1 month of Methadone after being on Suboxone

Methadone treatments have been the gold standard for treating opioid addictions for decades. What are the advantages of methadone? Questions about methadone-assisted treatment go here.
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rasspects
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1 month of Methadone after being on Suboxone

Post by rasspects » Wed Feb 06, 2013 2:57 pm

Hello all... I've now been on Methadone for just over a month after having my appendix removed. Prior to having my appendix removed I was doing well on a taper from 16mg of Suboxone and was currently in between 4-6mg. I think I had successfully made it down to 4mg but I will never know because I got very very sick due to my appendix. Anyways, so after being on morphine 1.5 months due to the appendix and then a bad infection that came afterwards I decided to go on Methadone instead of suboxone out of the fear I have of the suboxone induction. I've been inducted twice in the past and both were very horrible and painful experiences even after waiting 16-18 hours after my last dose of opiates. it usually knocked me out for 3-4 days minimum and took a full week or 2 before I felt somewhat stable. suboxone just didn't seem to agree with my body. in retrospect im not too sure if it did or not because while I feel like suboxone made me like a zombie, im also having some issues with methadone, although they are MUCH different.

At first when I stopped taking my morphine and started off at 30mg of methadone I was feeling ok. surprisingly good actually... my dose was gradually increased though because I felt like it wasn't holding me long enough. at around 60mg they thought I should have been fine but I was then starting to feel VERY VERY tired in the morning up until I took my dose at 12-1pm. I told my doc this and he thought that maybe I need to increase more so over a few weeks we went from 60mg to my current dose of 85mg. I think 85mg is holding me better but im not quite sure if I still need to go up or not. Im still tired in the morning and I feel like I need a fix but it's not SO bad that I cant function at work, although when im around my wife and kids I am a complete useless tool until I dose; im also very irritable around my wife & kids until I take my dose and I CANNOT get out of bed for the life of me. I set like 8 alarms between 2 different smart phones and a real alarm clock and it takes me over 1.5 hours after my alarm first went off to drag my sorry ass out of bed. some of it has to do with my sleep pattern gets interrupted due to my son waking up at 6:50 then my wife's alarm goes off at 7:15 and then 7:20... and then I have to get my daughter up if she wakes up while my wife is gone dropping my son off at the school bus or if my wife has gone back to bed im the one stuck getting my daughter up since my wife had already got up early to take my son to school while I slept. ANYWAYS, enough about my marital issues. lol.

Before I was on methadone, for example while I was on morphine or suboxone, I was always hard to get out of bed but this is something new and totally on a different level. I feel like I NEED to just keep lying in bed. It has actually caused a big riff in my marriage because my wife recently found out about my opiate dependency which I hid from her (I know it sounds lame but I hid it from her as to not hurt her. she didn't need to know her husband was addicted to oxycontin and I sure as hell would never tell her I had resorted to using H when I couldn't get oxy) . she doesn't understand that something about the methadone is causing me to be so lethargic in the morning. I mean, she does know now that I've explained it to her a hundred times but I guess she's just fed up with seeing her husband just lying in bed while I should be at work or on the weekends up with the kids - I lie there uselessly sleeping until 10:30-11:30 or later if I was allowed to sleep longer. I feel like I could easily go to bed at 11:30pm and sleep in till 12pm. infact I did once.

after I wake up and take my dose though, im good within 1-2 hours. ive got almost all my carries (5 take homes getting my 6th this week) so when I do get a full week of carries im going to try split dosing because my theory is maybe my body is metabolizing the methadone faster then 24 hours. so if I took 60mg around noon and then the remaning 25mg (my dose is 85mg) at bed time im thinking it might be enough to carry me thru the night until noon when I take my next 60mg dose. or maybe they'll need to increase my dose a bit more before doing the split dosing. no matter, im considering the split dosing very highly.

I just want to know if anyone here has personally had this same problem? ive read about people being tired from being on too high a dose. but im not getting ANY euphoria whatsoever, infact in the morning I feel like im craving opiates, although I could go from 8am till 1 or even 4pm if I had to without being too uncomfortable. I would just be VERY tired until I took my dose then within 1-2 hours I wake up and im back to "normal" or as normal as I can be.

