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Unread 11-24-2014, 02:13 PM   #1
benn11
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Default Currently tapering off methadone looking to switch to suboxone

Hi,
I used to be on Suboxone for about 2 years but lost a job that was providing healthcare making it possible to pay for suboxone. When I lost the job I was able to go back on my mother's healthcare (until she changed jobs) through Kaiser Permanente. When I was 17years old I had tried Suboxone through them but was not ready to quit using and so was only on it for a few weeks at that point in time before I went back to using. Years later after trying to stay clean and continuously failing to do so and decided I wanted to try Suboxone again. It worked well for me after figuring out to spit out the naloxone since it was making me feel quite sick. Anyways when I lost my job I called Kaiser to see if I could go back on Suboxone through them and they denied me because I had already tried it through them and failed. I told them I had been on it for years and was doing well with it, but they wouldnt budge. They said that the other option I had left was to go to a methadone clinic. I regretfully got on methadone shortly after. Now it has been over 2years on methadone and I am tapering off. I was up to 95mg and am currently down to 75mg. I was also able to apply for medicaid which has been a huge help, although sadly the clinic does not take medicaid. I have heard that some sub doctors take medicaid and it is very affordable. I deal with chronic pain, along with other co occurring conditions. The methadone has helped me to stay clean but I have heard how terrible it is coming off of methadone. I am now 25years old and want to get off methadone. Sadly going to the clinic is not much cheaper than paying for suboxone out of pocket, and I am struggling to keep up with the clinic payments. It has really taken over my life in ways I dont like; having to go to the clinic every morning, if I miss a day Im sick, and things like traveling or going on vacation is not easy to do. I have really had to fight to taper down on my dose, it seems that they want me to stay on it for the money. Thankfully the dosing nurses have been extremely helpful, and have really had my back in wanting to get off of methadone. So my questions are; is there anyone on here who has been on methadone and switched to suboxone? I could use any input or help on how to do this. I have talked to the dr at the clinic and he said I need to get down to at least 30mg and then "jump off" and that I would have to be methadone free for 3-4 days before I could start suboxone again. I have done a lot of research on methadone and from talking with other people I feel like it might take a lot longer than 3-4days before I could make the switch to suboxone without going into precipitated withdrawal. I apologize if this is the wrong forum, or if this is a suboxone only forum. But if its ok I could use any help/feedback. Thanks!
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Unread 11-24-2014, 07:15 PM   #2
jimash55
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Default Go for it!

Welcome my friend and you have come to the right place to get some good input- I myself have never been on methadone (legally) so I can't be of much help there but I do want to give you a little encouragement cause I know your really having a hard time...Buprenorphine(Suboxone) help save my life and at the present time life has nrver been better....whatever you do don't rush things and try to get well too soon...if possible wh n you get on suboxon try and find a support group or use this site because addiction is bigger than us and it's just too hard to attempt to maintain a healthy lifestyle by ourselves-I have been around for a while and there is good people here that really cares how your doing...so don't be a stranger and keep us posted ok? Stay strong and determined because better days are ahead of you!!
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Unread 11-24-2014, 08:01 PM   #3
NancyB
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Hi benn11, the methadone to bupe transition is one of the more difficult because of how long methadone stays in the system. Here is the recommended protocol:

Methadone
It is recommended that patients transitioning from methadone to Buprenorphine slowly taper to 30 mg./day of methadone, for at least one week. Last dose must be no less than 36 hours prior to induction, and may be 96 hours or more. A minimal score of at least 5 on the COWS is recommended, although some physicians prefer scores of 15 or higher.

Patients transferring from methadone or another long-acting opioid to Buprenorphine may experience discomfort for several days and dysphoria for up to 2 weeks.

The goal of induction is to safely suppress opioid withdrawal as rapidly as possible with adequate doses of Buprenorphine. Failure to do so may cause patients to use opioids or other medications to alleviate opioid withdrawal symptoms or may lead to early treatment dropout. To achieve this, some physicians have found they may need to dose as high as 32 mgs. the first day with some methadone to Buprenorphine transfers.


This is the link that came from: http://www.naabt.org/documents/NAABT_PrecipWD.pdf
On page 2 of that pdf is the Clinical Opiate Withdrawal Scale (COWS) by which you can gage your withdrawals. But with methadone, the longer you can wait, the better.

I hope this is helpful. Let us know.

