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Doing a switch from 15mg of methadone to suboxone. Terrified.
  1. #1
    Bottlecapbuddy is offline New Member
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    Default Doing a switch from 15mg of methadone to suboxone. Terrified.

    Hi all,

    I wrote a post yesterday in the general prescription addiction board, but didn’t receive any responses and I’m really worried, so I thought I might have better luck here?
    Long story as short as possible: been on methadone for 3.5 years (no other opiates) and have been stable on 15mg for 4-5 months. Decided to switch to subs with the over all goal of stopping all medical treatment fairly quickly. I went to my sub doctor 2 days ago and he said to just take my first sub dose 24 hours after my last methadone dose. I panicked yesterday morning when it was time to do that though and took my methadone instead (I have 2 days of take homes left), because I’m terrified of PWDs. It’s now been 28 hours since my last methadone dose and I’m in mild w/d. I don’t know when to take my dose, because according to my doc, I should’ve taken it already. I have work, I’m a full time student and I’m getting married in Nov. 11th; I’m so scared I screwed everything up by having bad timing. I just got so sick of the way my methadone clinic treated us... I’m in tears right now, imagining being in paws during my wedding.

    What should I do? Should I go back to my methadone clinic and ask them to take me back for a few months? I keep reading about people being sick for months at a time when switching, and I just can’t do that right now...

    Please help
    Last edited by Anonymous; 09-30-2017 at 08:11 AM.

  2. #2
    Catrina is offline Diamond Member
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    Quote Originally Posted by Bottlecapbuddy View Post
    Hi all,

    I wrote a post yesterday in the general prescription addiction board, but didn’t receive any responses and I’m really worried, so I thought I might have better luck here?
    Long story as short as possible: been on methadone for 3.5 years (no other opiates) and have been stable on 15mg for 4-5 months. Decided to switch to subs with the over all goal of stopping all medical treatment fairly quickly. I went to my sub doctor 2 days ago and he said to just take my first sub dose 24 hours after my last methadone dose. I panicked yesterday morning when it was time to do that though and took my methadone instead (I have 2 days of take homes left), because I’m terrified of PWDs. It’s now been 28 hours since my last methadone dose and I’m in mild w/d. I don’t know when to take my dose, because according to my doc, I should’ve taken it already. I have work, I’m a full time student and I’m getting married in Nov. 11th; I’m so scared I screwed everything up by having bad timing. I just got so sick of the way my methadone clinic treated us... I’m in tears right now, imagining being in paws during my wedding.

    What should I do? Should I go back to my methadone clinic and ask them to take me back for a few months? I keep reading about people being sick for months at a time when switching, and I just can’t do that right now...

    Please help
    Welcome!

    Sorry you didn't get any responses yesterday and I'm glad you posted again. Weekends are typically slow around here so don't get discouraged if there's not a lot of activity. It's always that way.

    OK. Now what you should do now. Stop the methadone until you are well into withdrawals. Sorry but you're going to have to get good and sick to get this done the right way but it is possible and if you do it right you won't be sorry. Don't rely upon the amount of time that has passed but instead, wait until you are good and sick. Are you familiar with the COWS? It's used to score your symptoms so that you'll know when you are far enough into withdrawal to introduce the subs. Methadone has a very long half life so it's apt to take you at least a couple of days if not a little longer before you'll be ready for that first sub dose. Did you find and read Robert's Sub Taper Plan?

    How much sub did your doctor tell you to take each day? More likely than not, he prescribed a dose that is too high. The best way to do this is to begin by taking very small doses of sub until you are stable (little to no symptoms). Because you're coming from Methadone, when you're ready to take your first sub dose, take .5mg (1/2mg) and wait an hour. If you're still not feeling well, take another .25mg (1/4mg) and wait another hour. Repeat this process being sure to allow plenty of time between taking more sub to be certain that it's at full effect. Follow this Plan exactly and you should become stable in a matter of several hours and be at the lowest effective dose. Taking the high doses of subs that doctors usually prescribe is totally unnecessary and you'll feel better at the lower doses. Switching from methadone is a little trickier than ordinary opiates so your dose may need to be tweaked for the first couple of days. Don't freak out because after that, you should be good and certainly by your wedding day you'll be well on your way and will have had time to even make some reductions.

    If you haven't seen Robert's Plan, please look for it and get familiar with it. Post often, ask questions and tell us how you're feeling. I'll try to watch for you and others will be along with more input for you. Hopefully Randy will pop in and help so watch for him.

    Peace,

    Cat
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  3. #3
    Bottlecapbuddy is offline New Member
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    Cat,

    Thank you soooo much for replying, I was really going down the rabbit hole of my brain for a while. I’m currently at a 10 or so on the COWS scale. It’s been 28.5 hours since my last methadone dose of 15mg.

