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 Post subject: Methadone to Suboxone
PostPosted: Sat Jan 31, 2015 1:14 pm 
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Hi there, I have been addicted to Heroin for over 20yrs (on & off !!) i am currently taking 20mg of Methadone after reducing down from 40mgs over the last 6mths and now I want to swap over to Suboxone for the main reason being that i currently still use Heroin on top of my methadone !! I dont use Heroin every single day but i want to stop using the gear alltogether and understand that going on to Suboxone will completely block out any gear so it seems like the ideal solution for me right now. I have been on Subutex before (for over 5yrs) and didnt have any probs with it except trying to get off it which ended up with me goin to a Detox Unit back in 2009. Unfortunately due to various probs i ended up back using Heroin again and then at the beginning of 2010 i decided to try methadone for the first time and other than the fact that recently i have been using gear on top of it eveything has been fine with it. I only went up to a max dose of 40mgs of Methadone which was fine and then about 6mths ago i decided to start reducing mt dosage with a view to coming off it alltogether.However as i said i have recently (last 3-4mths) been using gear as well and thats not because the Methadone hasn't been holding me its just more about boredome (I think !!??) so this Suboxone with its blocking power seems like the best thing for me right now ? I dont intend to stay on the Suboxone for any extended length of time (I hope !!). What i would like to know is what is the recomended length of time in between my last dose off methadone and my first dose of Suboxone ?? as my GP who prescibes to me under the "Shared Care" scheme dosn't by her own addmision know a right lot about Suboxone and my Drugs Worker hasn't been very forthcoming with any info that i have been asking her for (bleeding useless !!!). So allthough i appreciate that everybody is different and we all can react differently to withdrawalls i would really appreciate any info or advice that anybody can provide me with ??? I am 53yrs old by the way !! and to be honest i can handle most things that opiate withdrawalls can throw at me other than the endless nights without any sleep but i suppose its "No pain no gain eh !!??) Anyway look forward to hearing from anyone who can help, many thanks, Dave.


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PostPosted: Sun Feb 01, 2015 10:26 am 
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Hi Dave

Welcome to the forum! I have a couple of questions then i can share how a family member's switch from methadone to sub went.

I am your age but always referred to syringe etc as "works", is gear your works? i believe you hit the nail on the head and it is boredom possibly combined with the lower dose of methadone? The question is can you give up the addiction to your gear? What will you do to reduce your boredom?

Anyway, when my family member did the switch his doctor waited until he was in moderate w/d's & that actually took about 5 days. He did have comfort meds so maybe that's why it took so long. He had tapered to 30 mg methadone.

Since you know there is no one size fits all the question can't be answered as definite but IMO if you stop the methadone & have your doctor evaluate you on the COW's scale you should be able to switch without PW's. You will have to be honest about your w/d's if your doc isn't that experienced for your own safety.

As far as not sleeping, it will only be a few nights. Try to remind yourself in the middle of a sleepless night that in a day or two you will be sleeping again.

Good Luck!

Hopefully others pop in to share their own experiences.


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PostPosted: Sun Feb 01, 2015 3:34 pm 
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Good comments. I'll add that methadone to buprenorphine is a very tough conversion-- thought to be due to methadone binding to proteins in the brain, causing a very long clinical half-life.

With oxycodone and other short-acting opioids, being in withdrawal is a good indicator that PW (precipitated withdrawal) won't be a big issue. But with methadone, PW can occur even after being in withdrawal for several days.

If a patient comes to me for treatment, and is being prescribed methadone, I ask the physician to instead prescribe oxycodone for a couple weeks, then we do the induction. If the person is going to a methadone clinic, that is not an option... so the key is to get the tolerance to below 40 mg methadone per day, which you have done... and go as long as possible without methadone before starting buprenorphine. If you can have an interval of 3-4 days, you should be OK.

Two things... if you DO get PW, the key is to take your daily dose of buprenorphine and avoid agonists. If you do that, the PW will be gone quickly-- maybe even by the next day. If you start taking agonists including heroin, you will create a mess that can last for days,.

Second-- Please consider what you wrote with a skeptical eye. You went through all the trouble of stopping buprenorphine, and what happened? You reduced your dose of methadone, and what happened? You are describing the classic story for most opioid addicts-- a cycle of using, regret, confidence, and then using again. You are still around to tell the story, but so many people end up with hep C or die from overdose at some point in the cycle. Consider building a life for a few years.. and only then taking away the seat belt that has the ability to keep you alive.


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PostPosted: Sun Feb 01, 2015 8:35 pm 
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Dr. J took the words right out of my mouth. I think it's an admirable goal to quit the maintenance program, but it doesn't sound like you are ready. Try to think about this apart from the way you feel, as one looking in from outside. If you knew somebody who had been using for a long time and was in a constant cycle of relapsing, on and off of maintenance, would you encourage them to try and do it without that safety net? Give yourself some time on subs to build a good foundation of clean time and recovery before you consider getting off. Another year or so (or longer) on the meds won't do anything but help you.

Keep us posted on your progress with your switch. You have made good progress with getting yourself under 40mg, but don't try to cheat the WD's by using H on top of it before you induce. It will just make the switch harder on you. We're all here to support you if you need anything during that time. Feel free to post during the whole process if you need a kick in the butt. :wink:

Q

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Dr. Jeffrey Junig, M.D., Ph.D.

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