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Opiate addiction Support for coping with Opiate addiction and Opiate addiction treatment.

 
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  #1  
Old 11-04-2012, 23:41
BNelley24 BNelley24 is offline
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Switching from Methadone to Suboxone.

SWIM has been on 90-100mg percocet/day for a while now after a 7 day clean spell.

SWIM found 20mg of methadone, took 10 yesterday and 10 today.

SWIM went to local rehab place that helped SWIM sign-up for healthcare so SWIM could go in-patient detox, but it will take 2-3 weeks until insurance is approved.

SWIM got a hold of 4 Suboxone 8mg strips and wants to make them last, or maybe help SWIM get off this for good.

Only took around 10mg methadone today and it has been only 2 days taking methadone in general. How long should I wait until it's safe to take suboxone?
  #2  
Old 12-04-2012, 07:57
brettjv brettjv is offline
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Re: Switching from Methadone to Suboxone.

Well, it's medically safe whenever ... however, if you're talking about avoiding precipitated withdrawals, unfortunately ... it's very unpleasant to switch directly from methadone to subs. Either you have to wait a WHILE (and by that I mean at least 48 hours, preferably longer) from your last 'done dose ... like, you gotta wait til you're feeling really, really bad ... or the subs will probably make you feel considerably worse, at least for a while.

Assuming that you don't have the option of going back onto percs for like 4-5 days (which frankly would be optimal *IF* you can pull it off w/o getting right back rolling on those), my best advice is to wait to start the subs until you're feeling REALLY BAD. Not 'kinda bad', but REALLY BAD. Because it you start if too soon, you will probably make it worse, not better. Methadone takes a LOOONG while to clear out of your system ...

Also, start out with a LOW dose (like 2mg) and wait at least 4 hours to take more. Don't take >4mg the first day, and start working your way down immediately. 4mg is a hefty dose for someone with a 100mg/day oxy habit, esp. if you suck the strip for a good long while (I recommend 20-30 minutes).

Good luck and let us know how it goes

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correct, precise answer how to switch from methadone to suboxone.
Wise words indeed - though we expect it now from Brett.
  #3  
Old 12-04-2012, 10:42
TheBigBadWolf TheBigBadWolf is offline
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Re: Switching from Methadone to Suboxone.

BNelly,

Good luck for your switch.

I wish you had asked that before you took the methadone, that would have been easier if you'd let it out of your system, because of the long time methadone needs to get out of your system.

Brettjv above has given you correct advice concerning the doses of suboxone.

I wanted to add something re: precipated withdrawal, to make clear what awaits you if you do not have the time or patience to wait two days after your last methadone dose.
As you surely know, suboxone is a combination of buprenorphine and naloxone.
During the onset of the effects of suboxone naloxone will throw any opiates that are left at the receptor site off the receptors, which results in immediate withdrawal. (buprenorphine alone does this, too, but the naloxone is quicker.) This combination was invented to prevent people on Suboxone maintenance to inject their doses.

About fifteen to twenty minutes after ingestion of the subs you will start to feel bad, just like any normal withdrawal would make you feel.
And be told, this can make you feel really really bad, but it passes in a relatively short time.
About an hour later the buprenorphine will begin to peak in your system, setting back the w/d feelings, slowly.

Listen to berttjv, do not, under any circumstances, take a second dose before you have waited at least four hours. Better when you don't redose at all, to give the substances the time to work on you. A dose of 2mg should be sufficient to get the percocet off your system and to hold you for 24 hours until you dose next.

Even if the w/ds last longer than an hour, don't redose! This is essential.
The longer you wait (with first dose AND with second) the easier the transition will be.
Be patient.
Hard to be when withdrawing, I know.

Please update us on how it went, all the best wishes,

TBBW

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Excellent advice as usual BBW
  #4  
Old 12-04-2012, 15:37
BNelley24 BNelley24 is offline
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Re: Switching from Methadone to Suboxone.

