Methadone withdrawal

[lovepat906]

My son- 28yrs old- has tapered down to 20mgs of methadone daily. He has been a long term painkiller addict and has been on a methadone program for two years. His plan is to switch over to withdraw starting tomorrow- Friday- and move over to suboxone at 5 am Monday morning. He has to work on tomorrow and Saturday-he is a facctory worker and they have 0 tolerance for absence- even sick days are cause for termination. He ned this job to pay for his treatment- which is not covered by his medical insurance... I guess my question is: How bad is this weekend gonna be? Is there anything we can give him that will help him through it? Is his plan for a short term- two months- suboxone treatment and taper reasonable? Any advice would be deeply appreciated.

[wait2long]

my fingers are crossed but i am sure he will do well...
the job thing really stinks...karma will hit his boss someday...

and if you EVER have any questions, need information, etc..., please let me know, i will be there for the both of you anytime as needed...

and like i said dont worry about him getting addicted the first week,  use that time to make sure he is at a stable dose, which can be difficult, because you really dont feel anything on the sub...just make sure he feels well, no cravings, no withdrawal symptoms and just the feeling of normalcy...very important to make sure those 3 are at the top of the list when figuring  his dose...and then when he is stable and doing well, then depending on how he feels, you can go from there as to when to taper etc...
my GUESS is he will have to be on a stable dose for about 6 weeks...then start to taper him down, and it will be very important to do it slowly...do not rush the taper regime...he may suffer if tapered too rapidly...but we can discuss this all later...right now, just get him as comfortable as you can and get him to his appointment...
i would LOVE to hear from you tomorrow about how he does...you can send me a private message ANYTIME...but i really want to know that he did well, ok? so keep in touch...
thank you for not being upset with me, i really did not want to scare you...
talk tomorrow, hopefully...
W2L

[lovepat906]

Really W2L- I appreciate your honesty- it is better to be prepared - even if the posibilities are scary. Don't feel bad about telling me your story. I will get him to our GP for the clonodine if neccesary. He is already on a high blood pressure med so I think it would be good to go that route for the clonodine. The clinic he goes to- MATT ( Medical Assisted Treatment Technologies) has techs that distrib the doses and the actual Dr is only there a couple of times a week- so you have to make an appt to see him ( which costs extra of course) Unfortunately his insurance covers none of this. The Sub is gonna be even more expensive so he is truely hoping to get off everything altogether. The Dr also has a private addictions practice- so you would think he would be up on all this stuff.My son is getting married in August and his goal is to be clean by then. Another prob is his employer who has strict attendance rules- even a Drs note doesn't suffice if you miss more than six days a year. The only way around it is to be out over three consecutive days with a Drs. note and then it is under FMLA. Unfortunately he has already done that twice this year ( once for out of control High blood pressure and another time for acute bronchitus)and I fear that they will find an excuse to let him go if he continues to use FMLA. Keep your fingers crossed for us- and thanks for your supportive responses. It is good to have someone to discuss this with. lovepat

[wait2long]

hun, no, dont worry about the librium... and i want you to disregard everything i said to you above...
if he is this sick already, i hate to say it, but that IS a good thing...i was nowhere near that sick, this is a good thing and i am now pretty confident he will do just fine tomorrow...i now wish i had not shared my experience with you, because it is not relevent to your situation...
i think you should stay on track with your plan, he really is sick enough and i am sure within 1 hour after his first dose of sub, he will be ok...
i only shared my experience with you so you would be aware of the "what if's"..i really did not want to scare you....
stay on track with your plan, but when the doctor is in, do ask for the prescription of clonidine, it will help with the anxiety and sleep...non-addictive but very useful..

