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PostPosted: Mon Apr 30, 2012 10:49 pm 
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Jesus. I had a wonderfully detailed post written up and after composing for 30mins, the forums ate it somehow. Argh. Well, not typing all that again, here's the condensed version:

My history: I was an IV heroin addict for about...7 years. Before that, I was IV'ing oxy's. And before that, I snorted them. Pretty typical progression. I've been addicted to opiates for about 15 years total now. Sick of the lifestyle, I went and got on MMT about 3 years ago. And it changed my life. For the better. But...the clinic is over an hour away, one way, and I'm spending over 600 bucks a month on gas/dosing fees. I'm switching to the suboxone purely for financial reasons and convenience (going from spending 600 to about 35 in the pharmacy copay, and no more daily drives to the clinic).

I've been at 70mg for about 2 years, never went higher. Here's my tapering schedule:

March 10th from 70 to 50
March 17th from 50 to 40
March 31st from 40 to 35
April 7th from 35 to 35 (started to feel the effects of dropping to suddenly I think)
April 14th from 35 to 33
April 21 from 33 to 31
April 28th from 31 to 29

All of the above instances, I stayed on the current dose for exactly one week before dropping again. The exception being when I stayed at 35 for 2 weeks, and the fact I've only been on 29mg this past sat/sun. My last dose was at 8:30am Sunday. It's been roughly 36 hours since that dose, and I scored around 14ish on COWS (moderate wd)

I'm going into the clinic tomorrow, around 9am (so a full 48hours since my last dose). I'm supposed to take 1/2 of an 8mg strip in the office, take the other 4mg strip home for later, and start out on 12mg daily the next day. My doctor refuses to prescribe subutex, even for the induction phase. Her reason being that "Subutex is abuseable". I countered with a "I haven't picked up a needle in over 2 years; if I wanted to get high, it sure as fuck wouldn't be on a subutex". She didn't find that convincing. ;p

What can I expect? I've read both horror stories and success stories on these forums, so I'm anxious to say the least. Hell, I used my week vacation this week in anticipation of it being bad. ;p Given the specifics of my history/tapering schedule from methadone, any advice is greatly appreciated. I meant to post this about a week ago, but....yeah. Sorry for the short notice, any replies are welcome.

Wish me luck!


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PostPosted: Mon Apr 30, 2012 11:56 pm 
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Shun wrote:
Jesus. I had a wonderfully detailed post written up and after composing for 30mins, the forums ate it somehow. Argh. Well, not typing all that again, here's the condensed version:

My history: I was an IV heroin addict for about...7 years. Before that, I was IV'ing oxy's. And before that, I snorted them. Pretty typical progression. I've been addicted to opiates for about 15 years total now. Sick of the lifestyle, I went and got on MMT about 3 years ago. And it changed my life. For the better. But...the clinic is over an hour away, one way, and I'm spending over 600 bucks a month on gas/dosing fees. I'm switching to the suboxone purely for financial reasons and convenience (going from spending 600 to about 35 in the pharmacy copay, and no more daily drives to the clinic).

I've been at 70mg for about 2 years, never went higher. Here's my tapering schedule:

March 10th from 70 to 50
March 17th from 50 to 40
March 31st from 40 to 35
April 7th from 35 to 35 (started to feel the effects of dropping to suddenly I think)
April 14th from 35 to 33
April 21 from 33 to 31
April 28th from 31 to 29

All of the above instances, I stayed on the current dose for exactly one week before dropping again. The exception being when I stayed at 35 for 2 weeks, and the fact I've only been on 29mg this past sat/sun. My last dose was at 8:30am Sunday. It's been roughly 36 hours since that dose, and I scored around 14ish on COWS (moderate wd)

I'm going into the clinic tomorrow, around 9am (so a full 48hours since my last dose). I'm supposed to take 1/2 of an 8mg strip in the office, take the other 4mg strip home for later, and start out on 12mg daily the next day. My doctor refuses to prescribe subutex, even for the induction phase. Her reason being that "Subutex is abuseable". I countered with a "I haven't picked up a needle in over 2 years; if I wanted to get high, it sure as fuck wouldn't be on a subutex". She didn't find that convincing. ;p

What can I expect? I've read both horror stories and success stories on these forums, so I'm anxious to say the least. Hell, I used my week vacation this week in anticipation of it being bad. ;p Given the specifics of my history/tapering schedule from methadone, any advice is greatly appreciated. I meant to post this about a week ago, but....yeah. Sorry for the short notice, any replies are welcome.

