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PostPosted: Thu Sep 03, 2015 2:28 pm 
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Just a little info on my switch from suboxone to methadone since I see so many people asking about it. I just switched from suboxone to methadone. Im a heroin addict, started with oxys moved to heroin when it got to be too expensive. Done basically every drug in the book, lots of coke, acid, pills, benzos, alcohol, molly, E, dmt, everything... Ive been physcially addicted to optiates for 4-5 years and am 23 years old. Was addicted to xanax and klonopin perscribed for 6 years, 280 a month. Cold turkey w/d from both to get into the suboxone doc earlier this year. Had to go cold turkey or go to rehab before hed treat me, so I did it. Had small siezures, it sucked, but sub w/ds worse, and so I took the benzo w/d to get perscribed subs so I didnt have to get them on the street unreliably and stressfully.

It took 10 days from my inital intake to the day I got dosed which was suprisingly fast compared to what ive seen. I started taking suboxone last may to get off heroin/oxy, and except for a handful of slips ive been clean that time, last slip was 6 months ago. About 4 months ago I got perscribed suboxone for the first time, I had been getting it off the street for nearly a year. I was on 4mg a day when I was getting it myself, and it worked amazingly well for me for months, like it was great. Better for me than anybody else I knew taking it. Completely erradicated my w/ds from high dose heroin and made me feel good. I was started at 12mg when I got perscribed then bumped up to 16mg a few weeks later since it was wearing off much faster than usual. Over the last 6 months or so the subs havent been working anywhere near as well for me. In the last 2 months I was loosing it... I was sick 2 hours after, sometimes 1 hour, after I took a sub. It was horrible... I couldnt deal with it anymore I knew I was going to relapse and throw away 6 months of clean time. So I decided to switch to methadone. It was a lot of paperwork, my doc had write letters saying he wouldnt perscribe suboxone, blah blah. They told me originally at the clinic that I would have to get the suboxone completely out of my urine, which wasnt possible for me I wouldnt have been able to. So I kept pressing on about it and talking to them and eventually they just said alright, which is really suprising because everybody else I knew who went there, script or no script, had to get clean from the subs. I stopped ~36 hours before my first dose just to make it work slightly better... Now as far as the inital methadone dose, they wern't able to start me on anything higher than 30mg for the first 3 days... and thats nowhere near equivalent to 16mg of suboxone. Its been rough, I'm on day 4 now and today they gave me 40mg, ill be up to 50mg on sunday and I have to stay at 50 for 5 days after, and Im really hoping 50 starts to help because right now I'm in w/ds, not insanely bad, but my pain is thru the roof. I have severe tooth damage, every one of my teeth is open and ruined, they all need to come out. The pain is literally unbearable... I never realized suboxone did as much for pain as it did. I thought it was useless for pain but it actaully does a LOT more than you think when your off it. It made the pain of having a mouth full of dying teeth with the roots still in them bearable. Now its insane. The low dose of methadone isnt lasting more than 6-8 hours pain wise, maybe 15-18 hours w/d wise and its still not killing them completely. BUT it is getting slightly better each day from the buildup and the slow dose increases. And I can already feel like its working better for me than suboxone. I just need to be on an appropriate dose, a 16mg a day sub tolerance after being on it for over a year is higher than most people think. Anyways I dont mind going there daily, I get to smoke weed here which I couldnt do at all at my sub doc (really helps me)... Cant drink but thats ok, or take benzos which I couldnt on subs either, their both realllllyyy strict about benzos. I know I made the right choice, for me, to go on methadone. Everybody is different and subs are better for some while methadone is better for others. For me, methadone isnt that much harder for me to get off than subs, subs are a bitch for me due to the length, worse than heroin by far... I dont plan on coming off methadone though, possibly ever. I had a bad, length habit mixed with other things going on and I dont see myself being able to be off maintanence, at least not anytime remotely soon. Also, suboxone for me did one thing very well from the start, which was kill my cravings. I never had cravings on subs, hopefully the methadone works as well for me as they did in that aspect, but the w/ds I was having every 2 hours allday everyday for months was unbearable I wouldnt wish that upon anybody.. sucks too because it worked so incredibly good for the first few months. The last month on it was absolutely brutal. If you stop taking the subs for at least a day before the methadone you'll feel your first dose... I was on subs for 15 months and I skipped the day before and still felt my first dose from being on 16mg of subs a day and it was only 30mg of methadone. I cant wait to get my dose higher because I just want relief, this whole thing has been a rollercoaster ride. Another thing my clinic needed was proof of addiction over a year or else they could only place me in a 90 day detox program. Fuck. That. I just went over a year on suboxone which barely any progression in my treatment, getting me sick, taking 30 days to get me stable on methadone, then ripping me off before Im even clean from subs isnt going to help me... I didnt have the paperwork. I never tried getting clean before this year, and everything that happened last year was on the street, no doctors involved. I pretty much begged them I was like this is the only clinic in the area (their all run by the same company with the same restrictions) so I had literally NO other option for clinics and this one is only 3 mi from my house. Also that subs wernt working, so there was nothing else for me to try... detox wouldnt have worked, id have been in the same place when I got out, plus they wouldnt take me because I didnt have any heroin in my system at the time just subs... I had a dentist that cut me off of vicodin and percocet after I was calling at odd hours, calling the pharmacy incessently trying to see if my scripts ready, etc... just addictive behavior, and had him write up a letter about that to see if it would help... Well I go in this monday for my first dose, and they said I was in the maintance program ( even they were like congratz because here its pretty hard to get into, especially if you havent been in treatment before a year its a big thing here) and I was so pumped... they didnt even see the letter yet. The only 1 other clinic around 5 times further from my house, not currently accepting new patients, and I have a protective order from a patient there and they didnt want to coordinate it, so I was fucked if this clinic didnt take me for MMT not detox. I was so incredibly relieved when I go accepted and got into MMT that was the last obstacle. I almost flipped because when I went in there monday I took a urine test and 3 minutes later they come back saying well heres the problem. I cant dose you becuase you still have suboxone in your system and youll go into withdrawl... I said no, you wont, thats only if I take a sub AFTER the methadone. I can take subs for 10 years then take methadone with no problem, its after. And I said we disscussed this thoroughly that I understand your risks and concern but I cant do it like that, I literally wouldnt make it 1-2 weeks to get it out of my urine w/o using. So this other lady comes over and says "they said no" I was like wtf, then she said "I mean yes, they said yes" which was the greenlight to dose me. Some paperwork, PPD for TB, bloodwork, physical exam, bunch of questions, and a picture for an ID card later and you get dosed, at least thats how this clinic works. Took 10 days from the inital intake which was all paperwork and a urine test. Good luck make sure you want to do this because it is a lot of work its not just a breeze switching, it will take effort, and if you decide its not working as well for you which is possible, methadone isnt better for everybody, then you cant just go back to subs, youd have to abstain for 3-10 days depending on how long/much methadone you were on. So just make sure youre certain thats all. Luckily I can already tell its working better for me. Sorry for all the rambling, if you have any questions or want to check in with me as I get thru the beggining to give you tips or advice PM me. Im on day 4 right now.


