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Methadone To Suboxone "the In-between Period"
Chels
Posted: September 28, 2010, 1:23 PM







Hi,
I began methadone detox about 2 weeks ago. My starting point was 70mg and i'm at 40mg at this point. My question for people out there, is after my last dose (5mg) how long will i have to wait beofre starting suboxone? I got my levels done about 4 monthes ago and my methadone level was low then..Hoping someone can give me a little insight.
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Posted: September 30, 2010, 7:17 AM


Posts: 95
Joined: November 18, 2005



Hi chels, the protocol for switching these days goes something like this...the patient should taper down to below 40mg/daily methadone, and then wait approximately 48-72 hours after the last dose of methadone to be inducted on suboxone. Given that you are planning to taper quite a bit lower than that to 5mg, I would think you'd not have too much trouble making the switch. It is worth noting that even though it is generally suggested that you should wait a couple days before making the switch from methadone, you *can* take short-acting opiates like oxycodone or hydrocodone up to 12 hours prior to (i.e. the night before) your first dose of sub. If you are very uncomfortable for the 48-72 hours prior to starting sub, and if you have a compassionate doctor, you can be scripted a 2 day course of short-acting opiates. That's a pretty big if, but if you're worried about the transition time, you might try to be prepared.

As far as what to expect, like I said you should generally be OK with what you're planning to do, except perhaps for the day or two after your last dose of methadone (I doubt 5mg would keep you out of withdrawal for a full 24 hours anyway, much less a full 48-72). That said, everyone is different and the switch from methadone to suboxone, for whatever reason, is just tricky. Everyone reacts a little differently. I've heard of people switching from well over the recommended dose of methadone to suboxone after only a day or two and being fine. Then again, there are those who just can't make the switch successfully no matter how low they taper down their methadone dosage.

If you're not a long-term methadone patient, I think you'll do well on sub. Some longer-term MMT patients however do experience substantial discomfort as suboxone patients. I've heard several people describe an anxiety, antsiness, racing thoughts, etc. syndrome after making the switch that doesn't seem to respond to time or dose adjustments very much. They are different drugs, though they do similar things for opiate-addicted people--both medications bind only partially to receptors allowing for the brain's natural endorphin system to resume functioning, and thus allowing for stabilized dosage over long periods, lack of euphoria in stabilized patients, and generally erasing addiction-related behavioral symptoms in stabilized patients.

It sounds like you're planning to use sub short-term to taper and that's your decision, but while I'm at it, you should know that suboxone, like methadone, generally only works to treat addiction for as long as the medication is continued. Treatment outcomes are not much better for short-term detox using suboxone than they are for cold turkey cessation. Which is to say, the odds are very long indeed that you will find long-term success in a short-term detox. Many doctors nonetheless continue to script suboxone insisting that shorter is better, and so forth. The reality is, though, that you're not improving your chances of success really at all by going that route.

Evidence-based treatment, or the disease model of addiction treatment (as opposed to dogma-based treatment philosophy) as yet is still not standard in the treatment community, and many doctors, even those who prescribe and practice according to a medical model, still believe in their hearts that overcoming opiate addiction is about will-power and spiritual transformation rather than effectively treating a disease of brain chemistry. It is worth any opiate-addicted individual giving this question some serious thought and educating themselves about their disease, its known causes, treatments, outcomes, etc. no matter what it is you personally believe to be the best course of action.

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Chels
Posted: September 30, 2010, 5:19 PM







Hi Cicily,
Thanks so much for the insight. That answered basically all of the things i've been questioning. I'm supposed to get my prescrition for the subs on the 16th.. whenever i get them filled is up to me i suppose. I just wanted to be safe because i've heard a couple different stories, (which you can't always rely on heresay as we all know) about people starting the subs too soon, unknowingly still having some methadone left in thier system and then getting deathly sick because of the combo. That is what worries me. if i were to take the short-acting opiates in between, would they really even help with the withdrawl if there is a trace of methadone in my system. I mean i guess i would know that its out of my system if they did effect me right? I've also heard that soaking in hot baths will help to get it out, also charcoal pills? more hearsay lol. ahh so much to think about. I'm really trying to keep a positive attitude but i also have some worries. Im halfway through the detox so thats something keep in mind and be happy about. as of today i'm at 35mg =)
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Posted: October 3, 2010, 6:51 AM


Posts: 95
Joined: November 18, 2005



If you're all the way down to 5mg when you taper off to make the switch, then yeah, short-acting pain pills should have some impact. Methadone is a little different than sub in that other opioid medications can get through and offer some relief, even if you still have some methadone in your system, which you will for several days after cessation; that is simply the nature of the drug. Now, if you're on a dose of 80 or so mg of methadone or more, other opioids are not going to do much for you no matter how much you take (although they can still work as pain relief in high enough doses, but that's another question).