Im curious what people's opinions here are on my situation. do I

1) need an increase from 85mg to XX mg? perhaps 100mg?
2) need split dosing
3) need nothing, this is just something im going to have to live with OR
4) need nothing as it will get better over time

I must say it's affecting my marriage and im worried it will get me in trouble at work. I have a pretty flexible boss and hours but when im supposed to be starting at 9-9:30 and I don't wake up until 9:30-9:50 and don't roll in until 10:30-11:15 its going to get noticed eventually. I would really love a solution to this problem. I was hoping to not have to go up higher then 85mg. infact 60mg was the most I was hoping I would be on as it will be harder to wean down which is my ultimate goal over the next 6-12 months (or however long it takes on a slow taper). But if it means that I need 100mg to not be so damn useless and tired in the morning im totally A-OK with that. ZERO problems at all with going up in dose if it will solve my problem. Im just worried it wont though and i'll keep going up and building my tolerance for nothing until I realize it's useless. Honestly, I feel like split dosing is probably the solution if there is one I just don't know if I will need to go up to around 100mg before I do split dose or if 85mg will be ok.

As I mentioned above, I used to be on suboxone and I hated it the whole time I was on it. I felt like it sucked the life out me. it also made my very mild anxiety that used to poke its head up every once in a few years, come out in FULL FORCE. I needed serious help and was put on antidepressants and at first Atavan from my family doctor but then after telling my suboxone doctor about the benzos he said he strongly recommended I go on Clonazapam as it lasts longer, is safer and doesn't show up as a positive on the Benzo portion of the drug test I have to do. So I told my physchatrist this and he agree and prescribed me Clonazapam instead of Atavan. The Clonazapam seemed to help a lot more then the atavan although the atavan did wonders for me while I was on my second induction which was the roughest of the 2 times I was inducted onto suboxone. The atavan literally took me from an anxious, shaking, sweating ball of stress to a calmed down, almost normal feeling state. I had to take clonazepam for a good while during my suboxone days. But I was never tired like this in the morning. After I stabalized on suboxone I was actually somewhat ok in retrospect but I did feel like everything was a bit BLAH while on suboxone. I haven't been actuely anxious on methadone and having horrible panic attacks like I was with subs but I do feel like I am a bit anxious here and there... and I feel a bit panicy like Im constantly thinking about my next dose whereas I was NEVER Like that on suboxone. EVER. On subs I would easily go over the 24 hour mark without any feeling of withdrawal or cravings. infact one time I forgot to dose and didn't realize it until the next day so it was like 36 hours before I dosed. I can barely make 24 hours on methadone.

Any advice, suggestions, personal stories, etc are welcome and encouraged.

Sorry for the long rambling post. That's just how I am. I cant get all my thoughts out at once or as clear & concisely as I want.

Thanks in advance for your support and replies. I would love nothing more then to feel stable, not tired in the morning and be able to start weaning down. If I hadn't had the damn surgery I would have been either a) completely off subs by now b) at such a low dose like 1 or 2mg. my surgery was on nov17 btw. my tolerance has skyrocketed since then because I was on ALOT of morphine for a long time then I went on methadone at 85mg is a pretty strong dose compared to suboxone.

Take care and CHEERS!

Rasspects

PS I don't know if it's the methadone or the Effexor (antidepressant) but I have ZERO sex drive which is also causing maritial problems as my wife is young, hot and wants to have sex a lot... atleast more then once a month which is what I feel like. Best way I can describe it is I feel almost asexual. Although, before my opiate dependency and the antidepressants I was definitely interested in having sex with her. lol. Now, the thought of sex almost grosses me out or just makes me plain UNCOMFORTABLE. it's so messed up.

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Post by Amy-Work In Progress » Thu Feb 07, 2013 12:24 am

Welcome to the forum!

I wish I could help answer your questions, but I have zero experience with methadone and effexor. The only thing I can think of is, could you try to experiment with the timing of your dose? Can you, for example, set the alarm for 6:00 am, take your dose, and be ready to be up and functioning at 8 am?

I hope that someone else who has more experience than I comes along soon to answer your questions. But I wanted to at least welcome you to our forum!

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Post by TwinCitiesHardcore » Fri Feb 08, 2013 5:31 pm

85mg is considered to be a fairly low dose these days. Most people I see that are successful in methadone maintenence settings are on between 80mg and 180mg give or take either way to HUGE degrees. There are differences in the way that people metabolize methadone and split-dosing is becoming an option more and more easially available in clinic settings. If I were to give you any immediate advice it would be to gradually increase and if you're still having symptoms at less than 24 hours at 120mg consider that you may do better with split-dosing. You may find that 100mg is the 'magic number' for you or you may find that a split-dose of 120mg and 120mg is what it takes, it's going to be different for everyone...I was personally a 240mg daily guy for a long time. Be patient and keep updating SuboxForum!