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PostPosted: Sun Sep 06, 2015 2:02 pm 
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desurion,

How's it going today? I had to read your post almost twice to get an idea of what you're trying to do. It is rare to find someone who wants to change from Suboxone to Methadone. But you know yourself better than anyone else so more power to ya!

For being only 23, you've lived a hard addict life. I'd hate to see you on opiate replacement therapy for life but if that's what it takes to keep you alive and happy then so be it.

I did have one issue about a statement you made: "
Quote:
For me, methadone isnt that much harder for me to get off than subs, subs are a bitch for me due to the length, worse than heroin by far..."
No one has ever said anything close to that. Heroin being the worst and strongest of the opiate's, how could a partial agonist like Suboxone be harder to stop? It may last longer but the symptoms surely cannot be as bad as quitting H. That is only my opinion and I don't know your system so I'll take your word for it. It doesn't matter what I think anyway. What's important is for you to be in recovery and not out there using illicit drugs anymore.

So give us an update on how you're doing, okay?

Welcome to the forum!

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PostPosted: Wed Sep 09, 2015 2:44 pm 
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Hi,

Been a few days since ive been on here, posting an update. Im doing alright.... currently on 50mg of methadone, starting 60 tomorrow. Im in a lot of pain still, not anywhere near a comparable dose of methadone to the 16mg of suboxone I was on, itll take time before I get comfortable but im hanging in there...

