Methadone to Subutex...Need Help!

[Cruella]

Swim has been on a rather high dose of methadone for 2-3 years steady. Swim heard about a great way to get off with subutex/suboxone (?). Of course for years swim has been hearing horror stories about coming off methadone so swim feels this could be the way out...finally. Swim has seen a special doctor who prescribes subutex/suboxone and got a bottle of subutex 8mg. Swim has now heard the horror stories of being on too high of a dose of methadone and being thrown into withdrawls immediately by the subutex. Swim did a lot of research and found out that subutex is the better of the two to start because it contains none of the ingredient that stops the abuse of opiates (sorry, forgot the name). The doctor said to start subutex while still taking a portion of methadone dose and no "cold turkey" time is needed. Swim is scared and would just love to hear from someone who knows about a similar situation or even better...has been there, done that!

[Dickon]

Dear Cruella,

There is already quite a big "meth to sub" thread already here. You might want to look at that for details of others' experiences. I wasn't in a similar situation to you (I wan't on 225mg methadone a day) and I didn't clean up without (not) buprenorphine (subutex, suboxone). Well that's a new non-self-incrimination variant! I think there's good evidence that it's best to get down to 20mg, 30mg a day on the methadone, and then allow about 48 hours for the methadone w.d.s to kick in, and then transfer to the buprenorphine. You probably know that if you don't do this you get what's called a precipitated withdrawal and that is not a nice thing, at least if others are to be believed. It is thus not recommended to go from high dose methadone (I'm supposing you're talking 100+mg or at least 60+mg / day) to buprenorphine before tapering down the methadone. Don't worry, tapering down methadone is a lot easier than giving it up completely.

There are a lot of people on here who have tried this, and some have succeeded with it so best of luck!

Dickon

[dyingtomorrow]

Hi Cruella,

(I wrote this post using "suboxone," but I mean either suboxone or subutex - they both work the same)

SWIM is not going to make any recommendations for your case, but just give you some info he picked up. Not recommending illegal behavior, but the truth is if SWIY is the type of person who freaks out from withdrawals and can't handle the pain, a lot of people recommend switching back to heroin (or another short acting opiate) from Methadone for 2 days before switching to suboxone.

Generally speaking SWIY will have to wait 8 - 12 hours after your last dose of heroin before taking suboxone. This is best done by doing the last bit of H at night, taking some valium or sleeping pills, and sleeping through the night and as long as possible. Probably by the time SWIY is awake, SWIY will be feeling crappy, but the time will be up and SWIY can just take the suboxone and feel fine. Taking the last of SWIY's heroin during the day is not a good idea, because SWIY will be agitated all day long worrying, stressing, and waiting, and the withdrawals will kick in earlier and make the time a lot harder to pass than doing it while sleeping.

On the contrary, with Methadone it is highly recommended only switching over at a very low dose. In addition, SWIY will have to wait something like 36 - 48 hours since the last dose of Methadone. There is no pain or discomfort doing the H switch the way mentioned above, but SWIY will go through a lot more pain and discomfort for a lot longer period of time switching from Methadone.

Here is a link with a chart for waiting times for different opiates before you can take suboxone:
http://hubpages.com/hub/First-Dose-o...oin--Oxycodone

Whether or not to switch to H first depends on a person's mentality and how risky it is. A lot of addicts after going through so many withdrawals just can't take it anymore, and completely freak out from them or even the thought of them, and might not make it through the all the pain waiting through Methadone withdrawals. This could be a trigger to go back to using. On the other hand, depending on their mental relationship with H, going back to the H first could also be a risk. So really the decision should be based on how much pain you can take, and which is least likely to cause you to give up your struggle to be drug free.

Hope that helps. You should really start reading some threads here. A lot of people are here to help, and post their first hand experience. This forum is filled with safety information and truths that are suppressed by doctors and the government about opiates/H/methadone/suboxone that you really can't find anywhere else.

SWIM has done just about every experiment with suboxone and quitting, tapering, dose schedules, ways to use and abuse, and so on, so if you have any questions I would be glad to answer (about SWIM's experiences), and I'm sure everyone else would be too.

Welcome to the forum and hope we can help save you some pain.

P.S.

