I am starting today on suboxone. I was on Oxy and opana for many years post 14 surgeries including 2 hip replacements and re-do's after a recall. I finally went to rehab and got on methadone. I am really tired of the clinic I feel like they only care about the cash. My family Doc in Virginia Dr Ash Diwan is putting me on the subs. I went down from 75mg to 30mg of md over six weeks and am waiting to start the subs. I took my last dose of methadone yesterday and am waiting till the Wds get bad to dose. Any feedback is appreciated. My Doc says I will get adequate pain relief too as well as addiction treatment. So here goes. I'm giving up OBT at my clinic for this so I hope it works.

Welcome Equitalk,

You've come to the right place. We've all been through that same process of waiting to get sick, then getting sick, then wondering if we were sick enough before jumping to the other side. I think 96 hours is the recommended waiting period for methadone people.. But even more important is the relative intensity of your WD symptoms.

Methadone as you likely know can be a difficult transition, but I can't think of anyone who's come aboard
since I've been here...about 3 months...who didn't get through in fine shape.

Do you have access to COWS to assess your WD intensity. If not, just google "COWS OPIATES" or anything to that effect. Add the opiates or suboxone induction or something along those lines so you don't end up learning all about cows (of the 4 legged variety that is)...

The only question I might raise is that you're anticipating pain relief. I was told the same thing by one of the doctors I saw, but most people taking doses high enough to maintain an opiate block don't get that effect.Has to do with tolerance and the ceiling effect.

Can I ask what dose you'll be starting on? I have to add I'm not a doctor.

Wishing you the best. Lots of people will be along to support you and answer questions and wish you well.


Godfrey...

I am starting with the 8mg/2mg strip twice a day. Once in the morn and once in eve. So 16/4 every 24 hours. He gave me the cow scale and told me to start when I scored an 18 or higher.

Hi again,
So that's right in the middle of moderate. Sounds good. The higher you can get the better of course. It's what you can stand, thought of course you don't want to torture yourself either.

Some others will be along soon enough. I wasn't sure whether to mention the pain control issue as I could be wrong (though I don't think so), and I don't want to cause any upset at this challenging time. But seems to me you came for help and support as well as information. So I went ahead.

People who use bupe for pain control are under the ceiling effect which is to say under 4 mg's. And usually much lower. Less than a a mg. You're taking 16 mg/s a day, which compared to that is relatively quite large (though appropriate).

The Doc thought spacing me out at 8 and 8 am and pm would give me the best pain relief although minimum. I am not in bad pain since in had my hips re-replaced. So I am optimistic. He recommends a cow scale of 18 and 36 hours post last methadone dose. What are pwds like ???

Godfrey
Had you been on methadone prior and made the switch ? I am only mildly nervous. I don't like the way the methadone makes me tired in the afternoon. I also hate the clinic and the way they do it. I attend 3-5 AA meetings every week and have not touched booze or weed since 2011 and have a good job and supportive family. Luckily I never shot up. Just snorted Oxys. Like it's any better. Lol. It all sucks. I morally struggled with the methadone for four years and this seems like a healthier and saner and safer alternative.

I was addicted to opium for many years, the chief component of which is morphine. I'm very happy
to have made the jump. No cravings, and feel entirely normal. You're going to be very happy with bupe, I
can almost guarantee it. Just get through this first step. It's daunting no doubt about it. I was scared stiff.
But as I said I couldn't be happier.

Many of us have chronic pain, including me. You learn to live with it. There's really no other way I don't believe, long term anyway. And there's always the option of tapering down to a lower dose which would allow for some pain relief after all.

Hang in. Ask questions, even if just for support. It's a snowy day here in the east. Some of the regulars perhaps are dealing with that. They'll be along shortly.

Thanks so much. I live outside DC and it's sunny and windy one minute and almost a white our snow the next. Weird weather. Almost as unpredictable as our drug addiction. Thanks much for the help. I will let you know how it goes. I will probably end up taking my first sub sometime tonight which is going to be about 48 hours after my last methadone dose at 30 mg. I will wait till I am 18+ on the scale. I am at 14 now. Thanks again.

Yes, many people on methadone have to wait several days before they can start the suboxone. Methadone just stays in your body for quite a long time. We want you to avoid precipitated withdrawals, so the longer you wait, the better off you will be.

Also, your doctor has great intentions for sure and he has obviously taken the 8 hour course on how to prescribe buprenorphine. We have learned a few things here that your doctor may not have learned, however. First thing, when you are first starting suboxone after methadone, you might want to consider taking a smaller amount like 2mg at first. That way, if you do get precipitated withdrawals they will not be as bad.

Also, buprenorphine's analgesic properties last about 4 to 6 hours. So most of the time it is recommended that a chronic pain patient would take 4mg every 6 hours instead of what your doctor has recommended. He may not be aware that the analgesic effects don't last 8 hours.

I heartily hope that one of the doctors on this forum reads your thread and also chimes in. I am not a doctor. I've just been a moderator here for going on five years. If you only listen to one thing I say, please wait as long as possible to start taking the suboxone. Please keep us informed and best of luck!

Amy

_________________
Done is better than perfect!

Hi Amy:

Thanks for chiming in. So I'm wrong about the pain relief situation. The 4 mg's I suppose is right around the ceiling effect. This has been a source of confusion for me. Sorry about that equitalk.

I have tried splitting dosage along those lines, but never got anything in the way of pain relief.Perhaps you have to stick with it.

