Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
To all readers that are reading this post.
I am new on this forum & really cant believe there was a forum like this... It is really good as I have many questions to ask & hopefully someone can help...... so here we go.... (sorry if its too long)
I have 2 children under the age of 4 years old. SWIM is currently on Methadone & my partner has been working at a remote mining town. He has been there for 1 year now & has been promoted to Managers. This meaning that the life of SWIM & her 2 children will change as they are moving up there. There is no pharmacy that provides M/D etc. I guess this is a good thing so that SWIM can eventually get off.
SWIM is planning to leave at the end of Feb. So that leaves me with a few weeks to get off.
So for the past 2 yrs or so my life has been around drugs again.
Now I am planning to get off the Methadone & Heroin.
I have been on Methadone for around 5 years & & never more than 75mg.
I have been using Heroin of $150 a day on top of that, but not everyday in the past 5 yrs. (only the past year or so)
At this moment of time I am on 40mg a day. I cut down from 70 mg to 40 mg quite quickly.
I talked to my doctor which he said the first step is to reduce off the Methadone. The doctor wrote a timetable to give to the pharmacist of the dates to reduce & I am not allowed to know exactly how much I am on) So each week I will reduce by 10mg. But split it into 2. EG. 40mg for 4 days then 3 days on 35mg.
I now knows that 10mg per week is quite alot as I am now feeling the effect. From 70mg to 40mg seemed fine but now I thinks it will get harder as now she can feel the effect.
My Doctor advised that once the Methadone is reduced to 35mg I will be transferring over to Subutex (apparently not Subuxone as that would be a long term treatment) So I will start on 6 or 8mg of Subutex & do the treatment for 1 week or so.
The only thing is that I did have a try of both Subutex & Suboxone, & I could not handle it. The 1st dose I had at 8mg hit me so badly the feeling felt like I was having Withdrawels for like a week. I know it was because I still had Methadone/Heroin in my system & I took the Subutex/xone too early. Not only because of that but I think because I could not leave the pill under my tongue to dissolve... For some reason I found it quite difficult....there would be just too much saliva & ill swallow it... So if i do choose the subutex way , this time I wont take my doctors advice to reduce to 35mg & transfer but I will be reducing to 15-20mg then I will transfer.... cause from my previous experience I am a bit scared to try again.
The other thing I am unsure about is if it would be easier to transfer from Heroin to Subutex, Instead of Methadone to Subutex.
Is it easier if someone were on heroin (no M/D) & transfer to Subutex/xone.?
How long would it take for the Methadone to completely leave your system?
Is it just easier to taper off Methadone than Subutex?
Another option I looked in was the Naltrexone Implant.
To get this I would need to fly Interstate as at the Clinic there, they say you need to reduce your M/D & go in with Withdrawel Symptoms then they'll put in the implant.
Where as in another clinic in a different state say that they cant put you on the naltrexone implant if you still have MD in your system & that you would have to be on Subutex/xone.
But my M/D doctor had advised that there is no point in putting in the Naltrexone implant as it does not take away your withdrawel symptoms. All it does is take away your cravings. The only thing I am weak about is the physical withdrawel symptoms. Being in a remote town I believe I can handle the cravings... SWIMs doctor said that for eg if I got the Implant & stayed in my home town around people that use etc etc, the implant will help you with your cravings so then if you do use, you cannot feel it but it wont help you with you w/d symptoms.... So what is the point of the Naltrexone Implant if I will be moving into a remote town & knows that drugs wont be around?
The 1 thing I have been thinking of is that 1 or 2 weeks before the flight to Darwin, I will reduce my M/D and I will start Subutex & do the 1 week treatment. On the last day I will hopefully be on 2 mg & take the flight to Darwin.
Then in Darwin SWIM will have to try & get off Subutex there. But again what medication would make me feel ok... obviously not 100% but just to help with the symptoms abit.... it sounds too easy but I know Ill be in a rough ride..
I have also read many posts and I have read Dickons "A How-to Guide to Opiate Detoxification." Which I find quite helpful.... But now I dont know if I should taper off Methadone with some pills that can help with the withdrawels.... but the thing is with the pills such as lofexidine and clonidine where do you get them from? If I were to ask my doctor for some pills to help me with the w/d would he give it?
So in short now, What options do I have?
Reduce my Methadone until 15mg and:
-- transfer to Subutex 1 wk treatment & taper of Subutex
-- get the Naltrexone Implant
Reduce my Methadone right down to 2mg or so & detox from that???