As far as sub vs heroin w/ds.... Its different for everybody. For me personally, and ive heard this from others too, heroin is EASIER than subs for me to get off of. Yes, it is WAY more phsyically intense and painful, but the thing is, it peaks on day 3-4 then it gets better. Suboxone isnt as physically intensive, but because it doesnt peak until say, 8-12 days, its much more mentally intensive which makes it harder for me. It lingers... I can deal with the short days of intensive w/ds from heroin or other short acting opiates... I wish I just toughed it out when I was on heroin and went thru it cold turkey, but I decided to go the sub route without knowing then how it was worse for me to get off... so yeah basically heroin is more phsyically intensive but much much shorter, suboxone is less physically intensive, but more mentally because of the longer duration...

Ill try to keep you guys posted on how I'm doing, if anybody has any questions about switching feel free to ask here or PM me :)


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PostPosted: Fri Sep 11, 2015 8:42 pm 
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I recently started working at a methadone clinic, and I see benefits to each medication-- and drawbacks as well. For the record, the ceiling effect of buprenorphine creates a level of tolerance that is about equal to taking 40 mg of methadone per day. The conversion between doses is not entirely straightforward because a single dose of methadone is very different than taking methadone each day, for weeks. Over time, methadone binds to protein in the brain, and accumulates so that the medication lasts longer and acts with greater potency. Desurion, you will probably find that you feel more and more 'stable' over the next few weeks, as methadone accumulates in your central nervous system.

I'm surprised by your comment, Desurion, that it takes time for the methadone treatment program to prescribe to you. I don't understand why they would want to wait, for example, for buprenorphine to clear your system. You are correct-- that precipitated withdrawal happens when converting TO buprenorphine, and NOT the other way around. It makes the most sense, to me, to start people on methadone as soon as possible-- as waiting for drugs or medications to 'clear' only invites relapse, and risk of overdose. If a person can stay off all opioids for the weeks needed to clear buprenorphine, why do they need methadone treatment?!

The advantage I see in methadone treatment is at the back end-- when tapering off the medication. For most people, that isn't appropriate for a couple years or more, so I wouldn't see it as a reason to choose one approach over the other. But with methadone, the taper is made easier by having a dose controlled by someone else, and reduced very slowly over time. With buprenorphine as people know, the ceiling effect causes the taper to be 'back-loaded' so that all of the symptoms occur in the final part of the taper. People also are expected to manage dosing themselves-- which is a very difficult task. I think that the prognosis is likely better for people tapering off buprenorphine, because those people have proven that they can stick with a taper on their own. Anyone who can do that has shown him/herself to be very serious about sobriety!!

Buprenorphine has a number of advantages from a chemical standpoint. The ceiling effect allows for complete mu-receptor tolerance, which results in patients feeling essentially 'normal' on the medication. Methadone, on the other hand, goes up and down...at least to a small degree. But maybe that is a good thing for some people, who are not entirely ready to give up the feeling that comes from opioids.

I agree that the withdrawal from buprenorphine is less intense, and a bit more prolonged, than the withdrawal from heroin. The intensity is MUCH less with buprenorphine; people coming off heroin cold-turkey are virtually non-functional, whereas some people can even go to work during buprenorphine withdrawal. From a tolerance standpoint, heroin users almost always have much higher opioid tolerance than people on buprenorphine-- equating with much greater severity of withdrawal. I wonder sometimes if heroin withdrawal is truly that much shorter than buprenorphine withdrawal-- or if it just seems shorter, because 1. the worst parts of the withdrawal are so bad that they seem to be 'gone' after 3 weeks --- when in reality the person is still sick, but not near as sick as they used to be... and 2. people rarely go through the entire withdrawal experience with heroin, instead using before withdrawal is completely over.

I look forward to learning more about methadone going forward. I took the job because of 'the cap', which prevents me from seeing new buprenorphine patients. The methadone clinic is planning on adding buprenorphine treatment at some point-- and it will be interesting to see which approach is more popular, and more successful.


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PostPosted: Wed Sep 30, 2015 11:45 am 
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Hi,

I just had my 1-yr anniversary on MMT and so have reached the 6-takehomes-a-week level which requires a clinic visit only once a week. Yay!

This was achieved after 8 years of Suboxone treatment, during which time I had lost all urges or inclinations to get high on opiates. Looking back it's very clear that my use and abuse of opiates was always self-medication for what's called the disease of Depression but which I've always felt is a personality type.

Buprenorphine alone might be a perfectly fine drug for me, but unfortunately it's not readily available unless it's mixed with naloxone.

