Aa
Methadone withdrawal
My boyfriend is on day 5 of withdrawing off of 240mg of methadone. All he does is sleep, probably to avoid all the pain. He has restless legs, runny nose, diarrhea, restlessness in his sleep, and is only able to sleep at all because an urgent care MD gave him a 5 day supply of lorazepam to help with his anxiety. No MDs will take him on as a patient because he has no insurance so he is stuck withdrawing. He has herniated discs so he is in severe pain with nothing to treat it. I am wondering if there is anything I can do to make the withdrawal process easier for him. I am also wondering if there are any resources I can utilize to help him. We are located near Syracuse, NY and all methadone clinics we found have a 6 month wait. Any advice at all would be appreciated, I've never taken anything stronger than Motrin so narcotics and withdrawals are not something I am familiar with!!
hi Mandy....im so sorry for your situation but thats what happens when your not honest with the doctor........I had a hunch this was going to happpen when you told me how high a dose he was on a heroin addict only needs about 60mg to be ok I got pritty high all the way to 150 but thats where they stop at for pain management the persipatated withdrawals can las a wile
up to 10 days and he is now worst off thenn b/4 I cant imagine the pain hes got to be in
keep an eye on him make sure he stays hydrated that is critical and with the sweating and the runs it dosent take long to dehydrate ....abot the only real releaf hes got is going to be a hot soak for his mussels and bones soaking in ebson salt lots of gatoraid to drink.....there masy come a time here soon that he cant keep anything down if that happens get a shot glass and try 1 shot water or gatoraid every 15 min this is a minum to be drinking he really needs someone to be with him if you can arrange something here on the forum we call this the 7 level of hell when this happens and with more and more people getting methadone and sub off the street its becoming more common if it mean anything to you I will keep the 2 of you in my prayers reach out to God thats where I get my strength may God be with both of you.........Gnarly
up to 10 days and he is now worst off thenn b/4 I cant imagine the pain hes got to be in
keep an eye on him make sure he stays hydrated that is critical and with the sweating and the runs it dosent take long to dehydrate ....abot the only real releaf hes got is going to be a hot soak for his mussels and bones soaking in ebson salt lots of gatoraid to drink.....there masy come a time here soon that he cant keep anything down if that happens get a shot glass and try 1 shot water or gatoraid every 15 min this is a minum to be drinking he really needs someone to be with him if you can arrange something here on the forum we call this the 7 level of hell when this happens and with more and more people getting methadone and sub off the street its becoming more common if it mean anything to you I will keep the 2 of you in my prayers reach out to God thats where I get my strength may God be with both of you.........Gnarly
Thank you for all the information. Apparently, as I just found out, my boyfriend wasn't completely honest with his doctor. Because he knew going into the appointment that the MD was considering the use of Oxycontin. He has had a bad experience with Oxycontin in the past and said he didn't want to feel like a zombie again. Sooo he told the doctor that during his last week or two on methadone he tapered down to 30mg...not true! His last dose was 30 mg, but the dose before that was 240. Obviously lying to the doctor was a mistake...but hind sight is 20/20 huh? He has taken 3 doses of subutex 8 mg since 9 this morning, all at the recommendation and direction of the physician. His doctor has called back several times to check on his condition (so at least he seems truly interested in his wellbeing). Unfortunately Joe (my bf)'s status has only gotten worse with each dose. He has been going through a cycle of sweating to the point he is drenched, then being cold, then being ok for 10 minutes before starting the cycle again. His back is on fire, he is very anxious and has a terrible headache that resembles a migraine (sensitivity to light and sound). His MD has now instructed him to take one tablet every 8 hours starting 8 hours from his last dose at 3:15. I don't know how much worse he has to get before he starts getting better but it is making me nervous and I don't know how much I can do for him. He is now laying in bed where it is dark and silent. He took two benadryl, two tablets of melatonin and 600 mg ibuprofen to hopefully help him get more comfortable and be able to sleep. The lorazepam he got at urgent care is now all gone as it was only a 5 day supply. He still has a few days worth of clonidine to at least keep his BP under control. Joe asked his MD if taking oxycodone or oxycontin or some other pain reliever would help to halt the withdrawals and let the methadone clear out of his system further before restarting the subutex. The MD didn't think this would be helpful. I thought we had finally gotten him to where he needed to be with this process and thought the subutex was a god send, but it is now only causing him more pain!
