going from methadone to Butrans patch

[Juls711]

Been on methadone 40mgs daily .  Switched to Butrans 20mcg patch.  Why am I having withdrawal and any suggestions

[Juls711]

Hi guys my wi-fi is out .  Sitting in car at stop and shop.   Fentanyl 50 is much better.  BUT the 2nd one I put on fell off in shower.   I put on another one .  The one that fell off was on for 24 hours.  I saved the one that fell off.  I am MISS ing the initial euphoria after my morning dose of methadone does anyone else feel like this?  I will try and come back to wi-fi area for suggestions.  Can some one suggest a book non fiction about this.  I already have the BIG book.  Thanks  Juls

[Juls711]

Cancer and lymph node issues.  I am going back to my oncologist Tuesday.  I will give him an update on med situation.  

[weaver71]

You are on a higher dose of a stronger opioid now, you should feel better. Give it a few days, sometimes switching, especially from methadone, takes a little while to adjust. This doctor doesn't seem too knowledgable about these drugs, as he thought 20mcgs butran patch was equal to 40mgs of methadone, then I assume he didn't want to raise the dose of bupe, but gave you a higher dose of something even stronger. I am simply confused at the logic in the decisions your provider is making. I'm not saying they are wrong, I don't know all the details, but what I see, doesn't show me that doctor has much understanding of how to prescribe these drugs, based on what the pharmaceutical companies suggest. I would likely get another doctor opinion of how to treat your pain, but that is me. Let us know how it goes. Just know, if you build tolerance to Fentanyl, there is no stronger pain medication on the planet, just be aware.

[Juls711]

Better than the Butrans patch.  Thanks weaver

[weaver71]

Fentanyl is the only opioid stronger than buprenorphine and is difficult to determine equivalents. Methadone and all the synthetic opioids seem to have a different affect on everyone. Technically, legally, officially there is no accepted standard of converting methadone to other opioids. Most conversions are based on morohine equivalents, but what I found was approx .36 mcg fentanyl to 40 Mgs of methadone. The accepted practice of switching from methadone to any other opioid is based on individual response to dosage, not a chart. Like when I took methadone and used buprenorphine to detox, my doctor used a chart and found that 16mgs of subutex was equivalent to my 200mgs methadone habit. I took 8mgs and was fine, which according to my doctor, was not enough, but my body said it was. So, I suppose my next question is, how does 50mcgs feel?

[Juls711]

Hi Juls here , took advice and went to doc.  He now has me on fentynal 50mcg patch.  Anyone out there that can convert 50 mcg fentanyl 3 day patch to  40 mg liquid methadone daily.  

[clean_in_ks]

Never be sorry for asking questions, Juls.  That's how we learn, right?

At least now you understand more about the drug equivalency in your patch to the amount of methadone you were on which was your original question....and why you might be feeling so poorly.  Now you have some understanding and can talk to your doctor.  Let us know how  you make out, ok?

[weaver71]

Don't be sorry, any frustration I have is with my ability to make a point, you are totally welcome to say or ask anything anytime. That is a particularly difficult drug, in that most doctors really don't know much about it either. I'd rather taper the methadone more than drop that much dosage. I just want you to understand that, so you don't suffer more than you have to.

[Juls711]

Thanks for advice.  Sorry for the questions and I know I keep repeating myself.  I know nothing about Butrans patch except for what it says on line and the patient info.

[weaver71]

Thanks Connie, It's hard to explain for me. Basically, you should be taking 50-100 patches a day to get an equal amount. That's why you are not feeling well. Talk to your doctor.

[clean_in_ks]

I'm not sure I'm following you, Juls......

1.2 mg of bupe is equivalent to APPROXIMATELY 10-20 mg of methadone

20 mcg (micrograms) doesn't factor into the above equation because it takes 1000 mcg (micrograms) to make just 1 mg (milligram).

And yes, bupe comes orally.  Either as subutex or suboxone.  The sublinqual films come in 2 mg strips and also in 8 mg strips but 8 mg would be too much for you.  2 mg of bupe would be approximately equal to 40 mg of methadone.

