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PostPosted: Fri Mar 24, 2017 12:40 pm 
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I am 3 months pregnant and have been told by sub doctor to switch to methadone. But the point of going there everyday and waiting outside in line is very embarrassing for me. Everyday I have to lock myself in the bathroom for 20 - 30 mins cuz I can't talk to no one cuz of the horrible taste I gag always jus thinking I have to take medicine. I put a hard candy in my mouth to help with the gagging and wanting to throw up. I try to go for as long as I can before taking it cuz I know what's gonna happen then I start to get hot flashes and irritable so I know it's time to lock myself up in the bathroom. I never finish the whole sub cuz I start gagging and feel like to throw up. I don't know what to do but I know this is so bearing on my everyday life taking the subutex. Any suggestions I'm desperate and don't know what to do. I also am being totally honest I still look for things to get that high feeling even if it's an adderall. And I know this can't be good for my baby and I'm scared of being in methadone only cuz I don't want to be one of those people nodding out and having my kids see me like that. Please help


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PostPosted: Sat Mar 25, 2017 4:23 am 
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Hey lyndylynnlynnmarie..... now that's a mouth full :)

Congrats on ur pregnancy!

I don't understand why ur doctor would take u off buprenorphine and switch u to methadone (or even suggest it). Hopefully Dr Junig or docm2 can give u some doctor advice. What was ur doctors reason to u as to why he/she wants u to switch to methadone and stop ur buprenorphine? I don't understand, buprenorphine is safer for ur unborn baby and isn't a full opiate like methadone is. I wouldn't switch, not at all. I'd stay on bupe regardless of the taste or not.

The taste thing is something I've gotten used to over time. I didn't like it at first either, I take the strips. But I knew the alternative of not taking it, and I'll take a bad taste over actively using any day. U have to look at the bigger picture here, taste is a small thing compared to the alternative. There's also different types of buprenorphine, if the taste is just unbearable u can possibly switch to another form (not sure ur doctor would do that since ur pregnant but u can still ask).

About u still wanting to get high, have u discussed that with ur doctor? Are u around drugs that is easily accessible? U have to stay away from ppl using around u and not put urself in a position set up for failure. But u really need to discuss with ur doctor about ur cravings. If u take just one adderall u can fail a drug screen. So pls be careful.

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PostPosted: Sat Mar 25, 2017 9:39 am 
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Welcome Lindy...
No reason to switch to Methadone. Methadone and Buprenorphine are now considered equivalent for treatment of addiction when pregnant. Methadone is preferred if someone is pregnant and still active in their addiction and wanting to transition to MAT. Avoids the withdrawal necessary to start Buprenorphine. Personally, I think there is plenty of evidence and experience to justify staying on Buprenorphine. Will you have to switch doctors, or will they keep you on the Buprenorphine if you desire?
Regarding the taste and gagging, and I hesitate to mention it because I think it might annoy a few here but put 'plugging' in the search box and you can avoid the whole taste thing.
Someone once recommended putting in a Listerine strip with the tab and that seemed to help them.
Regarding the Adderall, Buprenorphine really only helps with the opiate piece of your addiction. I would recommend you get engaged with a counselor, group, 12 step, Smart Recovery; something that will help you with your triggers.
JennJenn is right that there are different preparations for buprenorphine, but that is depending entirely on the pharmacy and where they are getting the tabs. Others here will be more familiar with regarding size and taste of the different brands. Since it is generic they have the choice which wholesaler they will use and I cannot designate a 'brand.' If you want to change brands check with different pharmacies to see what they have, be sure to notify your doctor that you are changing pharmacies if you do. If your doctor is recommending switching to methadone I doubt if they would be open to trying different forms of the combo product, such as Films, Zubsolv, generic tabs or Bunavail.
Coming soon, I hope, will be a weekly and/or monthly injection.


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PostPosted: Sat Mar 25, 2017 10:52 am 
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Darn, jenn and docm2- you said everything I was going to say!

I don't write about it much, but I've been working in a methadone treatment program for the past 2 years ('on the side', in addition to my own practice). When I started at the methadone program my impressions were impacted by the stigma that most people have. Since then I've seen the good side of methadone programs. Buprenorphine is clearly a safer medication, and buprenorphine treatment is much more convenient for most people. But I've had patients over the years who didn't do well on buprenorphine, who have done better on methadone.

I agree with everything already said in response to your post. The only reason I can think of for your doctor to suggest changing to methadone is because you will be monitored more closely there. As docm2 wrote, methadone will not help you stop Adderall, and sometimes people feel the 'need' to take Adderall because they feel sleepy on methadone. I put 'need' in quotes, because the better thing to do, when feeling sleepy from methadone, is to lower the methadone dose by 4-10%.

If you change to methadone, you will likely start at about 30 mg methadone and increase to 40 mg , which is where your tolerance will match up with the ceiling potency of buprenorphine. But then your dose would likely increase. People on methadone are typically at dose ranging from 80-120 mg per day. Some clinics raise doses much higher than that. When women on methadone go through pregnancy they usually metabolize methadone mroe quickly, often requiring dose increases. Bottom line, you will have a significantly higher opioid tolerance after a year on methadone than you have now. If/when you eventually stop methadone, it will take a bit more work to deal with that higher tolerance. There are some advantages with methadone, mainly that you can taper more easily at a slow, gradual rate, since you will be dosed with a liquid.

Your baby will have about twice the risk of having neonatal abstinence syndrome. There are no long-term effects from that, but women (and men) go through short-term stress and guilt as the baby waits to come home, sometimes for a month or even longer. Some hospitals keep buprenorphine babies too, but in general I would think buprenorphinei babies are home more quickly.

You will be watched more closely on methadone, which may sound like a drag, but would probably be better for you and for your baby. For at least the first three months you will dose at the clinic every single day, except maybe Sunday in some states. You will be drug tested frequently, and you will be expected to make appointments with counselors.

Bottom line from my perspective, if you are doing well on buprenorphine you're better of staying on buprenorphine. If you are struggling, you may do better on methadone-- especially if you are using opioids. Cravings for Adderall won't be impacted by methadone, but you may have an easier time avoiding it knowing you will be tested, and it will show up. If CPS is involved in your care, they will demand that you let them talk with your counselor at the methadone program, and they will want to know if you use illicit substances-- and if you do use, they may remove your child/children temporarily. That situation provides a very strong incentive to avoid using!


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