to him about that but I get myself worked up if I have a question and I have to wait to ask. I wanna make sure that I can take it immediately and my PAIN WILL GO AWAY and it WILL NOT make me go through withdraw.


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PostPosted: Fri Sep 20, 2013 6:18 am 
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Hi Cece and welcome to the forum!

You did a great job of getting your Methadone dose down to 10mg per day. But you just can't take the Suboxone immediately after taking the last dose of the Methadone, and most like not even the next day. If you do the real risk of precipated withdrawals will be there and you certainly don't want any part of that I assure you.

Methadone has a very long half life and it takes time to get it out of your system just like the subs. But it is possible you could be ready in 24 hours or so due to many factors like your physical condition and metabolism rate.

You ideally need to be in moderate to severe withdrawals before making the switch. And that is going to take some time. How much time is a guess for the most part as we are all different. It may take some people 24 hrs, and yet others 36 hrs or more due to the very long half life of the Methadone. It is just about as long as the Suboxone is.

If it were me, and I was there before, I would use the Cows (clinical opiate withdrawal scale) to give you an idea of when it's safe to take the subs. You put a number score on your withdrawal symptoms and once you get to a score af appromimately 13-15 or higher it's safe to induct, or take the subs. But again, due to the long half life of the meth it could, and probably will take some time. It's just not safe to make the switch right away Cece.

Here's the link to the Cows Scale below....

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

Lots of doctors and others will say it's ok to take the meth after so much TIME has passed. And that would work fine IF you knew for certain exactly how much time that was. For example some may tell you it's ok to take the sub after 24 ours and that may be true. But it may not be true also! It can be a guessing game and I would want to make certain mself when the right time was.

Now that's just me and I did go into those PW's and let me tell you it's very nasty withdrawals and I was so sick I had to go to the ER. I'm not trying to frighten you Cece, only telling you what happened in my case, and trying to prevent it from happening to you.

As I said, you need to be in moderate to severe withdrawals to safely make the switch. According to the Cows scale here moderate withdrawals begin at a score of 13. So once you get there it would be ok to go. But the longer you can hold out the better it will be. Getting to a 15-20 is much better. Hopefully the doctor knows all about the Cows Sheet? Maybe you could print it and take to them?

Good luck Cece and hope this helps. Talk to the doctor and see what they say. I'm sure the doctor will say your ok after so much time has passed. I'm just giving you another option. It's up to you to do what YOU feel is best for you. Others may have different suggestions and that's fine too. Take the advice you feel is what is best for you, and leave the rest. I just know if it were me knowing what I know now I would use that Cows every single time.

Take care and let us know how it goes please. Please try to relax and not get too worked up. I know it's scary, but you can do this! If you have other questions someone will always be here.

Karen xoxo


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PostPosted: Fri Sep 20, 2013 8:19 am 
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HI Cece

I am not sure if Karen mentioned this but you can call the doctor today & ask your questions. That's what i did so i knew what to expect.

I do know someone (my GD father) who went from 30 mg methadone to sub but it took him 4 days to be in enough w/d to start. As others have said here, using comfort meds sometimes isn't a good idea, that's what he did. Of course his dose was higher but he did fine listening to the doctor.

In my case i KNEW i was done. I felt like a shell of a person & wanted to use sub to get my life together. I can honestly say i was shocked how the w/d's didn't bother me. I guess it was my mind set. I took my last dose on Saturday morning & was inducted Sunday. I went to work Saturday, did things in the house & was able to sleep. If that had been a day i was low on pills i would have sworn i was in w/d's. The doc did "assess" me to make sure i was at least 15 on the COWS scale.

Good Luck & ask your doctor your questions. Sub doc's are different, they know we are using so don't worry about telling him what you are taking.


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PostPosted: Fri Sep 20, 2013 10:07 am 
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You're asking specifically about not having to go through any precipitated withdrawal; to do that you're safest bet is to use the COWS sheet and have someone else score you, ideally someone with a medical background with the ability to be objective about the situation. Short of that, the Dr. I refer people to when switching from methadone to buprenorphine insists on 60 hours between methadone dosing and buprenorphine induction and in a perfect world likes that methadone dose to be less than 30mg.

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PostPosted: Sat Oct 19, 2013 12:07 pm 
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my doc made me wait 4 days. Felt great after leaving his office.


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