Wish me luck!






Hi Shun, and welcome to the forum.

I don't have any experience going from methadone to bupnorphine...but I have taken methadone as an addict.

I think you have a lot going for you in switching. First, you have waited long enough to avoid precipitated withdrawal, and second, you will not have to go everyday for dosing and do all that driving...thus saving on money as you said.

I can only tell you my experience with bup..and after a 29 year addiction to hydros, methadone and anything else I could get...the bup has saved my life. After dosing in the office I felt so much better..withdrawal gone...a high from the drug...the only time I ever felt a high...and just feeling normal for the first time in a long long time.
Unlike methadone..bup does not get you high..the more you take does nothing. If I took more methadone I could feel it, so I always took more.lol...with bup not so...and I am on 12 mg. now...started on 16 then12...will soon go to 8. I plan to stay on this drug for a while. I have been on it 2 years...I may try to maintain on 4mg. I just don't see me getting off because I know me and I would be right back out there.

Your Dr. not giving you subutex is sad, because it is so much cheaper. Subutex is what I take. Luckily my Dr. did not have a problem with me taking it.
Also you sound like you have had good contol of your methadone..taking it as directed and the ability to reduce down like that....I don't know if I could have done that. You will most likely do great on bup and it will do the same for you as the methadone did, just without he high.
I wish you good luck and hope you continue to post on the forum so we will know how you are doing.
Slipper

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PostPosted: Mon Apr 30, 2012 11:58 pm 
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Hi Shun,
Congrats on dropping your methadone dose over the last several weeks. Sounds like you're on the right track for starting suboxone. I also made the switch from methadone to suboxone and was taking 45 mg's of methadone a day prior to making the switch to subs. I, too, was tired of driving to the methadone clinic daily and after researching suboxone and finding a doctor, I realized that suboxone would be a little less expensive for me and far more convenient.
I think that because you're already experiencing moderate withdrawals, you should be fine with your induction to subs tomorrow. Everyone is different, but my doctor told me that I would be able to start suboxone after methadone as long as I was feeling moderate withdrawals. In my situation, I took my last dose of methadone on a Thursday morning (45 mgs) and started my suboxone on the following Monday morning after my doctor visit. So I ended up waiting a little longer than you are, per my doctor's recommendations, but was also on a higher dose of methadone than you are currently.
Needless to say, I felt pretty damned shitty on that Monday morning, but after taking my first dose of suboxone, the WD's began to fade. My doctor initially prescribed me 20 mgs of suboxone (2 and a half of the sublingual strips) per day, but I never even needed that much. She told me to take the suboxone incrementally at first to see what worked for me - just like it seems like you will be doing - and I ended up starting out at 16 mgs per day for the first month or so.
The first few days of suboxone might be slightly uncomfortable (or not) as you adjust. But nothing terrible. You'll feel good/normal and it will definitely take away those withdrawals you will be feeling from not having your methadone for a couple days. You might get a little sweaty...that's one thing that stands out to me but this should pass within a week or so as the methadone starts to leave your system and you become stable on your dose of suboxone. Methadone (like suboxone) has a super long half life - in fact, i tested positive for methadone for almost 2 months (via urine screen) after stopping it and starting suboxone! But anyway, I would guess that you'll start to feel very stable on suboxone within a week or so of starting it. And even when you're not completed stablized, you shouldn't feel too bad at all. Everyone is different, of course, and everyone responds differently to suboxone, but with some patience and guidance from your doctor, you should be able to find the proper dose to meet your needs.
I'm not sure if you plan to taper, but I found tapering from suboxone much easier than tapering from methadone. I've been on subs for over a year and was able to cut my dose down to 4 mgs within 10 months. Right now I'm not tapering due to my own choice and also because i'm pregnant, but I do look forward to a day when I can be completely sub free. Regardless of whether you plan on being on maintenance or eventually tapering, I wish you the best of luck as you take this next step.
And by the way, my doctor refuses to prescribe subutex too. My insurance doesn't cover suboxone so I asked about generic subutex and was shut down immediately - even when I became pregnant she didn't switch me to subutex as some doc's will do. But there are several doctors out there that feel this way and I'm okay with being on suboxone.... I've had great success with it thus far. I wish the same for you! Keep us posted. This is a great forum with many knowledgeable members! I'm sure others will have more advice for you as well.