But I'm not seeing how this works. Someone taking 16 mg/s a day has a tolerance in line with that. That is well above the ceiling effect. Not seeing how splitting the dose into quarters gets around that given long half life.

I'm really interested in this subject as I've got chronic pain myself

Godfrey, I'm sorry. I didn't read your full reply, so I wasn't responding to what you wrote. Here's what I think about his dosing.

He is coming from methadone, so he will need a high dose initially to cover his receptors. If he wants to reduce at that time he can.

Ceiling effect and pain relief are really two different issues. The ceiling effect has to do with the steady amount of buprenorphine in the blood at a certain level. The analgesic effect or the pain relieving effect from buprenorphine only lasts 4 to 6 hours. I have no idea why it only lasts that long when the effects that stop craving and withdrawal last longer. The ceiling effect is important for what the medication does for addiction. For regular pain relief, even microdoses can be effective, but this man needs to have his addiction symptoms taken care of and have a comparable dose of suboxone for the amount of methadone he has been on.

If I am creating any confusion, I apologize. If anyone wants to clarify if necessary, please do.

Amy

_________________
Done is better than perfect!

HI Amy,

Thanks so much for responding. And no worries, I didn't take it as a direct response and even it it was
I want to be corrected when I make a mistake.

I do understand that small doses are much more effective for pain relief. I thought this was because of relatively low tolerance in such cases. The larger doses like we talk about here for maintenance therapy of course involve a very high tolerance. And because we're way over the ceiling effect, the extra dose doesn't increase the opiate effect. So essentially a person is "locked out" so to speak from significant pain relief. (As well as the other usual opiate effects). No matter how much more we take, it doesn't help.

Anyway, that's my no doubt incomplete and perhaps totally incorrect understanding. I tend toward the mushy headed when it comes to technical matters.If I can get some pain relief by splitting my dose (I'm currently taking 8 mgs daily), I'm more than thrilled to do that.

I don't believe your next to last paragraph is correct, but I would really like to have more of an expert tag in. I've got PMs to docm2 and Dr. Junig. Hopefully they have time to stop by and clarify.

Amy

_________________
Done is better than perfect!

So I have the 8mg strips which he recommended I take twice a day. The 16mg dose daily because I was on methadone for so long. I have read many people suggest though the first day on subs breaking their strips into pieces.

I think you're better off taking small doses the first day as Amy recommends. It's what I was told to do as well. Maybe 2 mgs, wait 45 mins to an hour, see how you feel, then dose again. Keep dosing up to your 16mg's as needed.

In answer to your question about PW,you don't want that. It can be severe. That's why it's so important to wait as long as you can. Methadone can stick around in the body for a long time. The issue is you don't want too much Methadone on your brain receptors. The sub will knock the molecules off, and if there'a enough of them will precipitate withdrawal.

It can last a few hour, or much longer. If it happens just keep dosing up til your prescribed dosage. E eventually it will go away. Just wait long enough is the moral here.

Very interesting questions godfrey. I'm going to lurk on this thread for updates on those questions.

Equitalk-Welcome, I hope all goes well with your induction!!

So I took 2mg at 8:30pm and an hour later 6mg. I had some minor sweats and chills most of the night and a little sleeplessness but not as bad as I thought. I finally fell asleep at 2 and had to get up at 5am to go to work and felt good. Hot shower felt great. I took my morning dose of 8mg/2mg at 5:45 and I feel great. It's been about 72 hours since I took my last dose of methadone. I feel over the hump. I'll report in later. Most Important will be a good night sleep tonight. I'll let you know.

Equitalk,

That's really excellent news. I can now say one hears so many scary stories about methadone switchers, but
as I said upthread, all the methadone people who've posted on the forum have done very well. That's over a three month period and I'm guessing they've been 5 or 6. Keep us all posted! Please!

Hello HT:

Thanks for that. It's an issue I've been confused about for a while now. Some say you can get pain
relief at higher doses. My own doctor said that as well. But I don't see how it works. Once a person gets tolerant to a certain dose of any opiate the effects by definition are greatly reduced. In the case of bupe, you can't just increase your dosage....once over the ceiling effect because by definition it's not going to help.

Be great if one of our docs stopped by. Maybe it's possible to get minimal relief. Perhaps that's the answer.

I'll try to chip in more when I'm done 'at the office'- Godfrey, you are always spot-on with your answers. The problem is that some of the buprenorphine issues are hard to define for each individual. For example, some studies show that it takes 16 mg of buprenorphine to fullly saturate receptors in most people. But the ceiling on buprenorphine clearly occurs much earlier. I say that because I have a number of patients who feel completely 'level' at 2 mg per day. There is a big difference between 'full receptor saturation' and the clinical phenomenon of a 'ceiling effect'-- and that difference creates confusion.

I have patients waiting-- check out my last blog post: http://suboxonetalkzone.com/opioid-induced-hyperalgesia-prevented-by-buprenorphine/

I wrote a bit about what I see in pain patients on buprenorphine.

Thanks so much. It's 1:00pm and I still feel good. Will take my PM dose of 8mg tonight. I can report very mild withdrawal type symptoms. Some I attribute to the natural anxiety I have giving up the crutch of methadone. I attribute part of my pain concern to mental and anxiety any ways so that is why I am willing to give this a chance. I would love to hear you alls thought on the splitting of my dose to 8/2 twice daily based on the length of time and doseage on methadone. Also I still feel mild chills and a little anxiety. Do you think this is adjusting to the suboxen or a WD to the methadone? Thanks so much. This group makes the anxiety of the unknown much much more tolerable.