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PostPosted: Wed Mar 16, 2016 6:19 pm 
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Suboxone or subutex? Naloxone makes you go thru pw's or buprenorphine makes you go thru pw's???? I've heard it all and I'm f'n sick of it.

because getting methadone is so hard through any legitamate means I've decided with my doctors to switch from 25mg methadone to suboxone which I have never tried.

I got myself down to 10 mgs methadone first and was doing fine. Then my doctor wrote me for a couple of boxes of suboxone film 2.5 mg each with .5 naloxone and I knew all about how important it is to get as much of the methadone out of my system as possible. I have detoxed off of methadone a dozen times and I know from experiece that even if you jump off of 2mg or 1mg it takes at least 3 if not 5 days for it to really leave the system. I guess the mistake I made was not insisting that the doctor write me for subutex or the one that does not contain the naloxone. I have also been shot up with narcan more times than I can remmeber and know the feeling. You don't forget something like that! Yes, I have overdosed and needed to be revived many times!

love story longer, I did my last 10 mgs. of methadone and waited 36 hours and believe me, the cows chart at 36 hours was reading moderate which was all I could stand to wait. Moderate withdrawls is not enough!

I took one film under my toungue and within 30 minutes I felt like I hate just been shot up with narcan. heavy painful horrfic withdrawls which I put up with for 2 hours thinking even when I overdosed and was shot up with narcan it wore off within miniutes so what is going on? I took another film thiking maybe I jjust need more than 2mg bup..guess what. withdrawals got worse, as if they could. my blood pressure was 220 over 110, scary! I was getting ready to go to the er but just hung in for another few hours. all night long I was sick as a dog and could not figure out why the bup was not coming on. where's the relief? I'm not lieing about this. i had nothing in my system except that 10mg methadone 36 hours prior, actually longer since I'm now nearly 12 hours into the torturous wd's. I figured I couldn't get anyworse so I did one more film which made it a total of 6mg. By the it didn't get worse but never got better. When the sun came up and I was still sick as a dog I went to the methadone clinic which I had so happily bid farewell twi days ago and had them dose me 10mg. It took about 1 hour and I felt all better. Moral of story? WTF do they put in that shit to make us feel so bad?

I called my suboxone doctore and he said it's becuase even the smallest amount of methadone stays in the system for days after last dose and he should have written me a script without naloxone in it since he realizes I can't sit in wd's for 3 or 4 days waiting for the methadone to leave my system before taking the suboxone. I said thanks for realizing this, I knew that all along and why didn't he do it for me in the first place......at that point he said he'll take care of it and hung up in my ear. It took two weeks to get the suboxone film from all the insurnace red tape and pre-auth....and of course cost me 100 copy. Wonder how long it's gonna take to get this next batch.......God it's so wonderful having this disease don't you think!!

sorry about the long explaination but I hope someone gets something out of it.......megster


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PostPosted: Wed Mar 16, 2016 8:30 pm 
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Naloxone does not cause PW. It is the buprenorphine which has a higher binding affinity to MU receptors and will kick other opiates off of them. Buprenorphine has less of an opioid effect than other opiates including methadone which is why it's necessary to wait until withdrawal. Imagine methadone has a 10 effect and bupe has a 1, it kicks you from a 10 to a 1 instantly. I suggest that instead of taking the whole strip or pill, when you are in moderate WD try a .5mg-ish piece of it, wait an hour and repeat if you are not feeling PW And so on. Take it slow. Methadone is the hardest to transfer from to sub but you are at a very low dose. Good luck and sorry for the bad experience so far.


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PostPosted: Thu Mar 17, 2016 2:25 pm 
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Yep, you had the full effect of PW's due to the Buprenorphine in Suboxone. What I find surprising is the low dose you were prescribed. 2 mg's? I would think 8 at the very least to start with and then wait to see how you respond. IMO, it's best to start a little high and then back off down to whatever holds back the cravings. Tapering after you've stabilized is much easier to do.

From what I've heard, 2 days is the best time period to transfer over. You might want to wait 3 if at all possible. Yes, you will feel like death warmed over but ask yourself which one feels worse. The precipitated withdrawals or the slower acting one you get when stopping methadone?

