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How long to wait after heroin? How to treat precipitated withdrawal? What dose of Suboxone is best? Do I have to be in withdrawal?
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Question regarding tricky precipitated withdrawal

Tue Apr 19, 2016 2:18 pm

This is tricky, and hoping someone can shed some light. I'm doing this for someone else, because they're in no condition to even stand up. This person has been on pain medication for many years, due to her back pain, and foot pain. She was first on just oxycodone. Then she was prescribed some methadone. Now for a few years she's been on both oxycodone and methadone.

I'll get this out of the way now, both me and her know all about the tricky induction from methadone to suboxone. But to cut to the chase, she completely messed it up. Not only did she take it too soon, she took an entire 8mg strip. She didn't feel better so she did the dumbest thing she could have done and took another 8mg strip.

So here's what I need help with. First of all, this is precipitated withdrawal, right? I mean, it's been hours now since the last time she took suboxone. I've read that it only is supposed to last a few hours, but she's got no sign of getting better. And let me tell you right now, she's in bad condition. Her worse symptoms are intense nausea, and her stomach hurting a lot, I'm guessing from diarrhea. But every time she starts dry heaving, she doesn't actually puke anything up. And she's tried using the bathroom to get some of this diarrhea out, but she claims she can't actually go. So I guess the first thing I want to know is, did she prolong the precipitated withdrawal by taking more suboxone?

The second thing I need to know, is what do I do from here to help her? My main concern is, hours from now (since it's already been 11 hours since she took suboxone) should I give her a tiny bit more suboxone? Or will the suboxone she's ALREADY taken eventually start to grab onto her receptors and begin to work? I'm starting to feel completely powerless in helping her. Pepto bismol isn't helping her stomach, and zzquil isn't helping her sleep.

Thank you so much for any help anyone can offer us.

Re: Question regarding tricky precipitated withdrawal

Tue Apr 19, 2016 2:48 pm

Ok I'm no expert on coming off methadone to sub personally, I induced from oxycodone and I waited 32 hrs before my induction. Methadone is recommended much longer than that.

This is an important question that I don't think u said, how long has it been since her last dose of methadone?? And what was the dosage of methadone she was used to when she stopped?? These are very important questions that we'll need to know in order to fully help u.

There's tons of ppl here on this forum that's made the transition from methadone to sub and can definitely advise u on what to do. U should also go to the Methadone Maintenance section of this forum and read all these different experiences, it will help u also. I'm sure there's been others in her exact situation that u can read about. That can help u out in the mean time while ur waiting for others to respond to ur post that's been in her situation.

I think it's a pretty standard recommendation for someone switching to get down to a lower dose of methadone, then wait around 72 hrs or possibly longer before they start on sub. Like I said though, I'm not personally experienced with it, just going by others. I sure hope someone will be along shortly to help u better because I know she's suffering. One thing I know is that precipitated withdrawal is temporary....I don't know exactly how temporary but it does go away and ur supposed to just keep dosing ur regular dose of sub like u would without precipitated withdrawal. It's something u just have to ride out the storm. If she's under the care of a dr, I'd give the dr a call and let them know what is happening, if she doesn't have a dr then maybe Dr J will see this post and give u advice (he's a sub dr who started this forum). Please stick around, others with much better advice will be along any min.

Good luck!

Re: Question regarding tricky precipitated withdrawal

Tue Apr 19, 2016 3:10 pm

Thank you so much for your reply Jennifer. Yes, I apologize I should have mentioned how long it had been, but instead I just mentioned that she completely messed it up. It had been 36 hours since her last methadone dose, of two 10mgs. So 20mgs. 36 hours from methadone, and 24 hours since her last oxy. Like I said, she's prescribed both. Regardless of that, I personally, and I think everyone will agree, it was still too soon. So I told her, "if you're not going to be able to force yourself to wait longer than 36 hours, start off small. Don't go for the entire 8mg suboxone strip." But instead, she did the entire strip, and then once that didn't affect her (guessing because she still had crap in her system), she took another strip!!

So, hopefully someone who's got experience in it could not only confirm to me that this is indeed a prolonged precipitated withdrawal (11 hours now), but also be able to answer my question of what to do from here? Wait a certain amount of hours, and dose her suboxone again? Or if the suboxone she's taken will eventually work once it's kicked out all of her stuff? Blah.

Thanks so much again!

