How long to wait after heroin? How to treat precipitated withdrawal? What dose of Suboxone is best? Do I have to be in withdrawal?
Wed Apr 19, 2017 4:40 pm
Hi all. I'm 36 and have been on 40 mgs of methadone for the last 15 years, prescribed to me to treat chronic back pain. 4 10 mg pills a day. Last month, for the first time ever, my Dr randomly drug tested me and I got popped with dope in my urine. It was not a good day. I had been sniffing dope a couple time a week for roughly 8 months for a variety of reasons. My Dr decided he was not going to keep me on the methadone anymore, no surprise there, and switch me to subs. I've been slowly weening off the methadone since. I'm currently taking 2 and a half pills now, with the goal of getting down to 1 pill a day. At that time I will stop the methadone and make the switch.
My problem is my back pain. Its been very hard to live with just taking the 2 and a half pills a day, never mind any less. I brought this up at my last appointment but my Dr thinks it is too risky to switch me at any higher a dose. I have an appointment tomorrow. Would it make any sense to switch me from methadone to a shorter acting opiate for a few weeks? Then stop taking that opiate for a day or two and switch to the subs? Its been very difficult to stop taking dope, ween off methadone, and be in pain all at once. I really just want to get this over with and onto the subs as soon as I can. Any advice is really appreciated. Thanks!
Wed Apr 19, 2017 8:30 pm
I don't think it would be legal for your doctor to switch you to a short acting opiate under these circumstances. On the ongoing methadone taper, I think the protocol is you want to be down to somewhere between 20-30 mg's a day....maybe as high as 40...then abstain for some days...maybe as much as 4 days before switching over.
So one pill would be 10 mg's? (I have to interject here that I'm not a doctor.) He's just trying to be careful I'm sure as the switch to bupe from methadone can be difficult. Maybe you could argue he's being too careful and making things unnecessarily difficult for you. I'm not qualified to say.
On the issue of pain, be aware that while some people do get some chronic pain relief from bupe, some don't. I'm in that latter group. The issue concerns the ceiling effect, which essentially refers the fact that at a certain point, adding more buprenorphine will not increase.the opiate effects, including pain relief. Since addicts generally have a high tolerance, they usually need to start out at something exceeding the ceiling effect. So in other words, you're going to have a tolerance to the bupe you;re prescribed and taking more won't help. But as I said, some people do get some relief. Part of that might be bupe's ability to effect other receptors.
Other with more knowledge will likely chime in. Hope this helps a bit
Wishing you the best,
Wed Apr 19, 2017 9:39 pm
Godfrey is on to a few things. Its illegal for a Dr to prescribe opiates to treat an addiction diagnosis unless its specific prescription bup products or methadone dispensed in a specialized clinic. But there's no issues w a pain diagnosis - a chronic pain patient on methadone can be given short acting opiates to taper but once you tested positive for heroin, your diagnosis maybe changed to addiction aka opioid dependency. IDK. I would still think it worth asking altho, even if your Dr is unaware of these rules, the trust may be broken and s/he may not be open to it. I'd still check it out, for sure. Would be an easier transition. Also, search around here, some really good info on transitioning from methadone to bup. there's a search function at the top. you can put in methadone in keyword and suboxdoc in author field. AND be sure to go to the Talkzone link at the top and once there, click suboxsearch, you'll have 2 choices to search. LOTS of great helpful info will come up.
Hopefully others here will chime in...
Welcome here and keep posting. Helps us better help you once we learn more. Wishing you my best, P
Wed Apr 19, 2017 10:41 pm
Thanks for the responses.
Ive been reading a lot on here and have found it very helpful. Another worry coming off methadone is pw. Ive read you need to be off methadone 3 or 4 days to prevent that, which also worries me. I havent gone without an opiate in me for 15 years. Those 3 or 4 days are going to be hell. Figured a shorter lasting opiated would allow me to cut that time in half and get on the suboxone.
Have my Drs appointment in the am tomorrow so ill know more then.
Thu Apr 20, 2017 4:55 am
welcome to the forum, your dr is following the protocol and will not allow to go further, with 2.5 pills a day. Yes leaving it will be as bad as hell.
Hope dr. got better options for you.
Thu Apr 20, 2017 8:20 am
Is your Doctor going to expect you not to use THC once converted over to Suboxone? If so, will you be able to avoid it? If not you may as well continue to wean with the methadone or find a new provider.
If you do not have an opiate use disorder (and from your brief history it doesn't sound like it) your Doctor can legally prescribe a short acting opiate for a couple of weeks, then do a much shorter induction. Methadone from 40 mg a day is usually 5-7 days of waiting. Even 10 mg a day I would still wait at least 4 days.
Much of what I am saying is echoing what Pelican said.
In my view, if you truly have never had any issues with taking extra opiates, missed appointments, calling for refills, buying off the streets and the other things that go with opiate addiction this is probably not the best move. I think it would be reasonable to review clinic expectations, sign a no use agreement and move on. But, I am probably in the minority on this and with all the bad press pain clinics and pain docs are getting they feel they are under the microscope.
As Godfrey said, some do not get significant pain relief with Suboxone.
Sounds like you didn't get significant pain relief with the marijuana? Too bad, around here it is being touted as a miracle and alternative to opiates. (I need a snark button or emoticon for that last sentence)
Thu Apr 20, 2017 9:48 am
Ive read alot of your comments on other posts. Appreciate ypur input here. My dr is taking my off methadone because I was had been using heroin. I was on the same dose of methadone for 15 years and it wasnt working as well as it once did. Dr didnt seem receptive to upping the dose so I made a terrible decision.