I don't know what your tolerance is/was to drugs like hydrocodone or oxycodone, but it's possible that it might take a little *more* of either of those meds than what you needed in the past to keep you comfortable. Methadone is a powerful narcotic, even in low doses. You are already on a very low dosage, though, and are going even lower, so...who knows? But you don't have to have the methadone completely out of your system for other opioids to have some effect, nor should you need to wait more than 72 hours to start suboxone.

If you are very worried about it, go with the max of 72 hours between your last dose of methadone and first dose of sub, and try to have a plan in place to deal with some discomfort for those 2 days without either med...at the very least clear your schedule and be prepared to take it easy. And, keep in mind that you may not experience much discomfort at all in between. Methadone stays in your system for a long time. Keep yourself hydrated, take it easy, and see how it goes.

I wish I could guarantee you that everything will go perfectly smoothly and you will have a flawless transition, but as I noted above, it's just kind of a tricky thing and everyone is different. BUT, you are doing everything right in terms of giving yourself the best chances of success here:

1. Give it 48 to 72 hours between your last dose of methadone and first dose of sub.
2. Make the switch only after tapering down to 40 mg or less daily methadone.

Those are the two main things, and most if not all of the truly awful stories you've heard about this will have involved failing to take one or both of those key precautions.

It also would be great to have a good relationship with a knowledgeable, competent, and compassionate doctor throughout the process and to discuss this issue with him/her beforehand, although I realize that may be more the exception than the rule. Still, find out what, if anything, s/he recommends for you to do or is willing to do to help you. Not all sub doctors know much about methadone and making this switch, unfortunately, so keep that in mind, but it can't hurt to talk about it.

Good luck, just stick with your plan as long as it keeps going well, and remember you can slow down if necessary and give yourself time to make adjustments or re-evaluate. Get as much reassurance as you need from your practitioners. It is their job to help you through this. I think you'll be fine.
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Laur
Posted: July 20, 2011, 6:57 PM







Hi! I have been on Methadone mat for 8 years now,I am 35 female down too 30 mil and stable on that for 3 of the years. I have also been clean from ALL other drugs for these 8 years and have taken my recovery seriously, have a job, own a home a car.
Just recently my clinic has the SubOXNE program. I am going too make the switch in a week or so and am scared too death of the 3 days cold turkey in between. I am on the 30 mil and Doc said 30 is what was required. I need advice, should I go into a 3-4 day detox program before? Or Will I be OK home and detoxing cold for 3 days? Will the Doc prescribe clonidine (blood pressure med that helps with withdrawal) and trazdone? Should I ask? I am scared crapless and need advice. Thanks so much.
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jesse
Posted: October 27, 2012, 11:37 AM







Clonodine does not help with withdrawals, it just keeps your blood pressure under control because WD raises BP, and it makes for less of a risk of cardiac episodes. Trazadone is an ssri and people have very different reactions to it. I would suggest starting with half of the trazadone dose at first to see how you like it. It's not much but it's better than nothing. If you can, ask your dr. for baclofen, it's a very mild muscle relaxer with little abuse potential but is particularly useful for opioid withdrawal.
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benny theroux
Posted: July 19, 2013, 10:08 PM







I'm using a dictaphone so if there's a few spelling errors arm it's the phone translation are about day 7 for me I take it down to 25 milligrams of methadone and then I used box see about mum 160 milligram oxycotton for 2 days arm and then so would it be about 72 hours between my last message tone does and my face a box and o's 12 hours fro 12 hours from my last of the coast to my suboxin does arm with my first ghost of socks and I felt pretty confident harm I basically just got pretty advocated armj
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Simon A
Posted: August 15, 2013, 1:33 AM







Hey,
For anyone interested, here's a slightly different view on time-frames.
I'm making the switch today. I'm taking sub in about 5 hours. I took my last dose of methadone yesterday, but it was half my stabilized dose of 50mg; 25mg (used my calculator). My doctor is an expert on pain, opiates, addiction, etc. One of only two authorized prescribers (sic?) outside the central system in my city of 1.5million, and he has/keeps about 100 patients at a time (practices out in the sticks... or the front of the sticks at least). He says everyone is different, and that the 48 hours is precaution. Some people still get sick after 4-5 days, but most are absolutely fine after 24 hours. For nearly all of his patients who make the switch he recommends 24 hours, but they can decide. He just says wait til you get a little uncomfortable, and you're home free. Some have been fine after 12 hours, I didn't believe him, but he assures me. He wouldn't have recommended 24 hours without watching how I am at certain times after my doses though. If you know your patients well, you can be more liberal. That's the theory... doing the system flood option for Sub (32mg), instead of slowly increasing from low doses.