Thanks for replies,

SWIM got his hands on about 2 days worth of percocet. If SWIM takes the percocet for 2 days, would it be safe to start Subs the next? The percocet SWIM has it 12hr OP extended release 20mgs.
  #5  
Old 12-04-2012, 17:26
brettjv brettjv is offline
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Re: Switching from Methadone to Suboxone.

Yeah, I'd say 2 days on percs, then wait until the next day to start subs ... that'd be a lot less unpleasant than trying to switch directly from the 'dones. If you're going to do 12hr time release, I'd make sure you wait a good 18-36 hours after the last OC to start the subs. Just like w/the 'dones, you still wanna wait til you're feeling really bad. You just won't have to wait through a long time of feeling really bad like you would've before.

Oh, and BBW ... I just want to clarify something ... the Naloxone in Suboxone is completely INERT when the tabs/strips are properly used (i.e. sublingually), as it basically has zero ability to be absorbed through the mouth.

Thus, with proper RoA, Naloxone plays no role in the precipitated w/d effect ... that comes strictly from the buprenorphine, actually. The naloxone is only there to discourage shooting the stuff, because obviously it (should) become 'active' that way.

I also recommend spitting out the accumulated spit after your sublingual Suboxone doses ... bupe is destroyed by the stomach and liver anyways, no point in swallowing and risking getting unwanted naloxone into your bloodstream. Also, it does take like 20-30 minutes of sucking the pill or strip to really get a high % of the bupe dose. Many people seem to think you just dissolve it then you're done ... definitely not. It should be held for a 20-30 minutes, then spit out.

Personally ... I *SO* much prefer to just sniff the stuff. Although I've never sniffed Suboxone, only Subutex, at this point I've heard of many people sniffing Suboxone so presumably it still works pretty good. But I DEFINITELY would not sniff Suboxone in the very beginning of the switch. That sounds like a potential disaster in the making ... for the reason BBW mentioned above.

Last edited by brettjv; 12-04-2012 at 17:45.
  #6  
Old 12-04-2012, 23:41
TheBigBadWolf TheBigBadWolf is offline
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Re: Switching from Methadone to Suboxone.

Quote:
Originally Posted by brettjv View Post

Oh, and BBW ... I just want to clarify something ... the Naloxone in Suboxone is completely INERT when the tabs/strips are properly used (i.e. sublingually), as it basically has zero ability to be absorbed through the mouth.

Thus, with proper RoA, Naloxone plays no role in the precipitated w/d effect ... that comes strictly from the buprenorphine, actually. The naloxone is only there to discourage shooting the stuff, because obviously it (should) become 'active' that way.
Brett,

Thanks for this correction, I must have misread or misunderstood something,--
I'm not really very experienced, most of what I know of Bupe is educational, and especially Suboxone is not prescripted very much here, because of the much higher costs in relation to pure bupe.

Only thing I experienced myself with bupe is precipated withdrawal after too short off the 'done.

ouch!

TBBW

LOL for the parentheses at "should"
  #7  
Old 14-04-2012, 16:34
BNelley24 BNelley24 is offline
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Re: Switching from Methadone to Suboxone.

Okay, SWIM has one day left, only 1 20mg percocet OP. which compared to SWIMs normal 80-100mg/day dosage is a bit small, but shouldn't be too bad.

Tomorrow morning will be 3rd day without 10mg methadone. SWIMs last dosage of percocet will probably be this afternoon. Since percocet OPs are 12/hr will SWIM still be okay to take the suboxone sublingual strips tomorrow morning?

They are 8mg/2mg, from what SWIM read the naxalone cannot be absorbed in the mouth. For my addiction level 60-100mg/day percocet OPs mainly and some 10mg/30mgs what should SWIM take 1/4 the strip, see how he feels and then take the full dosage? My goal is to ween off of opiate addiction using these and SWIM only has 4 8mg strips.
  #8  
Old 14-04-2012, 16:47
søren søren is offline
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Re: Switching from Methadone to Suboxone.

good luck

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buprenorphine, injecting buprenorphine, injecting suboxone, shooting buprenorphine, shooting suboxone, suboxone

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