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Transition from methadone to suboxone
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Transition from methadone to suboxone

Can the transition from methadone to suboxone be done from one day to the next? Or, is there a ramp down of one over a period of time and a ramp up of the other?  I have a 19 year son getting ready for a clinic & we need to get him off methadone and on suboxone quickly.
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185545_tn?1331078466
Hi there. I transitioned onto suboxone whilst coming off of methadone. I was required to reduce my methadone dose down below 30mgs. My final dose of methadone was 22.5mgs of methadone, well below the therapeutic capabilities of suboxone. Methadone doses beyond 30 mgs exceed the ability of suboxone to cover sufficiently which can end up in underdosing for the prospective client.

I waited 4 days before having my first suboxone dose because i was frightened of precipitated withdrawals. I was allowed to dose within 3 days of my last methadone dose after meeting the minimum COWS score, which is a relative measure of personal withdrawal severity, but decided to wait an extra day.

I was transitioned and detoxed within a medically supervised detox facility. My suboxone doses were titrated 4 hourly by 2mg increments. My starting dose was 4mgs. I ended up settling at 16mgs then began tapering down the very next day. In total, i was only on the suboxone for 2 weeks.

I was supplied with an array of support medications ( clonidine, paracetamol, zopiclone, dietary supplements,etc... ) and physiotherapy/accupuncture via tensing machine and stimulation of areas around my knees and calves for RLS and my ears and back for restimulation of exogenous endorphin supply). This made the whole experience bearable and less traumatic  than the community detox i was required to complete to get my dose down below the 30mg threshold.

I swear by suboxone when used in this manner but accept that some people are not necessarily going to have the positive experience i had. I wish your son all the best. So, no, there is no next-day transition from methadone to suboxone and he will have to get his methadone dose down below 30mgs.

regards Jeremy.
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Avatar_f_tn
Hi--This is really something that needs to be explained to you by the prescribing physician.

The way you ask the question it sounds like you have to do this without guidance. I'm sure that's not the case...

Of all the opiates,I think methadone is the most complicated to leave when going to Sub.
It's complicated but there is a formula that's used when going from one drug to the other.
To me,there's nothing "quick" about this. These are two very potent drugs. The Methadone NEEDS to be tapered down to an amount it would be safe to "jump" from. Then the wait for the withdrawals to begin. Only when you son is in withdrawal can the Sub be induced
and it's tricky.

How much is he taking per day?
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Avatar_n_tn
He is taking 70 mg.  I have a private clinic ready to help, but he needs to either be on sub or down to 30mg of meth.  We are trying to get him to either but do not want to wait several weeks to do so.  He is home alone during the day and feel he is at risk.  Just had an arrest for cocaine & syringes.
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Avatar_f_tn
I was just about to leave...Glad I caught this but I'm confused for you!

What's confusing is you're doing this on your own. There has to be a doctor.Who's handing out the SUB?

It takes quite awhile to taper to 30mg comfortably. It's an absolute horror to do it fast.You need someone to help you with this...

Does he feel he's at risk during the day or do you?
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Avatar_m_tn
HI .....to get on sub from methadone the physicians desk reference suggest that you induce sud at 20 mg of methadone however there is more there about doing it at a dose of 30mg but having to wait 72hr b/4 induction its tricky and every doctor handles it differently I dont thik it is possible at 70mg at least I have never herd of it being done at such a high dose....nether sub or methadone is going to help with cocaine addiction that a whole nother can of worms
you need to find out wht he has been shooting up if its an opiate sub can block the receptors
so he wont be able to get high...if his u/a shows coke in it they very well might throw him out of the program I understand your question but I dont understand the urgency of having to to this quickly to taper down that far on methadone it going to take a few months so it kinda throws the whole urgency out the window what I would suggest to you is try to get him to start going to N/A meeting he needs to treat the addiction and not just with another pill you need to dig down to the root of why we deel the need to use in the first place as addicts we need to change the very way we think to get well utill he is ready to do that all your doing is switching addictions....keep us posted on how this goes good luck and God bless...Gnarly      
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185545_tn?1331078466
Hi there. I transitioned onto suboxone whilst coming off of methadone. I was required to reduce my methadone dose down below 30mgs. My final dose of methadone was 22.5mgs of methadone, well below the therapeutic capabilities of suboxone. Methadone doses beyond 30 mgs exceed the ability of suboxone to cover sufficiently which can end up in underdosing for the prospective client.

I waited 4 days before having my first suboxone dose because i was frightened of precipitated withdrawals. I was allowed to dose within 3 days of my last methadone dose after meeting the minimum COWS score, which is a relative measure of personal withdrawal severity, but decided to wait an extra day.

I was transitioned and detoxed within a medically supervised detox facility. My suboxone doses were titrated 4 hourly by 2mg increments. My starting dose was 4mgs. I ended up settling at 16mgs then began tapering down the very next day. In total, i was only on the suboxone for 2 weeks.

I was supplied with an array of support medications ( clonidine, paracetamol, zopiclone, dietary supplements,etc... ) and physiotherapy/accupuncture via tensing machine and stimulation of areas around my knees and calves for RLS and my ears and back for restimulation of exogenous endorphin supply). This made the whole experience bearable and less traumatic  than the community detox i was required to complete to get my dose down below the 30mg threshold.