To be fair, if I was not on MMT, my clinic charges $250/month for their Bupe doctor to write the scrips, which could very well be for Subutex, but my health insurance wouldn't pay a cent at the pharmacy because it wouldn't comply with their rigamarole BS. And I'd certainly need a lower dose of Subutex than the 16 mg/day I was needing of Suboxone.

When I enrolled for MMT I was completely isolated and needed the structure of going to the clinic six days a week. The social support provided by MMT is vastly superior to standard care for Suboxone.

I'm now perfectly fine at 66 mg/day of methadone. For the first time since being a teenager I have absolutely no desire to get high on anything. And I'm a witch doctor who, for example, was using large amounts of both MDMA and 2-CB for literally years before they were each scheduled.

When I was on Suboxone I was always getting high on something or other. But on MMT I can't even smoke pot from a dispensary. Any attempt to get high either does nothing or just puts me to sleep.

If it works (and it doesn't work for everyone) -- methadone is like the Holy Grail of drug treatment. The only side effects are sweating and a tendency to constipation. And it's well worth the $250/month I self-pay to the clinic.

Ask me some questions and I'll tell you no lies.

WD

suboxdoc wrote:
I recently started working at a methadone clinic, and I see benefits to each medication-- and drawbacks as well. For the record, the ceiling effect of buprenorphine creates a level of tolerance that is about equal to taking 40 mg of methadone per day. .


Last edited by wishdoctor on Thu Oct 01, 2015 11:22 am, edited 1 time in total.

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PostPosted: Wed Sep 30, 2015 9:52 pm 
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Rule,

I think what he's talking about is the very extended PAWS that a lot of people report after Suboxone detox. I've heard many many people say that kicking heroin is a breeze compared to kicking Suboxone. But if you have some theory about why it should not be so based on your understanding of opiate receptor interactions with mixed agonists versus straight agonists, it means nothing unless it's supported by data.

But all that's just gossip. I can tell you that I've had that very same experience in kicking Suboxone compared to pure agonists. I think that Suboxone detox can be so extremely painful to the point that it might be impossible to do for some of us. But maybe those people don't post here. Maybe only good things about Sub are posted here. Not due to anything malign, but maybe just from bandwagon thinking of usual crowd psychology.

Also, for inpatient detox run by supposed pros, as way back as 2010 some places were already going beyond the usual 30 days for Suboxone "addicts" ... because it can be so much harder to kick than straight opiate agonists. These places were arranging the longer stay length with patient sight unseen based on telephone calls. I saw that in posts heroin-detox.com message board all the time and confirmed seeing the longer stay mentioned at websites of at least one treatment center.

WD

rule62 wrote:
I did have one issue about a statement you made: "
Quote:
For me, methadone isnt that much harder for me to get off than subs, subs are a bitch for me due to the length, worse than heroin by far..."
No one has ever said anything close to that. Heroin being the worst and strongest of the opiate's, how could a partial agonist like Suboxone be harder to stop? It may last longer but the symptoms surely cannot be as bad as quitting H. That is only my opinion and I don't know your system so I'll take your word for it. It doesn't matter what I think anyway.
rule


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PostPosted: Thu Oct 01, 2015 2:33 pm 
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I'm a huge cheerleader for Subs, because they have saved my life in more ways than one. But that said, I recognize the drawbacks in buprenorphine maintenance, and I believe others here do too... so I don't think this forum has a biased view of Suboxone in general.

I do think you have a point about withdrawal, though... but I also think others have a point there, too. From my personal experience of both heroin withdrawal and bupe withdrawal, I have to say that bupe was worse. No question. This does not appear to be the most common experience, though -- I've read through plenty of threads on the subject, and lots of people seem to feel more like they have a flu than the debilitating sickness and crippling weakness and general horribleness that I experienced.

I've hardly made a methodical study of it, so maybe I'm not in the minority after all, but that's been my impression. (To clarify, bupe withdrawal was not more intense -- but it was close enough in character that the increased duration more than made up for the difference. At the nadir of either experience, it's bad enough that finer gradations of terribleness become hard to distinguish.)


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PostPosted: Fri Oct 02, 2015 3:08 pm 
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wishdoctor wrote:
Hi,

I just had my 1-yr anniversary on MMT and so have reached the 6-takehomes-a-week level which requires a clinic visit only once a week. Yay!