Hi Mandy,
I just got Gnarly's message, and here I am.
Ive had some Pharmacy training, and am sitting for the PTCE Aug 24th, so with your expertise, you will understand a lot of what I am about to say.
The crazy thing about any type of Buprenorphine treatment is that the practitioners are taught such a limited amount of information before they are certified to prescribe the medication.
Most Buprenorphine treatment providers do not like to script Suboxone or Subutex to methadone patients due to the long serum half life of Methadone. When I transferred from Methadone to Suboxone, I dropped down to 30mg first for a few weeks, and then had to go 72 hours before my first induction dose.
Now, take what you have been taught regarding serum half lives. Its has been roughly 216 hours since your BF's last dose of methadone which I believe was 240mgs. So lets just use that as a jumpoff point for conversations sake. With an average half life of 36 hours, your BF has undergone approximatelly 6 passes since his last dose. With my calculations, even after 9 days, your BF had 3.75mgs of active metabolite in his bloodstream when the suboxone was administered! Thats not even taking into consideration what his actual serum concentration was from the "Build up effect" from the total course of his treatment. No wonder the poor guy is in withdrawal!
Its great that the doc gave him subutex, I suppose. But the fact is, that has nothing to do with preventing precipitated wd's.
The Naloxone that is present in suboxone has almost no bioavailability when taken orally or sublingually. It is present in the combination product simply to deter abuse of the drug intravenously or by insufflation. Which both routes have an extremely favorable bioavailability with regards to naloxone.
The reason your BF is suffering so badly right now, is the actual dual action of the Buprenorphine. It has Agonistic and Antagonistic activity at the Mu Opiod receptor sites. At lower doses it acts more as an Agonist, which is why Temgesic (Buprenorphine for pain control) is often prescribed in common doses of 0.2-0.4 mgs, at higher doses Buprenorphine acts as an Antagonist in the ranges of 4+mgs.
It has a higher binding affinity to the already occupied Mu Receptors that are currently still occupied by the methadone, thus competing for the neuron... the Buprenorphine wins, thus inducing precipitated withdrawals.
Its hard to say how long the precipitated wd's will prevail before suboxone starts doing its inteded job and making him feel more comfortable.
Personally, I would do some research and call his doctor back, and rethink the Oxycodone idea. The suboxone is now blocking his receptors, so the oxy may not be of much help for the next day or so.
But his doctors thought process is, to barely maintain him on a fast acting opiod, where he can then detox enough to begin suboxone therapy within 24 hours after his last dose. While this practice isnt medically approved, many practitioners are going this route, with favorable results.
IF this is what the THREE of you decide, its imperative that your BF is put on a strict dosing schedule. IS there anyone that can maintain the medication and dose him ONLY at the prescribed times?
In the meantime, Have him take the "Clinical Opioid Withdrawal Scale" also known as the COWS Scale. Give his Sub doc the number he gets on the test, this will help him evaluate his condition. You can find the protocol for the COWS test here:
www.csam-asam.org/pdf/misc/COWS_induction_flow_sheet.doc
Also, Check out Dr. Richard Gracers paper on how Buprenorphine works in the brain to combat opiate addiction and withdrawal. Read it together with him, as its a short and relatively easy read that should be easy for the two of you to understand. That document can be found here:
www.gracermedicalgroup.com/resources/articles/rf_file_0009.pdf
Just remember, that knowlege is power, and sometimes we have to seek out that knowlege for ourselves, and be our own advocate! :-)
I hope this makes sense, and please feel free to contact with any questions. Best of luck to the two of you!
Henry
I just got Gnarly's message, and here I am.
Ive had some Pharmacy training, and am sitting for the PTCE Aug 24th, so with your expertise, you will understand a lot of what I am about to say.
The crazy thing about any type of Buprenorphine treatment is that the practitioners are taught such a limited amount of information before they are certified to prescribe the medication.
Most Buprenorphine treatment providers do not like to script Suboxone or Subutex to methadone patients due to the long serum half life of Methadone. When I transferred from Methadone to Suboxone, I dropped down to 30mg first for a few weeks, and then had to go 72 hours before my first induction dose.