You are only on 20 mcg of bupe right now and it's in the form of a slow release patch over a 7 day period.  Hope this helps explain it better~

[otterwatcher]

buprenorphine is the active drug in butrans. it is the same as subutex

[Juls711]

1.2mg of bupe equal 20 mcg bupe equal approximately 20 mgs Methadone?  Does this come orally bupe

[Juls711]

1.2mg of bupe equal 20 mcg bupe equal approximately 20 mgs Methadone?  Does this come orally bupe

[clean_in_ks]

That was just a typo.....he meant "bupe"

Buprenorphine (Bupe)  

[clean_in_ks]

It's important to differentiate between mcg (micrograms) and mg (milligrams) when you convert.  Here is an "approximate" conversion chart that I like to share with people because it helped me so much.  1.2 mg of bupe is equivalent to approx. 10-20 mg of methadone.  So what Weaver is saying is that the patch won't get you where you need to be.  Putting you on about 2 mg of suboxone or subutex would make you more comfortable and be a more equivalent conversion from 40 mg of methadone.
Here the link to the conversion chart....hope it helps.

http://www.medhelp.org/user_journals/show/18499/Conversion-table-other-drugs-equivalent-to-sub

[Juls711]

What is dupe,are we talking about the same medication.

[weaver71]

There really is no exact equivalent, but i can guarantee you that 20mcgs of bupe doesn't cover 60mgs of methadone, for anyone I have met. Maybe in someone's theory, but I have read it is closer to 1mg dupe is good for 30-60mgs of methadone. I was at about 200mgs methadone and 8 mgs bupe was about right, which is half what my doctor prescribed, but that is 50mgs methadone to 1mg bupe, was still a little off, but stabilized in a couple days. I'll try to find another conversion chart, but that conversion you shared means that 1mg dupe is equal to 300mgs of methadone, maybe check your source again.

[Juls711]

Butrans 20mcg hour patch is what he has me on.  When I looked at the conversion chart  it said 20 mcg patch is equivalent to 60 methadone.  Please please let me know if I read it wrong or Any info.  Thank you. Also,  it's for pain and I read that people sometimes need to take something besides the patch for break through pain.

[weaver71]

Oh, I didn't really answer your question. If you took perks now, on bupe, which is the second strongest opioid on the market, you would have to take way more for the same affect you are used to. Bupe is so much stronger than other opioids, other opioids don't work, that is why Bupe is used in addiction recovery. People often think it is the naloxone in suboxone that prevents other opiates from working, but the fact is, it works because bupe is that much stronger. Taking a perk right now, would be like having a beer after drinking a fifth of whiskey, it will have some affect, but it would take a lot to be noticeable.

[weaver71]

Taking Perks is not a good idea, even if they are prescribed. The issue is, you are wanting to be stable, not go up and down all the time. Perks are not very strong, compared to methadone or bupe, so your tolerance would be more affected than anything. Just my opinion. If you take a few perks, then they wear off in a few hours, then what, take more, then more? No, if you want to be stable, imo, you need to talk to your doctor about a more appropriate dose of bupe, at least long enough to taper down. Just for some reference, it would take 50 of those patches to be equal to the methadone dose you were on, minimum, that would be 1mg of bupe. I don't know why the doctor even thought you would feel okay on this transition, there is no science to back the dose they are giving you. Is this for pain or addiction? Personally, I think I'd be looking for a doctor who knows more about bupe, unless there is something I am missing here.

[Juls711]

Thanks for the advice.  I did wait 48 Hours before the patch.  So if I took a couple of Percocet what would happen

[weaver71]

20mcgs of dupe is not enough to cover 40mgs of methadone. Also, the partial agonist affect of dupe leaves some people feeling odd anyway, so taking too little is adding to that affect. From what I have studied, 1mg bupe is a closer dose to an equivalent. I'd talk to the doctor about this, there are no butran patches strong enough to cover 40mgs of methadone, I'd suggest talking to the doc about getting subutex to taper down to that low of a dose, subutex has 2mg tabs that can be used to get your tolerance down lower.

[clean_in_ks]

From reading your other 2 posts, I see that you had gotten yourself down to 40mg of the methadone for a year before you made this switch, right?
And is it safe to assume you went at least 48 hrs completely off before you put on the Butrans patch?

If those are both correct assumptions, have you talked to you dr about this?
What kind of w/drawals symptoms are you feeling?  With a 7 day Butrans patch, you don't get the full dose all at once (as you may know).  If you can share a little more with us, there are those with at least some experience of going from methadone to bupe that could possibly help.  Keep talking to us...and welcome to the forum~