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Sub vs. Methadone which one to try first?
Id like to hear opinions from experienced people who have used Sub or methadone and preferably a few that have used both. Im looking for a comparison of the two- which one helped you better to get off your drug of choice and most importantly which one helped your pain more? Im pretty sure I already know the answer is methadone. Ive heard a lot of people say Sub did nothing for pain or very minimal at best. I am planning on going on one or the other to get off hydrocodone once and for all, but I have both chronic and acute pain and will need pain control. difficult spot.
I have taken both and I would choose sub over meth any day. I got off oxycodone with sub but first I tried methadone. Meth is harder to get off of than suboxne. I had a very bad tooth ache and took a very small chip of suboxone and the pain went away real quick. Suboxone wd are less severe. There are drs out there that do nothing but suboxone weaning programs and they work. I am a big Ohio State football fan because my Dad and Uncle both went there. I am sure by football season this will be almost over and you will be on the mend. Good Luck, Dove
I've just hit the 4mg mark on methadone from a 40mg start and I've had no bad withdrawal at all nothing worth complaints. I sat at 30mg for a couple months then did 1mg a fortnight, then stabilized on 20mg for about a month tapered 1mg a fortnight to 10mg then sat on that for a month and have now gone 1mg a week to 8mg then a 2 week in 1mg drop to 5mg now I'm doing 1mg a week until I go into a detox centre on August 6th. So far I've only had a withdrawal when I had a minor 5 day binge on heroin after losing my grandmother at 6mg and it's been minor withdrawal and lasted 4 days until the dome stabilized again. I tried sub and could not stand the lingering taste it left in my mouth and it's recommended you go cold turkey for around 5 days before starting on it or you can experience extreme withdrawal from my research, so that's why I chose methadone.
I have been on methadone maintenance and it was for pain management. I chose to come off pain meds about six years ago and there are Suboxone clinics everywhere here in TN. When I first started I went to a pay clinic and it was for pain. Well now my insurance covers my doctor's visit and he says it is not for pain, and I am betting that I couldn't get into a pain clinic now that I have been on Suboxone for so long. If it were up to me Methadone was the best thing for my pain, but I can't drive everyday to get it. Why can't I just go back to a pain management doctor and they prescribe the Methadone to me? I am not allowed to even mention pain at the doctor I go to now for Suboxone treatment, and I truly believe it is because he accepts insurance. He's the only one in the area that does that I know of, and it's almost not worth it. I live off disability so I cannot afford to pay out of pocket for medication, yet I don't want nothing to do with pain pills. The pain clinic overdosed me with fentanyl as it contradicted with another medication I was on. I chose the Suboxone myself to get away from that mess. I can only hope my situation is looked at differently since I have such chronic pain. I was hit by a drunk driver years ago and my face is all metal and I have had two of five slipped discs removed. I have many other problems as well. So, what should I do? Will a pain clinic even consider me?
Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II
There is now an effective medication for both opiate addiction treatment and/or maintenance pain management that is FDA (Food and Drug Administration) approved.
The medication is buprenorphine, which is an opiate agonist/antagonist and a very effective pain medication for appropriate patients. It has been used in pain management for many years--mostly in its injectable form. Buprenorphine is now available in the United States as sublingual (dissolved under the tongue) medication and is many times more potent than injected morphine. Buprenorphine is different from other opiates in that the patient usually feels more "clear headed" when taking it.
Being the first oral medication that has been approved in the U.S., physicians can now prescribe buprenorphine in their offices for people who are dependent or addicted to opiates such as opiate pain medication, heroin, or methadone.
Buprenorphine is an effective medication for opiate addiction which does not require daily or weekly visits to a clinic. Buprenorphine blocks the effects of other opiates; it eliminates cravings and prevents withdrawal symptoms such as pain and nausea. Patients can be maintained on buprenorphine or go through detoxification.
Subutex and Suboxone are the brand names under which buprenorphine is being marketed for the treatment of opiate dependence. Both medications contain the active ingredient, buprenorphine hydrochloride, which works to reduce the symptoms of opiate dependence.