It would be great if anyone that can just give me some advice or opinions on what I can do.. I would appreciate that quite alot........I have also read alot of posts which I have found quite useful......thx to all you people that actually sit down & post up threads... it does make me feel like im not the only one doing this & there are other people in the same boat that are willing to help.....
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
Hey Spucky
thanks for da reply.... yeah a blind treatment is pretty good... but Its just that I know the closer I am to feb then I know that my M/D is decreasing gradually & then of course I would be getting more severe w/d if I know....
I did hear some people wean off M/D completely just buy taking some detox pills... but would it be the same as weaning off Subutex or even Heroin? My docs plan was to go on to subutex & the last dose I will have will be the last day in Adel. Well thinking about it I could even do this with M/D & hopefully be on 2mg or so & leave......
I just keep telling myself & every1 around me that I am leaving in Feb... so I can reach my goal... but deep down I am afraid that I cant do it... it is sooo hard without my partner or with no1 around.. it sometimes feels impossible for me to do... like I am dreaming of this to happen...
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
Hey SwiForeverNew,
It is real good to see someone who's devoted to making a change! Swim knows that having a 'Plan' that you feel comfortable with is a real help in getting through a detox.
Swim hopes it's not to presumptive to notice a few similarities between her and swiy! Swim spent months researching all the options available to her, until eventually she gave in to faith, and made the blind leap! Swim is actually on Day 6 of her detox from methadone, with the help of lofexidine, which was prescribed by swim's doctor.
Now it's important to point out that swim was only taking a stable dose of 4ml methadone before the jump, and so I reckon this has alot to do with the relative 'ease' of the detox, but swim knows that clonidine (a similiar treatment is available in Australia, and thinks that swiy's doctor would be able to provide non-opiate medications to help.
Swim has never tried buprenorphine medications, but the reaction swiy describes is definitely 'precipitated withdrawal', where the withdrawals were brought on by taking it too soon. If transferring from methadone, it's advisable to wait up to 72 hours before switching! Because of this prolonged waiting period, some people DO think that it's easier to use heroin before the transfer, reducing the waiting period to as little as 12 hours. Swiy would need to quit the methadone at least 10 days before-hand though. Swim knows there are least two members who have posted about great results with a quick suboxone/buprenorphine taper, and swim was also considering this method, but struggling with the fear of withdrawal.
But..here are the 'success stories': Thoughts on Buprenorphine and things that worked
In the UK, the naltraxone implant is only used once all opiates are completely out of one's system to ensure that if a user relapses, they are unable to feel the euphoric effects of opiates, so swim doesn't know how this would work for swiy.
Swim personally believed that a suboxone QUICK taper would be easier than a methadone detox, due to the long-lasting, full agonist effects of methadone often making for a protracted withdrawal phase, and yet didn't have the courage to try herself.
If swim were to detox from the methadone it may still be advisable to follow the fairly rapid taper mentioned in the How-To Guide, and visiting swiy's doctor to ask for some adjunctive medicines, such as clonidine. Drowsy anti-histamines are also a great help.
Swiy doesn't have much time to make this real important decision, and swim reckons, from experience, that too much thinking makes the process seem even more daunting than it already is. No-one expects an easy ride during detox, but it can certainly be less bumpy than we expected with the right frame of mind and a little extra help. Ultimately, no-one can make this decision for swiy, but swim knows that it's possible to get through a detox, and hopes swiy is able to make a choice she can believe in.
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
Hi Fnew,
moving can sometimes be hard enough without the problem like one you are dealing with.........Swim gives you allot of credit.It is do-able but any taper can be rough.
Swim will jump forward to when swiy will be in a remote mining town.......
Again isolation can often be hard enough,but lets be honest here....swim is sure drugs will make it a place where money is made and there are few places to spend it.And any heroin fanatic will find a way to get what they want as they are the most resourceful people in society.And should be proud of that fact.
Swim would boil it down to.....
If methadone is impossible there.......
how hard will it be to get monthly script for Suboxone,as even in a remote area,your husband's mining company has got to provide some outlet for healthcare......or for the workers as many of them may be on some medications.
Suboxone or subutex is often used for maintenance,although swim sees allot of people unhappy with the way they feel after prolonged maintence......like methadone.Why did I ever get on this stuff.....kind of reports,but the drug should not be written off totally as it can for many keep cravings away.
Sounds like you don't really have the time to try it again in your taper schedule.
But for infos sake........
Swim has very good luck using for it for very rapid tapers (of straight pharmaceuticals)even going to the extreme of taking it intranasal 12 hours after his last dose of long acting opiates......high and low mg amounts,didn't matter.