It is UNTRUE that subutex is better or significantly different than suboxone, and that no cold turkey time will be needed. It is disturbing how many doctors know nothing about the drugs they prescribe. Subutex contains Buprenorphine, Suboxone contains Buprenorphine and Naloxone. Naloxone will cause withdrawals if injected after someone has recently taken opiates. BUT, this is a moot point, because both subutex and suboxone both will cause withdrawals if taken in any form (sublingual, snorted, plugged, injected) before a significant amount of opiates in your brain have cleared out (i.e. you've gone through some withdrawals). This is because of the nature of Buprenorphine. It is a special kind of opiate that rips other opiates out of your receptors (it is called a partial agonist / antagonist), and this is what causes the withdrawals. The naloxone in suboxone is really almost completely worthless, and was meant as a form of propaganda to scare people into thinking they cannot inject suboxone, when infact the preconditions for safely injecting either drug without going into withdrawals are exactly the same. Both subutex and suboxone work the same, and both require you wait 8 - 12 hours for H, and 36- 48 for methadone, or you will experience hellish full scale withdrawals (a.k.a. precipitated accute withdrawal).

Reputation Comments on this post:

Useful and informative as well as offering support. Good stuff!

[Ilsa]

Originally Posted by dyingtomorrow

Hi Cruella,

(I wrote this post using "suboxone," but I mean either suboxone or subutex - they both work the same)

SWIM is not going to make any recommendations for your case, but just give you some info he picked up. Not recommending illegal behavior, but the truth is if SWIY is the type of person who freaks out from withdrawals and can't handle the pain, a lot of people recommend switching back to heroin (or another short acting opiate) from Methadone for 2 days before switching to suboxone.

Generally speaking SWIY will have to wait 8 - 12 hours after your last dose of heroin before taking suboxone. This is best done by doing the last bit of H at night, taking some valium or sleeping pills, and sleeping through the night and as long as possible. Probably by the time SWIY is awake, SWIY will be feeling crappy, but the time will be up and SWIY can just take the suboxone and feel fine. Taking the last of SWIY's heroin during the day is not a good idea, because SWIY will be agitated all day long worrying, stressing, and waiting, and the withdrawals will kick in earlier and make the time a lot harder to pass than doing it while sleeping.

On the contrary, with Methadone it is highly recommended only switching over at a very low dose. In addition, SWIY will have to wait something like 36 - 48 hours since the last dose of Methadone. There is no pain or discomfort doing the H switch the way mentioned above, but SWIY will go through a lot more pain and discomfort for a lot longer period of time switching from Methadone.

Here is a link with a chart for waiting times for different opiates before you can take suboxone:
http://hubpages.com/hub/First-Dose-o...oin--Oxycodone

Whether or not to switch to H first depends on a person's mentality and how risky it is. A lot of addicts after going through so many withdrawals just can't take it anymore, and completely freak out from them or even the thought of them, and might not make it through the all the pain waiting through Methadone withdrawals. This could be a trigger to go back to using. On the other hand, depending on their mental relationship with H, going back to the H first could also be a risk. So really the decision should be based on how much pain you can take, and which is least likely to cause you to give up your struggle to be drug free.

Hope that helps. You should really start reading some threads here. A lot of people are here to help, and post their first hand experience. This forum is filled with safety information and truths that are suppressed by doctors and the government about opiates/H/methadone/suboxone that you really can't find anywhere else.

SWIM has done just about every experiment with suboxone and quitting, tapering, dose schedules, ways to use and abuse, and so on, so if you have any questions I would be glad to answer (about SWIM's experiences), and I'm sure everyone else would be too.

Welcome to the forum and hope we can help save you some pain.

P.S.

