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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Shay Sweet on October 16, 2006, at 8:52:52
"]B]You have to get down to 30-40 mgs of methadone a day before switching to sub. Then you would have to withdrawal off methadone for a couple days before starting the suboxone. So you have a little ways to go at this point since you are on 145 mgs of methadone.[B/]"I have heard this as a general rule; I have been working with mental health and substance abuse, as well as dually diagnosed, clients/patients for several years but have not actually obtained certification/licensure in that particular field because I myself am suffering terribly on Methadone. However, the Psychiatrists I have worked with over time have had little if any knowledge about the prescribing information/limitations when it comes to these medications. When I heard about Buprenorphine two years ago, after only being on Methadone for a year--pregnant, no less--I researched the partial agonist properties of the drug inside and out. The only thing I couldn't do was to try it myself, but if it would take away the extra sixty pounds Methadone has afforded me, give me back my regular menstrual cycle (never thought I'd say that, but who stops getting a period at age 25?), and/or put the whole constipation thing behind me, I would do almost anything to make the switch.After working in treatment facilities on various levels, including Intensive Outpatient, Residential and Partial Hospitalization (PHP), both directly with the patients and indirectly through insurance companies and on medical records compliance, I have witnessed the administration of Buprenorphine/Suboxone in patients detoxing from either short-acting opioids like Percoset or from the more intense Methadone, and any difference in reactions to the overall detox process utilizing Bup/Sub is to try it myself, but if it would take away the extra sixty pounds Methadone has afforded me, give me back my regular menstrual cycle (never thought I'd say that, but who stops getting a period at age 25?), and/or put the whole constipation thing behind me, I would do almost anything to make the switch.After working in treatment facilities on various levels, including Intensive Outpatient, Residential and Partial Hospitalization (PHP), both directly with the patients and indirectly through insurance companies and on medical records compliance, I have witnessed the administration of Buprenorphine/Suboxone in patients detoxing from either short-acting opioids like Percoset or from the more intense Methadone, and any difference in reactions to the overall detox process utilizing Bup/Sub is not as notably different as I would have expected.Then again, these patients were/are being treated residentially and probably don't have the knowledge of the scientific/pharmacological properties and therefore are no so "in their own heads," so to speak.Bottom line: I have cut down from 160 mg/daily of Methadone diskettes to 80 mg/daily. The 30 or 40mg rule for Methadone is not accurate from what I have heard of others' experiences with the switch over, since that amount is still enough for the Methadone to be "stuck" to the receptors in such a way as to through the patient into instant and unbearable, violent withdrawals.Which brings me to my final question/point. Am I incorrect in saying that one must go through the entire weaning process from Methadone before starting Bup/Sub if one wants to avoid this nasty side effect? Most importantly, the Suboxone minus Naltrexone, or Subutex/Buprenex do not give the drug antagonist properties, although they are still partial agonist in nature. Do Subutex and Buprenex have the same effect in terms of making you feel markedly WORSE?Thanks to everyone and anyone who can answer these questions for me! Sincerely,Shay Sweet, M.S., Pharm D
Posted by Declan on October 16, 2006, at 15:25:29
In reply to Suboxone vs. Subutex...same effect/no naltrexone?, posted by Shay Sweet on October 16, 2006, at 8:52:52
I dunno anything about the naltrexone addition, except that I'd avoid it.
Switching from methadone to bupe at 30 or 40 would not be for the fainthearted. Two people I knew who tried (under supervision) to switch at 30 ended up with asthma attacks in hospital that were sufficiently severe to cause the effort to be discontinued.
For myself, I wouldn't think of switching above 15. This may sound terribly low from where you are, as if to get to 15 is almost as difficult as getting to zero. But I don't think that's so.
My explanation for last night's rotten sleep is that I went down 5 micrograms. Truly. Maybe I'm wrong. I suppose it's a question of how high the ladder is that you are on. I understand completely about how rotten methadone makes you feel.
Declan
Posted by Declan on October 16, 2006, at 15:33:22
In reply to Re: Suboxone vs. Subutex...same effect/no naltrexo » Shay Sweet, posted by Declan on October 16, 2006, at 15:25:29
To put that better, that is a reduction from (clearly an estimated) 10 micrograms to 5 micrograms per day.
Posted by Declan on October 16, 2006, at 15:38:50
In reply to Re: Suboxone vs. Subutex...same effect/no naltrexo » Declan, posted by Declan on October 16, 2006, at 15:33:22
This is why people take decades to get off it.
Posted by bulletproofair on January 5, 2007, at 23:20:34
In reply to Re: Suboxone vs. Subutex...same effect/no naltrexo » Declan, posted by Declan on October 16, 2006, at 15:38:50
I'm currently attending a methadone clinic and am on 110mg's of methadone once daily.
from my knowledge of subutex/subuxone, the latter (subuxone) i know contains naltrexone, an opiate antagonist i believe. this means that if there are any opoids attached to your "mu" receptors in your brain (receptors the opiates attach to for the most part) the naltrexone's job is the yank those suckers straight out of your receptors, sending you into immediate withdrawals.