Subutex contains only buprenorphine hydrochloride which was developed as the initial product. The second medication, Suboxone contains an additional ingredient called Naloxone to guard against misuse or abuse. Subutex is usually given during the first few days of treatment, while Suboxone is used during the maintenance phase of treatment. Both medications come in 2 mg and 8 mg strengths as sublingual (placed under the tongue to dissolve) tablets.
However, medication is not the only component of detoxification and treatment. At the same time that medication management issues are being decided, other treatment protocols must be developed. One major treatment intervention concerns the importance of developing an appropriate support system.
In addition, it is important to help people differentiate between the physiological and psychological/emotional components of their pain. Once that is done then cognitive behavioral approaches can help people manage the psychological components more effectively.
There is now an effective medication for both opiate addiction treatment and/or maintenance pain management that is FDA (Food and Drug Administration) approved.
The medication is buprenorphine, which is an opiate agonist/antagonist and a very effective pain medication for appropriate patients. It has been used in pain management for many years--mostly in its injectable form. Buprenorphine is now available in the United States as sublingual (dissolved under the tongue) medication and is many times more potent than injected morphine. Buprenorphine is different from other opiates in that the patient usually feels more "clear headed" when taking it.
Being the first oral medication that has been approved in the U.S., physicians can now prescribe buprenorphine in their offices for people who are dependent or addicted to opiates such as opiate pain medication, heroin, or methadone.
Buprenorphine is an effective medication for opiate addiction which does not require daily or weekly visits to a clinic. Buprenorphine blocks the effects of other opiates; it eliminates cravings and prevents withdrawal symptoms such as pain and nausea. Patients can be maintained on buprenorphine or go through detoxification.
Subutex and Suboxone are the brand names under which buprenorphine is being marketed for the treatment of opiate dependence. Both medications contain the active ingredient, buprenorphine hydrochloride, which works to reduce the symptoms of opiate dependence.
Subutex contains only buprenorphine hydrochloride which was developed as the initial product. The second medication, Suboxone contains an additional ingredient called Naloxone to guard against misuse or abuse. Subutex is usually given during the first few days of treatment, while Suboxone is used during the maintenance phase of treatment. Both medications come in 2 mg and 8 mg strengths as sublingual (placed under the tongue to dissolve) tablets.
However, medication is not the only component of detoxification and treatment. At the same time that medication management issues are being decided, other treatment protocols must be developed. One major treatment intervention concerns the importance of developing an appropriate support system.
In addition, it is important to help people differentiate between the physiological and psychological/emotional components of their pain. Once that is done then cognitive behavioral approaches can help people manage the psychological components more effectively.
Actually, you are right, and kinda wrong.
You are right in the sense that Suboxone is NOT indicated for pain control, it was manufactured and licensed strictly for the treatment of opiate dependancy.
The same goes for subutex, although without the risk of abuse there is no need for the naloxone, hence subutex being prescribed off label in the US for pain control.
Buprenorphine, the active ingrediant is however, indicated for the treatment of moderate to severe pain.
I am currently in Europe (But live in the states) and here, Buprenorphine is widely used for chronic pain control, it is sold as the brand name Temgesic. Temgesic is prescribed in super low dosages for pain control compared to those in the states for opiate addiction. Typically in doses of 200 to 400 MICROgrams sublingually every 6 to 8 hrs. Temgesic is not available in the united states.
There is a long drawn out explanation of why buprenorphine acts more of an agonist and super low doses, but its very technical.
Just wanted to clarify a little more, as Suboxone/Subutex/Buprenorphine is an often misunderstood drug.
Like I said, there are benefits to both. However with that said, if your goal is life maintenance you may be better off with one over the other, only YOU Ohio can make that decision!
You are right in the sense that Suboxone is NOT indicated for pain control, it was manufactured and licensed strictly for the treatment of opiate dependancy.
The same goes for subutex, although without the risk of abuse there is no need for the naloxone, hence subutex being prescribed off label in the US for pain control.