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Post by Lillyval » Tue Feb 12, 2013 7:15 pm

Unfortunately, I can't answer your methadone questions. I was wondering, however, what dose of Suboxone you were on. Many people can strike a balance between the side effects and the benefits by lowering their dose. What made me want to mention this was what you said about the anxiety. The only time I experienced anxiety as a side effect of Sub was when I was on 16mg/day. At lower doses I never experienced it. Also the zombie like effect diminishes at lower doses. Many people maintain at 4mg once a day. So, if the methadone doesn't end up working out, you might consider trying Sub again and adjusting your dose until it is tolerable.
Good luck.

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Re: 1 month of Methadone after being on Suboxone

Post by MaryBeth0586 » Sun Mar 16, 2014 8:02 am

Just wondering if u ever got an answer to
your problem. I went through the samething it methadone and effexor do not work well together in effexor should not be given if your taken methadone it causes an increase in ur metabolism causing your dose to ware of to soon! I just stopped the effexor and decreased my methadone im at 32 milagrams now and feel awsome i do everything my family does. Methadone is addictive so many think they have to increase right away when they should give it time. Iv been on it for six years and im thinking of switching to suboxin but im now terrified after reading so many horror stories about the withdraw sym u have to go through first:(

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Re: 1 month of Methadone after being on Suboxone

Post by tryin2getright » Mon Jan 26, 2015 3:43 am

Methadone has made myself and nearly everyone I know constantly tired. I am back on sub, thank god, buy methadone I'd a ball and chain. Get off and back on sub. You have no idea what's coming when you get off..... good luck

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Re: 1 month of Methadone after being on Suboxone

Post by RGB » Tue Jan 27, 2015 2:25 am

MaryBeth0586 wrote:Just wondering if u ever got an answer to
your problem. I went through the samething it methadone and effexor do not work well together in effexor should not be given if your taken methadone it causes an increase in ur metabolism causing your dose to ware of to soon! I just stopped the effexor and decreased my methadone im at 32 milagrams now and feel awsome i do everything my family does. Methadone is addictive so many think they have to increase right away when they should give it time. Iv been on it for six years and im thinking of switching to suboxin but im now terrified after reading so many horror stories about the withdraw sym u have to go through first:(
Never had Methedone.
But took plenty of MST and Oxys.
Going CT at home I went through Hell and after a few days in bed depressed and sweating and sore I would give up and go back to the Morphine/Codeine.
With the Sub I did it in a clinic.
Sunday I had to stay off the pills so I spent all day drinking Vodka and kept going till I booked in on Monday morning Drunk.
Spent Monday on Diazepam with a dose of Codeine that night and on to the Sub on Tues.
It was far easier than I thought and completely different than my home efforts.
I would reccomend Sub to anyone.
Am still using Diazepam and drinking some beer at night.
But I believe when I get my dose right I will be able to dump them as well.

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Re: 1 month of Methadone after being on Suboxone

Post by Doves7171 » Fri Jun 04, 2021 3:37 pm

I was on methadone 90mg, Effexor 150mg and olanzapine 5mg between 2017 & 2018.
Every morning about 2 to 3 hours before my methadone dose I felt my body and mind going into withdrawal. Ie. metabolising the methadone too quickly.
As another person pointed out perhaps it is the Effexor causing this rapid withdrawal of M. I don’t have this problem on 12mg film of Suboxone each day but remember that Subs do not have the ‘kick’ of M and also Subs have a much longer half life.
I’ve been considering switching back to M but I think I’ll wait until I come off Effexor. Venlefaxine (Effexor) could very well be the early withdrawal culprit.
I recall struggling to walk around the block, depressed, anxious and just low on life because of this fast metabolism of methadone.
Be aware that St Johns Wort also causes rapid metabolism of Methadone.

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Re: 1 month of Methadone after being on Suboxone

Post by rule62 » Fri Jun 04, 2021 11:22 pm

Be very careful trying to get off the Effexor. I too was on it for about 5 years and failed twice before finally understanding I had to go real slow. The capsules have small beads in them. 150mg's has exactly 150 beads. Yes, I counted. First try to go down to the 75mg dose. You may have to take half of them out if you start to feel w/d's dropping that much of a dose. The trick with this drug is only go down about 10% every two weeks and no sooner or you'll fail. Well, I did, you may be different. I sat down and counted out the beads and threw out the remainder. Put the lower dose back into the cap and took it. Going that slow still took me a little over 3 months to finally get off it. My doctor told me I wouldn't be able to do it. Too many side effects. It is called Effexor for the side effect IMO.

If you want to discuss it more in depth feel free to PM me and we'll talk. You can do it if you go slow. That is one drug that cannot be rushed.