My advice to you is to COMPLETELY detox from methadone, or if you wanna feel pretty bad for a good couple weeks, start the subuxone at about 5mg's to 8mg's. I SERIOUSLY don't think it would be safe to still have methadone in your system and start on subuxone. Bad idea all together.
Hope that helps. I'm somewhat knowledgable with my opiates....but I'm no doc. I surely recommend this and if you were I, I would completely detox from methdaone before I started on subuxone due to the instant withdrawals that will occur.
Also keep in mind that if you hurt yourself at some point while on subuxone, you will be unable to take subuxone and opiates (pain meds) at the same time because of the instant withdrawal effect. You'd have to just take the pain meds, which would be ok, because from my understanding, subuxone is not physically addictive.
Altogether, I've heard glory stories that subuxone works VERY well, but its costs more and in some areas of the US it is hard to come across. Keep in mind it does cost more though.
Posted by Shay Sweet on January 6, 2007, at 15:09:52
In reply to Re: Suboxone vs. Subutex...same effect/no naltrexo, posted by bulletproofair on January 5, 2007, at 23:20:34
In response to your post below, I have to say I'm surprised that someone else finally "gets it." I'm no expert, but I too have extensive knowledge of that particular class of drug (Opioids), so I get really frustrated by most of the inaccurate jargon I hear from medical professionals. I ask myself, "Self? How can a doctor possibly help you if you are the one enlightening him/her, and not the other way around?
I'm off track, and I need to get back on because I have been trying to 'catch up' for about two years and be able to post something that might trigger the process of change for me.
I have worked in treatment centers, both in-and-out-patient, in several different areas, although my intention was to teach English. I have a B.A. in the teaching field, specifically English, but I have never actually pursued a career in that field. I may be so enthralled with social work and counseling because I am seeking it for myself. The only big problem with that is that I have seen the 'inside edition,' and I'm very aware of my limitations as far as far as finding a doctor who's willing to work with me.
This has become long. And my four year old will burst through the door any second, so I'll just say this:
Three years ago, when my daughter turned one, her daddy passed away from an overdose, forcing us to move in with my parents, who treat me like I'm an invalid and blame all ailments and mishaps on Methadone. I have seen only one doctor for the past four years, once per month, at $125 per month (plus the cost of meds totalling about $200/mo.) and began decreasing my Methadone three months ago. I was doing really well.
Until his nurse called at 4:30 on Friday to tell me my Monday appointment is cancelled indefinately because the board has suspended or revoked the doctor's license. So basically, I should have gotten the same amount of medication and just saved the extra to taper with. Come monday, I will be out of Prozac, Phentermine, Methadone,and Xanax. Had she warned me on Dec 21st, when they first got the news, I might have had time to pick up my records and find a local doctor.
Now I have no choice but to wait and see how I get by with zero copiing skills, no meds, and a four-year-old to take care of.
On the other hand, I'm kind of excited because Methadone has been causing my health to deteriorate, constipation, water retention, memory lapse, cessation of menstruation and above all (vanity wise anyway) excessive weight gain! I was pretty hot before I got on this stuff.
But I also have zero pain tolerance, physical or emotional. I'm really, really scared.
Thanks for responding :)
Shay
I realize that Suboxone is a fairly new drug--in this country anyway--and that the patients who are switching to it or beginning treatment for the first time--are essentially Guinnee Pigs.
Basically it makes sense that one would be a self-proclaimed genius when it comes to his or her own medical needs/medications. I could walk up to a pot head who thinks our first president was Columbus, but if asked to compare measurements pertaining to weed, or the laws and particulars that apply to getting caught with it, he would perk up and recite them word for word. Entrapment is always a good one. But that doesn't make them District Attorneys.
> I'm currently attending a methadone clinic and am on 110mg's of methadone once daily.
>
> from my knowledge of subutex/subuxone, the latter (subuxone) i know contains naltrexone, an opiate antagonist i believe. this means that if there are any opoids attached to your "mu" receptors in your brain (receptors the opiates attach to for the most part) the naltrexone's job is the yank those suckers straight out of your receptors, sending you into immediate withdrawals.
>
> My advice to you is to COMPLETELY detox from methadone, or if you wanna feel pretty bad for a good couple weeks, start the subuxone at about 5mg's to 8mg's. I SERIOUSLY don't think it would be safe to still have methadone in your system and start on subuxone. Bad idea all together.
>
> Hope that helps. I'm somewhat knowledgable with my opiates....but I'm no doc. I surely recommend this and if you were I, I would completely detox from methdaone before I started on subuxone due to the instant withdrawals that will occur.
>
> Also keep in mind that if you hurt yourself at some point while on subuxone, you will be unable to take subuxone and opiates (pain meds) at the same time because of the instant withdrawal effect. You'd have to just take the pain meds, which would be ok, because from my understanding, subuxone is not physically addictive.
>
> Altogether, I've heard glory stories that subuxone works VERY well, but its costs more and in some areas of the US it is hard to come across. Keep in mind it does cost more though.
This is the end of the thread.
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