Nancy
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Important disclaimer: Any information in this post is not and does not constitute medical advice under any circumstances. Addiction Survivors, Inc. does not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. NEVER take any online advice over that of a qualified healthcare provider. Any information contained on AddictionSurvivors.org should only serve to inspire further investigation with credible, verifiable references sources such as your physician or therapist.
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Unread 11-25-2014, 11:14 AM   #4
bugman
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Default Be tough

Hey Benn, first off, congratulations...your at the point of really NEEDING help and you've realized it. You will get good advice and some needed tough love on this site. There are good suboxone doctors and some not as good, take time to find the well trained doctors. Don't be afraid to ask if they are keeping up to date with all their training to help addicts, some really want to help and others just see it as a sideline for more revenue into their practice. Having said that, I noticed that you mentioned the cost.....look at it this way.....what's the price for your life, happiness and well being? Do you drink? Smoke? Gamble? Travel or vacation? Your life is worth more than all those things...you got yourself here, no one else, so be tough and pay whatever it takes to make it right. Even if that means doing without something else. Getting clean is not about convenience but about doing whats necessary to fix your life and restore the trust of the people you love and who love you.
Your still very young and have time to devote to getting well, don't be in a hurry.....start the suboxone and then taper as directed, do the work and stick to the program. Most doctors have a 0 tolerance level for people who try to make it up as they go. As addicts, we get so used to lying to people, if you begin to think you can con your doctors with, "the dog ate my Suboxone, so I need more", crap, they will drop you. Stick to the program....even when you don't want to. I did it at 55 years old, you can do it.
So much for the tough love part......You ARE worth the effort, so man up and get started, addiction is too big to handle on your own. I wish you all the success in the world and while I don't know what your belief system is, don't be afraid to pray for help, our loving Father wants you to be well. Thanks for listening, Bugman
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Unread 11-25-2014, 03:56 PM   #5
benn11
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Thank you for the feedback and support, it is much appreciated. I am not even down to half of my original dose of methadone, which I have been told is when it really starts to get hard, and its already really kicking my ass. I have felt stuck for so long, and even though I am continuing to taper it slowly gets worse and worse. I have talked to people that have detoxed off of methadone before and everyone says they would rather go through heroin withdrawal any day, and that because it is stored in your bone marrow, especially when taken in high doses for long periods of time, that withdrawal can last months. Recently the group home I was working at shut down, so I am looking for a new job, but feel very discouraged since the taper is taking so long (and I am going down much faster than they recommend). So I definitely worry that I will be able to hold down a job during this, as I already have both physical and mental health issues. Luckily I have some savings I am able to live off of for the next month or so, so I am wanting to get as much out of the way as possible. If I take suboxone and some methadone is still in my system, does anyone know how long I would be sick before the buprenorphine overpowers it? I also have heard of a new formulation of buprenorphine called bunavail? I am wondering what the difference is between suboxone and bunavail since essentially they have the same medicines in it; buprenorphine and naloxone. Is it just a new route of taking it? Or is there actual more benefit in taking bunavail instead of suboxone?
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Unread 11-25-2014, 07:53 PM   #6
stp747
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Benn,
I have been a counselor at a Methadone clinic for three years now and I can tell you that Methadone isn't in your bone marrow. It's an urban legend that Methadone is stored in your bones. Good luck, Steve
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Unread 11-25-2014, 08:48 PM   #7
NancyB
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Hi benn11, if you took suboxone with methadone in your system, you would likely experience precipitated withdrawals which would not be good. There's no way of telling if you could even take enough bupe to override the methadone without suffering immensely with the WDs and setting yourself up for more pain than it would be worth.

Bunavail is a film that goes on the inside of the cheek. There is less medication in it because it is supposed to provide a better bioavailability. We haven't had anyone here post about their experience with it yet. I would imagine personal preference and cost would be two determining factors.

Thanks Steve for dispelling that urban legend about methadone being stored in the bones!

Nancy
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Important disclaimer: Any information in this post is not and does not constitute medical advice under any circumstances. Addiction Survivors, Inc. does not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. NEVER take any online advice over that of a qualified healthcare provider. Any information contained on AddictionSurvivors.org should only serve to inspire further investigation with credible, verifiable references sources such as your physician or therapist.
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Unread 12-07-2014, 04:35 AM   #8
gotoffmdone
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I took Methadone all total for ten yrs. When I left the methadone clinic for a pain clinic I was on 190mgs per day. I then went to a pain clinic. They were reluctant to start me on a high dose such as 190mgs. So the MD told the nurse practicioner to start me on 150mgs.

