How to Switch from Methadone to Buprenorphine (Suboxone)

Change Can Be Good

Change Can Be Good

I’ve helped about thirty or forty people switch from methadone to buprenorphine. Some were patients at my office, where I do office-based treatment with buprenorphine (formerly known as Suboxone or Subutex), and some have been patients at one of the two opioid treatment programs where I work.

Most of the time, the transition goes smoothly; however, around fifteen percent of the time, the patient doesn’t feel right on buprenorphine and goes back to methadone. I haven’t found a way to predict who will do poorly with buprenorphine.

Most of these patients had been in treatment for months or years, and were trying to taper their methadone dose. These patients heard that since buprenorphine is a partial opioid, it’s easier to taper off of than methadone. For the most part, that seems to be true, but everyone’s different.

Some patients switched because they wanted a medication that wasn’t as “heavy” as methadone. Most patients say they feel lighter, or less medicated, or more normal, on buprenorphine as compared to methadone.

Buprenorphine seems to have fewer medication interactions. For patients with complicated medical problems on many medications, it’s a better choice. It’s also a better choice for patients who have prolonged QT interval syndrome (condition of the heart) from methadone.

Also, restrictions on take home doses for buprenorphine when it is prescribed at opioid treatment programs aren’t as strict as rules for methadone, because buprenorphine is much safer than methadone. Patients switch to buprenorphine to get take homes more quickly, particularly helpful if they live a great distance from their treatment program.

In January of 2013, the federal government dropped the time in treatment requirement for take home doses for buprenorphine. With methadone, a patient has to be doing well with negative urine drug screens for a minimum of ninety days before getting extra take home doses. According to the new federal law, buprenorphine patients can get take homes regardless of time in treatment, so long as they meet all the other seven requirements for take homes. (These are: negative drug screen including alcohol, no ongoing criminal activity, regular clinic attendance, absence of serious behavioral problems at the clinic, stability of home environment, assurance that take-home doses can be stored safely, and rehabilitative benefits to the patient outweigh risk of diversion).

Some states have more restrictive regulations than federal law. In that case, the opioid treatment program has to follow the more restrictive of the two laws. In my state of North Carolina, time in treatment regulations still apply. However, I can petition the state opioid treatment authority for early and extra take home doses for patients who are doing well, and those requests are nearly always granted.

Some patients switch to buprenorphine at the opioid treatment program to prepare for transition to an office-based buprenorphine program. Office-based treatment is better for patients who have made progress on their recovery, and need less oversight with dosing of their medication. It’s an excellent step for stable patients.

Buprenorphine is a partial opioid and methadone is a full opioid. And buprenorphine has a higher affinity for opioid receptors. This means that it sticks like glue to the receptors, and if there’s methadone on the patient’s opioid receptors, buprenorphine will toss it off, throwing the patient into withdrawal. That’s a simplistic explanation, but you get my drift. This is why patients on methadone have to be in at least moderate withdrawal before taking the first dose of buprenorphine. Otherwise, the patient will be miserable, in withdrawal, with little to be done to ease the situation.

I ask patients to taper to about 30 or 40 milligrams of methadone per day prior to making the switch. I recommend tapering by about 5mg per week, or more slowly if needed. If I’m in the opioid treatment program on Mondays, I ask the patient to take her last dose of methadone on Friday, and then skip Saturday and Sunday. I see her first thing on Monday and evaluate the degree of withdrawal. By then, this patient has gone without methadone for seventy-two hours, and should be in at least moderate withdrawal. We check vitals signs (blood pressure, heart rate, etc.) and check a COWS (clinical opioid withdrawal scale) score. I talk with the patient and do a quick exam. If she’s in enough withdrawal, we start buprenorphine, usually at 4mg. If possible, we have the patient stay for an hour or return in an hour so we can see how she’s feeling. Sometimes we give a second dose on that first day.

Here are some issues I’ve seen in patients making the switch from methadone to buprenorphine:
-Coming down too fast on the methadone dose. Don’t zoom from 115mg to 40mg in a week or two and expect the transition to buprenorphine to go well. It probably won’t. I tell patients that if you’re going to expend time, money, and energy in making the switch, do it the right way, and optimize your chance for success.
-Not planning ahead for the increased cost of buprenorphine. In most clinics, buprenorphine costs more than methadone. If it’s not financially feasible over the long term, it’s best to stay on methadone.
-Expecting to take buprenorphine for a few weeks and then taper off with no withdrawal. Most people do not have this experience. Even the taper off buprenorphine can take months and be difficult. Besides, getting off opioids is one thing; staying off is another. I tell patients not to taper off buprenorphine unless they are ready. Have they spent the time getting counseling against relapse? Have they changed friends, and put distance between them and people still using drugs? Do they work around people using drugs? Do they have a chronic pain condition that will require opioids intermittently? If so, what’s the plan to avoid relapse?
– If buprenorphine lasts longer than methadone, don’t be tempted to miss days without telling your counselor what is going on. Some patients on buprenorphine are able to dose three times per week, so talk to your doctor about setting this up instead of missing days on your own.
-DO NOT attempt to divert medication. At one treatment center, we’ve detected many patients trying to “save” part of their dose for later use. I think most are telling the truth, but some are probably selling their medication. I can’t tell who is selling and who is saving doses for later. If we have a problem with patients selling their medication in the community, our treatment program can get a bad reputation in the community and even get closed down. So we have to act on any attempt to divert medication, and at times may even have to dismiss a patient from treatment, which I hate to do. So don’t divert medication.
-Don’t feel bad if buprenorphine doesn’t work for you. No medication works for everyone. If methadone did work, go back to it. Methadone has been around for forty years and has a proven track record.

I’m happy to work for two opioid treatment programs who offer both buprenorphine and methadone. It’s a little more difficult to offer buprenorphine, and the profit margin is likely much slimmer than treatment with methadone, but it’s the state of the art treatment. I fear some methadone clinics are going to get left behind with their “methadone only” mindset. Methadone will always be needed, but now we need to have other choices readily available for patients seeking treatment. Soon, I think we will see opioid treatment centers also offer naltrexone/ naloxone, medications that can prevent opioid relapse in patients who have completed withdrawal from opioids.

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176 responses to this post.

  1. Posted by William Taylor, MD on July 22, 2013 at 1:14 pm

    I had a patient decide on his own to taper from 130 mg methadone to zero over 1 week, thinking he would go onto suboxone. In the office he was pretty sick. He got suboxone as a trial over our misgivings, and then got REALLY sick, as he still had some methadone on his receptors which the suboxone displaced. There are no shortcuts to the process.

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    • thank you, so true

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    • Posted by patrick king jr on February 28, 2018 at 6:09 am

      Please Dr. I need this question answered correctly . I am on 60mgs of methadone. I want a quick transition with subutex not suboxone there is naloxone in suboxone that’s why people hit the floor. But will subutex with out naloxone at a 8 to 12 mg dose put me in withdrawal? I dont see how it can without naloxone . please get to me asap

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      • Posted by friend indeed on April 3, 2018 at 1:56 pm

        Unfortunately my friend, it will. Naloxone doesn’t have an effect sublingually and is there to deter folks from injecting the suboxone. Because methadone stimulates the receptors to a high degree, as a potent full agonist, and subutex stimulates them to a lesser degree, you are left with withdrawal symptoms. Subutex is more competitive at the receptor because of it’s high binding affinity, and it knocks methadone off. But as a partial agonist, once subutex is on the receptors it stimulates them to a lesser degree than the methadone did, and this difference is what causes you to feel withdrawals. You really need to be in worse withdrawal than you would have caused by taking the subs for them to improve how you feel – wait 72-96 hours. Maybe take clonidine or gabapentin in that window to help manage symptoms, but don’t start the subutex too soon.

  2. I have thought of switching from methadone to something else but i have seem the effects of stopping to use methadone and I don’t think i want to go through that.

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    • I also am on methadone I was on subs then switched to meth been on that for 4 yrs and I’m sick of it. I’m still a drug addict the only difference is I’m going to a clinic to get it…that’s how I feel..I’ve heard ppl that go from meth to subs don’t have much luck..Can anyone plz help me with this..it’s driving me nuts..I have 3 kids I cant b sick..I just want to be normal again

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      • I think you need to see the doctor at your opioid treatment center and explain your concerns. I’ve seen many people switch from methadone to bupe and do fine, so don’t lose hope, especially if you did well on it before.
        I’d also challenge you about still being a drug addict. At the proper dose, patients should feel back to normal of methadone or buprenorphine, with no high and no obsession to keep taking more. I hope this is the case for you, but you do need to tell your treatment center staff about your concerns and what you’d like to happen in your life in the near future.

      • Posted by patrick king jr on February 28, 2018 at 6:15 am

        I really hate to tell you this but this is a street option and not a medical one so bare with me . buy 10 bundles of heroin 100 bags . stop methadone completely use the dope up and switch smoothly to suboxone . I did it and it was absolutely great transition methadone leaves the system and you get held with dope and change your brain chemistry . worked great just take proper percussions

      • Yeah, but you could die from the heroin, so I do recommend patients the correct way, supervised by their doctors.

    • Your almost done don’t go on anything else you don’t want that monkey on your back . The nightmare of methadone is over for you at yourself on the back and never go back and enjoy your new sobriety. Good luck . You did something many people are incapable of doing . Dont

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  3. Posted by Vicki H on July 24, 2013 at 9:51 pm

    I attempted to make the switch to quickly and ended up in the ER with absolutely nothing they could do about it. Truly evil withdrawls. I am working my way again down to 20ish mgs and will try again, anxiously. I found out my metabolism is so “slow”, I am able to function ok with 7 days of not dosing. I have been on MMT for 4yrs at 70mgs.

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    • Did you try it again? I’m in same situation

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      • Posted by Speechie on October 4, 2014 at 7:22 pm

        Yes I did! For me, the one most important thing I did was to shred my mental calendar. I was no longer anxious, fearful about a “time frame” to make the switch. Once I did that, I decide to go down 3mgs a week but also knowing I could stop and level out for a couple weeks if I felt like it and because I finally realized that I’m the one in charge the pressure was off. 3 things..Get rid of your expectations…go down slowly… and know that you make the calls…not your family or your friends. Good luck and keep me posted please

  4. […] How to Switch from Methadone to Buprenorphine (Suboxone) […]

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  5. Posted by Glenn on December 20, 2013 at 11:41 pm

    Hi Jana .. Thanks for shariung your experiences. I have a question.
    I made the switch to Sub..!5 days ago.. I still get headaches and feel hot at times.. Is this normal in the transition period?. I have been on methadone for ten years,,,Thankyou .

    Glenn

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    • Posted by Glenn on December 20, 2013 at 11:42 pm

      Thats 15 days ago

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    • Yes, I’ve noticed many patients report headache on Suboxone. Sometimes it’s better on Subutex, sometimes not. Usually the headache goes away,but not always. I hope it does in your case!

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      • Posted by Jessica on August 21, 2015 at 1:35 pm

        Hey my I wanted ask I had knee hurt n needed physical therapy n back pain since I had epidural with both my kids I do want try get on some kind of low mg of sub or methadone but does that risk anything me being mom I don’t want loose my kids I jus want get help I usually only take 10-20mg day of done n I would like find dr to jus try get on treatment but don’t want to lose my kids or anything? Can u help me with advice on this thanks!

      • You should not lose your kids for asking for help!
        Does it ever happen in this country? I wish I could say no.
        But you have a much better chance of being a good mom if you are in recovery. You can go to this website to find treatment in your area: https://findtreatment.samhsa.gov/

  6. Posted by Ryan on January 25, 2014 at 8:43 pm

    I was on methadone for over 13 years. Highest does was 100mg and lowest was 13mg. I bounced up and down in dosage over the years. I will say methadone saved my life! Originally addicted to pain meds for years, since early teens. Only did heroin (no shoot) because it was much cheaper then “legal opiates”. Anyway, I switched to Suboxone almost a month ago. I was on 60 mg meth for last few months then dropped to 30 mg week before, then took no methadone for 2 days before 1st dose of 8mb of Suboxone. I knew I would go through immediate withdrawal because I did my due diligence and researched on my own, took no one’s personal experience or advice to serious. It all depends on positive attitude, readiness, and a few days off work or long weekend. Long story short, the first night, maybe 30-45 after first dose (sublingual film) I stared withdrawal but nothing like I thought it would be or remember from w/d of oxy, p-dan, etc. Not that bad at all. I expected the worst and had prepared ahead of time. e.g. empty stomach so no diarrhea or vomiting, blankets for cold \ hot sweats, and ambien to help sleep. I do not recommend taking ambien often. I stopped taking after second night. Again…long story short… I feel GREAT on Suboxpne!! One month and no regrets!! I have a clearer mind, more energy and don’t feel any cravings, etc like I did on methadone when time to dose. My DR said to take 8mg 3x daily. Morning, noon, night. After first week, I never took 3rd dose and sometimes only need 1 a day. So next time I see DR I’ll ask we drop dose to lower amount.