As far as marijuana goes, we haveent talked about its continued use. It helps some, but its not a replacrement for opiates.
Im sitting in the office now, really hoping he is open to switching me to somethinv besides Methadone before suboxone.
Thanks again for all the input. I have no one else to share this with.
Thu Apr 20, 2017 11:06 am
Best of luck. There have been a few people who who eased their way from methadone to bupe by mean's of short acting opiates. In one case I think is was kratom...though I'd stay away from that. Of course no one here can recommend that without your doctor's approval, and now with his radar up he's likely going to test you beforehand.
Hope things work out for you.
Thu Apr 20, 2017 11:10 am
All I get to do is echo?!
I agree with trying to stay on the methadone if you truly have significant pain (i.e. pain beyond muscle strain and the usual 'degenerative disc disease/bulging disc/arthritis', which hurts but probably doesn't warrant a life of opioids.
I suspect, though, that your doc was looking for an opportunity to stop prescribing agonists, because that's what most docs are doing these days....
Thu Apr 20, 2017 11:37 am
I'm so sorry I misread your first post. 'Dope' for me has been marijuana since I was a teen in the 70's. If they found heroin in your system there aren't too many options left.
A last gasp could be at a treatment center but that would only allow daily dosing and you probably need twice daily.
Thu Apr 20, 2017 11:43 am
Dr. Was definitely looking to get me off it. I unfortunately gave hin the ability to do so.
Appointment went well. Dr gave me 3 options. Keep me on the current methadone level for a month, as I hust bought a house and need to be functional for the closing. Option 2 was switching me to oxycodone for 2 weeks. Problem there was dosage. I would be feeling some withdrawel effects while on the oxycodone, as it wouldnt fully fill the methadones strength. Option 3 is going to the hospital for an in patient detox for a couple days, then going on subs.
Whatever option I take, I need to be functional on March 10 for the closing on my house.
Thu Apr 20, 2017 12:12 pm
If you elect option 1 and stay on methadone for another month which gets thru your house closing, do options 2 and 3 come back into play? Otherwise, how would option 1 work? One more script w nothing else is not a help. Is he giving you only 1 more month of time w him as your Dr.? Help me w this first and then I'll have more thoughts.
Thu Apr 20, 2017 12:23 pm
I can do option 1, then 2 and or 3 later.
Thu Apr 20, 2017 3:48 pm
How bad will the withdrawals be if I were to just stop at 25mgs? Ive read varying accounts. Think 3 or 4 days is about the time I would have to wait to start taking the subutex? My dr is going to start me on that for the first few days then switch me to suboxone. I really dont know what to do.
Thu Apr 20, 2017 9:09 pm
I haven't done it and can't answer on how hard and hope pugmommy or others who transitioned will see your thread.
For all 3 options: Are you doing this alone or w support? can you take time off given whatever your life obligations are?
Option 1 is staying at 25mgs for the next mo. Can you do this or is it too hard? Conversely could you continue to slowly taper?
Option 2 is 2 wks of oxy. What dose and frequency? Maybe one of the Drs can tell you if that might work?
Option 3 is inpatient hospital detox. You mentioned a couple of days, could it be longer? I'd check out which hospital and their program and make sure they use comfort meds. I started bup in an inpatient hospital detox unit. I was on fentanyl, after methadone, is the next long lasting. The parital back story is I went to rehab and for all 30 days had a hard time. l learned of bup there bc another resident snuck it in and he did great! I left after 30 days, barely got myself home and got to ER asking for bup where I was admitted to their locked psyche ward. I had no induction time bc I'd had no opiates for 30 days. The other 12 there were for heroin and pain pill detox. 1 was a chronic heroin relapser and was going onto a 9 mo out in the booney rehab. Only 2 of us were starting bup. Sad...
One tactic not yet mentioned but important, is comfort meds at home during Option 1 and 2. Clonidine and gabapentin. What others?
Thu Apr 20, 2017 9:57 pm
Minimum support. No one knows about the heroin. Just switching from methadone to subs. Luckily, time off of work is not going to be an issue. My dr filled out fmla forms to cover me.
Option 1. Yes, it is too difficult. Being in pain and craving heroin is too much to handle for any longet length of tine. Just being honest.
Option 2. I dont know yet. He said he would figure out the equivalent to 25 mg of methadone, so it cant be much.
Option 3. Im thinking is not the best idea after thinking on it today. Would probably be more comfortable at home, and at least have the option of smoking some pot, if I choose to.
I talked to a P.A. buddy of mine today. He seemed to think switching to oxycodone for a week, then stopping and then switching to subs is the way to go. I know the oxycodone wont do much to me at this point, and ill probably feel crappy the week I take it. But, the 3 or 4 days of going with out anything seems daunting.
Mr Dr did prescribe clonidine and lorazapam so far. Havent had to really use em much yet though.
Thu Apr 20, 2017 11:27 pm
Thanks for all that really helps. Your Dr is doing much more that I expected unless you were the wiser one and asked for it all?
Seems like you're coming to a decision. Makes sense. Yup, I get it. We all do. A couple things I'll mention. Its a small point bc I'm alive today bc of going to ER, but I've run into an issue w a inpatient psyche admittance record which is imo what detox will be called. but if its needed it needed.
No matter your option, you have heroin at home. Somehow you have to cut that off. Have to. Wishing you my best Rlsub bc this is all so hard, Pel
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