I'm so sorry to hear you went through such misery. Now you know and will hopefully make a smooth transition later on.

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PostPosted: Thu Mar 17, 2016 2:58 pm 
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Thanks for the responses. They help. And you're right, it's the bup that causes the pw's not the naloxone as I first thought. The hardest part is waiting for the methadone to leave my system. It takes no less than 3 but usually 5 days and I say this from having done it at least 10 times. That stuff is long lasting ! The problem I'm having is that I can't sit in withdrawls for more than 36 hours which is not enough for the crossover to sub. If I could sit with that amount of misery I wouldn't be a damn drug addict in the first place so how do the doctors expect us to do this right?

My bup doctor is nice but I just got him and the meds so next time I see him I"m going to ask him if he'll write me a script for short acting opiates. Then at least I can take them for 3 or 4 days hopefully the methadone will be titrated out through my liver and the short acting opiates will take over. Then all I'd have to do after taking my last say 10mg oxycodone is wait for 5 or 10 hours and start feeling really crappy then take the bup. Does anyone know if short acting opiates would make the methadone xover to sub easier? There has got to be a better way because I don't have the inner strength to suffer for 72 or more hours. Who does that kind of medical practice? We have the technology why do they make us suffer in order to get to a different medication. I just don't get it............Sometimes I think the medical community really doesn't understand what they are dealing with when it comes to people with life long addiction......wahhhhhhh!


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PostPosted: Thu Mar 17, 2016 3:13 pm 
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Good afternoon megster,

I'm not familiar w methadone to bup transfer. Nor have I any medical expertise, but I've read here several times that its illegal for USA MDs to prescribe full opiates for addiction purposes... Others will likely come along with accurate info for you. Best, P


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PostPosted: Thu Mar 17, 2016 3:45 pm 
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Thanks for the reply Pelican, all input is helpful. I am indeed aware of the laws, and practices regarding doctors and when and how they can justify prescribing methadone. They can only prescribe it for severe pain and not opiate replacement therapy. Hence the existence of methadone clinics for which I have been a patient/client/slave/ of off and on for many years. Methadone has saved my life many times and I will always sing praises for it's invention and availability to those of us that need it.

Unfortunately for most people it is not covered by insurance so for myself and many it becomes cost prohibitive for long term use which is what I need. Thus is the reason I am being forced to make the change to Suboxone. Not only can doctors prescribe it an office setting but most insurance will cover it although many do gouge us if we don't have the best coverage, which would be me.

In any case, I'd rather pay 150. a month for suboxone and doctor than 300. a month for methadone and have to go to the clinic nearly everyday until I've been on it for a year or two which it takes to earn a month of take homes. I love my life on methadone. I function like a normal person and don't get high nor do I want to. I hear that Suboxone works the same way so I'm going to give it every chance I can to make the transition work. I just wish there were some way to do it with the least amount of suffering. I've suffered enough in my life and I know there's got to be a better way to switch from 5 or 10 mgs of methadone to suboxone without having to white knuckle hardcore WD's for 3 to 5 days. I'm just asking if anyone has any idea how to make it happen the gentlest way possible in order to avoid failure. The doctors are the ones that should have the answer to this but so far when I ask they pretty much say no easy way around it. Unless I want to go into the hospital and then they said they'd give me "non-narcotic" comfort meds. I've heard that one before. I've been in hospitals that dole out non narcotic comfort meds. Here's your tylenol # 3.....or maybe some tramadol. I guess I could go that route if I want to pay 260. bucks a day for the hospital visit but I'd rather not.