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    • Excellent! Thanks for this positive report.

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    • Posted by stephanie on June 6, 2014 at 4:25 pm

      omg your post really has helped i have been on methadone for 6 years at a dose of 30mg, i just took a suboxone for the first time this mornning, after not dosing on methadone for 49hrs, i feel ok i think? if i was to get withdrawals would i have gotten it by now? its been 7 hours since taking suboxone, if anyone know i would appreciate it, because i am feeling fine and i cant believe it thanks

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    • That’s cool to hear your positive results. I’ve been on methadone for a little under two years. I was a needle-shooting heroin addict for 18 years and methadone enables me to live a normal life (my own apartment, a job, hobbies) rather than being homeless and strung out when I’m not in jail.
      I had taken bupe in all its forms (on the street because the onerous licensing and prescription limitations were ridiculous) and did very well over periods of several months. I had no desire, and still don’t, to take a dose higher than four milligrams per day (half an orange stop-sign / half a strip). To me, bupe feels like methadone mixed with a stimulant or antidepressant or something, which gives me a great attitude and outlook. But anything over 4mg wires me too much and is just unnecessary. The common practice of prescribing 8mg three times per day is baffling to me and I’d be bouncing off the walls after one 8mg dose. My clinic also does bupe but I haven’t discussed it yet with my methadone counselor. I’m sure that the prescribing doctor will be cool about me not wanting to dose more than 4mg per day of bupe.
      I know from several experiences how rough the transition is from a regular opiate habit to bupe. Transitioning from methadone seems even scarier but I feel that it would be worth the time it takes to do it right (tapering down low, maybe 20mg or less first).
      My motivation to switch is almost entirely because of weight gain. Despite regular cardio and trying to be active too, the weight slowly adds up. I’m about 30 pounds overweight. For me, it’s methadone’s only drawback.

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    • Have been on methadone for 11 years I’m a big guy weigh about 320 I just switched to suboxone yesterday was taking 40 me of methadone for 9 years I weighted 50 hours before taking 4mg of sub withdrawals got better in a couple hours so I took the rest of my strip to Al of 8my I feel a little bad but nothing like I was feeling before taking the suboxone

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      • Posted by Zakkary Palmer on March 3, 2017 at 7:52 pm

        Hey man I’m currently At 35 mgs of meth and was wondering if 48 hours will be long enough to take2mg sub?? Would that put me into precip?? Know that I’m5’6 130 pounds worth a very fast metabolism!! Please help let me know!!!

      • You need to discuss this with your doctor.

  7. Posted by jacob on February 19, 2014 at 4:06 pm

    Ok here is. The real deal….I’ve been on 75mgs…for 18 mths…methadone that is…..I decided to switch for financial purposes my last dose of methdone was on a Friday.went to sub dr on Monday he wrote 25 subutex I started them on Tuesday. I tried to wait as long as possible before I took them it took almost 48hrs before the withdrawals to subside…I am now almost two weeks in and feel fine I will go back to the dr Monday to start the suboxine……there is really no euphoria on them my best advise is to be patient it will work if you want it too

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  8. Posted by april sprague on April 19, 2014 at 1:28 am

    I switched four days ago. Was on 60mg methadone. My doc didn’t tell me to wait and I suffered PW s for two days. Its day 4 and no more Pw s but I haven’t left my couch hardly at all. Will I start to feel better??

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    • Hard to know; everyone is different but I had a patient make the switch from 70mg (I thought he was on 40mg) and he had a rough time for about 7-10 days, but each day got better. He actually did very well, tapered off Suboxone completely over a year or two and to my knowledge is still off opioids.

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  9. Posted by kay on May 25, 2014 at 5:05 pm

    Hi I switched from 25mg of methadone on 28th April and had expected to do a suboxone detox over the space of a month. After 2 days we realised I was taking 2mg tabs instead of 8mg so the most I tapered upto was 8 mg. I had a great experience with them. I was so anxious about taking them. Today I have had no dose, my last 2 mg tablet was taken 48 hours ago and I have been told that I will be fine. Maybe just running nose, feeling a bit anxious. I hope I don’t have much more to come. Expect the worse and hope for the best. Just wanted to share my experience.

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  10. Posted by leeann on May 26, 2014 at 11:39 pm

    Ive been on methadone for 3 years highest dose was 105mg over the 2 years I tapered properly onto 25mg. I just recently did the 3 day withdrawal and it wasnt nearly as bad as I thought. I drank lots of gatorade, took vistaril 50mg and clonidine 1 mg and trazadone at night. Im now today on my se ond day of taking suboxone 8mg twice a day but I dont plan on staying on it longer then a month. I only went this transition because I cant handle months of post methadone withdrawal because I did it once a few years ago. Does anyone know if its possible to taper properly off subs within a month and avoid both withdrawals? ????

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    • Again, it’s not only the getting off of the opioids that matters…it’s the staying off.
      Studies show a high relapse rate for patients who take suboxone for a month or less, but it sounds like you had treatment for a few years. Please talk to your doctor and counselor and let them serve as your consultants regarding the timing of your taper.

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    • I have been on methadone for 13 years and I went from 200mg to 30mg I want to do something. I lost both legs and 96 surgeries after a car accident plus I have Lupus, I want so bad to get off methadone and try subox, Can you suggest anything? I am sick of the methadone controlling my life.

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  11. Hello I came across this blog and its made me feel alot better. Im still trying to find a suboxone medicaid friendly doctor who will take me.i think my biggest fear is going days without my medicine.i have severe anxiety. Not being treated due to methadone. Ive tried several anxiety medicaitions and nothing has worked or even strong enough since my doctor wont prescribe klonopin which is the only one ive found to actually help hut since on methadone its a no go.so hopefully soon ill find a doctor and the courage to switch. I been on methadone 3 yrs now and my highest dose was 160 which was 2 months ago and dropped to 24 mgs as of now and im great. But the continuous drop will eventually im afraid start to get to me and I work in extreme heat and want to be ok to manage work and my 3 kids safely. I only plan a short term sub. Use hopefully. But after my lomg ramble thanks for this post.

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  12. Posted by Jordan Fenninore on July 8, 2014 at 8:41 pm

    Hey everyone.. Stumbled on this page… I am currently on 90mgs and plan to drop to 30mg over the next 7 days. I had a private doc write me a script of Subutex for the first two weeks. Then I will be prescribed suboxen films after … I haven’t made the switch yet, but I was wondering if skipping days ( dose w/ methadone one day- not the next) would help my transition. I have been one methadone this time around for 4 months only.
    I would like to just “walk off” the methadone clinic , and just wait as long as possible before taking the Subutex…. Considering I have been on methadone such a short amount of time, do I have a better chance at a rapid detox off from methodone? I really want off this juice farm, but don’t want to set my self up for failure .
    How low do I “have to be” before walking off?

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    • Posted by Brad Cain on September 16, 2014 at 1:10 am

      You’ve already set yourself up for failure by finding a Dr who will break the law by prescribing you Suboxone when you have a prescription for methadone.$ months is laughable. I’ve been clean on methadone for 11 yrs now; been on it since 1985. So find out your self. Don’t walk off anything.

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  13. Posted by dawn feeley on September 30, 2014 at 2:26 pm

    I have been on methodadone six yes got down to 30mgs we to the suboxne doc took it after waiting three days and it was so bad. So I went back to the methadone I wanna switch but I can’t find a doctor to give me subutex for a few days really scared but I got to do this just don’t want to be back in the er again.I’m single mom with two kids and one is special needs so i can’t be withdrawing

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  14. Posted by Greg on October 22, 2014 at 9:47 pm

    Hi ,I have been on methadone for 7 years. I was stable for the last 4 years at 33 mills. I am going down 3 every 30 days. I am now down to 27 mills. Should I go down 3 every week to every two weeks… or keep going down 3 a month. Also, where would I go to get the meds talked about above. I just really want off this stuff. I can say methadone saved my marriage and my life. I live close to Wichita Kansas. Thanks for your ears and any help anyone can provide.

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    • I really think the slower, the better, unless you have a time limit for some reason. Keep up the good work and talk to your doctor about how you are feeling.

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  15. Posted by lannie on October 28, 2014 at 10:25 pm

    This was helpful. Im very upset with my treatment center. They switched my dosing time from mornings to afternoon.I cannot function now in the mornings, ive became severly depressed, im experiencing withdrawal & craving something for pain. It has made me gain tremendous weight because I have no quality of life by the time I get my dose ive been so ill that when I finally get relief my days over and I have no life. Barely shower or feel like getting dressed. Im in hell. I am angry at myself and really angry at the clinic because I was doing wonderful before they switched my dosing time. I was on my way to a real recovery and was able to finally see a future for me. I know it’s supposed to last 24 hrs but I also do have chronic pain and stiffness in my joints & lower back. Ive got lupus on top of that. So I really do need my medicine first thing in the morning. Ive tryed and tried to make it work because they say its a mind over matter time thing. Which offended me so bad. Its been months now that they changed my time and my life is completely different I cannot get use to it. I feel like I have no hope and that I only had a tease of recovery. The clinic will not listen to me. They treat people like criminals there. I came for help on my own accord and pay them all THIS money to

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    • Why can’t you dose in the morning if that’s what works best for you???

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    • Posted by Sick on February 8, 2018 at 5:11 pm

      You must live in Detroit too, because they don’t help anyone here. I was so sick from the flu and couldn’t get to the clinic to get my methadone so in 3 weeks I’m down to 8mg/day now from 160mg and I’ve been taking met since ’06. I want to go back to suboxone now that they’ve had enough time to figure out how to dispense it (my doctor back in ’05 didn’t know anything, as I was his first patient and stopped me after a few weeks. Thanks to him, I couldn’t work because my chronic back/neck pain was back.) , but not if I have to go through the hell of another one of these “parole office like” clinics! Hearing about the possible withdrawals from switching too fast can’t be worse than what I’m going through now. I’ve been throwing up for a few weeks now and can’t sleep. Only now it’s not heroin so I have no idea how long this will last

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  16. Posted by shayla gay on November 15, 2014 at 4:16 am

    I know this is going to sound like a broken record but I am on 30 mg methadone now and on Monday I am going to this place where they help me with withdrawls for three days then give me subutex…I am so freaking scared because I had a bad experience with the suboxone before…a so-called friend gave me a 8 mg sub and told me it would make me feel great and to take it the next day after I dosed at 60 mg methadone and I literally have never been in such a hell on earth before this. I was in extreme w/d for hours…I mean like not being able to make it to the toilet. Please…anyone who has person experiene, good orbad, I am all ears.

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  17. Posted by shayla on November 16, 2014 at 5:48 pm

    So it’s Sunday. I go tomorrow to start my three day withdrawl. I am nervous and scared. I will post my day to day from then on.

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    • Posted by SpeechieVicki on November 27, 2014 at 7:28 pm

      Shayla,
      How did your “switch” go? Are you doing OK on the Suboxone? Any advise to others looking to make the switch?

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  18. Posted by john5tra on November 30, 2014 at 3:31 pm

    hi I have been taking 40 mlgs of methadone for 3 weeks and just took my 3rd and last 5 mg dose on a cascade order decreasing 5mlg every other day and I am fine would like to know what to expect next I see the Dr. Tomorrow and had a bad experience with subs in the past was in pw’s for days please respond .

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    • I’m sorry but I can’t tell you what to expect – please keep your doctor’s appointment, and be honest about how much withdrawal you are feeling. You don’t want to start buprenorphine, if that’s what you are planning, unless you are in at least moderate withdrawal.