This was achieved after 8 years of Suboxone treatment, during which time I had lost all urges or inclinations to get high on opiates. Looking back it's very clear that my use and abuse of opiates was always self-medication for what's called the disease of Depression but which I've always felt is a personality type.

Buprenorphine alone might be a perfectly fine drug for me, but unfortunately it's not readily available unless it's mixed with naloxone.

To be fair, if I was not on MMT, my clinic charges $250/month for their Bupe doctor to write the scrips, which could very well be for Subutex, but my health insurance wouldn't pay a cent at the pharmacy because it wouldn't comply with their rigamarole BS. And I'd certainly need a lower dose of Subutex than the 16 mg/day I was needing of Suboxone.

When I enrolled for MMT I was completely isolated and needed the structure of going to the clinic six days a week. The social support provided by MMT is vastly superior to standard care for Suboxone.

I'm now perfectly fine at 66 mg/day of methadone. For the first time since being a teenager I have absolutely no desire to get high on anything. And I'm a witch doctor who, for example, was using large amounts of both MDMA and 2-CB for literally years before they were each scheduled.

When I was on Suboxone I was always getting high on something or other. But on MMT I can't even smoke pot from a dispensary. Any attempt to get high either does nothing or just puts me to sleep.

If it works (and it doesn't work for everyone) -- methadone is like the Holy Grail of drug treatment. The only side effects are sweating and a tendency to constipation. And it's well worth the $250/month I self-pay to the clinic.

Ask me some questions and I'll tell you no lies.

WD

suboxdoc wrote:
I recently started working at a methadone clinic, and I see benefits to each medication-- and drawbacks as well. For the record, the ceiling effect of buprenorphine creates a level of tolerance that is about equal to taking 40 mg of methadone per day. .


I can say the exact same thing about buprenorphine. If it works (and it doesn't work for everyone)--buprenorphine is like the Holy Grail of drug treatment.

It's really not helpful to compare the two because they are so very different. We have a number of people here who were on methadone and switched to bupe because it worked better for them. People on any kind of MAT need to stick together, because we all get the same "substitute one drug for another" crap. I'm very glad that you found the best treatment to aid your recovery. I'm grateful that I also have found mine in buprenorphine.

Amy

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PostPosted: Fri Oct 02, 2015 4:46 pm 
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Hey wishdoctor,

I mis-typed a sentence that you took offense to. Sorry about that. After realizing my mistake I went and edited the first post and your copy to make it correct.

The only data I go by is taken from this forum and our on staff doctor Junig. Your opinion is just as valid as anyone else's here and you obviously know much more about methadone than I do.

r

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PostPosted: Thu Oct 15, 2015 10:45 pm 
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Hey Desurion. I haven't been on MMT for a long time, but there's a couple of things I noticed when I was on methadone that are noteworthy. Firstly, dose-creep was more of a problem for me on methadone than on Suboxone. This is especially noticeable in the first few months or first year on methadone. What happened for me on methadone was that, after I got stabilised on a dose, gradually as I became more tolerant the dose would stop holding me like it did initially. Sometimes I'd wake up with mild withdrawal, and temptation to use would come into the picture. I'd then see my doctor and get my dose bumped up 10mg, only to experience the same thing. I actually started on 30mg, and within a few months my dose creeped up to 90mg.

While it may be safer to be on a really high dose of methadone, the flip side is this makes eventually coming off a lot harder, and you can experience more side-effects.

I guess while it's often a normal course for methadone to end up on high doses, it may be worth resisting the urge to have your dose increased a bit to make it easier in the long term.

Like Dr J said, one of the benefits of methadone is the taper can be a lot smoother. While you arguably feel more withdrawals with each drop compared to Sub, these drops can be done in such a gradual way that uncomfortability is minimised. Also, at least in my country, you can get your doctor to setup a blind taper. Basically you tell your doctor you want to reduce, and they suggests a time-line. He/she then puts his script in an envelope so you can't see it, and you give it to your dispensing chemist / clinic and get dosed each day but they don't tell you when, and how much you're getting reduced by. I know people who were on massive doses who tapered off without having any idea whether they were on 5mg or 50mg. The lack of the psychological aspect to withdrawal can make a huge difference.

And like Dr J said, I'm not familiar with any reason why they'd delay putting you on methadone when switching from Sub. Really, you should be able to have your first dose the day after your last dose of Suboxone.


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