Let's see what happens... I don't expect a hell of a lot, then again, maybe it'll just be a lot of hell. I know the drill, but that makes it no easier... and it's no consolation.
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andrew
Posted: November 20, 2013, 3:40 PM







hi my name is andrew and im 27 years old ive been on metadone for about 7 years now i recently went from 130mgs down to 70mgs in the past few months. the past few days ive been trying to switch to suboxanne so on sat i dosed 70mgs then sunday took half sub strip and felt just fine then monday couldnt find subs so i went to the clinic and dosed then tuesday i took a whole sub strip and omg i went into instant withdrawls!!! i felt like i was gunna die and had to fly to the clinic and dose now im not sick but im not well my body is confused and i dont know what to do for tomrow cuz i work and go to school and dont have time to sit home sick please help me sumone??
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josh
Posted: November 27, 2013, 1:03 PM







ANDREW>>>>>>>>>>I DID EXACTLY WHAT YOU DID< AND LEARNED A LESSON> FOLLOW MY INSTRUCTIONS...I will not lie.

I too was on 85mg of methadone for a year, I am also your age by the way, now I know you said you got down to 70mg but there is no difference between our dosages when were talking making the switch.

Now first off, suboxone will work the same as subutex, the naloxone is only there for opiate addicted people to make them extremely sick and thrown into intense withdrawal if trying to use it I.V. but it will also cause an opiate addicted body to go into precipitated withdrawals when taken by mouth also. WHY? well the chemical that attache's to your receptors(buprenorphine aka suboxone or subutex) is what will make you feel better when in withdrawal, but if taken while on methadone or any other opiate, you will get an intense withdrawal, that last from half a day to 3 days......depending......now since we were both on the same dosage about of done this is what ya do.

Take your done........Tell the clinic thanks but no thanks..........That is of course assuming you went to a doctor and have a script of subutex or suboxone in hand, if not do not quit. just go down slowly...anyway continued.......After your last dose of methadone, being at 70mg you will not be sick for at least 4 days, I was able to last 6 before I would crawl back to the methadone clinic, I did that do to financial reasons, anyway, the point is, you must wait until you truly are really sick from not having your methadone, and no matter how sick you get, you must wait 48 hours minimum......now that 48 hours is all i waited and that was a big mistake, I wanted to see how bad Precipitated withdrawals was gonna be, well call me crazy but i figured, im gonna be sick for a week or i can take 2mg of subutex and be extremely sick for hours or 3 days, so u suffer more but for less time, so i ended up having precipitated withdrawal, which by the way is what you experienced.......i had it for about a day, i would describe it as, the very peak of withdrawal....when you just wanna jump outta your body....but still, bearable....mind set is important..you must know your gonna get through this.......so after the serious effects went away, i took more bupe hoping it woulnt happen again and it did not,,,,now i am taking 4mg twice a day, and im on day 4 off of methadone and i feel almost 100 percent....everyone says it takes a week to two weeks on suboxone to feel normal.... SO the most important lesson i learned...........Precipitated withdrawals are real, they suck, but for me they were not as bad as other people experienced, It felt to me just like an immediate peak of withdrawal, so instead of slowly climbing the ladder of agony while withdrawalin until you hit that peak on day 3 with nothing, you get there in about an hour...and for some sooner............SO TOO AVOID THAT NOT SO GOOD ORDEAL , and not too mention, you may hurt your self, try not to do what i did,,,,,

SO TAKE YOUR METHADONE,,,,,,last dose,,,,,,,sit at home or go about your regular business......when you start to feel sick, check how many hours its been since your last dose....you want to hit that magic 72 hour mark........or longer if your not feeling bad.....keep on living life until you can no longer take it anymore, if you are close to 72 hours , take 2mg of bupe,,,,,,wait and see if you feel worse or better,,,it will take a couple hours to notice how you feel, if you feel better take another 2mg, and your good,,keep that up for the amount of time you need, then taper from the suboxone to......nothing.....clean....or stay on it..but if you do ...warning.......the withdrawals are as bad as methadone I hear....but only if you on high dose.....so if your going long term, stay at the lowest possible dose like a milligram or two a day tops.......and then ween from there,,so yo will be eating tiny crumbs. very hard to judge but do your best...... GOOD LUCK.....HOPE YOUR NOT SCARED AWAY FROM THE SUBUTEX.....just dont do what you did last time........make sure you wait........as long as you can , make sure your on like day 4 off of methadone...and your so sick......then take the subutex or suboxone.......if you dont suffer for a few days,,,you will suffer precipitated withdrawal which can be horrible or not so bad..........its almost like rapid detox while being awake,,,,so yes its dangerous,,,but many have done it.........but after doing it....i would suggest just waiting it out man, suffer for five days then take your subs,,,,,,,,,,,,you can do it..i did.....oh and by the way,,,i still feel a bit lazy.......the energy you got from your methadone dose, you wont get unless you wait until your really sick,,,,,the sicker and longer you go without methadone the better the prize is you know.....if you wait long enough, you may get the best and even a quite euphoric sense of relief......but for that you would have to be very strong....and wait....a week....with no methadone.....sweating....s***ting.....no sleep......all that....but just think the more you suffer....the more sweet the suboxone will feel..lol.......addictive mind...excuse it...but its true...anyway.....yeah...just wait...as long as you can...all the doctors told me ...and everything I read said,,,it was near impossible to switch from done to subs in 4 days....well I was on 85mg for a year,,,and the last day i dosed i doubled up to 160mg then 48 hours later took the subs and had pw,,,,that precipitated withdrawal....anyway.........you choose..............
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Posted: May 23, 2014, 7:02 AM