It is UNTRUE that subutex is better or significantly different than suboxone, and that no cold turkey time will be needed. It is disturbing how many doctors know nothing about the drugs they prescribe. Subutex contains Buprenorphine, Suboxone contains Buprenorphine and Naloxone. Naloxone will cause withdrawals if injected after someone has recently taken opiates. BUT, this is a moot point, because both subutex and suboxone both will cause withdrawals if taken in any form (sublingual, snorted, plugged, injected) before a significant amount of opiates in your brain have cleared out (i.e. you've gone through some withdrawals). This is because of the nature of Buprenorphine. It is a special kind of opiate that rips other opiates out of your receptors (it is called a partial agonist / antagonist), and this is what causes the withdrawals. The naloxone in suboxone is really almost completely worthless, and was meant as a form of propaganda to scare people into thinking they cannot inject suboxone, when infact the preconditions for safely injecting either drug without going into withdrawals are exactly the same. Both subutex and suboxone work the same, and both require you wait 8 - 12 hours for H, and 36- 48 for methadone, or you will experience hellish full scale withdrawals (a.k.a. precipitated accute withdrawal).

yeah, that swidiying guy knows his way around an opiate--take his advice. and definitely use the forum search engine (utfse) before starting a new thread--there are a lot of ppl with a lot of experience (collectively and individually) here, so chances are the issue has been addressed in some form on another thread. welcome, may you find what you seek, and namaste.

[Richard_smoker]

At any rate, you'll be much better served using the suboxone or subutex as a rapid taper to get off the methadone.

i suggest following the advice of this thread. however, i happen to disagree with the methadone to H to buprenorphine idea. I know it definitely has earned its place in the detox plans offered here of late. But, honestly, there's an aspect of withdrawing which tunes your mind and spirit into a celestial alignment which will leave your ship on course for continuing a life free of all opiates... as opposed to a "pain-free" plan.

sorry, i just believe that switching to H then subutex will run the risk of ruining your entire mindset. The whole idea of methadone maintenance is to get AWAY from the terrors of heroin use. Both the highs AND the lows... You do whatever you want. it's your body. but with MY DOG being 13 days out (completely clean) from a nasty buprenorphine habit, i firmly believe that if he'd done heroin just before detox, he would be totally fucked up in the head right now. compare that to a natural 'high' from life. -DICK

[Cruella]

I want to thank you all for your time and expertise. Swim has a lot more research material to read through thanx to you all and I will keep you posted on swim's decision. Swim takes 200+mg of methadone per day so sudden withdrawl would be a really bad thing! Swim is very happy to have this forum as a support system...

[Richard_smoker]

any time. i have no idea how or what caused the sudden rush to detox, but the last month has brought out a sudden rush of long-term opiate maintenance users to throw down the habit. honestly, it's not that hard. the reason most people keep using is simply out of FEAR of withdrawals, and fear of the unknown... trust me when i say this-->it's not that hard to quit. and once you feel yourself starting to recover (not that long...really), you will likely find that your quality of life has run through the ROOF! HONEST!

It almost feels like "Catching Religion!" PRAISE JESUS! (j/k) -DICK

[Dickon]

Cruella, you could always do what my cat did, and simply cut down the methadone. Growltiger was on 225 mg methadone and he cut down over 36 days to 5 mg and then stopped. It wasn't exactly pretty, and he wasn't purring or catching mice for a while, but he seems to be doing better now. The (long and involved) story of his detox although written in the first person through the eyes of a pathological lier is on the "Screaming on the night air,....." thread, but Growltiger didn't use buprenorphine. However he is a good example of what can be achieved. Both my cat and Dick's dog are winning through. Maybe your elephant could join the happy throng, Cruella!

[dyingtomorrow]

Question for both Cruella and Dickon ...

Where SWIM is, every methadone clinic around is extremely resistant to lowering you. The methadone clinic SWIM went said they wouldn't even start lowering his dose for 6 months after he started. And then after that, they would only let him go down 1mg a week. His brother's clinic was a little better, but still trying to stonewall any attempt to go down. This makes going from a high methadone dose to suboxone a very long wait, could be years (yet another reason many recommend switching back to H).

Is it the same where SWIY is Cruella? (assuming SWIY goes to a methadone clinic)

Same question to you Dickon. From what I've heard from UK people it sounded like they can control their doses a lot more.

I'm asking this because I wonder if it is a clinic to clinic thing, or a legal / state / country thing.

[Richard_smoker]

well, if you're in the US, there's a reason for that mentality.

sorry to sound harsh here, but the reason is 2-fold.
1. as Chris Rock said, the money isn't in the CURE... the money's in giving you drugs that will allow you to LIVE WITH THE SHIT (the maintenance).

