MMT to Sub induction in 10 days-any advice?

[Dopeless Hopefiend (OP)]

Hey there. I haven't posted in a bit, been busy with school. When I signed up I posted about the slow methadone taper I've been doing for the last year +. I finally made it down to 30 mgs last week and went to my doctor to set a date to transition onto bupe. I'll take my last dose of methadone on a Sunday, then have an appt 4 days later on Thursday for my Subutex induction. I'm so freaking nervous, but so relieved to think that I will be out from under the control of the 'done clinic in a little more than a week. Don't get me wrong I'm grateful for MMT. It literally saved my fucking life when I got on it, I just never thought I'd be on it this long. The side effects (sweating, significant weight gain, fatigue) and the control the clinic has over people's lives are my main reasons for wanting to get off.  I get a week of take outs every week, but should've been getting a months worth at a time years ago. Anyway, that could be a whole other post.
Bottom line, I'm pretty freaked out about the transition. I've heard so many different things from different people. From the subs took away all w/d symptoms the 1st day to they didn't do anything at all or even that they caused precipitated withdrawal even at 72 hours after last methadone dose. I'm waiting an extra day to make sure I don't take the subs too soon, so I'm pretty sure I won't have to worry about the PWD, but I'm sure I'll be plenty miserable for at least days 3 & 4. I do have some comfort meds, but I've been reading a lot about different vitamins & supplements being really effective for some of the w/d symptoms. Anyone have any experience with that? And most importantly, has anyone here done a methadone to subutex/suboxone induction?

[Chip]

I can't help but I thought 20 mg. was the highest dose that one could transition from.

keep us posted, please.

[Dog Food]

I would completely stop the done and use a short acting opiate for about a week then do the normal induction everyone else does. Why make yourself suffer for 5 days then end up with pwds when you coulda just bought a couple grams or so and maintained on that till time to induct.

[Snout]

I did this a long time ago. It was unpleasant. I cAnt recall exactly, but I think I got down to 20 Mgs done before switching . I don't want to set you up mentally, but it took about 5 days until I was feeling normal again. It was 2006 I think. Good luck

[Chip]

yeah, I'd even leave it until 15 mg.

just try to get as dopesick as possible and then the transition will be easier.

no pain, no gain, in this game.

[Dopeless Hopefiend (OP)]

@dogfood I've thought about that. Not actually doing dope, I've been clean for 8 years on MMT, but about switching to a short acting med for a week or so first. I actually have a pretty awesome stockpile of IR meds that I've been sitting on for a long time "just in case" (You know, gotta be prepared for anything) that would probably do the trick. In fact my doc had already said that I could take short acting meds for my first 2 days off methadone. Just said I needed to be 12 to 24 hours off of even those before she starts my subs. I could just stop taking the methadone a couple of days sooner than planned and take the oxys instead. I'm clear that that PWD shit is no joke, so I'm willing to do whatever to avoid that.

[dizzle]

Yeah I'd NEVER, in a million years take subs after methadone, unless I was down to like 2mg of done. I'm sorry but I have to say this is a horrible idea if you don't have a short acting opitae inbetween. Also, I'd wait AT LEAST 72 hours after taking the done.

It sounds like you're putting a lot of trust in that sub doctor. but hopefully you know that most sub docotrs know fuck-all about bupe. Especially transitioning FROM METHADONE. 30mg's is too high to jump. 72 hours isn't really enough IMO. My only advice to you is to be incredibly careful when you dose the subutex. I'd start insanely small, like 1mg, give it 30-40 mins and see how that goes, then if not horrible, and actually seems to help a bit, then take another 1mg. Id not take more than 4mgs that first day either.

IME bupe seems to really act more antagonistic at higher doses. "Less is more" is the way bupe works, especially when transitioning.

Good luck to you.



Also, I'm intrested what "CONTROL" the done clinic has over you? Do you mean stopping in once a week, peeing in a cup, and giving them money? It's somewhat unclear to me. Also, did your side effect symptoms get alleviated when you dropped down to 30mg? Did you try to stabilize yourself there for a bit and see if that helped the side effects? Just wonderin....

