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PostPosted: Fri Jul 08, 2016 5:37 pm 
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I want to start off by saying I did not start Suboxone because I was an opiate addict. However, I was a coke/weed/alcoholic, and so my dr thought that it would be the best way to treat my pain while also preventing me from addiction (I should have never told him) :x

I am on 12 mg Suboxone (4 mg, three times) a day and it just is not strong enough to kill my horrible neuropathy/paresthesias all over my body and terrible joint pain from Lyme Disease. We talked about switching to Methadone (which also means I have to quit Amitriptyline) but he tells me their office limits Methadone to 30 mg/day. I have never heard of such a thing.

Switching from 12 mg/day Suboxone to 30 mg Methadone seems like very little so I feel like I will need more. I don't want to go through the hell of withdrawing from Suboxone, titrating up to 30 mg Methadone, and then still being and pain and not able to raise the dose. He also tells me I will need to start at 5 mg methadone and add 5 mg every couple days (or week, I don't remember) until I am at 30 mg (wtf?).

He also offered to double my Suboxone dose to 24 mg/day - I told him I'd think about it. I tried this at home as an experiment to see if it would help. For 2 days (all I could afford) I tried 24 mg/day but it did absolutely nothing. I felt no different. My pain was still bad. I guess there REALLY IS a ceiling effect for the analgesic properties of Suboxone.

My question is this: Is methadone THAT much better at treating pain that it will take the place of 12 mg suboxone AND amitriptyline? Please I need help, I am feeling almost suicidal from the pain and I need options. :cry:


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PostPosted: Fri Jul 08, 2016 8:25 pm 
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ALL opioids are subject to tolerance. I've had patients come for help who were taking huge amounts of narcotic for pain. One petite woman was discharged after running out of medication early month after month; she was prescribed Oxycontin 80 mg, three times per day. After she was kicked out of the pain clinic she started buying pain pills with money she inherited. She sold the house of a deceased relative, and had over $300,000 to play with. When she came to me, she was taking 900 mg of oxycodone per day-- which is equal to 180 percocet tablets per day! She was getting no pain relief from the medication though, because of tolerance. Tolerance will follow your dose, no matter how high you go.

There is very little difference between 12 mg of buprenorphine and 24 mg of buprenorphine. Both are about equal to 40 mg of methadone per day. So going from you current dose of buprenorphine, to 30 mg of methadone, will be a step DOWN the potency ladder.

People on buprenorphine can simply start methadone immediately. There is no risk of precipitated withdrawal when going from buprenorphine to methadone. There IS considerable misery if a person goes in the opposite direction-- but that's not relevant to you. I can't tell you what to do-- but a person on 8-16 mg/d of buprenorphine is often converted to 30 or 40 mg of methadone without any delay. The buprenorphine slowly leaves the body, reducing the blockade of methadone-- and the methadone slowly replaces the buprenorphine. You must follow the directions of your doctor, as these are tightly controlled medications. But you might want to question the need to 'go through the hell of withdrawing from Suboxone' before starting methadone-- because that isn't necessary from a scientific perspective. Many docs would either start methadone at an equipotent dose-- around 30 or 40 mg per day-- OR taper methadone up over a week or so, as the buprenorphine leaves the body.

BUT... as I wrote above, staying on buprenorphine would give you greater opioid effects than 30 mg of methadone. Of course no matter how much methadone you take-- even if you were to keep raising your methadone dose to 200 or 300 mg over time-- tolerance would remove the pain relief from the medication. That's why opioids are always a losing proposition. There is NO way to maintain pain relief, no matter how much you take--- unless the dose is constantly increasing. And that is just not possible, as eventually you will run out of money-- or run out of room in your stomach to dissolve the amount of medication you swallow!


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PostPosted: Fri Jul 08, 2016 8:49 pm 
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I'm sorry, I didn't mean for it to sound like I've grown tolerant to the Suboxone - I haven't. It's that I hurt myself since I've been on the Suboxone so my pain has increased.

I want to take the facts that you've told me about buprenorphine -> methadone equivalency and tell my dr that 30 mg of methadone would be going down the ladder of potency, but he doesn't like being told when he is right and wrong. I have heard, however, from many people that methadone is much better for their pain than suboxone (ESPECIALLY for nerve pain), so equivalency between the two may not be so cut and dry maybe?

My dr is basically letting me wean myself off of suboxone in whatever way I choose, so if I want to jump straight from Suboxone to methadone, he wouldn't know. All I know is that he told me he would start me at 5 mg a day and go from there to 30 mg.

I don't need to be on opiates for life for pain (at least I don't hope so). I only have 6 months of school left, and I need pain relief to get through it. If my current dr is not going to help me, how hard is it to switch pain med drs? I hear sometimes it can be very difficult. I've also been told I could just go to a methadone clinic and get it there.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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