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  19. I was on MMT for a little under 10 years and aside from being on too high of a dose, I was stable (not using heroin) At my family’s urging I went to a medically supervised detox facility – they stuck me on suboxone and now I’m paying out the nose to fill my prescription each month. It’s not economically feasible for me – do you have any advice on the best way to switch back from buprenorphine to methadone? I’m just curious as to what the time frame/machinations I’d be looking at. I truly feel that switching would alleviate so many of my financial worries. I pay 245 a month for private insurance, my doctor visits are 45 and my co-pay for suboxone is $100 – in my county, methadone is 9 bucks a day. Aside from my addiction problems, I am in peak physical health and have a very high metabolism. The family (ex-wife) is no longer in the picture and my new wife supports whatever decision I make. Any insight would be appreciated

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  20. Posted by Trudy on March 2, 2015 at 2:06 pm

    I have been on Methadone for 18 months. A year ago I was @ 100 mg, I am now @ 23mg. I’m woundering how many days do you have to be without method one before you can take suboxone?

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  21. Posted by Mike on March 14, 2015 at 2:57 am

    I have been on methadone for 4 years. For the past year I have been tapering. I am moving and there are not any clinics where I am going to be. I have to switch to suboxone then find a dr that prescribes it out there. I am on 50 mils and have been been for 2 weeks. Before that I was on 60 for a month or so. What is the best way to switch. I have the 4mg suboxone films I don’t know how long to wait and how much to take please help. I’m really scared

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    • I think you have it backwards. Please talk to your doctor, and make the switch the right way, under a doctor’s care. It’s more likely to go smoothly.

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  22. I made the switch from methadone to suboxone and it definitely wasn’t easy, however I’m extremely glad I did. I didn’t realize how numb methadone made me. I became very complacent and didn’t even realize it. I was okay with things I normally wouldn’t be okay with… now I’ve got energy, an appetite, a libido, and my awareness back. My experience is as follows:

    I was on 40mg of methadone daily for about 3.5 years. I decided to switch to suboxone. I stopped dosing cold turkey and lasted 6 days before I gave in to suboxone. I had delusions of grandeur that I could just kick everything for good. After the 3rd night in a row of uncontrollable spinning in bed, no sleep, no food, no energy, sweating like crazy, cold and then hot flashes, extreme anxiety and depression… I decided suboxone was a good idea for the time being.
    On day 7 in the morning, the doctor induced treatment with 2mgs to start and within 15 minutes I was able to be still enough on the exam table to get a few minutes sleep.

    Over the next few days I titrated up to 12mgs, then back down to 8mgs on day 5.

    I will say that in the beginning, I could feel when the suboxone would run low and it felt like the methadone was still seeping out of my cells. Hints of withdrawal would creep in, I would go from being happy, easy-going, and serene to anxious, irritated, and lethargic/achy. This lasted for about two and a half weeks. That leads me to believe that the suboxone masked the withdrawal symptoms from the methadone, but when the suboxone ran low, the methadone withdrawals were definitely there. It was a very weird feeling. I was almost bi-polar in my moods during that time and thus it was very difficult for me to work through. I knew that I was working towards something, but it was definitely a struggle.

    On a random note, my appetite came back with a vengeance, but mainly at night.

    Now it’s been almost three months on suboxone and I feel like there’s enough of a store built up on my receptors. That makes me feel comfortable and weary at the same time. I’m hoping that I’ll be able to ween off this within the next six months.

    If anyone has any questions or just wants to talk about what it’s like for them feel free top email me. Jcsnyder415(AT)gmail(DOT)com

    Best of luck to all of you. We all share the same pain, but we can also share the same love.

    | | | | ||||| Jon

    Reply

    • Posted by teresa on March 3, 2016 at 4:39 pm

      hey jon.i had the same thing happen..i did a 3 day detox then went on 8 mg sub I was so sick ,then I kept feeling like you described,with the methadone withdraw feeling ..im on week 2 and still fighting that feeling.at times I feel great at times but real bad at times as well, how long did you have this feeling last and what doesage sub do you take?

      Reply

  23. Posted by michelle on May 27, 2015 at 4:29 pm

    Ive been tapering down for the past few weeks rapidly by four mgs each day and am now down to 42 mgs from 155 mgs of methadone.im going to see a doctor for subs on nxt wed.because i did great on that for years before and methadone has not been helping me much.i dont feel like myself anymore.im fearful..im tired and ive dropped over sixty pls.as a single mom im desperate to get better for the sake of my child and myself.i feel methadone is not for me.i can describe it as torture.this is what comes to my mind.it seems the clinic doesnt care about me one bit.if you dont have money or loving famiy you are alone.thats what i feel.ive called evrryone i know and noone will help us while im withdrawing
    Its very terrifying now because my childs dad demanded that i quit methadone.he expects me to FEEL JUST FINE!! SO.WHILE HE HAS WENT OUTTA TOWN TWELVE HRS AWAY FOR TWO WEEKS TO WORK..IM ALONE WITH A TODDLER AND MUST WORRY ABOUT GETTING THE HOUSE SPOTLESS BEFORE HE GETS BACK AND MY SWEET BABY IS VERY ACTIVE SO ITS NOT EASY AT ALL.i feel.tons of weight on my shoulders as its hard to find strenth to do anything.ive asked my clinic to help us as i want a detox that accepts moms with kids and of course they do not seem to have but one offfer.go back up on my dose.i am already feeling wdrawlz.i shake sweat and just feel like death and itz like my body is falling apart on me im a sick woman.i envy all the posts as people seem to be able to clean house and do homework and they THINK they are in withDrawal.lol.ok.i pray that this disease never does finally take over their body.i laid in the floor with drool coming outta my mouth the day before i got on methadone..i think many have no idea yet just how bad it will get if they do not get a handle on it.i am desperate.i called my doctor and ill have to be without for days before sub induction jun 3rd.i think that its fair to say methadone is the worst ride of my life and now the clinic admits itz much harder to come off of than heroin
    My plea iz please never start it if you are at all able to function
    When you misx payment and cant dose you will be sick folks.i pray to make it .i feel so alone in life now.i wish the staff in these clinics gave a damm.i am only speaking of my experience.i know their are better clinics and some are actually there to help.but im just a number.id do anything to be able to afford daycare or pay a person to become our family for three days.when you are poor life is very lonesome.no money is a bad place for me now.i just think that itz a time ill need help with my child.i am wondering if i should stop dosing on sunday morn or mon morn
    To get on subs at five thirty wed eve??im telling you ..im uncertain because i feel.each morning that im already in full withdrawals and some days i wonder if im actually about to die.this is a severe situation.i heard that the other sub docs dnt make you actually quit .theyll start subs at 30 mgz of methadome especially not wanting ypu to stop if already in severe enough withdrawals.so.
    .im wondering what i can do
    Also..subs are actually covrred my medicare amd medicaid.dnt pay hundreds a month for long at a climic.search for a private psych dr who is also lisenced sub dr and understamd that some clinicz say amything to leave you hopeless and dependamt pn them.they need ypu.ypu are their income.pls do not give us folks.methadone should b just one option as its clearly not for everyone.i wouldnt wish it on my worst enemy if i had one….to feel any of what i am feeling right now.im so afraid.

    Reply

  24. Jana do you have any experience with shifting the patient, that is on a high dose of methadone, to another opiate with a shorter half life, leave them on that opiate for some period of time and later allow them to have a shorter period of detox prior to induction of the buprenorphine? We’ve considered this with some patients, who have a tough time getting their methadone program to bring them down to the 30mgs. of methadone and/or can’t seem to manage the four days that we, typically, wait.

    Reply

    • No, I have not done that. Since I treat patients with addiction I worry the patient won’t be able to take the short-acting opioid appropriately, will use it too early, and end up in withdrawal. Plus, it’s against the law to prescribe anything other than methadone or buprenorphine for the purpose of treating addiction, so there’s that.
      I also worry about rushing the process; if someone is on a usual dose of methadone, meaning range of 80-120mg, I think it’s smart to bring the dose down slowly, say by 5mg per week down to 40mg to make the switch. If the patient wants to try buprenorphine, I’d advise doing everything to ensure the switch is successful. Crash-tapering methadone over a few days to weeks isn’t usually the best way to go.
      Once the patient is down to 30 or 40mg, I don’t think you need to wait more than 72 hours. I have the patient miss dosing on Saturday and Sunday, see them Monday to see if the withdrawal is at least a 12 on the COWS (clinical opioid withdrawal scale) and give the first dose of buprenorphine.

      Reply

  25. Posted by Anjana on July 4, 2015 at 10:10 pm

    I tapered down from 50mg to 35mg methadone in one week. Now I’ve been without methadone for 5 days but have had heroine to stay comfortable. Can I start Subutex now?

    Reply

    • Sorry, I can’t play doctor over the internet. Please talk to your doctor. You do have a doctor, right??

      Reply

      • Hi , I just needed some input on my situation. I’ve been on Methadone going on 11 yrs now. I’ve weaned myself down to 12 mlg. My Mental health team is trying to get me started on the Subuxone. Can you tell me how long I would have to wait to switch over to the Sub. ??

      • I can’t say specifically because each patient is different. You need to ask your prescribing doctor this. I can say that in general terms, patients can switch from methadone to bupe if their methadone dose is less than 40, but they must skip a few days in order to be in at least moderate withdrawal prior to the first dose of buprenorphine. In most cases this means missing at least 2 days of methadone.

  26. Posted by lindy on August 17, 2015 at 9:42 am

    Hi I’m methadone I was on 100ml in Feb and nw im on 50ml and I want to go onto subtext and not sure which dose I need to be on to switch over

    Reply

  27. Posted by Ashley d on September 7, 2015 at 12:57 pm

    Today is Mon and I will be starting sub wed after being on methadone for a year. Its helped me as far as drug use but made me so sleepy n sluggish. I hate it its also made my nerves awful. I’m praying that the other helps me so much better.

    Reply

  28. I’ve been on methadone for about two years. I’m detoxing at 10 mg a week from 85mg and ill be down to 35mg tomorrow. I’m going to dose at that mg fri,sat and sun. I’m not going to dose mon,tues or wed. then ill transition over to sub. I’ve went five days without dosing one time and did a little piece of a sub and it sent me into the worst and weirdest wds. my question is. will i be to sick to pick my kids up from pre school and middle and my wife from work. methadone has changed me into a boeing person over the time. i barely have a since of humor or social skills. i used to be the loudest person in the room. no I’m the quietest. on top of all that I’ve turned into a fat ass. gained 60 pounds and eat nothing but sweets after sweets before bed. i just want to know if ill feel as bad as i did before doing the sub on methadone

    Reply

  29. Posted by T peer on October 14, 2015 at 9:26 am

    Hello there- it looks like you have pretty knowledgable and responsive forum here. I have never posted a question or done anything other than read information(and in this regard I have been very active). I commend you for the tireless and often frustrating efforts you are involved with. I have taken sumo one for a year at a time twice. Both times it was very helpful also both times after about a year I’ll say that my efforts began to wane. Nonetheless fast fwd to now. I have been taking methadone for the past 3.5 years at a stable dose for about 4 years. And I feel it is important to say I have had zero revisits of former bad habits. Recently I initiated a step down, sometimes 2 mg a week sometimes more sometimes none but the clinic I was associated with began some unrealistic expectations. Long term relapse prevention meeting that wasn’t set up yet before continuing and other frustrating progress halting stipulations. So after being rapid detoxes from 78mg to 58mg and then successively -10mg a week until 18mg. At this point which was last wed,s I started the sub film treatment. I feel that it is saving me from some worse version of discomfort and the past two days have been a bit more pleasant than not, however I am very uncomfortable and I visit my new dr for these meds today since we are on a weekly basis but his communication skills are a bit green and his experience seems to be the same. I feel pretty educated on the chemical differences (partial vs full etc) but my question, and it would be so very helpful to hear what an educated and experienced mind has to say on this, as once again, I am not impressed w the drug forums and the competitive non pro feedback there. Side note: I am very close to opening the doors of a new business. I have 3 kids a wife and lots of stress. I think I am handling this pretty well but I am scared and tired. My body and mind are exhausted and I am frustrated w the horribly inconsistent effects of 8mg’s of sub/naltrexone and my doc doesn’t seem to have much experience in metha to sub. Have u experienced this w patients in similar situations? Can I look forward to the effects becoming more consistent as the methadone completes its tour of my physiology? I appreciate any response as a comfort in this trying and poorly timed situation I am in. Once again. Last two days much better past day which is into tomorrow now-no sleep-very very uncomfortable. I am also taking busbar for anxiety to supplement from my family dr whom is aware as well of my situation. Is there an effective anti anxiety remedy or “comfort med” that would be more effective since benzo class is considered a deadly and big no no w insurance here supplemental medication? Thank you so very much for your time.