dysphoria is the complete opposite of what he feels after he took his drug of choice to get high-which is called euphoric or euphoria   dysphoria is like the BLAHS...nothingness...no feelings one way or another, not sick but just not well, not motivated...its hard to explain...but it does subside with time...clonidine helps with all of this...but he will be fine 1 day without it...
YES, YOU CAN MAKE IT THROUGH THIS...he is definately sick enough to start sub tomorrow morning....
i am so sorry to have scared you with my experience and story...
my only concern now would be to make sure his dose is high enough so he feels well, it could be just 16 mgs, or it could be the max of 32 mgs..just make sure they give him the dose he needs until he is better...it CAN take up to 2 hours to get the full benefit of his dose...but as sick as he is right now, i dont think it will be that long...
i am so sorry he is having to suffer this long...but trust me on this. it will be so worth it tomorrow morning and he is feeling better....i am confident he will get relief...
i was in withdrawals...but not like he is now, and remember i stated my dose fluctuated..i was not a a steady dose....this is most likely why i suffered some...
please keep me posted to how he is doing and how everything goes for him tomorrow.
please disregard my story and experience...except the clonidine...ask for it, or get it on tuesday...
please keep me posted...and do not be scared....

if the doctor is not going to be there to administer his dose, who will be there?  can you ask that person about clonidine?  it would be worth it to ask>

[lovepat906]

now I am terrified. My son has planned this whole scenario with the addiction dr and he is sure that the switch over to sub from the methadone is going to be all good. He did take some librium early this am (Sunday 4:30 ) to help him sleep.If he starts the sub tomorrow at 5 am- is that gona cause problems? He is doing this through a private clinic but the Dr is not there on Mondays and Clonadine hasn't been prescribed. Do you think I should suggest that he wait till Tues to make the switch? And get a script for clonadine? Would it be better for him to go back to the 20 mgs methadone and taper down slowly some more? He is paying $320 a month to this clinic and cannot afford to lose his job. He has been pretty sick since Friday- throwing up, severe cramps and diarhea and sleeplessness. Is that good enough WD? he is very thin and has a very high metabolism.
What is dysphoria and how does one cope with it? Anxiety he knows- thats why he started doing drugs in the first place... OMG. Can we get through this?

[wait2long]

giving him librium or anything of that nature now should be fine, but not for sunday., he should be good to go on monday morning with the sub.  but clonidine would be safer and can be taken with the sub, i highly recommend him asking his doctor for a prescription of clonidine for his induction. (not klonipin) it really helped me more than i can describe, especially with precipitated withdrawals.  
precipitated withdrawals is what happens when you take suboxone and still have an amount of another opiate (usually methadone) left in your receptors in your brain. the suboxone will rip out what it can of the methadone from your receptors, and instead of the suboxone filling your receptors, and stopping withdrawals, the suboxone and the methadone (in a sense) fight each other off leaving your receptors empty, causing immediate intense withdrawals...i really have only heard of this with people who take methadone because methadone has such a long and strong half life - meaning it attatches to your pain receptors in your brain like super glue, but mine was short lived and i swear it was because of the clonidine helping the withdrawal symptoms, it was severe and intense for about 5-6 hours, by that time i had already taken my full 32 mgs of suboxone and she called in a prescription for the clonidine that i took 3 times a day. i then started over again the next day with success, but not COMPLETE comfort, that took about a week to get comfortable for me, but a bit over 5 weeks to really feel the normalcy that everyone feels from sub.  it is such a different experience switching from methadone to sub than switching from oxies to sub,  my sub doctor even told me if she gets another methadone patient that she will prescribe them a shorter acting opiod for 2 weeks before doing the induction to sub.
i really am not trying to scare you...this very well may not happen to him at all, but better to know ahead of time, JUST IN CASE.
and in MY opinion, 21 days wont cut it.  i know it didnt for me, but i also chose long term maintenance ahead of time, i do not think the 21 day taper protocol would benefit him at all, that MAY work ok with a transition from of a low dose percocets or oxies to suboxone, but not methadone, NO WAY, that taper regime is with low doses, he WILL need more than 4, 6, or even 8 mgs of sub, i am CERTAIN of this part. remember, my dose fluctuated from 20-30 mgs of methadone, and on occasion even more, but 98% of the time it was 20 or 30 mgs daily for under a year ( he was on a higher dose for a longer amount of time), i was on the full 32 mgs of sub for close to 6 weeks, and i had NO PROBLEMS tapering quite rapidly down to 10 mgs, you will just have to REALLY pay attention to how he is feeling, that really IS the key..he may be just fine and i really dont want to scare you, sub does work, but just requires more patience when switching from methadone.  it IS possible to do this, ok?  i did do it, but no way in 21 days and i suspect this will hold true with him also...and i hope if needed you wont be afraid to give him a higher dose or leave him on it longer than 21 days...so he can be successful with this treatment.
also give him more immodium..it wont hurt if his diarhea is on the extreme side, i think it says in the thomas recipe to double up on the dose or even more, but check to be sure i am not wrong about this.....
also prepare him for learning how to cope with feelings of absolute "DYSPHORIA"...that and the anxiety were the worst, but dissipated after the 5-6 weeks on the sub...
i dont have all the answers, but i hope my experience and knowledge will help some...
if there is anyway i can help with information, let me know....
best of luck!!!