Back then they gave two scripts. One was dated for the day they wrote it and the other one was post dated 28 days in advance. Two months later, at my second visit, the NP ask me how I was doing. I told her I could use an increase at least to where I was when I came to them. So they added another 40mg diskette to my diet. Two months earlier they thought 190mgs was too high but now with the addition of another diskette I was taking 200mgs per day. I ended up on 200mgs of Methadone a day plus two bottles of liquid oxycodone for breaktrhu which was a joke. Very few opoiod concoctions will get over on 200mgs of Methadone a day. So if 200mgs a day of Methadone does not stop whatever pain you have n either will anything for breakthrough short of it being something to put your lights out.

And if you end up having to deal with Methadone wds at that high of a dose my experience taught me that only more Methadone will stop the wds. I really wanted off all that Methadone after ten yrs especially when I started taking 400mgs a day. That occurred once I left the pain clinic and my family Dr took over the prescribing.

I was getting 320 40mg diskettes a day plus 90 of the 10mg tabs to add 90mgs to what I was taking each day for breakthrough pain. Finally I heard of Subutex and went to a Sub Dr. I had taken my dose the day before and despite the girl who answered the phone telling me I could dose the morning of the induction since it was going to be late in the day. I had just learned a little bit about inducting with Sub but was smart enough to know I should not take a days worth of Methadone the same day as taking Subutex. So I did not.

The DR gave me 2mgs of Subutex, waited a half hour then came in to see me. He was very pleased I had not gone into precipitated withdrawal. He then gave me 8mg tablets enough for a week. He told me to fill it then take only 4mgs more. I did as he instructed but there seemed to b a flaw in his plan. Rather than taking anymore Sub that day, I should have been told to wait until the same time the next day to take 4mgs more. Actually I should have waited on feel. Had I not felt the need thru wds to take anymore Sub, I should have foregone the next day.

There is nothing wrong with waiting until the Sub is needed then act accordingly. On the other hand, take Sub too soon and when its not called for, you cannot put the bullit back into the gun. Once you experience precip wds with Methadone being the drug you are using, there is not much you can do to feel better except waste a lot of Sub trying. It has been over 8 yrs ago but I have a flawless memory of what went down that day. Once the precip wds kicked in after taking the other 4mgs, I ended up taking a total of ten more 8mg Sub tablets to no avail. I never felt any better nor any worse. Had I that day to do over I would not have taken another crumb of Methadone until I started feeling wds come on and then I would have stayed very low at around 2mgs. As time went on and the methadone in my system started to leave I could have used how I felt as a gage to determine my dosage of Subutex. Chances are with Methadone's long halflife ,within that first week, I may not have needed more than 2mgs per day but had I, there would have been plenty. Once I precipitated methadone wds there was no cure except for maybe an even greater amount of methadone than I had been taken. Not certain how I managed but I never touched the methadone I still had left over. I just kept thinking that taking Methadone would mean all the agony I had been thru would have been an extraordinary amount of pain in vain. I kept taking Sub and for ten days I didn't want to see the sun come up. l got to where I could get out and umpire and exercise but it wasn't easy. The protocol is to be down to 30mgs or less of Methadone and stop for 48hrs before dosing and be watched during the induction phase.

The DR I had told me there was no getting around feeling bad when making the methadone to Sub changeover. You do it by protocol and you will feel bad possibly while tapering or for sure when stopping cold turkey for those two days once you get to 30mgs. Or even worse do it the way I did and induct without tapering at all and therefore precipitate methadone wds. There is no way to un-ring that bell especially if you are on an obscene amount of Methadone like I was. Luckliy that is an extremely rare ocurrance. If you are on a small amount of methadone and precipitate wds, you have a chance to feel better before I did which was ten days. If you have more Sub to take then that along with half of the methadone leaving your body every 24 hours then in time you will start to feel better. Just do not think taking more Sub is better or you will run out and unless you can get more from your DR, time is you only ally. I had plenty of Methadone and yet time was my only ally cause I had way too much Methadone in my system. Bottom line is I should have never been inducted at that point in time. My words matched what was seen on the COWscale. I was nowhere near ready to be put on Sub. Live and learn. I believe the awful start Sub and me got off too has accounted for why I never received the same positive benefit other claim upon starting Sub.

wayne
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