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PostPosted: Tue May 01, 2012 3:45 am 
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Hey Shun!

First, welcome to the forum! I am a new member here as well and have found the support and advice here to be so valuable and important. I feel very fortunate to have found this place and the wonderful people here. I don’t know where she finds the time, but it seems like slipper somehow manages to give a very personal, supportive reply to every new member here (thanks again, slipper!). But of course she’s not the only one, as you can see from JenW’s reply and as you will see from others who will join in supporting you here. :)

Important disclaimer: I was a pill popper, not an IV user, and I’ve never been on methadone. My DOC (hydrocodone) has a much shorter half-life than methadone. Reading between the lines, it sounds like you are fearful of something called precipitated withdrawal, which can happen when you start sub without being in sufficient withdrawal. I too was afraid of this, given years of abuse of high levels of hydro. I did my induction when I was about an 8 on the COWS scale. I tried to grade myself strictly so as not to kid myself. I waited over 50 hours from my last ingestion of hydro before I finally inducted.

If you are truly at a 14 on COWS, and you are grading yourself honestly (as Romeo told me in my thread, it’s best to have someone else grade you objectively if at all possible), then perhaps you have nothing to worry about. But I have read that induction for methadone users is more difficult because of methadone’s long half-life.

Because I graded so low on COWS, when I decided to induct, I only took 2mg of the film sub. My hope was that if I had a precipitated withdrawal, it wouldn’t be too bad because of the relatively low amount of sub I took. Within 30 minutes, I felt much more comfortable, about 70% free of w/d symptoms and cravings. That told me that I was okay and would not experience precipitated withdrawals, so I took another 2mg and after that got into my system, I felt no w/d symptoms or cravings. And off I went onto my journey to sobriety.

Since you will be inducting with your doctor, my advice really means nothing (I inducted on my own; my doc prescribed the sub several days before my scheduled induction and just had me call him on his cell phone when I felt ready to start sub). Obviously, it’s best to ask your doctor! But if you are really afraid of precipitated w/d, maybe you could ask your doc if you could begin with just 1 or 2mg to see if you get precipitated w/d? In fact, I’d be curious to know from your doc if taking a small amount of sub (1-2mg) vs. more (4-8mg) at induction can lessen the severity of precipitated w/d. That was the assumption I made at my induction, but maybe even just 1-2mg is enough to trigger complete precipitated w/d?

Finally, it sounds like you already have the COWS scale in hand. Here’s a link to that scale, with a really good, simple explanation of why and how precipitated w/d happens: http://www.naabt.org/documents/cows_ind ... _sheet.pdf (credit to Romeo for giving me this link).

So there you, my .02 FWIW.

My very best wishes to you with your induction!

SI


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PostPosted: Tue May 01, 2012 11:44 am 
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hi shun! i switched from methadone to subs 2.5 years ago, it was the best thing i had ever done, and i didnt want to! my doc actually forced me, he refused to write any more meth scripts and i will forever thank him. you are going to be just fine. when i switched, i was on 100 mgs of methadone. no lie! and i only waited 24 hours. i figured the wd's couldnt be any worse than what they were already. wrong! given your waiting time and smaller dosage, all will be well. have fun with your new life! good for you.


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PostPosted: Tue May 01, 2012 1:04 pm 
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Hello Shun,

How did your induction go? I don't have experience with methadone, but it looks like you got some good advice on doing the switch.

I've had the forum eat my posts too. I think I took too long to type it and when I clicked submit...poof...there it went! After that happened, I started copying my posts half way through if I am writing a long one, just in case that happens!

Keep us posted.


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PostPosted: Tue May 01, 2012 8:19 pm 
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Hey Shun ...

a couple of days post-induction, after the seas settle, you'll find some of your humanity and feeling has come back. That was my experience with switching to Sub. Because Sub has less of an agonist effect than methadone, being on Sub is kinda like half way between being clean and being on methadone. And it feels good to have some of that human feeling back...

