advice: starting suboxone

[sunshinegal76]

my friend "J"  is going on suboxone after 3 years of being on methadone for pain management, not heroin use.
In the last week, he took approx 20 mg (2 pills at 10mg) for 2-3 days, on 2 days he took 40 mg. And then on Sunday, he took 9 (90 mg as a sort of last day of fun - I know- I advised him otherwise). So yesterday, he naturally felt like **** and ended up taking 2 oxycodone (30 mg each) at 8pm, and that is the last thing he has taken. We are trying to figure out when he can take his first suboxone, and I know that taking it too early can push someone further into WD if they take it too soon. Technically it will be 24 hours at 8pm tonight (but that is for the oxy). He has the following symptoms thus far:

-sleepiness
-sinus issues, sniffling (but no tears or runny nose)
-achey body, lethargic
-irritable

He is hoping to start tomorrow morning. If anyone can provide advise we would surely appreciate it, as I know his having the methadone in his system is the most important thing to consider. Thank you so much in advance.




    

[motye51]

Did i read he was taking oxycodone in between the sunday night methadone dose and the sub at 1:00?
When i started sub NOTHING could be in my system for 48 to 72 hrs before they would administer it....was urine tested before they would start me. My opinion, "j" ****** up taking the oxy's....could be percipitated withdrawals.
I felt better within a couple of hrs starting the subs....so no, the reaction hes having is not right.

[sunshinegal76]

James has taken 8 mg of Sub sublinguily at 1pm today. He had taken his last methadone at 8pm Sunday night and had taken a few oxycodone in between that time period. Today, we scored at 17 on the COWS test and his anxiety was really bad when he took it, he was unable to sit still. I also gave him .5 mg xanax which helped a little bit. Since he took the sub, he has been feeling worse in his words, his symptoms of leg pains, anxiety have increased. He is having tingling all over his body, and we are uncertain if it's the withdrawals or having a bad reaction to the subs. His anxiety is really bad and I just gave him another .5mg of xanax. Is this a normal reaction to sub? Should he take another sub at this point? I think that he should, as he has been methadone free since Sun night as I previously mentioned, and 1 - 8mg sub isn't going to be enough to stop the withdrawals, but I think he has some legitimate fear about the sub causing a bad reaction. Any advice/thoughts/experience would be GREATLT appreciated, thanks guys. I am trying to help him through this as best as I can. He also keeps having to pee...?!!

[EvolverU]

Hi :),

I've heard the recommendation that patients taper to 30 mgs. before transitioning. However, many responsible & experienced Drs. would consider this a high dose for that transition. Methadone to Suboxone is often a difficult switch. In my experience (including myself), patients switching from MM to Subs aren't happy with the results & sometimes relapse. A better dose to come off of would be 20mgs. or lower. This is a little more realistic.

Also -- & this is really important: It takes @ LEAST 72 hrs. off your last M'done dose before you can safely take your first dose of Bupe & as pillguy pointed out you should be in moderate to full withdrawal (a 6 to 15 on the COWS scale) before your first dose. This is difficult to determine without a physician if you don't have solid experience of full-blown w/d's. The time needed off an opiate like Oxy's or Heroin is quite different than the time needed off M'done which has a much longer half life. Most people are okay @ 72 hrs but I watched a friend who's Dr. had taken her down to 15 mgs. & made her wait 3 days go into precipitated w/d's which were absolutely horrific. We were helpless to do anything for her & it was terrible to watch. It took days for it to wind down to a place where the Subs started to ease it. She had a rough time of it afterwards on Subs. I was also told by the detox I went to that when they initially opened, they followed the 72 hour protocol & although it wasn't common, occasionally they had folks go through the same terrible reaction & that as a result, they began waiting 5 full days to transition people from M'done. Better safe than sorry!

Question: If your friend was only on 20mgs. of M'done, why didn't they try tapering all the way off M'done, getting counseling & perhaps trying the non-narcotic pain route? Like motye51, I don't believe that M'done to Subs is a particularly effective route for pain management. I really don't understand the point of transitioning from M'done to Subs for the purpose of addiction treatment. Of course, that's based on my personal experience :) I believe it will be doubly fraught for myriad reasons if he attempts to treat himself! I don't know anyone who's done that successfully with this drug. (maintaining themselves @ a consistent & steady rate off street Bupe while treating an addiction)The magic lies not in the medication but in understanding the nature of addiction & your personal relationship with it as well as how these drugs are actually affecting our mood & behavior. (Unfortunately, it doesn't matter if your friend came to M'done for pain-management or heroin, the fact is that from what you describe, he's now an addict [in terms of behavior -- not dependency]. So, the best thing, would be for him to go forwards with an acceptance of that (if he hasn't already :) & make the best informed decisions he can for himself & those who care about him.

You sound like a good friend. Thanks for posting & good luck to "J". :)

[motye51]

Are you using a dr? Because quite honestly, we shouldn't be giving advice on how to take suboxone without going through a dr.....Taking subs off the street is going to get you really broke and nowhere.....to me, not a good switch methadone to suboxone.

[Junip]

When I was on subs (which for me was worse to kick than Oxy and Percs) I was told to wait 24 hours. I became really uncomfortable around 12 hours and took my first strip around 14 hours and that was apparently enough for me because I had relief immediately. I started on low dose (2mg strip per day). I was taking 60-180mg OxyContin per day and 2-4 Percocet 10/325 at that point; I am 5'1 petite female. The dose was perfect. I strongly advise a short useage (many docs say 21 days) because the longer you are on it the harder it is to kick. I was on it for around 16-18 months and I went back to my DOC during withdrawals.

[pillguy]

Heroin, Crushed OxyContin®, Percocet®, Vicodin®, Oxycodone and others)
Prior to induction, patients must abstain from all short-acting opioids for 12 to 24 hours and/or have objective withdrawal symptoms sufficient to produce a score of 5 to 24 on the COWS.

[pillguy]

Google "COWS ASSESSMENT"

Methadone
It is recommended that patients transitioning from methadone to Buprenorphine slowly taper to 30 mg./day of methadone, for at least one week. Last dose must be no less than 36 hours prior to induction, and may be 96 hours or more. A minimal score of
at least 5 on the COWS is recommended, although some physicians prefer scores of 15 or higher.

http://www.naabt.org/documents/cows_induction_flow_sheet.pdf

COWS = Clinical Opiate Withdrawal Scale