Re: Question regarding tricky precipitated withdrawal

Tue Apr 19, 2016 3:42 pm


With methadone, the more info we get, the better. What was her maintenance dose? did she taper down to 20mgs? over what amt of time? also, what was her oxy dose. did she taper it down? Thx, P

Re: Question regarding tricky precipitated withdrawal

Tue Apr 19, 2016 4:22 pm

I wish that she could just give the information herself. Due to a lot of circumstances her doses fluctuated. But I know that she did not do much of a taper what so ever. She only got about two days worth of a taper, because she knew she would be out, and then was going to try the suboxone. The oxycodone also had no such taper. That's why I really need to get people's opinions on what I should do next. I wish i knew more about her numbers and all that. I don't know enough about suboxone to know if the suboxone she's already taken will begin to work evenow after being in this withdrawal, which I can't even tell if it's a prolonged precipitated, which seems more likely because she clearly had stuff in her system, and the suboxone did nothing to help her, or if the suboxone has flushed everything out by now (13 hours as of typing this) and now she needs to take the suboxone again to get relief. That's the main question I need answered. Even if it's just an opinion.

Re: Question regarding tricky precipitated withdrawal

Tue Apr 19, 2016 4:40 pm

Gosh I know she's suffering and hearing that breaks my heart. I'm obviously not going to be the person to be able to give u good solid advice but from what I have gathered from others experience, if she's willing and committed to stick this out, then she just needs to keep taking her sub dose like she would have normally. The sub will eventually start filling up her receptors. How long will that take, I'm not sure and hopefully someone else who knows can answer that for u. But I do know that it will eventually happen as long as she keeps dosing her suboxone. I'm not sure what a dr would have her do, start over and get her methadone dose lower first and then wait the appropriate amount of time or just have her keep going and taking the sub. If the precipitated withdrawal weren't going to last a long time, I'd stick it out, but I don't know that answer.

Again hopefully someone else can help u with ur questions. Pelican is pretty wise and I know there's others here that had a rough time during their transition, I hope they come along and add their recommendations. Bless her heart, I would love to be of more help!

Re: Question regarding tricky precipitated withdrawal

Tue Apr 19, 2016 5:13 pm

Thanks so much Jennifer. It really means a lot to us. Under the circumstances, she's really got no choice but to wait it out. I'm just SO CONFUSED why I she's still in such bad condition after 14 hours now. Everyone says the precipitated withdrawals only last a couple hours. And if this isn't precipitated withdrawal anymore, how is it she's getting absolutely no relief from the suboxone? If anyone who has had this experience or knowledge comes across this post who can give any opinions or answers on those specific questions, that's the main thing were both wondering right now. Why in the world after 15 hours of brutal withdrawal, is the suboxone offering no relief. I don't even know if that's how it's supposed to work, I'm definitely not the expert. I just know how it works by kicking off the other dope you have on your receptors, but from what I've researched.. I would have thought by now it should have a hold of those receptors and be giving her some relief.

Re: Question regarding tricky precipitated withdrawal

Tue Apr 19, 2016 10:05 pm

Hey Suboxduction,
I understand how horrible this is for her. I can not answer all your questions but this is happening because of tolerance. There is a fight going on with her reseptors. Her tolerance must have been high when she began. Pelican did ask earlier just what she has been taking and for how loug. This would give us a better idea why this has been going on so loug, but its done now. Jen is spot on. At this point she should just keep taking your Suboxone doses, and over time the Buprenorphine will win out.
People with a very high tolerance really ,especially with methadone involved need more time to drop. I dont know if that helps at all, but your a good guy to hangin there with her.
Good luck Sub.
Just my opinion. .


Re: Question regarding tricky precipitated withdrawal

Tue Apr 19, 2016 10:50 pm

All of you have been such great help. I've been sitting here all day researching, and it definitely does seem like it's just a high tolerance thing. I decided about a few hours ago that I was going to continue dosing her suboxone and just let her ride it out. She kept thinking that suboxone just doesn't work on her, and I had to keep assuring her that that just isn't possible... I knew it had something to do with her tolerance, and not waiting long enough.... Methadone is a beast of its own just like suboxone. I've just been so afraid to give her more suboxone because some people scared me into thinking that it would worsen and prolong her withdrawal... But I think we can agree it's just not the case, right? If anything, in your guys experience, do you think she would get at least A BIT of relief if I give her a bit more? To help the suboxone take over? It's clear she won't be feeling normal effects of the subconscious until she's cleared of this methadone... But if she could just get SOME relief..

I must say though, I've FINALLY gotten her to sleep some.. Not a lot, but previously, it wasn't at all.

Re: Question regarding tricky precipitated withdrawal

Thu Apr 21, 2016 7:16 pm

Hi! I unfortunately went through this. The suboxone already took over the receptors, that's why pw occured. What was the dose of methadone? The worst is behind, keep dosing with suboxone, it won't happen again but I'm sure she's scared to take it.I'm going to go through and read it all, I wanted to hurry a response to you.

Re: Question regarding tricky precipitated withdrawal

Fri Apr 22, 2016 9:44 am

Pugmommy I was hoping you'd respond because I know u made that transition.

I hope the poster will update us on how she's doing now.

Re: Question regarding tricky precipitated withdrawal

Fri Apr 22, 2016 6:00 pm

Hey jennjenn! I was doing good checking in, but the minute I don't a post like this comes through and I'm late. I've been thinking about her all day, I hope they come back