I found for my induction - 40mg -> Subutex for 1 (or two) day -> Suboxone ... I think I had two or three days break? Fuck my memory is bad ... Anyway I was having moderate withdrawals prior to induction. Enough to have mucus hanging from my nose (gah) ... and first dose of Subutex - 4mg? It didn't make me feel better per se. It kinda "transformed" the withdrawal into a speedier edgier form - ie precipitated withdrawal. It wasn't any worse though. However I found over the next few hours, things slowly started getting better... I had my 2nd dose that night, and I felt a lot better by that stage, even if the 2nd dose returned some of the PW symptoms a little. By the next day I felt ... almost good ... but I was a bit "rattled" for a couple of days after. It does shake the system a bit the old methabox transition.


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 Post subject: Update
PostPosted: Tue May 01, 2012 8:32 pm 
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[align=center]UPDATE![/align]

First, thanks to all for the positive replies, they were VERY much appreciated in my time of need.

The actual induction dose of suboxone went phenomenally well. Due to some incompetence on the part of some staff members, I didn't actually take the 1st 4mg dose until almost noon; four hours later than I expected. Which was fine, in a way, as the way I saw it the more I was into WD's, the better (I can say that now--at the time, not so much ;p ). I actually ended up waiting about 52 hours since my last methadone dose; after taking the 4mg sub, I was at first kinda scared because after 30mins I still wasn't feeling any relief from it. I started kinda obsessing over it on the drive to the pharmacy (which was a debacle), but suddenly, while standing around inside my 3rd! CVS Pharmacy...I noticed something. I felt better. A lot better. Yay! It's now around 8:30 EST and I'm still doing fine; even managed a small nap earlier as I didn't get much sleep at all last night. I just took the other 4mg for today; I was feeling fine, but I was told to take it in the evening, so I did.

I'll be honest...I was also kinda afraid I'd miss the "high" from methadone. Now, let me explain; when I say high, I don't mean nodding out/drooling dropping cigarettes everywhere (how can you spot an addict who smokes? Look for the burns in their shirts/carpeting ;p ). It's more like a warm glow of slight euphoria. I've always gotten that, even at a low dosage, even after almost 3yrs on MMT. I experience the same on suboxone. BUT, as I was telling a friend who'se also in recovery "maybe that's just what normal is". To be honest, I wouldn't know; I haven't felt normal in so damn long.

Overall, my first day on suboxone is going SO much better than I had hoped; and I am sure the strong words of encouragement found on these forums helped immensely (seriously, all of you guys and gals rock). My only bitch about the experience was with the actual "Doctor" visit. It basically boiled down to "what pharmacy do you want to fill this at?" No discussion of COWS, how I was feeling about the switch, advice on what to expect based on other methadone patients transitioning, etc. Thank christ for the internet, and these forums specifically, for providing the information and support.

TL;DR My transition from methadone to suboxone went swimmingly, my doctor kinda sucks, and you guys are awesome.

Thanks again.


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PostPosted: Tue May 01, 2012 10:16 pm 
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Taurus wrote:
Hello Shun,

How did your induction go? I don't have experience with methadone, but it looks like you got some good advice on doing the switch.

I've had the forum eat my posts too. I think I took too long to type it and when I clicked submit...poof...there it went! After that happened, I started copying my posts half way through if I am writing a long one, just in case that happens!

Keep us posted.


Next time that happens, and you hit Submit and you lose your post, hit the back button on your browser..and it'll be there just as it was typed. It's still in the cache unless the page responds (which cleans the cache with new data)..so if you hit back, you just pull up the cached text you typed.

That happens when you have an idle time-out on the forum..meaning it takes a while for you type a post, and your timed-out..

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PostPosted: Thu May 03, 2012 3:52 am 
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hi shun'. and welcome to the forum'. i was just thinking about b-boy in his great full switch from suboxone to methadone.
does methadone fog our memory as much as suboxone? just a thought!

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PostPosted: Tue May 08, 2012 1:50 pm 
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I'm really interested in hearing how you are continuing to progress on the subs. I am a long time methadone maintenance patient, but have often thought about switching to subs. My major concern -- something I thought of when you worried you'd miss the "high" of methadone -- is that I won't "feel" my dose. I don't get high off my methadone -- not at all -- but I can feel that something is working in their.

Good job, good luck, and please keep us posted.

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