    Reply

    • I’m a little confused – you have switched over to buprenorphine and are off methadone at this point? What is your dose? If you are still having withdrawal you can ask your doc about increasing the dose.

      Reply

  30. Posted by T peer on October 14, 2015 at 9:27 am

    Auto correct changed sub to sumo. Fyi

    Reply

  31. Posted by Jenny on October 30, 2015 at 8:44 am

    Dr. Burson,
    About 4 years ago I moved from the Midwest to California. I was 40 years old and had no previous drug problem, in fact when I got here I hadn’t even smoked pot. I was assaulted by a neighbor and he really hurt my back, which is why I started taking pain pills. When the doctor wouldn’t refill them, I was in so much pain I could barely walk. A “friend” talked to me about heroin, how it gets a bad rap, that you have to use it for months to get addicted, ect. She said nothing about getting dope sick or abscesses or the fact that it’s a felony. I tried it, and I used it every day. I really could function. But then I ran out of money and found out just what dope sick really meant. So I went on suboxone, did great on it, but my back pain was so bad, I went back to heroin. I was an addict for 8months, spent $4,000, and ended up in the hospital with 6 abcesses and blood poisoning. I finally admitted to my doctor what I was doing and was placed on methadone maintenance, 100 mgs a day for exactly one year almost to the day. Then I get a call from back home…my sister had just gotten a pacemaker after an unsuccessful ablation for a-fib, and my grandmother got gangrene in her big toe and had her leg amputated. So I’m on 100 mgs mmt and am needed home immediately. There is no clinic within an hour and a half from my grandma’s, and no car there for Mr if there was. So instead of dosing down 2-4 mgs per month, I began to dose down 4 mgs even other day, till I got to 46 in about 3 weeks. I was so so sick, I can’t tell you. I went back in and asked them to put me up 10 mgs and hold me there until my appt with the sub doc. He told me to go 72 hours before using the suboxone films. I thought it would be no problem, because I metabolize fast. But I am now 70 hours since my last dose, and although I’m in pain and feel crappy, I’m only a 17 on the COWS scale. I’m doing this myself. my plane leaves in two weeks. My question is, I know what severe withdrawal is and for me, it includes pretty frequent bouts of vomiting and diarreah. I’m afraid to give myself the suboxone too soon, because I know what will happen. Should I wait another day or two? Remember I quit the clinic 3 days ago at 56 mgs. Can I ask you what number you would suggest I get to on the COWS scale? My grandma is dying; my objective is to get on that plane feeling ok. Any advice for me?

    Reply

    • Well, I’d go with what your doctor told you.
      Personally, I would have suggested you try to get some take home doses from your methadone clinic before starting such an abrupt taper, but the situation being what it is, I guess that wasn’t an option.
      In the studies where patients are induced onto buprenorphine, a COWS of greater than 12 was predictive of an uncomplicated transition, even for methadone.

      Reply

      • Posted by Jenny on November 1, 2015 at 9:37 pm

        Thank you for reading my post. When I got the suboxone the first time, it worked really great for me. But I wasn’t on methadone then and I had a wonderful doctor. He evaluated my withdrawal symptoms in his office and then watched me as I took the first dose. He watched me for another hour, then sent me home. This new doctor I went to see…seems a bit fishy to me. I had a weird vibe and he talked about himself the whole time. Anyway, I knew something was wrong because no one would fill his prescriptions; not my pharmacy, not one of the big chains, but they wouldn’t tell me why. Finally I call his office and they said to go to one particular pharmacy about a half hours’ drive. I went there and they filled it. The pharmacist said that as a condition of his probation, (wtf?) He is not allowed to write schedule 2 drugs and has been shunned from the city’s pharmacies for that reason. I can’t tell you, I wake up every single day and I hate myself for getting involved in any of this mess to begin with. I have no desire to get high, no desire for the lifestyle that brings. I just wanna be clean.
        Anyway, I waited until day four (97 hours into withdrawal) and finally called the nurse helpline because my doctor wouldn’t receive my calls. I took the suboxone yesterday and felt a little better but still awful bone joint pain. Today, even better. I was a 26 on the COWS scale. I still don’t feel good, but hopefully evert day will get better. Thanks for listening, and for being there.

  32. Posted by Janelle Schmidt on December 7, 2015 at 3:41 am

    Hi I have bed on methadone for 14yrs. I am 33and I can’t take going to the clinic everyday. I want to switch to subutex thn subxone. I scared of withdrawal. How can I switch and what can I take to ease withdraw l I heard about withdraw ease but its expensive n I don’t know if it works?! Please helplease help me get on to suboxone from methadone.I would appreciate everybody’s feedback.sincerely Janelle

    Reply

    • I don’t have much else to say other than what’s in the blog post. Most people don’t feel great while they are tapering, but most feel OK enough to be able to go about their usual activities. You can also ask your doctor to prescribe clonidine, a blood pressure pill which can block some of the bothersome withdrawal symptoms.

      Reply

    • Posted by Vicki H on December 10, 2015 at 11:56 am

      Hi Janalle..Do you have a sub doc appt? Often they will offer free phone consult and explain their “switch” transition process before your initial induction appointment. Personally, I was on methadone for 10yrs. I was so fearful of switching from methadone to subs and it took me 4 YEARS to go down from 75mg to 35mg! I stayed at 35mg for 7 days then took my last 35 mg dose on a Sunday. Advil on Monday and on that Tuesday morning I went to my Suboxone induction appt. Transfer was smooth and unexpected. I did a cartwheel in the doctors parking lot as I left. And admittedly..I’m too freaking old to be doing cartwheels!!
      I was so mad at myself that I had waited so very long in fear…Please find a doctor, you CAN do this!

      IF YOU FIND YOURSELF IN HELL…KEEP ON GOING! -Winston Churchill

      Reply

  33. Posted by Melissa on February 3, 2016 at 1:48 am

    I have been going to a methadone clinic for 3 years and am on 60 MG a day. I went to a dr today to try suboxone, he gave me enough for one week and an appointment in a week. He told me to start the suboxone Fri (72 hrs from last dose of methadone) Is 60mg too high to transition from?

    Reply

  34. Posted by Chris jamez on February 9, 2016 at 7:13 pm

    Hello. I’m an opiate addict, was on mtd.for about nine months this time around and stable between 85 – 110mg.. However unfortunately my job is seasonal, I have no insurance and had been paying cash @ $125 a week, long story short I wasn’t able to pay for three weeks and was put on a seven 7 day rapid detox for this reason solely… My last dose of 18mg was Saturday, today is Tuesday, I couldn’t hack the pain from a serious back injury which occurred over ten yes. Ago, plus the withdrawal… I have a few subtex tabs, but scared to take too soon, based on a previous bad experience with mixing the two too soon… I used fentanyl and four bags of dope today and yesterday… My main question to you is When this heroin Wares off and I’m in full withdrawal has enough time lapsed to start the sub’s? I was on suboxone seven to eight yes. Ago and flourished for the eighteen months I was on it.however w no insurance I have to obtain them illegally for time being.. How many mg.should I start with? How many hours after opioid.. Pain pill use do I have to wait to start first dose? what is recommended first dose? Please help me..I don’t wNt to use any more opioids than I have because I’m setting my self up for a mtd and pill/heroin detox and I don’t want that or any part of the life of running again…please rep!y t.y.

    Reply

    • These are questions best answered by a physician who is familiar with your case. I am sorry but I can’t give specific medical advice – only general medical information.

      Reply

  35. Posted by teresa on March 1, 2016 at 5:20 pm

    I went on a fast detox bymyself,from about 75mgs methadone, waited about 3 days then took 8 mgs sub went in wd very bad…im not sick but not feeling good,my mood is bad and hot cold sweats..what is your opioun on how I could help this prosess..ive been taking 2, 8 mg subs for about 5 days now?any advice is great..

    Reply

  36. Posted by Hmeow on March 8, 2016 at 3:23 am

    I’m currently on 135mgs of methadone and want to make the switch to subutex, not suboxone, so I can move. But there is no time for a taper down to 30mgs and I know I would relapse far before I got down that low, would a larger dose of subutex perhaps help? And I thought there was.no blocker in subutex so that one on methadone could safely use it?

    Reply

    • Please talk to your doctor and make the switch the right way.
      The blocker, naloxone, isn’t absorbed when you use it under the tongue. It’s used to prevent people from injecting this medication.
      The buprenorphine has less of an opioid effect than methadone, being a partial agonist. But it has a higher affinity for your opioid receptors, so when you take the buprenorphine it will replace the methadone at receptor sites. Replacing a full opioid agonist with a partial opioid agonist can cause precipitated withdrawal.
      Trust me. You do not want to start buprenorphine fresh from 135mg of methadone.

      Reply

  37. Posted by Dan on March 8, 2016 at 9:22 pm

    I have taken suboxone on methadone
    With no ill effects

    Reply

    • Posted by Jeff on October 9, 2016 at 10:37 pm

      DO NOT LISTEN TO THIS FOOL. if you take an opiate and plan on taking suboxone you need to wait until your in almost full withdrawal from the the opiate that’s still in your system if you take suboxone to soon it will put you through living hell a sudden wicked bat out of hell withdrawal will happen in less than 20 mins that will make you flip out and it will last a good hour or so as the suboxone is fighting to rid your body of the opiate.

      Reply

  38. Posted by joey rubalcava on March 10, 2016 at 1:57 am

    oh wow wish i would have read this yesterday, loong story short had probledms on md fom a head injury, they said it was not the md of course so i quit goig my head felt great! but i was so sick i was on 95mgs and went a few days drinking a few sips from my take hlome i run out after a week n was trying to get drugs, but i said no way suboxone i was on it b4 it was great, i took it last night 8mgs felt good n was falling asleepn then bam was sick so i putn2 more * 8mgs of subs n wow, never been or heard of no one being so sick i was gonna call 911 but didnt want to go anywhere i was so sick i just wanted a gun to blow my head olff, but i took 4 mgs clonidine 6 mgs of clonzapam and 100mgs of doxipine lucky it was so much it knocked me out but now im scared to take more subs i feel like it was all the md leaving my sytem, im sick but nothing like kast night what should i do? go back to clinic or take the subs ?

    Reply

    • Please see your doctor ASAP.

      Reply

      • Posted by Joseph Rubalcava on March 10, 2016 at 10:15 am

        Thank u for the fast reply, I wish all people actually cared as much as u do, but I can’t offered to c my suboxone dr until next week, I want to go to the md clinic and just tell them to give me 30mgs, but I’ve only saw the dr there once 9 months ago! I have hepc and read that I should have been on a dose about 120mgs and what was strange I went from being on16 mg of sub to the me
        D clinic and they wouldn’t let me past 95 and I was still sick it felt the same as 60 mgs, but I was taking 120mgs of brand name non racimic mixture 5 years after my head injury no problem, I went to prison 2years was sick 11 months and PO made me get on subs n I did great never dropped dirty had job everything, now the cherry methadose they have don’t feel like methadone and wears of fast some days and hits u so hard other days and never last 24 hours, but my question is if I go to the md clinic will I get in trouble for having the suboxone I’ll bring it in and talk today but they need to switch there md or at least for me and I’ll pay whatever cuz after stopping there methadone my head stopped hurting and I stopped fainting and blacking out I almost died! But I’d rather b a lil sick then die off of md or going through sub wds from md in stem, ty for ur time ur the first dr that I felt actually cares 🙂

  39. Posted by Tony on March 14, 2016 at 5:11 pm

    Hi Dr., I have been reading all these posts left here and some of them are just plain confusing. If I am understanding correctly, the “average” dose to switch from methadone to suboxone should be around 40mg. Is that correct? I am currently stepping down from 90mg methadone. Today I have started at 80mg and next week plan on going to 70mg and continuing to decrease by 10mg each week until I get to 30mg. At that point I plan on switching to suboxone. I am being supervised by an orthopedic doctor and a private clinic. I have a prescription for Xanax 0.25mg prescribed 3 times a day of which I don’t take it but twice a day. In your opinion, is this drop too fast? I also plan, when I get to 30mg, to dose on a Friday but not on Saturday or Sunday, switch to suboxone on Monday morning at 4mg and see just how suboxone works for me. Also in your opinion, is that enough time without taking anything to make the transition from one to the other? I ask because it never hurts to get “legitimate” advice from people who have experience with these types of treatments. The internet is full of self-proclaimed doctors who aren’t afraid to post anything and it seems to make the average reader confused about what is really right or wrong. I am a firm believer in doing what your doctor tells you to do but I also believe in doing your own research as well simply because doctors are human too and they do make mistakes as well. I would also like to add to your readers, to not believe everything they read about these types of medications due to so many wrong conclusions given by people who do not know what they are talking about. Thank you for having a very sensible and credible article that people can read and actually understand.