Now, take what you have been taught regarding serum half lives. Its has been roughly 216 hours since your BF's last dose of methadone which I believe was 240mgs. So lets just use that as a jumpoff point for conversations sake. With an average half life of 36 hours, your BF has undergone approximatelly 6 passes since his last dose. With my calculations, even after 9 days, your BF had 3.75mgs of active metabolite in his bloodstream when the suboxone was administered! Thats not even taking into consideration what his actual serum concentration was from the "Build up effect" from the total course of his treatment. No wonder the poor guy is in withdrawal!
Its great that the doc gave him subutex, I suppose. But the fact is, that has nothing to do with preventing precipitated wd's.
The Naloxone that is present in suboxone has almost no bioavailability when taken orally or sublingually. It is present in the combination product simply to deter abuse of the drug intravenously or by insufflation. Which both routes have an extremely favorable bioavailability with regards to naloxone.
The reason your BF is suffering so badly right now, is the actual dual action of the Buprenorphine. It has Agonistic and Antagonistic activity at the Mu Opiod receptor sites. At lower doses it acts more as an Agonist, which is why Temgesic (Buprenorphine for pain control) is often prescribed in common doses of 0.2-0.4 mgs, at higher doses Buprenorphine acts as an Antagonist in the ranges of 4+mgs.
It has a higher binding affinity to the already occupied Mu Receptors that are currently still occupied by the methadone, thus competing for the neuron... the Buprenorphine wins, thus inducing precipitated withdrawals.
Its hard to say how long the precipitated wd's will prevail before suboxone starts doing its inteded job and making him feel more comfortable.
Personally, I would do some research and call his doctor back, and rethink the Oxycodone idea. The suboxone is now blocking his receptors, so the oxy may not be of much help for the next day or so.
But his doctors thought process is, to barely maintain him on a fast acting opiod, where he can then detox enough to begin suboxone therapy within 24 hours after his last dose. While this practice isnt medically approved, many practitioners are going this route, with favorable results.
IF this is what the THREE of you decide, its imperative that your BF is put on a strict dosing schedule. IS there anyone that can maintain the medication and dose him ONLY at the prescribed times?
In the meantime, Have him take the "Clinical Opioid Withdrawal Scale" also known as the COWS Scale. Give his Sub doc the number he gets on the test, this will help him evaluate his condition. You can find the protocol for the COWS test here:
www.csam-asam.org/pdf/misc/COWS_induction_flow_sheet.doc
Also, Check out Dr. Richard Gracers paper on how Buprenorphine works in the brain to combat opiate addiction and withdrawal. Read it together with him, as its a short and relatively easy read that should be easy for the two of you to understand. That document can be found here:
www.gracermedicalgroup.com/resources/articles/rf_file_0009.pdf
Just remember, that knowlege is power, and sometimes we have to seek out that knowlege for ourselves, and be our own advocate! :-)
I hope this makes sense, and please feel free to contact with any questions. Best of luck to the two of you!
Henry
HI Mandy .........I sent some messages out to some of our members that know more about sub then me I do know what the doctor is telling you is right he dont know whats going to happen if ther is still a serum level of methadone in his system he will get deathly sick by taking more sub one of the members I sent a note to will have a better answer for you check back in a few hr im sure he will reply when he sees the note hang in there things will get better.....Gnarly
He went to his doctor's appointment today and was prescribed Subutex 8mg twice daily. The MD gave him a script for a 10 day supply and he has a follow up appt on Tuesday. They had him take his first dose and stick around for about 2 hours to see how he reacted. He had little response to it so they had him take a second dose. He then went home and about 7 hours later felt worse than he did before he took any of it so he called the MD. The MD told him to take another tablet and that he may feel better or may feel worse. How long should it take for the subutex to help him? Is it normal to feel worse before you feel better? I know if he had gotten suboxone there was the risk for induction of withdrawals, but his doctor gave him straight buprenorphine without the naloxone blocker. I just want him to get some relief!!
Have an Answer?
You are reading content posted in the Addiction: Substance Abuse Community
Is treating glaucoma with marijuana all hype, or can hemp actually help?
If you think marijuana has no ill effects on your health, this article from Missouri Medicine may make you think again.
Julia Aharonov, DO, reveals the quickest way to beat drug withdrawal.
Tricks to help you quit for good.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