Buprenorphine, the active ingrediant is however, indicated for the treatment of moderate to severe pain.
I am currently in Europe (But live in the states) and here, Buprenorphine is widely used for chronic pain control, it is sold as the brand name Temgesic. Temgesic is prescribed in super low dosages for pain control compared to those in the states for opiate addiction. Typically in doses of 200 to 400 MICROgrams sublingually every 6 to 8 hrs. Temgesic is not available in the united states.
There is a long drawn out explanation of why buprenorphine acts more of an agonist and super low doses, but its very technical.
Just wanted to clarify a little more, as Suboxone/Subutex/Buprenorphine is an often misunderstood drug.
Like I said, there are benefits to both. However with that said, if your goal is life maintenance you may be better off with one over the other, only YOU Ohio can make that decision!
Ohio, I don't have experience with Methadone - although I was prescribed it in a very low dose for pain along with hydrocodone - and it worked great. I used suboxone for nearly 4 years and avisg is right, it does have some pain benefit, it was used for pain before it was used for addiction. Henry said it perfectly, I could not give better advice that the info he has given - nice job Henry.
I have done both the Methadone and Suboxone routines long term (7 years methadone, 2 years Suboxone) for maintenance treatment, but not for pain. I can only give you my experiences for both personally.
Methadone- While it can be great for pain, You will indeed build a tolerance to it like any other opiate. I was induced at the standard 30mgs and by the time I was at my peak I was at 700mgs daily. And this was for maintenance, not pain control. The side effects even at low doses were aweful for me. I gained over 100lbs, was always tired and sleeping, had horrible constipation, stomach cramps, and nausea... even in the early years of treatment. To top all of this off, my cravings never really went away, hey just turned into cravings for more methadone.
The clinic system in itself for methadone is a pain in the *** to deal with. Now granted, any doc can prescribe methadone for pain, but if you are needing it for maintenance (Addiction) you are required to go to a methadone clinic. Most clinics do not accept insurance and charge weekly. Mine was $60 a week for low doses, and $120 a week for the higher doses.
The wd's from methadone are borderline unbearable, and that was even with a taper plan in place.
If you can find a regular or PM doc to prescribe for you for chronic pain...tis isnt easy in iself as a lot of docs dont like writing for methadone.
Suboxone- Suboxone worked great for me with cravings and keeping wd's at bay. It gave me the time and clear head I needed to work a solid program and make some serious life changes. I never felt drugged on the sub, nor did I ever crave it. Upon starting suboxone treatment, I lost all the weight I gained while on methadone, never worked out a day.
Suboxone can indeed work wonder for pain management. Althought at much lower doses than are used to keep cravings at bay. This can be somewhat difficult for you seeing as you need pain relief and are battling addiction. The lower the dose of buprenorphine that is used, the stronger agonist effect that is received, IE more pain control. The higher the dosage goes up, the drug begins to take on more of its antagonistic properties. For example, when I worked in the OR, we would give patients .4mg's IV for severe post op pain control. Yet when I was inducted onto sub for maintenance, I started at 16mgs!
Subxone can be VERY expensive, as most sub docs charge some outrageous intake fee, plus monthly charges for the script. If you dont have insurance, be prepared to spend $6-700 a month on meds.
There are all so many variables. The bottom line is, you really need to speak with a good pain doc, or specialist in addiction medicine. They can guide you to make the decision that is best for you! But there is no magical cure. Both treatments have their positives and negatives.
Good luck,
H
First off sub does work for pain it has been used for pain for quite a while now .Ohio I could understand you considering trying sub if you have put 100 % effort into getting clean and it did not work .You haven't you have tried stopping taking the pills but not gotten the recovery care needed .I am not saying even if you do recovery care there wont ever be a time when you wont have to put surfactants in place for short term for extreme pain .You know I have had too and that's OK just have a good plan in place If you do not put a full recovery plan in place you will end up replacing one pill for another .The other question here is they both a expensive how are you going to swing it .Why don't you try one more time putting everything into the full recovery process in place .Make your recovery your first priority and see how you do. If it still isn't working then consider a maintenance drug.