    I did read Robert’s plan and it’s surprisingly close to my doctor’s plan. The best thing about this sub doc is that he completely understood that I was looking at only using subs to get off of methadone, so a short time on it and lows doses were discussed. He wanted me to take 2ng and see if that could hold me, with the hopes that 2mg would be the most I need to take. I’m going to do what you said though and do .5mg first. My biggest concern with the doctor was that he wanted me to start at 24 hours after, which seemed like I would just be asking for pwd. He said he’d has a few people at my dose do it though, and that he didn’t want me to have to go through wd symptoms if I didn’t have to.

    It feels so weird to be worrying about w/d and COWS after being stable for so long. It’s really setting off all those anxious feeling I had while in active addiction.

    Thank you again for replying, the only person I’ve had to talk to about this is my fiancé, and he just left for work! He’s never been an addict, but he is still so supportive, so I am lucky in that way.
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  4. #4
    Catrina is offline Diamond Member
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    Quote Originally Posted by Bottlecapbuddy View Post
    Cat,

    Thank you soooo much for replying, I was really going down the rabbit hole of my brain for a while. I’m currently at a 10 or so on the COWS scale. It’s been 28.5 hours since my last methadone dose of 15mg.

    I did read Robert’s plan and it’s surprisingly close to my doctor’s plan. The best thing about this sub doc is that he completely understood that I was looking at only using subs to get off of methadone, so a short time on it and lows doses were discussed. He wanted me to take 2ng and see if that could hold me, with the hopes that 2mg would be the most I need to take. I’m going to do what you said though and do .5mg first. My biggest concern with the doctor was that he wanted me to start at 24 hours after, which seemed like I would just be asking for pwd. He said he’d has a few people at my dose do it though, and that he didn’t want me to have to go through wd symptoms if I didn’t have to.

    It feels so weird to be worrying about w/d and COWS after being stable for so long. It’s really setting off all those anxious feeling I had while in active addiction.

    Thank you again for replying, the only person I’ve had to talk to about this is my fiancé, and he just left for work! He’s never been an addict, but he is still so supportive, so I am lucky in that way.
    Good. It sounds like you have done your homework and understand the process. Hopefully your symptoms are going to ramp up quickly. They usually do once they start. I'm glad that PW scares you because it should. You don't want that to happen so stick with it and be sure to wait this out until you can safely take that first dose of sub. Don't take any comfort meds. None. That includes Immodium and Tylenol. It'll delay your scores and have you waiting longer than you need to.

    I should be around on and off today so I'll watch for you. Keep updating. You're home alone and I'm quite sure that you're antzy at this point so spend some time reading threads to pass the time and keep posting! However often you feel like it.

    You're going to do great.

    Peace,

    Cat
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  5. #5
    Randy35 is offline Platinum Member
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    Quote Originally Posted by Bottlecapbuddy View Post
    Cat,

    Thank you soooo much for replying, I was really going down the rabbit hole of my brain for a while. I’m currently at a 10 or so on the COWS scale. It’s been 28.5 hours since my last methadone dose of 15mg.

    I did read Robert’s plan and it’s surprisingly close to my doctor’s plan. The best thing about this sub doc is that he completely understood that I was looking at only using subs to get off of methadone, so a short time on it and lows doses were discussed. He wanted me to take 2ng and see if that could hold me, with the hopes that 2mg would be the most I need to take. I’m going to do what you said though and do .5mg first. My biggest concern with the doctor was that he wanted me to start at 24 hours after, which seemed like I would just be asking for pwd. He said he’d has a few people at my dose do it though, and that he didn’t want me to have to go through wd symptoms if I didn’t have to.

    It feels so weird to be worrying about w/d and COWS after being stable for so long. It’s really setting off all those anxious feeling I had while in active addiction.

    Thank you again for replying, the only person I’ve had to talk to about this is my fiancé, and he just left for work! He’s never been an addict, but he is still so supportive, so I am lucky in that way.


    Welcome!

    I just wanted to 2nd everything Cat has suggested to you. Perfect advice as she always gives so you're in good hands. Time is never a good indicator of when it's safe to induct on the subs. People are all different with different metbolism's. Might take you 24-30 hours and you're ok to induct and might take someone else much longer coming from Methadone. With it's long half life as Cat mentioned it can take a while before wd symptoms get severe enough for a safe induction.

    I made the successful switch (after 2 failed attempts getting in a hurry to induct) myself from Methadone to Suboxone. My dose was down to around 10mgs and it still took me quite a while before I reached the necessary 26 score on the Cows. Just be prepared in advance and if you're ready in a timely manner it's a win for you. I put myself into PW's not once, but twice I was so antsy to induct and paid a stiff price. PW's are just as bad as you read and hear about. I was never so sick in my life. Went to the ER and they could do nothing. Have to just let it pass. So use that Cows and get to an honest score of 26 and you'll be just fine.

    One of the most important things Cat also mentioned was to not take any kind of comfort meds that will make you feel better while you're waiting to induct. Things like Imodium, Tylenol, Motrin, etc can indeed make you feel better, but will delay your Cows score. You'll suffer longer than you need to and you don't want that happening.

    You are going to be just fine I have no doubt.

    Randy
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  6. #6
    Bottlecapbuddy is offline New Member
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    Thanks for replying Randy! I wonder why my doctor was so sure about the 24 hour thing, I told him I was terrified of pwds. I’ve been in them before from back when I was in active addiction and it was terrible.