[Dog Food]

Youd have to take a short acting opiate for at least a week to be worth it. Just stopping the done then taking perks for 2 days doesnt erase the done in your system. The idea is to take a short acting drug like perks for a week at least if not a lil more so the done gets out. Doin perks for 2 days then sub on day 3 would be no better than stopping done and then taking sub on day 3.  I wouldnt personally touch sub till a week after the done, precipitated withdrawals are no joke,the worst thing ive ever gone through. Ive been putting off taking sub for at least a month now, cause they make me feel worse the first day or two.

[Dopeless Hopefiend (OP)]

@dizzle, where should I start?  The clinic that I go to isn't a juice bar. I wish it was. They require groups which are a total fucking joke most of the time, 1x1 counseling, etc. Also their policy on weed usage is bullshit. Weed is now legal for recreational use in my state, and has been legal for medical use for years. I don't even smoke, but was using topicals (a salve for pain relief) which is mostly CBD based but has a small amount of THC in it. I tested positive at literally the lowest cutoff level and they cut my takeouts in half. Now, they're saying that I need to stop filling my (very small) ativan script or go back to 5 day a week dosing with only weekend takeouts. I've had it for more than a decade without ever increasing the dose and my primary doc already had the psychiatric nurse practitioner in her office take over prescribing it almost a year ago when my clinic insisted it couldn't be prescribed by a pcp anymore. So, I'm just over it really. And no, my side effects really haven't gone away as I went down. A little more energy maybe, but for the most part no.

@Dog Food, I didn't mean I was just going to take the short acting for two days. I'm clear about that PWD being no fucking joke! My original plan was to stop the 'done on a Sunday (my sub induction would be 4 days later on Thursday) I was just wondering if you thought it would be a better idea to stop the done 2 EXTRA days earlier, say take my last dose on Friday so I have 6 days between that last dose & my sub appt. I would take short acting opis for the first 4 days, then nothing (except benzos & other comfort meds) for the last 2 days before my appt. That should be more than enough time for the done to be out of my system I think.

Oh, and @dizzle I'm not an expert by any means, but when my clinic switches people over to subs from methadone they do it at 30mg too. I'm sure the lower you can get the better, but 30 is pretty common here.

[DeadCat]

I agree with the previous posts. However you go about it, wait until your truly dopesick, not just "uncomfortable" before you take the Subutex, and start with a tiny dose. You  can always take more but if you take too much too soon get the puke bucket ready.

The one time I went through percipated withdrawal I had been gettting by on scraping empty stamp bags for a day and it wasn't enough. Beofre I went to bed I put an 8mg tablet under my tongue. I fell asleep and then woke up 100% dick after maybe an hour. The worst lasted all night and I didn't take any more Subs.

After a day I was basically OK and the next day one of the guys I would middle for wanted me to get him something and I was  actually well enough to debate going in to get it. But of course I did.

Bottom line: wait as long as you can stand it. Technically you are supposed to induce under medical supervision and they are supposed to examine you and find physical evidence of opiate withdrawal before administering any buprenorphine.

[Dopeless Hopefiend (OP)]

Yeah, I'm for sure doing it under my doctor's supervision. She said she uses the COWS Scale and I have to have a certain score before I can take my 1st dose. She did say that my 1st dose would be 4mg though, and that I would go up by 4 every 30-40 minutes as needed up to 16mg. She said she never goes higher than 16 the 1st day and that most people don't need to go higher than that. I've been hearing that less is more with bupe from a lot of people, so I'm thinking I may ask her if I can start with 2mg instead and do smaller increases.

[Griffin]

I would wait the 6 days for sure! I had the idiot doctor do the cows scale with me, and they sent me into pwd had to have my gf drive me home because i was shaking so intensely and basically shitting and puking on myself for the 3 days, of course the doctor wouldn't answer the phone during that period after he put me into pwd to tell me if i needed to take more of the subs or wait, so i ended up waiting 3 days going through hell.

I hear you on wanting to leave the clinic, my fucking counselor who is awesome is leaving for another clinic because the cilnic i am at is a money hungry for profit clinic, os they are always doing stupid shit to increase profits and fuck over the counselors and patients. Now the clinic director who is the biggest cunt in the world is my counselor until the person they hired gets upto speed. I hate the guy, he is such a prick, constantly an arrogant, condescending asshat.