    Reply

    • Doctors have different “recipes” for how to taper from methadone to make the switch to buprenorphine. Your doctor goes a little faster than I do, but probably it’s OK. And yes, I ask patient to skip dosing for two days, same as your doctor.
      If you read my blog, you’ll know I’m not crazy about mixing benzos like Xanax with any opioids

      Reply

      • Posted by Tony on March 16, 2016 at 10:44 am

        I understand about the Xanax and that is part of the reason that I don’t take the full prescription and my doctor is aware of this. I have been diagnosed with chronic pain due to several physical issues which I won’t get in to but, basically got tired of taking pain pills for fear of addiction. I was prescribed pain pills for several years and do believe I was addicted to them. I was told that it was a chemical dependency and not addiction but nonetheless I had to have them. I made the switch to methadone in hopes of stopping several prescribed medications and it has worked out great for me and I do stress for me. You are absolutely correct about some medications working for some and not for others. Have you had success in the treatment for people with chronic pain conditions using suboxone after they made the switch from methadone? I understand that methadone is, to put it simply, a full opiate and suboxone is a half opiate and realize that I am speaking simplistic here, but are the results of treatment pretty much the same? I am also on blood thinners due to several blood clots and this prevents me from having any type of injection blockers and surgeries thus the reason for pain management in the form that I am currently taking. I explain this to show that everyone who takes this medication is not a “junkie” and that sometimes there are not other options for some people. I have seen that there are a lot of people who are ashamed to take these medications due to the bad reputations that they have and that they should not ne ashamed if they are taking these medications for the right reasons. There are more people than you think that get caught up in this vicious cycle not realizing what happened until it’s too late. I have always said “you don’t realize you have been got until you have been got”. Your blog here is the first that I have found that is not only simplistic about switching these types of medications but allows people to actually understand in “normal average reader” style and not language that only doctors understand. Thank you for allowing us the opportunity to be real and make real comments. I know a lot of this has nothing to do with your article on this age but, in another way it has everything to do with it. Thanks again.

      • Posted by Hailee Bruton on March 16, 2016 at 7:03 pm

        I’m on day 6 no methadone and i jumped off at 135mgs. I start subs tomorrow thank God. The doctor made me go a week cold turkey

  40. Posted by jimmy on March 30, 2016 at 1:53 am

    I’m on 10mg of methadone a day for 6 years,on a low dose,can I go straight to subutex without any time in between?

    Reply

    • Probably not, but talk with your doctor. You have to be in at least moderate withdrawal.

      Reply

      • Posted by Em on April 4, 2016 at 4:34 am

        Hi, I have been on 35mg of methadone for a year and in the last month have gone down to 25mg. Today I saw my dr to go on suboxone. I had my usual dose of 25mg this morning and my dr told me to start on 6mg of Suboxone tomorrow morning. I asked if I should wait 72 hours and he said no I didn’t need to wait at all. I feel like I should wait as I can’t afford to be sick with a very active 1 year old to look after. Would really appreciate some advice please

      • Hmmm…I usually say listen to your doctor…I do think current evidence supports waiting until you are in at least moderate withdrawal prior to taking the buprenorphine. That’s not 72 hours in everyone, but usually needs to be more than 24 hours. I’d recommend calling your doctor and make sure he understood that you were on methadone, not other short-acting opioids.

  41. Posted by Tony on March 31, 2016 at 7:55 am

    I have gone from 90mg to 80mg for one week then 70mg for one. I stopped taking anything for two days, like my doctor said, then started Buprenorphine at 4mg. The 4mg went to 8mg the same day and today I will be on 8mg again. I really wish I had gotten down to 40mg or 30mg Methadone. This is not easy at all but, of course it never is. You do have to be in what they call moderate withdrawal, although by the second night I believe I was getting to severe, before you switch. I am no doctor and I do believe everyone is different in that some can do more and some can not. Do what your doctor tells you to do and do not rush as I have. I think that’s part of what has made this transition harder for me was the rushing part but, if my doctor had not thought I could not have done it, he would not have let me. Even taking the Buprenorphine for the first day I was suffering withdrawals from the Methadone. I do feel a little better this morning and was able to get some sleep last night but it was still pretty rough with the sweats, chills, and sleeping for about 30-45 minutes at the time but the sleep was appreciated. I do expect today to get rough this evening but it is only the second day and if I feel a little better on the third day great, if I don’t then I’ll look forward to the fourth and fifth day. My whole point to all of these posts is exactly what Dr. Janaburson tells everyone here. Work with your doctor and do the plan that you and your doctor makes for you, and then stick to it by any means necessary. I also utilize a counselor that works in my doctors office to help people with this and I do believe that has helped also. The biggest part for anyone during any part of this is your commitment to do it. You can utilize every tool available but, if you don’t have your “ducks in a row” first, forget it, it is not going to work. Talk to your doctor, work up a plan of action, and then stick to it period. Success is not measured by the number of steps it took you to get there or the length of time it took to get there but rather the end result of your accomplishment. Stay the course.

    Reply

  42. Posted by Ashley V on April 10, 2016 at 1:33 pm

    I am currently on 160mgs of methadone and was recently given a peak and troph (not sure I spelled that correctly) because the doctors thought I was a good candidate for split dosing, What are your thoughts on split dosing? When I was around 100mg I had blood work done and my levels were around .28 and I guess the therapeutic dose levels are around .4-.6. I really do not want to continue to go up, I’d rather take as little as possible in hopes of switching to suboxone. I am not sure what direction to go but I don’t want to be on methadone for years but I want to trust in the process and set myself up for success not for failure. What should I do? Going to the clinic everyday is a constant reminder of my past and ive been on both Suboxone and Methadone and there is a total difference in my quality of life but now that I’m used to methadone the transition is scary.

    Reply

    • Keep talking to your doctor. If you are thinking about switching to buprenorphine (Suboxone) soon, you may want to postpone increasing your dose. But if your peak and trough show that you’re a fast metabolizer, you may feel better with split dosing.

      Reply

      • Posted by Amber on April 18, 2016 at 2:17 pm

        I really need someone to be honest and tell me if after two days of not taking methadone and I take suboxone will I be in withdrawel??

  43. Posted by Amber on April 18, 2016 at 2:14 pm

    HI me and my husband take methadone and we have been out of our take homes since Friday, we are at 40mg today is Monday if we don’t take anything for 2 days and wed, take suboxone will we be in withdrawel?

    Reply

    • I don’t know.
      I can tell you how I treat the switch over – as I described in the post – but everyone is different.
      I cannot and will not give specific medical advice. This blog is meant to give information to people who need it. You can certainly get ideas to talk to your doctor about. But the decision if you are ready to make the switch to buprenorphine needs to be made by your doctor.

      Reply

  44. Posted by Kathryn on April 25, 2016 at 6:22 pm

    Wow. First of all, thank you, Jana, for your dedication to this blog as well as the methadone community in general. As a 10 yr methadone patient, I can say that it’s always comforting to find someone in the medical profession who clearly cares. Anyway, I have a quick question relating to my upcoming switch from methadone to Suboxone or Subutex. I’m currently on 60mgs of methadone, down from my highest dose of 150 a cpl yrs ago. My taper is – 2mgs every other week, stopping for a month after every 10mg drop. So far, I’ve felt fine, as I’m going as slow as possible. I’ve read that it takes a body about 6-8 wks to notice a loss of 20mgs…not sure if it’s true, but sounds logical. My doctor instructed me to get down to 30mg, then we’ll discuss the transition. I’m the meantime, I’m doing my own research, as this is a major decision. My question is this: do you have an opinion on which is “better”, Suboxone or Subutex? I’ve been clean on methadone for 10yrs as I said, w/no relapses, no triggers, nothing. I have no concern that I’ll ever go back to opiates (I’ve never done heroin, I was an Oxycontin addict for roughly 3 yrs). I’m apprehensive about taking a blocker, because what if I’m ever hospitalized and in need of pain medication? That’s my biggest fear at this point. Of course I’ll discuss this with my doctor, but I’d like your opinion, as you seem very knowledgeable on the subject. Any info you could share would be greatly appreciated. Thanks for your time!

    Reply

    • Most doctors switching a patient from methadone to buprenorphine use the monoproduct buprenorphine (Subutex) for the first few weeks. Most doctors want the patient to be on 30-40mg or less prior to making the switch.
      as far as “takes the body 6-8wks to feel the loss of 20mg…” I think that would be unusual. Most people feel the effect of a dose decrease within five days, so I’m not sure where that’s coming from.
      You are tapering slowly enough that you should do fine.
      Acute pain can be a problem, but usually easy to manage if your suboxone doctor and other treating doctor are able to talk and work out a treatment plan. communication is key.

      Reply

  45. I’m Kathy and need to know how long a 65year old woman should wait after last dose of 40mg of methadone to buprenorphine ? I was at 85 and am now down to 40. I’m solo scared and want it to work and not to take my first dose of buprenorphine to soon!please help!!!

    Reply

  46. Posted by Shannon on June 12, 2016 at 3:15 am

    OK so I really need some advice here is my story with going from drugs to suboxone to methadone back to subs and back to methadone and I would really like the opinion from a doctor preferably the one who wrote the post about change Is good and making the switch ok so I did heroin from 03 to 09 first attempt to get clean with suboxone Dec 09 only took one a day and did good for 2 years (had a few screw ups in thst time thinking I could get high 1 more time but fortunately suboxone did its job and I didn’t get high after a few times of realizing it was a waste I stayed clean 2.5 years later I went thru a really bad time didn’t manage to stay clean wasn’t raking my subs and started using again then I would wakr up wanting to be clean so bad so i would take subs then still use I got to the point where I was literally addicted to subs and dope at the same time and nothing was enuf so i went to methadone gained 40 pounds stayed clean after about 9 months of screwing up here and there but I was so tired all the time and so depressed about my weight gain so I went from 140 to 70 in about 2 months then I was on 70 for like a month then stopped dosing one dsy cuz I had an appt to get back on subs (remember i was at 140 for about 2 years) so I knew I had to put my self in deep withdrawal from 70 mil to start subs and do good couldn’t stay clean so I did oxys for about 6 days to let the 70 mil of methadone detox out of my system then I went one day without anything then started subs from the day I started til the next 11 months straight I never felt right again had the hot cold body temp change constantly had brain zaps the entire 11 months my skin didn’t even feel rihbt to touch like I really felt like I stayed in a mild to moderate w/D the whole time but I had dropped the 40 pounds I gained from methadone in like 5 weeks and I was so happy that I just stayed hoping I would feel better one day that day never came started using again and ended up back at the clinic that experience has made me hate subs when they did me so good before I ever tried methadone but so bad after my question is this since i feel so bogged down all the time and wanna do nothing having very little motivation and hate the extra weight I am carrying around again I want to get off so I went from 125 to 90 in a very slow steady pace like dropping only 10% of my dose onxe a month about to be at 80 mil tomorrow and I will go slow until I get down as low as I can if I wanted to switch do u thinkill have the same experience as before or was before my fault for going from 70 to nothing well to oxys for a week then to subs Afrer a day of nothing like was that a bad switch or is my body just doing better with methadone I just want off methadone cuz the weight number one so unhappy with my self Ya I’ve been clean for a few years but I never wanna do anything I don’t go out or wanna do fun things with my kids and it makes me sweat so bad and not be able handle the heat where subs didn’t make me sweat like this and also cuz I want my life back I’m clean but my quality of life isn’t great should I switch or just come off methadone at a very slow pace I just don’t know if I’m ready to be totally off been on something since 03 I Def want to be off off at some point I just wanna finish my masters degree and get in a good job first, I never will be at a perfect stress free time that is great for quitting it all but Def a better place than I am at now please any feed back would be greatly appreciated thanks Shannon

    Reply

    • I empathize with your situation, but you may not like my suggestion. Your situation is complex, and you need to talk to your doctor before deciding what to do.