"they'll NEEEEVER find a cure for AIDS. They'll figure out a way so you can LIVE WITH YOUR AIDS!...that's right. The government's nothing but a bunch of fucking DRUG DEALERS! Shit... they lost too much money on polio. think they'll make that mistake again?"

So, if you look at doctoring as a financial venture, you'll see that rapid methadone tapers are NOT in their best interests!

2. (a little less disenchanted of a theory) All Dr's have their minds SET on what is the SINGLE-MOST-EFFECTIVE-THERAPY or approach to treating any given condition. In this case, the methadone docs have been conditioned by

1. their own negative view of addicts,
2. listening to their colleagues' negative views on addicts;
3. the experience they've had with using methadone as a MAINTENANCE DRUG to TREAT the SYMPTOMS of heroin addiction. 'addicts' have no self-control. these dirty 'addicts' are SO VILE and SUB-HUMAN, that they're incapable of actually getting OFF the methadone. Since they have no control over their actions, addicts need to just keep taking high dose methadone for forever. otherwise, they simply CANNOT BE TRUSTED!
4. 99% of doctors already "KNOW" what is the 'best' treatment for you...they KNOW this within the first 20 seconds. any kind of ideas or suggestions that you might have for your own treatment that differs from what they KNOW to be the 'truth'--(i.e. YOUR opinion--thus, a dumb opinion--and the voice of ignorance)--will be totally ignored, and if you push for your ideas, it only pisses them off. why does this piss 'em off? is it cuz they think you're dumb? NO! the reason is because you're causing them discomfort, but MOSTLY you are 'wasting' their precious time.

• Remember:
  • 'Good patients' are fast and easy.
  • they offer little to no back-talk.
  • they just listen to god like they're supposed to--er, listen to the doctor, and they don't ask questions.
  • they sure as hell don't threaten his fragile GOD-Complex. Such an action proves the patient is anti-social.

#3 probably carries the most impact. But, the good thing about this is that you shouldn't need a dr to taper your dose. Dickon just made a plan to reduce his intake by a certain amount, and DESPITE HAVING SHITLOADS OF EXTRA METHADONE LYING AROUND THE HOUSE, he STILL was able to taper himself to zero mostly out of willpower. If your methadone clinic only doles out 1 dose at a time, and you need to return daily, then take your scheduled piss tests, and PASS THEM! Be clean for all drugs except methadone. Usually this trust-building will lead to the doctor being more liberal with the doses. In fact, I know of one guy who jumped thru all the right hoops (granted, at first, his piss tests were 'dirty' with other drugs), but eventually he 'got serious with himself' and subsequent piss tests (that he requested) were crystal clear except for the methadone. after a few weeks of this repeated behaviour, the dr started prescribing him weeks of his methadone via scripts, and finally 1 month at a time.

this seemed to be much easier on the user. he HATED going to a clinic every morning, and waiting for his SINGLE dose. no freedom there. and no ability to start tapering your dose accordingly. at least, not if there's a nurse (with nothing else to do with herself but make you miserable--why not?) these particular nurses spend all day kissing dr asses, and doing sporatic shit. I'm sure they cannot WAIT for someone to try and pull a fast one on them--although these evil nurses (not ALL are like this, but just like Dr's, ones who are surrounded by 'addicts' are typically cynical and love nothing more than to assume the WORST in a patient. ironically, even when someone tries to decrease their daily dosages, even something as benevolent and intelligent as THIS can be easily misconstrued as being evil, untrustworthy, and manipulative. how? well, for one thing, if they catch you taking the 'whole' dose they give you, and see you taking only part of the dose (ESPECIALLY if you're private about this act, and even WORSE, if you actually try to LEAVE THERE still clutching onto the remaining methadone that you didn't take). This only means ONE THING to these people-->YOU'RE MANIPULATING THE SYSTEM, AND YOU'RE TAKING THE 'REST' OF YOUR DOSE OUT TO YOUR BOYFRIEND OR PIMP BECAUSE *THEY* WANT TO GET HIGH TOO--DUH!! and, unfortunately, the label you're given by nearly ANY medical professional is that since you're an addict...and since you require methadone, you simply cannot be trusted with anything. even when you tell them that you're trying to taper your dose, they will IMMEDIATELY assume that you're lying. (all addicts are liars, right?) the MOST ironic thing about this is that half the time, the nurses & even doctors are really just addicts themselves...and somehow it makes them feel better about themselves to PROJECT their own desires onto every single 'addict' in the methadone clinic. Anyone who's ever worked in a hospital with a closet drug-addict will tell you that these people tend to accuse EVERYONE of being manipulative, conniving, with ulterior motives--to score more drugs. why? because secretly the accusing party (dr or nurse) feels resentment to the patient. somehow, it makes them feel better about themselves when they're projecting their own worst secrets onto another human being. especially if it's acceptable for them to imply that their patient is somehow subhuman or a piece of shit or manipulative or dishonest or 'only out for 1 thing.'