I went to rehab in Atlanta, a really good one, in 2004 and had to have an operation WHILE I was there in treatment for 13 weeks. They put me on Sub for pain, and it worked GREAT for me. I would at least try it before methadone. That seems to be awful to get off of when the time comes!
Good luck! Sorry about your back.
Good luck! Sorry about your back.
HI I was on methadone for pain management and although it worked well for many yrs I built up a tolerence to it just like any other narcotic I started at only 30ml a day but wound up at 150ml a day then it quit working all together...after going this route for pain control I could never recommend it there are to many side effects that go along with it because your addicted to it you tolerate them but in reality its no way to live...I have no experience with sub but I would tell you to stear away form the methadone my withdrawals were long and hard its no fun tapering off something for 8 1/2 mo then once off it takes months to feel better I would try something else good luck and God bless......Gnarly
By the way,my dose is now 5mg a day,and did not have horrid W/D to get this low.Be clean in weeks. Hope this info is useful kc
First,I have never taken suboxone or subutex.However I have taken methadone for 5 years at a low dose of 30mg ,NOT,for pain but to keep off pills,and it has worked.100%.
Wondering ,if you go on sub.,with it's ceiling,will there come a point that you may have to look at other alternatives anyway?This is a question only,but maybe one to consider.
Methadone clinics are created in hell too. Wish you well karl
Wondering ,if you go on sub.,with it's ceiling,will there come a point that you may have to look at other alternatives anyway?This is a question only,but maybe one to consider.
Methadone clinics are created in hell too. Wish you well karl
Because of buprenorphine's ceiling effect, you should feel little to no withdrawals until you get under the 4mg threshold. Taking 4mg of Sub is just like taking 24mg. Take it very slowly and be patient.
I forgot to mention when I was on methadone I didn't want to do anything but sleep. I gained about 30 lbs. When I switched to suboxone I immediatly started losing all the weight. I also feel like I used to b4 the pills. I highly recommend the sub. I have not heard neone say that they had a positive exp on the methadone. I've always heard people comain about how it made them feel.
I have had both and tappered down to a low dose of both. Sub has been more succesful for me. It's been easier to tapper from, where methadone was a long drawn out withdrawl for me but since I've been tappering from sub I haven't experinced ne withdrawls yet and I'm down to 4 mgs. I'm confident that this isn't going to be hard for me to get off.
I don't know where you get the information that Buprenorphine doesn't work for pain, but I'm afraid that isn't true. In fact, the first mainstream use for Buprenorphine was in labor delivery. It's an extremely potent analgesic and is much stronger milligram for milligram than morphine. Also, ANY doctor can prescribe Suboxone OR Subutex for pain, not just those that have special opiate dependence DEA numbers. For many people, Buprenorphine provide substantial pain relief. I's suggest going that route WAY before attempting methadone for the simple reason that buprenorphine overdose deaths are extremely rare (most were using benzos as well), and methadone deaths are common at best.
thx rckrgirl- that pretty much confrims what I've heard in the past and read in numerous articles and forums. I wish the Sub worked more for pain because its the lesser of two evils but like I said I need pain control as well. Yes, Sara , back on again. I only lasted about a week off or thereabouts. My back has gotten much worse and I likely need back surgery at this point. They are trying to get me set up with state insurance so I can see a neurosurgeon. (when I say "they" I mean I saw a social worker at the ER I had to go to recently after I slipped and fell down basement stairs-that is what wrenched my back worse) They want to do an MRI but without insurance wont unless Im actually hospitalized and need IV around the clock pain control before the hospital would do that) so for now Im home and just suffering, taking hydro and oxy but of course I still overuse due to my addiction. ONce i get out of this condition and have surgery (if they decide thats the best treatment plan), I will go on either Sub or methadone. I dont see me ever getting off this merry-go-round without maintenance substitution. The main thing at this point is getting me off drugs that will not have so much aceto in them, and maintaning NA meetings etc.
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