[lovepat906]

Thanks to all for your kind responses! My biggest concern at this moment is whether giving him Librium is a good idea as he will be starting Suboxone on Monday- is there any interaction problems between the sub and the librium? Also- the Dr. said that with a half dose of 10 mgs of Methadone Friday am ( down from his normal 20) , he should be good to go with the Sub Monday am. IF Wait2long's time frame- methadone late Sunday to suboxone on Thurs caused "precipitated withdrawals" then my son may be in for that. What exactly will that mean?
Right now- Saturday night- he has major stomach cramps and intense diarhea. Imodium is not helping. Wait2long- do you think he could follow the 21 day taper protocol that is described on the suboxone health page? I don't want him to get addicted to the sub and then have to go through this whole WD thing yet again. But then again I don't want to make unrealistic recommendations.
His history is that he has been on methadone for two years. He has slowly tapered down from  a high of 95mgs and has been doing a 2mg a week taper for the last year and has been holding at twenty for a month or two. He went on the methadone to escape from an oxycontin addiction.

[wait2long]

I successfully transitioned from 20-30 mgs of methadone to suboxone.  it was a rough transition but i made it and i did it.  BUTi will have to say because of the half life of methadone, it DID take a little over 5 weeks to get the FULL benefits of the suboxone, i wasnt sick, but i still didnt feel well.  the worst part was the anxiety, he may have to wait as i did to get the full benefits of the suboxone...methadone acts like super glue in your receptors, and takes 4-6 weeks to leave your system completely. with or without sub. i was also on the maximum dose of suboxone 32 mgs of suboxone daily, split dose, 16 mgs in the morning, and 16 mgs at night, for just under 6 weeks, at this time i was able to taper quite rapidly down to 10 mgs. ( i have since gone up and back down again in sub dose to try to help with some chronic pain i have)

if he was on a stable dose of 20 mgs (only) of methadone (which i wasnt) for an extended amount of time he may not have this problem.

i was also put into precipitated withdrawals, i took my last dose of methadone late sunday afternoon, by thursday i THOUGHT i was in withdrawals enough to start the sub...i was wrong...but again, i was not on a stable dose of just 20 mgs for an extended time either...if he has been, he has this working for him in his favor....

if you have any questions about this let me know, i may be able to answer any questions you may have... to ease any withdrawal symptoms he may have, ask the doctor for some clonidine, it helped me IMMENSELY!!!
good luck!!

[avisg]

wait2long is one of our forum members she has been thru this exact thing .If you click on her profile you can send her a message I think she could give you some good info on this

[Becky102]

My husband is beginning a long taper to get off methadone.  If you click on the "Thomas Recipe" (you can usually see a link for it on the right side of the page) it mentions librium as useful while in detox.  
I'm no expert on this, so maybe someone else would like to chime in, but I think you should take a look at it (the Thomas Recipe) as I've heard many people say how it helped them.

[lovepat906]

My son is coming off of methadone this weekend and will be going on to suboxone on Monday morning( see earlier post for details) Can we give him some librium to take the edge off today and sunday?

[goldenarm]

I have been on Methadone twice,,in the 80s and.early 90s.Went on a solid 15 month run of  speedballs, and i dont mean speed, Then the detox.After 3 months of 80 of the cherry Meth,,i stopped and by day 3 and 4 it was undoable for me,,i went back on the 30 day meth detox,,Taper..and for about 20 days after that i ate 1 vicodan a day then nothing,,my body ached and went thru some changes for a month and  a halfeven after all that,,,sleep was difficult,, i did work for the most part except when i got really sick ,at 1st,Was on edge hard at beggining,but it was doablenot with out any help though,,,,Stayed clean for yrs,,then back problems,,now its pills,,oxys ,,they work ,,but im dependent on them ..I tried to stop and the Dr, said not yet..and i couldnt of done it without some treatment,,ive looked at the Sub inside and out ,,i will use that when it comes time..2 month taper,,,,no more ,,no less,,nothing else except,hot *** baths and showers combined,,Lots of water,,good juice and good food,,not alot of caffine and sugar products,,lots of vegetables and fruit,Good hr, walks,,Rubdowns,,sex,,,,and keep occupied with postive stuff that makes you feel good and relaxed,,,Tv at nite ,,perfect,,and NA