that's why it's necessary to get a dr who sees outpatients or has a clinic (not hospitals). if you can get yourself in the multi-day prescription program, FUCK whatever your dr says... you can initiate your own comfortable, slow taper. He'll be non-the-wiser. and plus, if he actually goes against the idea of your taper & kick, then he DOES NOT DESERVE to know what's going on.

for those who attend daily methadone (single-dose) clinics, your only options are to try and get the dr to taper you down or get him to trust you with a 1 week or 1 month script. SUGGESTION: if you tell him your sincerest plans to get OFF the drug, he'll probably be much more open to the idea. deep down, almost all dr's start out as nerdy, bookworm, loving people who want to help others. But they inevitably become cynical after dealing with actual patients. if you can strike a chord that goes against the 'every addict is scum' cynical mentality that he likely has (at some level), then i think you'll be pleasantly surprised.

-DICK

[Dickon]

^ ^ ^

In answer to dyingomorrow, the UK system seems a lot better these days. Certainly it's better for the greedy ones! When I talked about cutting back my cat's methadone, my first drugs woman said t owait some months and do it slowly (I guess no more than 5mg/week/fortnight/month etc.), but the thing is patient-let. However, because my cat managed to get his prescription on a weekly basis fairly early on (after a couple of weeks/months), and sometime later made sure he wasn't drinking a dose in the pharmacy on collection day (he didn't do this early on, but some blip in the system put the "supervise on day of collection" on his vet-prescription, but that was removed the day he asked for it to be removed, although that was quite a time later, as his regular pharmacist never bothered with that), so my cat did his whole reduction and quit completely without telling his rather nice drug-worker Jenny. I'm going to channel for my cat now as it's easier to work in first person: Growltigers speaking " In fact as I see Jenny only once a month, the time before last I saw her I hadn't formulated the plan, last time I saw her I was down to 15 mg/day (and said I had a mild cold/flu-thing to explain that I wasn't quite 100%), and if all goes well next time I see her I'll be 26 days off the stuff. As I get 2 prescriptions at a time I'm going to bring in the unused one and rip it up in front of her, give her a nice card and some Body-shops or chocolates and say my farewells. It's one of those little moments (Ikiru in Japanese I think) that I'm looking forward to creating. It will be something to stick in her mind, and just maybe a lesson in something! You know me, always got that imp of the perverse on my shoulder, at least now the monkey's gone! Well here's to day 17. It's all coming together slowly: but be afraid, be very afraid, in the nicest possible way of course [laughing to myself like a child!]!"

OK folks, hope that helped. I'm going to try something new. I'm going to attach my cats reduction schedule, it's a .xls (excell spreadsheet) so should be openable in Microsoft Office, or Open Office on Linux, presumably there's a Mac equivalent too. It was a very useful thing for him to look at as he added the bars day by day on the little graph. Kept him plodding downwards. The jump from 215 to 175 was enforced! My cat only had 175 mg methadone that day, but he did well staying on it for the next day and not going up!

Love to all

Dickon and Growltiger (a very beatiful Bengal cat. See him on my profile page in the family pictures. You'd never guess what a naughty pussy cat he is by looking at the photos! lol)

[Cruella]

To dyingtomorrow:
Swim does go to a methadone clinic that will detox at 5 mg. every 2-3 days (if swim is paying for "detox"), but try not paying your fee and miraculously you can be detoxed at a rate of 5mg per day!! lol Funny how that works, huh? Swim thanks you for the link you posted, it was most helpful.