He did have precipitated withdrawal symptoms but let swim explaine..........He felt almost every withdrawal symptom in order as they normally appearer in order by the way.Swim thinks there is something to that........always in the usual order of symptoms.Now this all happened within a half a hour...Swim could describe the feeling of the switch over from one drug to the other in his body within that time.
Looking at it this way.......he often feels like crap for a half hour when he wakes up so this half hour of withdrawal could easily be tolerated.Followed buy three days use of the drug(intranasal),and with the long half life.....any lingering symptoms could be considered very minor.Often non-existent....and then your off to deal with reality.
Swim cannot stress enough ..........No matter how much it is against conventional thinking.......Less is more with this drug,all the way down to sub mg dosages.But this is from straight pharms.And swims experience only,and reports are honest.
Another swimmer from this board has allot of experience making the switch from heroin to Suboxone,and has reported a longer waiting time from his last shot...found 24 hours,was best for him to make the switch to subs.So the drugs may make a difference and the also the person.......but just giving you some time frames and effects.....
So whats really left for options once swiy is there?
implant.....
going clean......
Swim can only say about the implant that a few here might have some intimate knowledge with it,more with knowledge of the pill form of the drug,check around with the search engine......
So if no pharmaceuticals are available there for maintence.......
Swim may try the implant for a round or two and then go whatever is considered clean,although swim could continue further....both those options have there own set of problems,hopefully you can be prepared to deal with them correctly and the tasks at hand.....at that time.
bige
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
Swim has used suboxone and has done a taper with it. Swim has detoxed many, many times from opiates. this is what she would do if she was in your position, forever new:
Both switching someone from methadone to suboxone without waiting 36 hours or getting a naltrexone implant without finishing detoxing will result in precipitated withdrawal.
If she could afford it, swim would jump off the methadone and use heroin for a week or two before starting suboxone. Swim was able to take suboxone 12 hours after having a hit in the morning. If she can't do this, swim would cut down methadone to under 30mg and wait 36 hours before taking suboxone. Start with 4mg and if that's ok, go up by 2mg at a time, look at the other tapers for further info. Don't be put off by one bad experience.
Go to the doctor and ask for lofexidine or clonidine if that isn't available, valium and sleeping tablets, swiy should have no problems getting these from a drug and alcohol doctor to detox with.
Swim has never heard of a chemist/doctor in Australia being able to prescribe a monthly supply of suboxone to take home in one go, sorry.
Swim would find out if there are home detox nurses in her area and organise for one to come whilst she is detoxing. Swim would also get rid of drug paraphenalia and ask using friends to stay away while she detoxes. Is there anyone who can look after your kids for a few days?
Each state in Australia has different laws/ systems with methadone and suboxone dosing. Swim would google and then call drug and alcohol services close to where you will be living. There will be something, just to find out about services available in the area as swim might want to stay on suboxone for a little longer. Bear in mind though that the longer one stays on suboxone, the more they will withdraw from it once they stop. Use this service to find a new doctor and to organise counselling if possible.
After swiy has been in her new town for a couple of weeks, fly over to get the naltrexone implant once fully detoxed. Swiy will find drugs if she his looking for them and in a small town it can spell trouble for all of your family.
Exactly how many days does swiy have before she goes?
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
Realise that naltrexone will block any chemical in your body that binds to the mu-receptors, including natural endorphins and a host of other vital compounds(there are many). Such a blockade will have numerous side effects such as depression, fatigue etc.
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
Quote:
Originally Posted by Trapped_under_ice
Realise that naltrexone will block any chemical in your body that binds to the mu-receptors, including natural endorphins and a host of other vital compounds(there are many). Such a blockade will have numerous side effects such as depression, fatigue etc.
It will not reduce your cravings either.
This is notthe experience in Red Rock's case where he has been on the Vivitrol shot (380mg extended release naltrexone once a month injection shot). He was not depressed or fatigued (except for the normal PAWS after detoxing and the first month while on the shot. He has been on the shot for over 2 years and has not felt any of the effects you described during that time period. He has still been able to enjoy the beauty of life and activities such as sex, runner's high, etc.
Of course this has just been Red Rock's experience in over 2 years and might not be the same for everyone. If it weren't for this shot, he would not be where he is at today, nor would he have reached the 20 month mark in recovery.
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
That's great to hear. Personal experience always hold more weight.
