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PostPosted: Thu Mar 06, 2014 3:44 pm 
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I am totally disgusted with the whole methadone/suboxone system! I have been going to a methadone clinic for 3 years and for the past year had tapered down to 13 mgs with the intention of coming completely off. I have had the same dr at the clinic all that time and when I got down to 13 mgs he suggested that I switch over to suboxone - he bumped me back up to 23 mgs of methadone while I waited for an appointment at his PERSONAL PAIN MANAGEMENT CLINIC (he was just a consultant at the methadone clinic) For those of you who have followed my postings here, I was very hesitant about this so for about 9 days I didn't know what to do. I asked for advice on here and asked what the equivalent of methadone to suboxone would be and everyone said not to worry about the equivalent, it is like comparing apples to oranges, etc, etc. I decided to switch over to suboxone - I was in pretty bad withdrawals for 4 days before I inducted at 2 mgs - I was told to add 2 mgs every 2 hrs up to 8 mgs a day. I never did that, I stayed at 2 mg because my withdrawal symptoms were gone. I have had a HORRIFIC headache EVERYDAY since starting the suboxone - I thought it was from lack of caffeine but even after I drank some Mountain Dew it hasn't gone away so I went to see my primary care physician and tell him about the headaches and that I switched to suboxone 2 mgs a day. My doctor gives me a physical, checks my eyes, etc and leaves the room for about 10 minutes. When he comes back in he tells me that my headaches are probably because my suboxone dosage is the equivalent of about 100 mgs of methadone!!!!!!!!!!!!!! I am FURIOUS at the suboxone dr - WHY would he give me such a high dosage knowing my history?!?! I KNOW why - for the money! Plain and simple, that is the reason! I paid NOTHING at the methadone clinic, my insurance covered it but for a visit at his pain management clinic he doesn't accept insurance - the first visit was $150, the second visit was $145 and he wanted to see me 2 more times this month at $125!!!! I paid almost $300 for 8 8 mg suboxone strips, an increase in my dosage by almost 7 times and a headache that won't go away!!! Needless to say, I am NOT going back to that doctor and I am actually considering talking to my lawyer to see if there is anything I can do. Probably not though. I should have followed my gut instinct and just continued to taper off of the methadone! My primary care physician called an associate of his who saw me today FREE OF CHARGE and said that I was not a good candidate for suboxone in the first place because I was at such a low dosage of methadone! He made a tapering schedule for me with the remaining 5 1/2 strips - I am done with methadone and done with my short experience with suboxone. Today I only took .5 mg of suboxone and magic - no headache! I am NOT putting down suboxone and I am not putting down this group at all - just disgusted over the way the MAJORITY of methadone and suboxone dr's take control of your life! They scare you, rob you, mislead you and overall RAPE you in every way possible. Methadone DID help me - I have been free from heroine and oxy's for 3 years but as soon as I said I wanted to come off, everything changed. Now I have been setback by about 3 months because of this whole suboxone thing! Done with methadone, done with suboxone - hopefully by following this chart I won't have to go through withdrawals... AGAIN!


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PostPosted: Sat Mar 08, 2014 2:12 am 
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WHOA!!!!!

The second doc is an idiot. The 'ceiling effect' of Suboxone-- the opioid effect that it reaches at a max, that it cannot go higher than--- is 40 mg of methadone. There is no way for ANY dose of buprenorphine-- even 40 mg of buprenorphine-- to be more potent than 40 mg of methadone.


It sounds like he made the common mistake of assuming linear kinetics-- i.e. saying that since 0.1 mg of buprenorphine equals 10, then 10 mg of buprenorphine equals 1000. It doesn't work that way-- because of the ceiling, and non-linear dose response curve, for buprenorphine.

The reason it is so hard to predict the risk of precipitated withdrawal is because you are on methadone--- and that is just very hard to predict. one person will do ok, and the next will have a bad reaction. The general goal would be to get your methadone dose and tolerance down to at least 40 mg per day-- equal to the strength of buprenorphine 8-16 mg per day. But you would need to go a week or two to get the methadone out of your system, or else you will get PW.

Going down to 13 mg of methadone was a good idea; from there, you would want to go to about 4 or 8 or 16 mg of buprenorphine, after waiting at least a couple days. But whether you go to 4, or 8, or 16, or 24 mg of buprenorphine DOES NOT MATTER-- they ALL are at the ceiling, they ALL create the same effect, they ALL create the same tolerance, and they ALL are the same difficultness to stop. Tapers on the flat part of the dose/response curve do not result in withdrawal; the withdrawal from buprenorphine STARTS when you get below about 4 mg per day.


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PostPosted: Thu Mar 20, 2014 7:00 pm 
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I might have been a little too harsh on the first doctor! The second dr did not explain (or seem to be aware of) the ceiling effect. I consulted another suboxone dr without telling him what the first two said specifically and he has me on .5 mg a day. I live in Baltimore city, the heroin capital of America, I thought the dr's knew how to treat this addiction here of all places! The methadone programs all have the same guidelines and are all run the same way, why are the suboxone dr's so divided on everything? Is it because methadone has been around for so long or is it because only one-day of training on suboxone is all it takes to prescribe suboxone? Again, not complaining but my life would have been alot easier if I had just continued to taper off of the methadone instead of switching to the suboxone.


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