He is probably going to fuck over my chances of getting 2 weeks of take homes at a time next week when i am supposed to get it, I can just hear it now him coming up with bs reasons why I can't move up that my other counselor already okayed. Other than taht i really like my clinic its just the director is a dumb asshole, and my counselor who kicks ass just left so it's definitely on the down swing.

They luckily just changed their policy back to letting people on 2 weeks at a time only have to do one counseling session or one group a month instead of both, they are still screwing over all the pot smokers, and people who aren't at that level, with 4 groups and a counseling session a month, and insurance will only cover 1 a month. So I am luckily past that point and wish you the best on your adventure... dont take subs until you feel like or start puking and pissing out your ass at the same time.

[Chip]

yeah, demand to be supervised if you must do this but why do it at all ?

you can still taper from the 'done, can't you stay with it ?

[Griffin]

I think he doesn't want to be married to the clinic anymore chip, which is understandable. It was so much easier when I was on subs except for the money part of it. I only had to go in once a month or less, and I could schedule it on my own time, I didn't have to do monthly counseling sessions and groups, I could smoke pot, and drink, I could save up a rainy day fund, which I could do now technically I just don't have the will power which is sad since I get nothing outta taking it.

I hope that in the future methadone regulations are eased up quite a bit, it is so annoying especially when you want to travel, you don't have to make all these arrangements and be approved by the clinic. If i need extra take homes or have more take homes than I am allowed, it has to be approved by the clinic and then they have to send it to the state to be approved. If I guest dose its a hassle and the last place I went to was $25 a day to dose there.

It seems so much better I wish it worked for me and that it wasn't so expensive. When I was on subs I lost my job and my insurance I had through it and my 28 script was $600 and the doctor refused to write me for generic sublingual bupe/naloxone even though it was less than 1/3rd of the price, and when I argued with him about it I was kicked out of the program now that I could of stayed but it is still irritating.

The doc had no reason to not prescribe generics. I accused him of taking kick backs from Reckitt benckiser. That was the only logical conclusion I could come up with for him to refuse to prescribe me the exact same medication that was 1/3 of the price.

It made absolutely no sense to me, and he couldn't list one reason why he wouldn't prescribe the generic version of the exact same medication after I had lost my job and insurance. I asked if he would rather risk having a patient relapse, and possibly od and die instead of prescribing the generic, and he still refused. How can he pretend to be about anything other than money.

It was november of 2013 and with the switch over to obamacare happening and me having a pre-existing condition now thanks to being on subs for 10 months, the cheapest plan I could find that would cover it was $550 a month for just me, because I would have to switch plans in january when obamacare came in effect.

Lucky for me my methadone and treatment is 100% free with medicaid, medicaid here is amazing they just paid for my dui classes to which would of cost me $350 for the 6 classes, intake, and exit assessment. My clinic costs 230-400 a month with no insurance and with kaiser it's 60 a month, and that is the only insurance besides medicaid which is free that they take. My clinic is a for profit clinic and they are very adamant about the for profit part of it.

[Dopeless Hopefiend (OP)]

@Griffin , yep. That's the main reason. Being married to the clinic is getting old. I just finally got a decent counselor again, but still. Like yours it's the director & the doctor at mine that are total fucks. They're both on a huge power trip. And it's 100% for profit too. It's crazy how hard they make it for people to taper & get off, but have no problem increasing people's doses up to 300mg a day or more. It's all about the $$. It's taken me over a year to get from 85 down to 30, and so many fucking hoops to jump through. The doctor only approves your taper down to a certain dose, then you have to go through the whole dose eval process with your counselor again to get a new order. That takes 2 to 3 weeks to get approved each time. Then the whole process again every 20-25 mgs or so. And if I don't get a pregnancy test every 30 days forget it, I have to hold my taper. It's fuckin maddening.
I know I could just continue this very long & drawn out methadone taper @chipper but it would take for fucking ever. I'm off school for the summer, but got accepted into a pretty academically challenging program that starts in the fall. So really the subs are the quickest route for sure. I can't imagine trying to taper down to zero while I'm taking 14+ credits and taking care of my kids. I'm just not that tough man.