[lovepat906]

We have so been there for him- it has been a long, tough go. I am still hoping that there will come a time when he will be free of this... I wish I could do it for him- but of course it is his road to walk. It is so hard to stand by and watch your child struggle with these demons. Life is so short- what a crappy way to spend it. My heart breaks...

[worried878]

I have never taken methadone nor suboxone but see meth WDs alot where I work...the patients do no feel the WDs too intensely usually until the 2nd or 3rd day...he should be fine at work tomorrow without a dose...by sunday he should definitely be feeling the missed dosage, but he will need to in order to start the sub on monday from what I have read...Be there for him...sounds like he is making a step in the right direction....

[lovepat906]

Yeah- he has used FMLA twice this year- once for acute bronchitus and again  for the flu- you need to be out at least 3 days with a Dr.note for that and I don't think he wants them to know what's up with him... He is afraid of screwing up his employment- plus of course he doesn't get paid while he is out. BUT I will suggest that he just do it- if times get tough. He tells me he will get a half dose(10mg) of methadone tomorrow- Friday am- and then will get his first dose of the suboxone Monday am. From what I have read here- I am gonna suggest that he stay on the sub as short a time as possible- perhaps the 21 day protocol that is described on the health pages.  This has been hell. I hope he can make it. He is so not good with any kind of suffering- which is how he ended up here in the first place...

[Savas]

that's the dispute I mentioned... I've heard a lot of anecdotal evidence that says that a 3 week course of suboxone or less is the safest way to go. It is a very addictive drug and taken long term can be as addictive as oxy or heroin.

But methadone stays in the system a long time. It could take quite awhile before the residual effects are fully out of your system. So he may want to do the full three months and hope for the best (and prepare for the worst. If you do that, even the worst won't be that bad.)

[skitz758]

theres a family medical leave act look into it he could have time off with out getting fired.
good luck skitz

[lovepat906]

so... any advice as to the optimum time on and then tapering off of suboxone/

[lucyred68]

it is doable, the methadone should be out of his system, and the shorter time he takes the sub, the easier it will be to detox off of.
Lucy

[lovepat906]

Thanks for your advice...He is under the care of a Dr. in a clinic situation. I think he will not get any methadone tomorrow- Friday. And then he will not get anything until 5am Monday- that will be his first dose of suboxone. I think that it was planned to have the least impact on his work- he will be working 3-11 on saturday and Monday. So... is the idea of gettng on and tapering down off subozone over a two month period doable?  He is terrified of being sick...

[Savas]

There's a bit of controversy on methadone to suboxe switch. first, 20 is the absolute maximum, which could make it a bit rocky (although it is doable).
If his last dose is today, then he should be okay for the switch. But if he doses tomorrow...it's cutting it a bit close. There's a small possibility it could be too soon (not likely, but possible).

(I'm not trying to scare you here, just giving you fair warning so you can prepare for anything).

If he's been on his 20 dose and takes it tomorrow afternoon, lets say, then he should be okay into Saturday. Sunday night should be when he starts feeling bad. As to how bad...I can't really say. But by Monday he should be in full withdrawals (a good thing, needed for the switch).

[flmagi]

This weekend may get pretty ruff for him. But on monday morning after he takes the Sub. at 5 Am, he should be feeling pretty normal within 1 hour as long as his dose is correct and he was in sufficient withdrawels. He would be safer to take his last methadone friday AM, which would basically put him at about 2 days of withdrawels before taking the Sub. Is he doing the Sub under a doctors care?

[lucyred68]

it shouldn't be too bad the first day, because of the half life of methadone, but Sunday shoud be rough.  the sub will help, according to what i read in here.
Lucy