Posts: 13
Joined: May 23, 2014



It’s really great posts.

--------------------
192.168.1.1
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Megan
Posted: June 19, 2014, 3:59 AM







Hey, I think it is always good to have several different views on this as we are all different. I have been a patient of pain meds for 13 years. Was on A LOT of Rx medications in the beginning. Literally, 2 50 durageesic patches one on each arm a 24 hr morphine pill (cannot remember the mg but I want to say like 30) 60 mg of oxycontin and 600 mcg fentanyl lozenges. I also abused what I had. So you can count that and probably double it. It was awful. I never had been told about the withdrawls if you stopped taking any of these. An odd thing to leave out in my opinion but given this doctor put me on ALL OF THAT I cannot say it was odd that he left out what would happen if I stopped. He was that doctor that had the RX fentanyl clock on his wall and his RX pads were for some other narcotic/opiate medication. Anyhow, Cold turkey off all of the is the ABSOLUTE WORST I HAVE EVER FELT WHILE DETOXING. Good reason for it I guess :) But when I went into a detox (it was like the hilton of detox, only 8 rooms just like an acute care hospital, well it was a hospital with a detox floor) I had my own flat screen and everything. Not that I cared TV was not my need at the time. But the base rule from going off of anything onto subos was 48 hours. There was a kid in the room next to me who begged so badly because he was so sick (heroin) that they finally gave in and he kicked the walls screaming the entire night. 3 days later we saw him and he was okay but had been really sick by getting the suboxone early. I know I was given it after 48 and was fine. Probably would have been okay at 36 if I had to guess. But I was also only on oxy at the time. Methadone stays in your system about 2 days longer than other narcotics/opiates. This may make things different. So just be sure. However I know that they would have given a methadone detox patient the subo after 48 hours as well. Whether someone got sick is another story I guess. What they are more or less looking for are physical withdrawl symptoms. If you are not experiencing the regular symptoms of withdrawl and good enough too, then you very well could get sick. Wait the 2 days. It is well worth not getting sick. Might even be worth waiting 2 and a half days etc. The longer the better at least you know you have a reprieve when you take it. Sorry for the long a** story, but wanted to share. Narcs opiotes are tricky. Nobody should ever be put on them if not absolutely necessary, they destroy so many lives. I did not ever need to be on the amount I was on and it destroyed who I was. Hope this information can be useful to someone who is just not sure about any of it. The first answer to this post was the best and most accurate.
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angela
Posted: July 19, 2014, 3:09 PM







Its bn 24 hours since my last dose and I feel like crap I'm going through withdrawls it sucks can I take suboxone ?
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karen
Posted: August 1, 2014, 6:41 PM







I was wondering if you ended up o. k after 48 hrs or did you have those pre cip withdrawals?
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Danielle
Posted: August 6, 2014, 6:48 AM







I am currently at the 48 hour mark and I do not know what to do. My withdrawals aren't too bad but I'm super anxious. I took my last dose of methadone (30mgs) exactly 48 hours ago and already have my script for suboxone but am so scared of the precipitated withdrawals that I am battling myself. I went to the doctor yesterday and they did a drug screen on me (exactly 24 hrs after my last methadone dose) and with their not such great quality drug test he said the methadone didn't even show in my system and that I could take the subs right then. I knew I'd go into precipitated withdrawals so I have been waiting but I just don't know if my sanity will last much longer. So I figured id ask this question. Anyone that is around 110 pounds (which apparently makes a difference) gone through this and have any advice?
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charles
Posted: August 13, 2014, 8:40 AM







ok so i im quiting methadone clinic i was at 45 now i no its crazy owell ive only been there 5 months what can i do to make it easyer to come off i got a few suboxone pills what ekse please let me no thank
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