I swear by suboxone when used in this manner but accept that some people are not necessarily going to have the positive experience i had. I wish your son all the best. So, no, there is no next-day transition from methadone to suboxone and he will have to get his methadone dose down below 30mgs.

regards Jeremy.
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Avatar_n_tn
Jeremy,

Thanks for the informative reply.  It is very helpful.  We have a medically supervised detox facility ready.  My son must be either on Suboxone or ramped down to 30 mg of methadone.  I met with his counselor from his treatment program yesterday & he suggested a 1 mg reduction per week.  We, (his family) believe that is far to risky.  The facility he is attending does not seem have much interest in getting him drug free any time soon.  It appeared to me to be a maintenance facility. I may be wrong.

If my son can gut out a couple of days off the methadone & the subsequent withdrawals, I can take him in to the detox facility for a 2 weeks.  From there, we can get to a live in drug rehab center for a month or two.  The issue is this, he seems very afraid of grinding out the couple of days of no methadone.  His current dosage of 70 mg is, I believe, keeping him pain free, and high...  Which clouds his ability to dig in against the addiction.

Regards,
Leaster
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Avatar_f_tn
I'm not sure you understand what you're saying here. If it's a detox facility that you've got standing by,then THEY would take him now and help him detox...

I,also,don't think you realize what you're asking of him to "gut it out" for a couple of days. What's a couple of days?  To stop Methadone at 70mgs, and let him be, is inhumane in my opinion. I don't know how else to say it or what to compare it to. It's just awful.

This is very strange. Why is a decrease of 1mg per week risky?

I really don't blame him for being afraid. I'm sure he's petrified!!
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495284_tn?1333897642
What is his doctor saying to do here?
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Avatar_m_tn
I am a fifty-six year old man with a  forty-two year narcotic addiction.  I started on light narcotics such as Norco, Tussionex, etc. and very shortly thereafter was using Heroin 6-10 times daily (my first Heroin "fix" was when I was fourteen).  I ultimately was fixing about a "quarter piece" (6 - 1/4 gm.) daily.  Again, my total addiction time was a bit over forty years.

I was a "functioning addict for a majority of this time, but still managed to serve a couple of stints in prison.  As I aged, I grew weary of the chase and most of all I grew tired of feeling like I was an old dog on a short leash so, I made the decision to do it legally and soon went on Methadone maintenance.  My dose very quickly rose to 120 mg. daily.

After a few years of this cloud over my head, I also became fed up with the methadone program, even though I regularly had one week take-homes with occasional 27 day take home doses.  Too many hoops to jump through and program interference in my personal life finally made me take a stand and say, "enough."  Addicted or not, I wanted my life in my hands.

Over the following five years, I slowly titrated down from 120 mg. daily to 5 mg., three times weekly.  I suffered no physical withdrawals and only minor psychological stress.  Cannabis, occasionally, helped me through this anxiety.

Finally, after all this time, I felt that I was at a point where I could safely stop taking narcotics and did so abruptly.  The first five days were met with absolutely no problems, what so ever.  After that point, anxiety and physical withdrawals manifested themselves and I swiftly deteriorated to the point where I was in the midst of THE WORST withdrawals I have ever experienced.  I already knew that I was in for a minimum of four months of Hell.  This turned into a reality, especially since I did it "cold turkey." and though the physical was subsiding, I was a wreck both physically and mentally.  It was about thirteen months before I was able to do anything similar to functioning and that was at a minimum.

What I ultimately learned was that the dose is not so important as your age and the length of time of continuous addiction that are actually the two things which primarily determine the severity of the withdrawals.  If you are fifty or older and have had a good long run (5 years or longer) you can expect severe withdrawal discomfort.  (The first two months, I literally could not walk even short distances and spent the time in bed.  Nor did I sleep for that two month period,  FACT not B.S.)  

I am at nineteen months clean and am barely getting some type of normality in my life.  BUT, I must be honest and let you know that there is still a pair of large monkeys on my shoulders and I am very seriously considering going on Suboxone or Subutex, in order to be able to return to a semblance of functioning and peace of mind.  I don't really want to die a "Junkie" but, if I have messed myself up so much that it is necessary for me to return to a narcotic, even just a few days a week, I will.  You see, after all those years of addiction, I became quite anti-social and non-functioning without some type of narcotic.

Seven years ago, a doctor with Kaiser Permanente, Addiction Medicine, advised me to stay on methadone for the rest of my life.  I could not accept that, so went ahead with what I described earlier.  He may have been correct, I don't have any definitive answers.  I will still give this experiment a bit more time, but if things don't start to improve, I will go with Suboxone.  Low dose and miss one or two doses per week.  I have recently tried a small amount of Suboxone and found it to be very satisfying and even though it is only a schedule three narcotic (same as hydrocodone), it is very, very strong.  I was actually itching and scratching on two milligrams.  In fact, 2 mg. Suboxone felt about equal to 10 mg. Percocet.  The best part is that it is RELATIVELY non-addicting.

I don't know if this helps for your particular case, I hope it does, but perhaps I have been able to shed a little light on the subject for those wishing to understand narcotic addiction just a small amount more than they already did.
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