      Reply

  47. In 2005 i was in an car accident and started taking oxy 80s and other pills. I was doing for about a yr and a half. Iwanted to get off so i got a bed at rehab but a couple days before i started taking half a methadone pill daily, i saved for getting off. I felt good, i took it for a couple days then went to rehab on that pill. The nurse waited until the next morning to give me subutex. I actually felt it and did not get sick. Everyones saying ull go in withdrawal but i didnt. Ive been on methadone since because i socially thought i could take a pill once but it brought back all the pain. Ill never take another tab again. I didnt know that would happen. I wasted my life on methadone. I really want to be done with it. Ive been on 15mlg now for a month but less than twenty for a while now. Do u think ill get sick if i take subs? It doesnt hold me, barley through the night. I just keep thinking about the past and how easy transition was. Maybe cuz i wasnt on meth long at all?? Idk. What do u think, think im on a low enough dose. I split it too, now on 12 since wed. Six at 6-7:00am and six at around 8pm or later.

    Reply

  48. Posted by clinton r silon on October 16, 2016 at 1:53 am

    hi, I am struggling so. I want to be clean for myself, my life, my career, my family, for Heavenly father. I am on about 80 mg of methadone and I progressed down to that agressivly and I feel fine. I can handle discomfort and even sickness but the depression is something that is difficult cause I have always tried to look for positives. If I took 25-30 mg and then waited for the withdrawals and then went by the cows form could I then take suboxone when I scored the right number. I realize that methadone and suboxone do not mix well and I haven’t been on methadone that long(6months) so in you opinion could I make the jump from methadone to suboxone using the system I just typed out. I truly hope so cause I have waited to go home and see my kids until I am clean. I stay in touch but I want to be without methadone. Please help and I greatly appreciate any advice you can give.

    Reply

    • I have some great advice: don’t do this on your own. Please talk to your doctor and do it the right way. You want to do this in a way that maximizes your chance of success, and also acting as your own doctor is rarely a good idea for a person with addiction.

      Reply

  49. Posted by April Ward on November 12, 2016 at 1:20 pm

    My boyfriend is on 120mg methodone a day. How far dose he have to go down to switch to suboxen and how long dose it take to do so

    Reply

  50. Posted by Vicki H. on November 12, 2016 at 7:38 pm

    In the doctors blog entry it says…”to taper to about 30 or 40 milligrams of methadone per day prior to making the switch. I recommend tapering by about 5mg per week, or more slowly if needed.”

    Reply

  51. Posted by Kelly on January 21, 2017 at 1:14 pm

    I don’t take methadone regularly. I took 4 md tens then 25 hours later took 2.5 md tens. I only take about a sixteenth or so of an 8 mg sub at a time. Before I took the methadone I recently described it had been years since I’ve had any. It’s been 2 days will I be alright to take a .5 mg of sub this morning?

    Reply

  52. Posted by Stacey on March 1, 2017 at 6:59 pm

    I was a successful canidate that switched from methadone to suboxone however my husband has had a horribble transition. He walked off at 43 mgs of methadone 3 full days later tried to take suboxone and went into precipitated w.d in the worst way he used heeoin iv for 14 days and started suboxone yesterday he was “ok” at first one tiny little pieces then took a full half and lastnight same thing. rls insomnia sweating stomach. He waited 12 hrs through all that hell and took 1/8 of an 8mg suboxone hes not better im lost i dont know what to do.

    Reply

  53. Posted by jennifer casey on March 17, 2017 at 4:52 pm

    I have been on suboxone and now I am currently on methadone 90 mg I have been clean and sober for almost 4 1/2 years on methadone but I have never felt physically ill unmotivated, unhappy and downright plagued with a weight issue that no matter what I seem to do I truly feel I gain 2 lbs. A day just for taking my methadone my teeth are literally rotting at such an incredible rate that even my dentist doesn’t know why, my everyday well being and health is 75%of the time poor, and when your family and friends notice how sick you are all the time compared to when I was using and especially towards the end when I was withdrawing more in 30 days then being high absolutely has me wanting to quit methadone cold turkey but I quit suboxone cold turkey 6+ years ago on 2-8mg. Tablets a day when my doctor kept black mailing me for more money or I wouldn’t be able to get my suboxone prescription well I eventually ran out of money and options so I had no choice but for 2 weeks I begged my husband my mother in law anyone and everyone especially God to just kill me and put me out of my misery I have never been in so much pain but then I woke up one morning and just felt good enough to shower and I remember shaving my legs it was so incredibly painfull but for the first time in my life I was feeling pain for the first time in over 10 years but for me it was the next 3 months that I struggled with the most and it was the wanting to feel free because I finally was free from needing to take anything so.i could avoid being sick and I was sitting at my kitchen table dressed showered not in pain nit withdrawing and I couldn’t feel an ounce of happiness or.even the desire to want to be happy I mean I should of been on cloud nine I finally was free from my addiction and free from suboxone and I did it and yet I couldn’t smile I didn’t even want to exist and I found out that I depleted my bodies ability to feel good ever again and that they don’t come.back once they have been taken they don’t come back and I said oh my God there is no way I can live like this for the rest of my life but thankfully I saw a doctor who had me take different things and eventually I gave my body what it needed to replenish what I had stolen from it and 4 months and 2 weeks after I finally felt free but then 1 year later I’m finding myself separating from my husband of 13 years 4 beautiful children and I have no where to go no.job no money nothing but because he refused to stop using and being clean just wasn’t a path he wanted that I needed to leave so I did and moved in with a friend and long story short I met the man in now engaged too and have 5 amazing children and 1 amazing step daughter and I had used for 2 months while separated from my now fiancé because he had gone back to his ex I went back to my ex and all he had to do was put it in front of me and I took them with no regard or.concern for the well.being of my un born daughter. My now fiancé found out I was with him confronted me requested I take a home.drug test I did and I then started withdrawing from pain pills and the occasional suboxone and as day 10 came and I was only feeling worse off then when I started I reluctantly went to the hospital scared to death they would take my child for the horrible things I had done to her and the fact that everything I feel.she feels and they said if I choose to continue to withdrawl I am changing losing my baby on can go upstairs and receive help by methadone and raise my chances of giving birth to a healthy baby but after being told that by me taking methadone she would in fact most likely be born addicted and will have to stay in the n.i.c.u. Until her body stops withdrawing and I have never been so torn so sick and so angry with my selfishness I made a decision to take the methadone and right away I felt reborn and it would continue to feel good but after my daughter turned 1 I started to notice my weight increasing as if overnight and bloated constantly feeling sick.or off and no motivation at all period I went to bed and woke up with a tooth that turned black overnight literally and it hasn’t stopped getting worse and i.cant take it I have no other option but to come off methadone but because I’m so unhappy with my body and my lack of purpose in this world I don’t think that coming off methadone and not going on something else would be a huge mistake but I’m done going to groups and going to pick up my medicine I want a doctor who will help me with all of my other health issues like my adhd my migraines and on methadone I have struggled with not being able to take them because they are not allowed and trying to hold down a job has proven itself impossible I just can’t concentrate long enough to learn the simplest of tasks so I just want myself back the me I know I am meant to be supposed to be and I feel methadone has or is robbing me of myself the only positive thing that has come out of it has been being clean and sober for 4 1/2 years but I was able to do that on suboxone but withdrawing scares me and I need to know what has been the one way people have suffered the least when coming off methadone to get on suboxone and I was thinking of trying zubsolv because I struggled with the orange taste of the suboxone

    Reply

  54. Posted by Garrett Pruett on April 14, 2017 at 10:46 pm

    I was on methadone for opioid dependence and I became more addicted to it then any other drug I was ever on (I self medicated after serving in Afghanistan) I quit cold turkey because that was the only other option I could think of. I called a subutex Dr but they put me on a waiting list. I’m terrified of relapsing. I’m only 2 weeks in from quiting methadone and the cravings and restlessness are getting unbearable

    Reply

    • Please take a look at this website to look for other treatment options: https://findtreatment.samhsa.gov/
      Also, it sounds like you may qualify for some benefits from the VA? They now have some opioid treatment programs and office-based buprenorphine programs, so you may want to call them too, and see what’s available near you.

      Reply

  55. Posted by H on April 21, 2017 at 7:36 am

    Hi Jana! My doctor put me on a 1 year Methadone program due Endone & Targin abuse I was taking for back pain. I was spending up $1000 a week buying Endone’s of the streets. I was taking at least a pack a day, 5 mgs Endone. I started Methadone program & reached up to 65mgs max I didn’t like Methadone due to constant sweating & always on edge so decided to switch to suboxone. I was on Methadone only for 4 months I dropped down to 40 mgs. Waited 2 days off Methadone and started 8 mg suboxone. I done feel too good I’ve only been 3 days on suboxone. Does it get any better. Kind regards

    Reply

  56. Posted by Daniel on May 12, 2017 at 12:53 pm

    I’m on methadone and have been for little over a year . I’m wanting to make the switch to subutex. Reading this really helped me realize that it has to be a slow process to be successful.

    Reply

  57. Posted by Amy dooley on May 13, 2017 at 11:26 pm

    I’ve just made the switch from 90 mg of methadone to 4 days later am on 12 mg of Bupenepherine I don’t feel really sick but am quite irritable and haven’t slept in going on 3 days. I’m a traveling welder by trade and spent almost 3 years dosing at a clinic daily. Having to transfer or guest dose on a regular basis. I feel like methadone was working for me but was also making me numb to just about everything in my life. At this point I can’t say either way how I feel about the transition long term but I can say with just over 24 hours after dosing on methadone I transitioned to subutex without alot of discomfort and am really hopeful that this will work . Methadone gave me my life back, then I gave my life to methadone tx. And I’m ready for a new start , one that doesn’t continously keep me tied down to a clinic everyday, life has so much to offer I just pray it’s has something more for me…. Good luck to anyone going though the transition. I’m a recovering opioid/heroin user/junkie/pill head who spent 17 years dedicated to looking, seeking and finding ways and means to get high if I can attempt this anyone can…. Good Luck and God Bless

    Reply

  58. Posted by Jane on June 25, 2017 at 6:35 pm

    Hello, thank you for this information. I have a question and was wondering if maybe you could help. I’ve been stable (clean) on methadone for 5 years and am at 30mg (down from my 140 “maintinence” dose- took a year and a half to taper) and I’m getting ready to switch from methadone to suboxone. I’ve done lots of research on switching and know what I’m in for. For the switching period, where I will stop taking the methadone and wait 48-72 hours until I can take the suboxone, are there things I can do to make the withdrawal not as bad? I have a script for Clonodine and a small script for Lorazepam. I’m wondering if i can take them to lessen the withdrawal feelings. I’ve heard Gabapentin helps too and I have a few of those saved for my transition. Will these medications interfere with the process of getting enough methadone out of my system to take the suboxone? As I’m at such a low dose on methadone as is, I start to feel withdrawals around 8PM (I take my methadone around 6:30 AM) and am in full blown withdrawal on the COWS scale by the time morning rolls around. As it’s hard enough going 24 hours in between doses, I know 48-72 is going to be very hard and I just want to make myself as comfortable as possible. Please let me know if you think Clonodine, Lorazepam and Gabapentin would be safe to take during the transition/withdrawal period. Thanks. (I know the risks of benzodiazepines and methadone/suboxone and have discussed them with my dr, which is why my lorezapam dose is so low so no need to go down that path please.) I plan on discussing this with my dr as well (meds during withdrawal) but my appointment isn’t for another week and I’m just curious/want to be prepared as best I can. Thank you for your time!

    Reply

    • Thanks for reading my blog but sorry, I can’t give medical advice except in very general terms.
      You have done the right thing by talking to your doctor and going about the switch thoughtfully.
      I expect you will do very well.
      Let us know.

      Reply

  59. Posted by my2andme on June 29, 2017 at 2:23 pm

    I am currently on a dose of 6mgs a day, and am stabilized. I have tapered over a period of months-year, decreasing 1 mg every 2 weeks . Now at 6 mgs, I am FINE. Your thoughts will get the best of you, ONLY, if you let them. Rather than focusing on the number, I focus on the goal. Obviously, I don’t feel like I did at 60 mgs or 90 mgs. But I’m not “sick” either.
    I have decided that I want to discontinue methadone.
    I have already begun a 48 hr. stint of oxycodone (10 mg Percocet), (currently 36+ hrs w/o methadone and feeling better than I did on methadone). I wasn’t sure if I would have any euphoria or effect from the Percocet at all, but I do. Therefore, I can only assume that the methadone isn’t completely blocking my receptors.
    My 48 hrs w/o methadone will be at 4pm today.
    I plan to wait an additional 24hrs and start my buprenorphine, starting at 1-2mgs per hr.
    No one wants to be “sick”, therefore, I don’t think its necessary to go on a redundant rant about how many kids I have or what I’ve got going on in my life.
    All Id like, is to get some insight on the situation and maybe some advice from someone experienced.