Anyway, I'll see what my suboxone doctor will do for me when I ask him next week if he'll give me some short acting opiate to help me through the long acting methadone detox......thanks for your opinions. I learn a lot from what I hear on this forum......megster


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PostPosted: Thu Mar 17, 2016 5:37 pm 
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megster,

Thanks for all the good info. I learn alot here too. My reply was missing clarity. I meant to say I thought MDs were unable to prescribe short acting opiates to diminish WDs bc they are full opiates and cannot be prescribed for addiction purposes such as WDs. If true, did not want you to get your hopes up. I read all your other posts and are aware you are well experienced, disappointed w the transition and have been having a hard time. Sorry this has been so difficult for you. Wishing you my best, P

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PostPosted: Thu Mar 17, 2016 6:01 pm 
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Yeah, you're probably right. If I ask my doc to prescribe me short acting opiates he might not be allowed to do it that way. Perhaps I should enter his office hunched over moaning in pain insisting it happened because the wd's were so bad I fell in the shower. You know, give him some legitimate reason to help me with my terrible pain......wahhhhh

wishful thinking....megster


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PostPosted: Fri Mar 18, 2016 8:06 pm 
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Lots of good things in this thread-- and as I read through the responses, I am proud to see the knowledge that people share here. I think that many docs out there know less about buprenorphine and other opioids than the people writing in this thread!

Yes, bupe causes the PW, not the naloxone, and yes, it is illegal for docs to prescribe opioids to treat withdrawal symptoms. The '3 day rule' allows docs to dispense, but not describe, opioids to reduce withdrawal symptoms-- provided that only a one-day supply of medication is dispensed on each day, for up to three days. The rule allows hospitals to cover for patients on methadone maintenance, but doesn't really do much else. Docs in outpatient practices are not usually in a position where they can dispense narcotics.

If a patient is being treated with methadone for pain, then the doc could switch over to a shorter-acting med for a couple weeks. And yes-- that would allow for a much smoother transition to buprenorphine medications.

I agree with earlier posts about the dose issue... in that 2 mg of buprenorphine is a very low dose for induction. Many people have claimed here that PW responded to higher doses of buprenorphine-- and I suspect that megster would have had a smoother transition, had she taken 8 mg of buprenorphine instead of 2 mg. It all comes down to competition, and a higher dose of buprenorphine would likely have pushed methadone off the receptors more quickly. In any case of PW, the best course of action is to stick with buprenorphine. That will be the quickest path to comfort... and will prevent the need to start all over again. PW can be severe, but it never lasts very long. Next time, no matter how sick you feel, just stay with buprenorphine-- and you will be fine in 24 hours.


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PostPosted: Fri Mar 18, 2016 8:22 pm 
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Hi! I also went from methadone to suboxone, and the switch for me didn't go very well. After two days of the switch, I said the same, I need something else as this doesn't work for me like it does for everyone else. But methadone is a beast, after four days, it was like someone flipped a switch and i was fine. More than fine, I felt normal and the tears rolled down my cheeks in happiness. I thought I felt normal on methadone, I soon found that I was anything but. My doctor made me switch and I was not happy with him at all, now I can't stop thanking him for saving my life. Please push on, It may take a few days, but trust that it will be worth it. Also went through pw, definitely the buprenorphine doing that.

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PostPosted: Fri Mar 18, 2016 10:29 pm 
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Thank you all for the input, I can't tell you how much it means to me. It's extremely comforting particularly having you with us Subdoc. The voice of wisdom and first hand knowledge in this storm of confusion is a life saver! Just no words to thank you enough.....

I am determined to make the switch but there's no way I'm going to be able to sit in even moderate withdrawls or PW's for 2 or 3 days. If I could do that I wouldn't be the addict that I am. I appreciate what you said about the docs ability to prescribe a small amount of short acting opiate or whatever there is. I'm wondering if 50mg of Tramadol will help me cross over because I have some of that from my last dentist appt. Anyway, I'm going to see my doc next week and ask him to help me with this transition and also up the mg of the Sub. At 2.5 I don't think it's enough for my needs either.

It's scary when your heart rate goest up over 220 and you're a 60 year old woman that is not sure her body can take another shock like that. It was traumatizing and it's not the first time I've heard that word used for trying to make this transition. But I'm a tough and determined old broad so I'll not give up on this one until it kills me or I make it work. Sick of the methadone and being tethered to the clinic and the bills......

Thank you all for your input. I will keep you posted as to how the next effort goes. I'm holding on 10mg methadone again and building myself up for the next round. Hopefully I will get the right meds and mindset to make it work next time I try........peace to all. and thanks for the support, you too pugmommy!.....megster


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