Naltrexone is a competive antagonist, that means it can be overcome with higher doses of opiates. The dose SWIY is getting now has been tested to block 25 mg heroin IV. With continuous blockade, the body should eventually adjust with time, but still, naltrexone will induce profound changes in the body.
Endorphins effect every part of the body, including the immune system. Low doses of naltrexone have been shown to help against some autoimmune diseases such as MS. Interestingly, high doses have been shown to worsen the same diseases in animal models. Naltrexone is also slightly hepatoxic and can elevate serum cholesterol. Noone really knows what the long term effects are in humans. But I suppose it's better than relapsing...
Good luck staying clean of these hellish opiates.
Last edited by Trapped_under_ice; 23-01-2010 at 23:00.
Reason: Forgot to SWIM
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
Quote:
Originally Posted by Trapped_under_ice
That's great to hear. Personal experience always hold more weight.
Naltrexone is a competive antagonist, that means it can be overcome with higher doses of opiates. The dose SWIY is getting now has been tested to block 25 mg heroin IV. With continuous blockade, the body should eventually adjust with time, but still, naltrexone will induce profound changes in the body.
Endorphins effect every part of the body, including the immune system. Low doses of naltrexone have been shown to help against some autoimmune diseases such as MS. Interestingly, high doses have been shown to worsen the same diseases in animal models. Naltrexone is also slightly hepatoxic and can elevate serum cholesterol. Noone really knows what the long term effects are in humans. But I suppose it's better than relapsing...
Do you have a source for the 25mg of Heroin part? I am aassuming that this is referring to diamorphine or something that the purity is known. Red Rock has personally tested up to 2.2g of heroin in 2 shots back to back and the heroin rush was felt for 2-3 seconds and then completely disappeared, which is why I am curious to read where you got the 25mg of heroin part. This was back when Red Rock was first put on the Vivitrol shot though.
He is also interesting in reading about how naltrexone can help fight off some diseases if you have more information on that. This seems very interesting, especially considering Red Rock's mom has MS and that it is unknown if it is a genetic thing or not.
Also, what are the profound changes in the brain with naltrexone? I know once coming off the naltrexone that the opiate receptor sites are much, much more sensitive, thus the real possibility of overdosing if one goes back to opiates goes up exponentially.
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
Sure, I'll be glad to help.
The 25 mg number is also quoted in FDA guidelines.
I'm not allowed to post the links so I quote instead:
"Clinical studies indicate that 50 mg of Naltrexone hydrochloride will block the pharmacologic effects of 25 mg of intravenously administered heroin for periods as long as 24 hours. Other data suggest that doubling the dose of Naltrexone hydrochloride provides blockade for 48 hours, and tripling the dose of Naltrexone hydrochloride provides blockade for about 72 hours."
Also try googling "determination of naltrexone dosage for narcotic agonist blockade", then you will find the other article.
But this is pharmaceutical heroin(or diamorphine if you like) IV. I don't know if you SWIU used brown or white but here the brown is diluted ridiculously.
Not only does endorphins modulate many body functions, they're also directly connected to the balance and production of other peptides. For instance, ß-endorphin is a byproduct of pro-opiomelanocortin which incidently also is the source of adrenocorticotropic hormone, which again controls excretion of corticosteroids such as cortisol and alsosterone.
So when you take a powerful drug, be it an opiate agonist or antagonist, it will have an impact on the brain, good or bad.
The so called 'low dose naltrexone' treatment is very controversial in the medical establishment. I'm highly sceptical of it. However the small doses we're talking about probably won't do any harm.
Finally, the future looks pretty bright for MS treatment. There are a number of new drugs in the pipeline that have done well, several of them are already in phase III trials and may soon get FDA approval.
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
The difference though is that Red Rock is on a Vivitrol 380mg once a month naltrexone injection verse taking 50mg naltrexone pills daily. Thus, the transient initial peak is reached on the Vivitrol shot about 2 hours after administered and peak concentrations are observed approx. 2-3 days afterwards. The length that Vivitrol is supposed to last is around 30 days, and Red Rock has found after being on it many months, that it seems to have a cumulative effect meaning when he came off the shot, it took about 10-12 days after the initial 30 days from the last shot (so 40-42 days total since last shot) before real euphoric effects were noticed when opiates were used.
This graph shows the difference in peak concentrations between the Vivitrol shot and oral naltrexone.
Last edited by chillinwill; 27-01-2010 at 18:15.
Reason: clarified meaning
and hopes swiy is able to make a choice she can believe in.
Re: Too many options..... Methadone, Subutex, Naltrexone??? What else is out there?
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