    Just a side note: I am a person that plans ahead. That being said, I am a biweekly clinic pt. and therefore have my untouched methadone on hand should anything do wrong.
    I also have 8/10mg Percocet on hand.

    I am an experienced addict, as well as, a current BSN Nursing student. So I would like to think that I have enough education to pull this off on my own…With your help of course!

    My timeline is crucial as I am entering into clinical’s soon.

    Reply

    • No. You don’t. You need to find a doctor to help you.
      This disease of opioid use disorder is all about loss of control.
      I know a lot of doctors who couldn’t control their opioid use. They had to ask for help. Your chances of success will be greatly improved if you ask for help.
      You must be seeing a doctor if you were down to 6mg of methadone. Please ask your doctor for help, and please don’t stockpile methadone.

      Reply

    • Posted by Vicki H. on June 30, 2017 at 2:46 am

      You sound like your making the switch to Suboxone on your own? Surely you know that eventually you will need a Suboxone doctor for additional monthly prescriptions? I’m sorry but I’m leary of your commitment when you stock pile methadone and oxycodone “just in case” Also..I am sad to hear that your in a nursing program that hasn’t taught the s/s of opioid addiction. Possibly they have, but you have failed to recognize them in yourself. I hope you’ll reconsider doing this alone, for we don’t need anyone else dying from this disease.

      Reply

  60. Posted by my2andme on June 30, 2017 at 3:11 am

    Maybe I worded my last post wrong, or gave the wrong impression.
    Yes, I have a Rx for methadone from a clinic. I also have a Rx of subutex. NOW, before any one goes on a rant about what’s legal/illegal. Let me say, BOTH doctors know about the other. NO, they are no encouraging me to take BOTH, NOR would I for obvious reasons.
    Now the next thing… I’m not nor have I ever “stock pilled” methadone. I am a 2 week clinic patient. I’ve also been clean, well “clean on methadone” for 10 years.
    I have an ongoing close relationship with my counselor (at the math clinic) and even she knows what I’m doing. I also have a PCP that knows everything as well.
    I have consulted all of them and…
    The clinic says wait 48 hrs.
    My PCP is not familiar.
    And the Subs. doctor told me I could take the subutex in 24 hrs.

    All I want is an experienced opinion on how long after my last dose of meth at 6mgs shud I wait to take subs.??? remember though, I have taken 2 Percocet a day for the past 48 hrs. with NO meth

    Reply

    • Posted by Vicki H. on June 30, 2017 at 4:06 am

      I read your reply and realize that I have forgotten what it was like to make the switch from methadone to Suboxone. Days before my ‘switch’..I recall that I was truly freaking out and so very very scared of going into precipitated withdrawal. I’m sorry I wasn’t more helpful. Here is what I know… I tapered down my methadone dose to 35mg and stayed at 35mg for 10 days. I consulted with the Suboxone clinic and my Suboxone induction was scheduled 48 hrs following my last 35mg dose of methadone. So I took my last dose of methadone (35mg) on a Monday and my Suboxone induction was on a Wednesday. Words cannot explain how I felt! All I know, is that I have never been that happy in a very long time. Although I was relieved and happy, I was also upset with myself that it had taken me so long to get to that point of actually switching. But I guess we don’t know what we don’t know. Still I was proud of myself for the commitment I had made to make the switch. I hope my experience helps. Hang in there! You’ll be happy you did!

      Reply

      • Posted by my2andme on June 30, 2017 at 4:26 am

        So let me make sure I understand completely. U were stabilized at 35 mgs.
        Waited 48hrs and took subs.
        And you were fine?
        I’m stable on 6mgs. and have been off meth for over 48 hrs now. But I have taken 2 Percocet per day for the past 48 hrs.

        Thanks for the info.

      • Posted by Vicki H. on June 30, 2017 at 3:50 pm

        Yes I was! Re-read the docs blog post we are commenting on. She’s transferred pts from 40mgs. One thing tho, since you’ve taken Percocet, you’ll want to wait 24-36 hours to start the subs so you don’t go into WDs. Let everyone know how you did with your induction with the subs!

  61. Posted by Eric Bush on July 12, 2017 at 3:34 pm

    I have been considering switching from methadone to suboxone and I am on a dose of 40mg a day of methadone, and I was kind of scared to do it but this article has really helped me reconsider being scared to do it. So I plan to start the process of switching but I wanted to thank people for putting this kind of article out for people to see so people like myself can read about it and make the right decision for them. There are many people that are on this type of treatment that doesn’t know how to do it the right way but things like this truly helps. Thanks again

    Reply

    • Posted by Vicki H. on July 17, 2017 at 12:33 pm

      Eric that’s awesome! Just make sure you wait 48-72 hrs and your not feeling well before your induction. Also know that the doctor is there with you and is not going to let you suffer. Good luck! Let us know and post your experiences

      Reply

  62. Posted by Jamie Carlisle on July 22, 2017 at 12:44 am

    My husband and I have been on mm for lil over a year. Got up to 70mgs each, now we’re tappered down to 50mgs. it’s been at least a few months at 50. Anyway we’re tired of the clinic. We’ve got some suboxone strips and a few days off work. I’m determined!

    Reply

  63. Posted by my2andme on July 27, 2017 at 3:56 pm

    Negative experiences seem to be the overall experience for most throughout this forum. Therefore, wanted to post my experience, as it was a positive one.
    I was on methadone for approximately 11 yrs. My dose ranged from 100 mgs to 6mgs. Long story short…When I decided to switch from methadone to suboxone I was stable at 6 mgs.

    My experience:
    Last dose of methadone @ 6 mgs taken on Tuesday at 4pm.
    Wednesday I took 1/10 mg oxycodone (Percocet) at 8am and again at 4pm.
    Thursday went exactly the same as Wed.
    By Thurday night I could feel the w/d setting in, however, tolerable. Went to sleep.
    Awoke at 1am in mild w/d. Forced myself back to sleep.
    4am, again, awoke in mild w/d. It was time…

    Induction phase:
    At 4:30am I took 1 mgs of subutex.
    Waited a hr.
    At 5:30am I took 1 mgs of subutex.
    Waited another hr.
    (started feeling better)
    At 7:30am I took 1 mgs of subutex.
    Went to sleep!

    After inducting myself, I continued on the subutex throughout the weekend.
    Monday morning I made an appointment with a suboxone doctor.

    It is important to remember: that each experience is personal to that individual and may not produce the same results for another individual.
    It is IMPERATIVE that you START LOW, GO SLOW to produce the most desirable outcome!

    I want to mention and make myself clear:
    ALL medications mentioned in this post were/are all Rx to me.
    I made my PCP fully aware of my plans for induction, as well as my counselor at the MMT clinic.
    The subutex mentioned was also a Rx from a physician at a suboxone clinic.
    I feel it is important to mention that the physician that Rx the subutex wanted to me to begin the process only 24hrs out from my last dose of methadone, I waited well over 48 hrs.
    I have noticed that most physicians being the induction process at 2mgs every hr until the patient is comfortable. As mentioned, I was extra careful and decided to start myself off at .5 – 1 mg an hr.. Safety is of the utmost importance when switching from methadone to subutex/suboxone.
    I cannot stress enough how IMPORTANT it is to START LOW, GO SLOW!!!

    Thank you for listening! I hope my experience helps someone else!.
    God Bless!!!

    Reply

  64. Posted by Dustin hadley on September 17, 2017 at 4:03 pm

    I have been on methadone for chronic pain. I switched to subs yesterday. The withdrawals are gone but not the pain. What should I do?

    Reply

    • Posted by my2andme on October 17, 2017 at 11:14 pm

      Sorry this reply is so late. I would consult my physician about Rx something for pain that will not contravene the Suboxone. I have notice myself that subs. do not help with pain like methadone. Consult your physician. There are options out there. Best of Luck!

      Reply

  65. Posted by Jen on October 12, 2017 at 4:17 am

    If i am taking a low low .25 mg of methadone a day … will it be ok to start the sebutex tomorro ( waiting 24 hours after the last dose of methdone)

    Reply

    • Posted by my2andme on October 17, 2017 at 11:08 pm

      Jen, Did you detox to that amount slowly and stabilize? If so, U may not go through any withdrawal. I would think at 24 hrs on that amount, if you are going to have any withdrawal symptoms they will have hit within 12-24 hrs.
      HOWEVER, once u begin the subutex…START LOW! You can always take more once you are definite that your not going to be thrown into horrible withdrawal.
      In my personal opinion, at that low of a dose, you should be ok. START LOW, GO SLOW!!! Best of Luck!

      Reply

  66. Posted by Luke Foster on October 25, 2017 at 10:54 pm

    Hello, I have been clean off opiate drugs (everything including alcohol) for over 15 years. I got on methadone and it seemed to save my life. It all started with a really bad fall from a third story of a building while fighting a structure fire as a Firefighter/EMT. Before my accident at work I had only smoked weed now and then at a party once in a blue moon and never liked alcohol. After my accident and many surgeries later, I found out I was an addict addicted to pain medication. I tried really hard to stop the RX drugs to no avail and finally my doctor recommended Methadone. He said it would help and as long as I did not do any drugs or drink I could keep my job as a firefighter. Well I bought the advice hook line and sinker. It worked great and kept my job until I retired with many accomodations. The big problem is that I still take methadone and am tied into the whole clinic thing here in Florida. They make me feel like a criminal, treat me and anyone who comes there like drug addict scum of the earth. I did not wake up one day and say: “Hey I want to be a junky!!!”. They took away my take homes because I missed a bottle check and had to show up every day for 30 days to get them back and they only give me two weeks at a time. I use to go once every 28 days and that was not too bad, but now it’s back to the every 2 weeks. I have never had a dirty urine, never sold my medication, and am a productive member of society and am treated like shit at theses clinics. So, I looked into finally getting off this stuff and went from 140 mgs to 70 in a little over a year. So far all is good, it just that my daily dose only works for say 18 hours. I really want to switch off to subutex or suboxone or whatever and I understand that I need to get to 30 mgs and then wait 72 hours after my last dose of methadone before starting the subutex ( or what ever one does not have Naltrexone). Here is my big fear. Methadone gives me a feeling of wellbeing, like the opiates did. That feeling makes me feel normal. Without that feeling I am depressed and I really do not think my body makes the appropriate amount of chemicals that make me feel ok. Because without these drugs I am very depressed. I have no reservation that I will ever be 100% drug free and my hope is that I can get away from the clinic crap and stigma with methadone and have a normal life on suboxone with the same feeling of wellbeing that methadone does for me. I here all these people not accepting the fact that they might have a chemical imbalance as I feel I do and that is why we do opiates in the first place. The problem is trying to get completely off. For me maintenance treatment works, what I need to know is if suboxone will help me or should I stay on methadone and accept that I can not go to a private doctor to get methadone like suboxone, even though I have never done drugs and have stayed urine free of anything except my prescribed methadone? I wish I could go to a private doctor who would work with me with methadone or the other treatments so I never have to go to those f_ _ king clinics again. We are treated like 2nd class citizens or 4th if there is such thing. It’s a real problem and not just with me. we all just want help without all the BS.

    Reply

  67. Posted by Luke Foster on October 25, 2017 at 11:02 pm

    P.S also the cost of methadone and suboxone is outrageous!!! We are funding the rich. This is crazy and any drug that helps should be almost ZERO!!!!! How dare BIG PHARMA and or any doctor or clinic not be NON PROFIT when it comes to addiction. It was part their fault TOO!!!

    Reply

  68. Hi,I’ve been on methadone for 5 years and highest dozewas120 mg tapered down 5 mg. Month till now I’m on 35 took my last dose thurs day morning and will not take anything till I go to doc. On Monday morning my question is if, my withdrawal systems become unbearable I do have a small piece of suboxene someone gave me my question is if I take a tiny piece just to help a little will i get sick!!!! P. S ,. Terrified of withdrawal systems I dint want to go thorough what I did coming off ox’s. Thanks

    Reply

    • Please talk to your doctor about this.