Welcome to the forum!
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Re: 1 month of Methadone after being on Suboxone

Post by suboxdoc » Fri Jun 18, 2021 3:17 pm

Rasspects, a couple thoughts. Buprenorphine and methadone have very different characteristics. Methadone is an 'agonist', meaning that the opioid effects are directly proportional to the level of the drug at the receptor. Buprenorphine has a ceiling effect and different terms are used to categorize it - partial agonist, agonist/antagonist, mixed agonist, etc. But with that 'ceiling' on effect, the opioid effect remains completely constant as long as the drug level is higher than that ceiling. So buprenorphine never wears off in a typical day, where methadone DOES wear off, at least to some extent.

There is some information missing that would help with suggestions. For example do you know your peak and trough? Those numbers would help to determine whether you would benefit from a dose change or from split dosing. For most people, methadone has more side effects than buprenorphine. I say that after working in a methadone program for 6 years as the clinic's only doc, and treating over 800 people with buprenorphine in my own practice. Both meds have actions at receptors besides the mu opioid receptor, and those other receptor effects can cause a range of side effects.... but in general methadone has more than buprenorphine. We also know that the opioid-related side effects, like lowering testosterone, are greater from methadone than from buprenorphine. I think the main reason for that is because the biggest opioid effect possible from buprenorphine is equal to the effect of 30-40 mg methadone/day, and most people on methadone use higher doses than 30-40 mg.

If anyone wants a good read on methadone, Google 'Tip 43'. It used to be listed at the SAMHSA site, but it is now considered outdated and replaced by (I think) tip 63, which you have to pay for. But Tip 43 describes things like therapeutic blood levels, when to split-dose, etc. Split dosing, by the way ALWAYS feels better. But clinics usually place limits on it to help reduce diversion. Some clinics don't do split-dosing except for pregnant women, who metabolize methadone more quickly.

I've heard many men complain of low sexual desire on methadone. I've heard the complaint from men on buprenorphine too, but not as often. Methadone lowers testosterone, but that takes months or years to develop. I've heard men theorize that methadone creates a type of 'numbness' that interferes with arousal or orgasm -- not true loss of sensation, but a lack of the type of feeling that gets then 'over the top'. And Effexor, being an SNRI, makes orgasm difficult or impossible in some people -- so the combination is going to work against you.

When I started this post I was going to vent about my observations from a methadone program that was bought out by a large company. I realized halfway through that I wasn't answering any of your questions, so I cut the whole thing - and now it sits in my computer clipboard. I'm going to paste it because it took a few minutes to type, and I think it has a couple valid warnings. If I can be of help with your issues, feel free to email me... you can find my email by going to my blog and navigating to the 'contact' page.

My vent:
I worked in a methadone program for six years, leaving last summer after the place was bought out by a large methadone treatment company. BE CAREFUL with methadone. I worked hard to keep our patients at reasonable doses -- i.e. less than 200 mg/day. The company that bought the place has other clinics where people are on 400 or 500 mg/day -- and that's how they want it, because they want patients to STAY, FOREVER.

Patients love the start of methadone treatment. What opioid addict wouldn't? You get to pick up a big dose of an opioid at the start of the day, for free if you're on medicaid... you can still use illicit opioids as much as you want, and the clinic won't do anything about it.... and you get to increase your dose every few days, usually without even seeing a doctor! Patients have tons of 'opioid hunger' at the start of treatment, and doctors write orders like 'increase methadone dose by 4 mg every 5 days if patient has withdrawal symptoms.' And surprise -- almost everyone asks for dose increases, every chance they get. At many programs they will keep raising doses to ridiculous levels as long as the patient comes in and says 'I need more'.

That's all fine. But over time, people run into problems. Now and then a patient would take a good step forward and find a great job. But then the person discovered that methadone stood in their way. If they lost their state insurance, they would be on the hook for over $500 per month to keep receiving methadone. Or the employer wouldn't be comfortable with them operating heaving equipment while on methadone. They would come in and say 'I need to be off methadone as soon as possible.' And I'd explain that people generally tolerate a taper of about 2% of their dose every week - i.e. about 1 mg/day from 50 mg methadone. In other words, it took a year to taper off 50 mg methadone, IF they don't take any breaks from the taper. Can you imagine how long it takes to get off 400 mg of methadone?!!

I enjoyed working in the industry, and I'm generally a fan about methadone-assisted treatment. But when clinical decisions are made by non-medical people who have no understanding of addiction, treatment suffers. If you go into treatment in a methadone program, you MUST protect yourself-- because the goal of many programs is to KEEP you there - for the rest of your life.

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