      Reply

    • Posted by Vicki on January 27, 2018 at 4:13 pm

      Everyone is different but I got down to 40mg day x 4 wks and waited 48 hrs for my dr induction and it was fine. Sooo, you’ll be ok. Another option is call your doctor and see if you can get in earlier. And congratulations too! It’s hard to get down so low on methadone from 120mg. Most people can’t do it. You’ll love the freedom of Suboxone!

      Reply

  69. Posted by Hope McElligott on February 18, 2018 at 12:12 pm

    This comment is in to regards to the paragraphs using a female patient as an example for how to properly taper off methadone : I feel it is inappropriate to reference a specific gender even when using an ” example “.

    Reply

  70. Posted by Lori on August 14, 2018 at 10:44 am

    I am in the medical field so I’m a wee bit embarrassed to say I do not understand something . I have been detoxing from Methadone and am on 30mg and looking to make the switch to Suboxone . I don’t understand it what was said meant when you get to 30mg you can switch it when you get to 30mg you go down 5mg weekly until you got 0 stay in withdrawal 72 hours and then you can switch? I want this so badly as I have been successful over the last 6 years on methadone and am ready for the switch . I am 47 and don’t know if I can handle the pain that methadone withdrawal offers ?

    Reply

    • Posted by Lori on August 14, 2018 at 10:51 am

      Not a reply , sorry I forgot to mention I am seeing a Suboxone “ Dr” today so my answers will I gather be answered then . I am looking for some early insight as I’m scared of it not working out for me .
      I also am suffering horribly from depression, and major anxiety causing panic attacks where I actuall stayed home yesterday as I was terrified to be around people . I am not wel I guess myself or maybe I am and that’s not working out . Thanks for having this for people like me .

      Reply

    • Most doctors have their patient be on 30mg for at least a week, then skip 2 days of dosing and start on buprenorphine on the third day if the patient is in enough withdrawal. Your doctor can give you more personalized recommendations.

      Reply

      • Posted by Lisa Peterson on August 16, 2018 at 7:15 pm

        What I wouldnt give to find a Dr. as this who actually did have the least bit of concern for the actual patient and whis best for their success in pursuimg a journey in sobriety. God bless you and the work you have done.

  71. Posted by Amanda gullotto on August 24, 2018 at 7:10 pm

    Hi I have been on 90 mg of methadone but it was making me sick I went from 130 to 190 and gained most of it with water my whole was oozing out of it any how I couldn’t take it so I went and got on suboxone I’ve been off 5 days but when I take a tiny piece I go into withdrawals is the methadone still in my body

    Reply

  72. Posted by Steven Hartsell on September 5, 2018 at 7:21 am

    Can someone please help, I switched over to suboxone from methadone way too fast and still feel like crap after a week, I switched because for some reason I didn’t ever feel the methadone at all, but now I’m going nuts because I’m not only not feeling the suboxone and I did when I took it before I got on methadone, but I’m sick, I’m so confused, some people say I wasn’t at a high enough dose on methadone and some people say I needed to go lower to feel it, I don’t want a huge high from it, I just want to feel better to have normal energy, now that I already switched and feeling like crap, I feel stuck, I’ve also heard I might feel so bad because my dose of suboxone is too high at 16mgs, can someone please tell me how to deal with this bs???

    Reply

    • I think you need to talk to your doctor. Sometimes when patients make up their mind they want to switch, they want to do so too fast, and it almost is a setup for failure. One option your doctor may recommend is to switch back to methadone, stabilize again at the lowest effective dose, then start a slower taper down to 30-40mg of methadone. Then after a week or so on that dose, you can miss several days and try again with the buprenorphine product (Suboxone).

      another point – when you say you didn’t “feel” the methadone at all…you probably know this, but the methadone should get rid of opioid withdrawal symptoms. Our goal with methadone isn’t for patients to feel any sort of high or opioid effect. Hopefully you can talk to your doctor about what your expectations for medication-assisted treatment are.

      Reply

    • Posted by Patrick King on September 8, 2018 at 12:44 pm

      What your experienceing is not uncommon . My advice would be to stay on the Suboxone or Subutex your taking every day gets better over the course of about 7 days . You will feel better everyday . Tell your doctor to give you some kind of benzo with a long half life to help ease your symptoms for the next 5 or so days . Librium,Ativan, Clonazepam,diazepam are good ones. Hang in there and good luck.

      Reply

  73. Posted by Lisa A on October 22, 2018 at 6:09 am

    is it posible to come of methadone im on 2.5mg and have been tappering for over a year everyone talks about going on something else is it possible to come of this drug without switching to something else

    Reply

    • Yes it is! Please see today’s blog post.

      Reply

    • Your almost done don’t go on anything else you don’t want that monkey on your back . The nightmare of methadone is over for you at yourself on the back and never go back and enjoy your new sobriety. Good luck . You did something many people are incapable of doing .

      Reply

      • Posted by Lisa on October 24, 2018 at 5:00 am

        Thank you so much for your encouragement I will go down one more time for a week to two weeks then come off. Hoping and praying I stay strong I never want to come back on this again . Thanks so much I pray others can do the same

  74. Posted by Jeremy Branch on November 6, 2018 at 4:34 pm

    I have been on a methadone program for several successful years. For about 5 years I was on a metro clinic dosing @200mgs daily, I quit that “cold turkey”and for 18mths I was in full swing withdrawal that I never got over, but due to my normal pain levels being so extreme I need something to assist my life so I went back to a mdone clinic and have been there since it is working great, but clinics are not set up for people like myself. You have to make it work, that means passing on certain jobs, not taking that vacation or whatever it is. Suboxone on the other hand (at least here) you can almost immediately get a months script which makes life’s options more open to us.I do plan on making the switch as soon as I can take a few days off (I work all 7 @least 12 hours ea.)
    The point is for most of us that make the switch, whether done is working well or not is not the deciding factor, its getting un-handcuffed from the clinic and being able to give our family more options than how close is the nearest clinic. I read a lot of these forum discussions and I like this one the best it seems like this person really cares about helping and not just passing judgment with a stupid comment or a smert ass answer. I look forward to reading more. The only other problem I have with clinics is the doctor who works them will quickly pass it dgment on something he/she knows nothing about other than what that book told him. Methadone effects is something you learn over time and its very personal none of which can be learned from a book written by people that have never lived it..

    Reply

  75. Posted by Craig Robertson on November 7, 2018 at 12:24 pm

    After being on methadone and jumping of 30megs was not to bad as two weeks of broken sleep and late nights as l was not eating right at the time yet it was remarkably soft come down and exit. Now on 6 megs of suboxon l have noticed that its not to bad skipping a day here and their as for jumping off 6 megs steeping down a meg every say three to four days or just biting the buliet and jumping off the 6 megs as l know that it may feel uncomfortable at best for my tolerance to pain is high. So l will let you.all know how l go with breaking the chemical handcuffs once and for all this time and doing it right for me not what other people have gone through for everyone is different for our chemical make up is different to the next person. What’s good for Peter may not be good for Paul and visa versa.

    Reply

  76. Posted by Dee199 on April 24, 2019 at 2:49 pm

    Thank you. I appreciate you sharing.

    Reply

  77. Posted by Kirk on June 10, 2019 at 11:51 am

    As someone about to make the switch because I’m leaving my clinic this was actually a pretty comforting read. Thanks for your take on the issue.

    Reply

  78. Posted by Pete on July 4, 2019 at 9:58 pm

    I appreciate your information regarding transfer from methadone treatment to Suboxone. How to learn more about it? Is formal protocol available now?

    Reply

  79. Posted by Lindsay Rebel on August 9, 2019 at 12:52 am

    First of all I just want to say kudos to you about worrying about your clinic’s reputation and integrity. I have been on methadone for 4 years and about 18 months in the small private clinic I went to was bought out by XXXX, a much larger corperation that operates in all 50 states and Puerto Rico. Since then it has become a unsafe terrible environment that will let any piece of trash in. They have more councilors than offices because the maximum amount of patients a councilor can have is 50. They keep taking in more patients and hiring more councilors but only will pay to have one doctor in charge of 3 clinic’s making her only available 2 days a week which also happens to be their intake days. They took away the FLOAT or person on the floor that is in charge of making sure rules are being followed both inside and outside the clinic. And people aren’t showing up and being dosed while under the influence. What was once a clinic that I credited with saving my life, I now watch people, buy, sell and use drugs in the parking lot, tailgate (cheap beer and all, you can see the evidence left behind in the parking lot) fights regularly breaking out and today I got in trouble for reporting 2 people having sex in the backseat of a car. Why did I get in trouble you ask? Because they said I was loitering (I was in my car waiting for my friend to get out of her appointment) not only was I reprimanded by a clinic manager I have seen litterally once because she stays in her office during dosing hours she also told me I was lying (because she got complaints from nobody else, even though you could clearly see both parties getting out of the backseat and the male pulling up his pants on the video footage AND I know for a fact my friend called and reported it to her councilor from the car before I called) but she also told me I was the problem. If it would have been 3 to 4 years ago I guarantee I would have relapsed. What’s worse my councilor sat there and said nothing. Nevermind how she is always telling me I am the model patient and knows I have PTSD and one of the things that go with my PTSD was social workers ambushing me and speaking to me exactly the way that clinic manager spoke to me. The reason I called it an ambush is I was there to see my doctor. Nobody told me I had to meet with the clinic manager. Long story short today I decided while I am already tapering and have been for about 9 months I want out. That clinic is no longer a conducive place for my sobriety but I don’t feel ready to be off medicine completely yet which lead me to research if it’s possible to make the switch to Suboxone and when it would be safe for me to do so. That is when I came across your blog post and as I was reading it gave me hope that there are clinic’s out there that care more about their reputation and their patients mental wellbeing over the God all mighty dollar. That’s another thing they have started taking patients phases away if they owe the clinic money. Yet they wait until you owe them months worth of co pays before they say anything about the charges and if you dare ask what they are for and when they were aquired they tell you it’s your responsibility to be involved in your care and if you want that information call your insurance company. But if you want your medicine you need to pay up. Needless to say there is also never any consistencey with when they charge you and how often or how much they charge you. One day you have a balance of zero and the next you mysteriously owe them 60$ for “co pays” that’s all they can tell you. It sickens me to no end and I have to get out because it is effecting my mental health. That said I still need a maintenance drug. I feel like I am in a catch 22. I am stuck in an abusive and unsafe environment that is hurting my mental health and want out but at the same time I don’t want to put my sobriety even further at risk. So I need to find a way to transition out of the clinic and on to Suboxone yet I don’t know how that is possible without the clinic offering Suboxone. I was hoping to discharge at 40 and have a doctor somewhere else lined up for when that day comes. Is that even possible?

    Reply

    • First of all, congratulations on your recovery. I’m sorry you are having problems at your OTP. I did delete the name of the program, partly because I work for the same organization, and partly because I think you aren’t being fair to OTPs and the way they are run.
      We don’t admit “any piece of trash” but rather human beings with the medical problem of opioid use disorder. Sometimes those people bring some difficult behavioral issues into treatment with them. It’s hard to know where to draw the line, because we know change takes time, yet we DO want to maintain a safe place for other patients. How much should we put up with before we kick someone out of treatment? Particularly when we know kicking someone out of treatment increases their risk of dying three-fold, we have to be careful with such decisions. I absolutely agree that parking lots need to be free from drug deals and fights, yet you’ve pointed out the problem – if we outlaw all “loitering” then some people waiting for rides, etc., will be scrutinized too.
      I think it is a very good thing that patients aren’t being dosed if they are impaired. It’s also a good thing your program has hired new counselors, to meet the 50:1 requirement by the state. As for physician coverage, not many physicians are trained in Addiction Medicine, so many programs hire physicians with little experience and hope they can learn quickly. Also, working at an opioid treatment program doesn’t appeal to some physicians. I happen to love it, but some physicians want no part of treating people with substance use disorders.
      Yes, treatment of opioid use disorder costs money. But then, in this country right now, treatment for all medical disorders costs money. It is standard practice to revoke take homes if the patient is unable to afford them. Some administrators worry that if the patient is already having financial problems, they will be tempted to sell take home doses.
      As for moving on to an office-based practice for buprenorphine/naloxone products, you will need to call providers in your area and make an appointment to be seen. this link should help you :https://www.samhsa.gov/medication-assisted-treatment/practitioner-program-data/treatment-practitioner-locator

      Reply

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