    My withdrawals are the weirdest I’ve ever had, nothing like short acting opiate w/ds. My stomach is going crazy and I have permanent goose flesh at this point, slight aching/restlessness, my anxiety is bad... but I have no yawning or watery eyes (which used to be my very first symptom). I have terrible allergies and I have to take medication for them daily, so I wonder if that’s having an impact? They aren’t really optional though. I’m also not having much hot/cold flashes. It seems weird that some symptoms are so obviously there, while others aren’t. Making it hard for me to read my symptoms.
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  7. #7
    Catrina is offline Diamond Member
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    Quote Originally Posted by Bottlecapbuddy View Post
    Thanks for replying Randy! I wonder why my doctor was so sure about the 24 hour thing, I told him I was terrified of pwds. I’ve been in them before from back when I was in active addiction and it was terrible.

    My withdrawals are the weirdest I’ve ever had, nothing like short acting opiate w/ds. My stomach is going crazy and I have permanent goose flesh at this point, slight aching/restlessness, my anxiety is bad... but I have no yawning or watery eyes (which used to be my very first symptom). I have terrible allergies and I have to take medication for them daily, so I wonder if that’s having an impact? They aren’t really optional though. I’m also not having much hot/cold flashes. It seems weird that some symptoms are so obviously there, while others aren’t. Making it hard for me to read my symptoms.
    It's entirely possible that your allergy medication is affecting some of your symptoms. It sounds like things are kicking in so I hope that it's not long before you're ready to induct. Be patient. The longer you wait and the sicker you get, the better your induction is going to go. Even though I'm sure you'll have to take a few doses before you stabilize, you will begin to feel better right away, just not perfect but in a few hours you should be able to become stable. Keep scoring yourself based on the symptoms you do have, be conservative, and you'll be fine.

    Some sub doctors are better than others and it sounds like you might have one of the better ones because at least he's on board with you taking low doses and reducing to get off of them in a timely manner. Lots of sub doctors want their patients to be on them long term. Having said that, he's telling you that you will only need to wait 24 hours because that's what he's been told. They need very little training to become certified to prescribe subs but most importantly, they've never used them. No sense second guessing any of that. I personally would follow the advice of those who successfully used and tapered off the subs. Now that's the real deal. They lived it and know what's it like.

    Keep checking in. Glad Randy found you because you won't get better than him to help you through this.

    Peace,

    Cat
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  8. #8
    Bottlecapbuddy is offline New Member
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    Okay, I have to be honest, I’m overthinking right now and really scared. I don’t feel good at all and I’m thinking maybe switching to subs was a mistake. Maybe I should have lowered my methadone dose even further first. I have 2 take home I can still take, but I had to switch clinics to get the subs, so if I go back to my methadone clinic I will likely lose my take homes. I don’t know what to do, I’m so so worried and sick.

  9. #9
    Bottlecapbuddy is offline New Member
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    Okay, I broke down and took .5 of a sub. It’s been 15 minutes and I’m just sizing up how I feel. So far, no real difference. (If it helps, I was at 36 hours and had a 20 on the COWS scale, which I know breaks the rules). I was just really panicking.

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    Bottlecapbuddy is offline New Member
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    I wait 90 minutes to take another .5, right? I’m not feeling any different, one way or the other.

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    Bottlecapbuddy is offline New Member
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    Okay, just an update for anyone who might be looking for info in the future. I waited 90 mins and took another .5mg. I still feel sick, but my legs aren’t kicking and my anxiety feels reduced. My goosebumps are gone too. Still feel nauseous a little, have a headache, but no pwd and seem to be improving. I’m gonna take this slow, keep seeing how it goes.
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  12. #12
    Catrina is offline Diamond Member
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    Quote Originally Posted by Bottlecapbuddy View Post
    Okay, just an update for anyone who might be looking for info in the future. I waited 90 mins and took another .5mg. I still feel sick, but my legs aren’t kicking and my anxiety feels reduced. My goosebumps are gone too. Still feel nauseous a little, have a headache, but no pwd and seem to be improving. I’m gonna take this slow, keep seeing how it goes.
    Sorry I missed your updates! No worries now. If you were going to get thrown in PW it would have happened very quickly. You only need to wait about an hour before you take another piece and I'd slow down now and only take .25mg pieces until you're stable (little to no symptoms). You're doing well! Some of the symptoms are already subsiding so keep following the plan by adding .25mg pieces. Fingers crossed that you'll land somewhere around 2mg but by taking it slow you may need less or a bit more. That's the reason to go slowly and to wait between doses.

    I'm in for the night now so I'll keep checking in with you to see how you're doing. You did great and should be feeling quite well shortly.

    Peace,

    Cat
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  13. #13
    Bottlecapbuddy is offline New Member
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    So I made it through yesterday with only 1.75mg, I took 1.25mg this morning, but I’m feeling kind of sick today, not w/d bad, just a bit of chills/hot flashes/headache/ nausea. I’m trying to follow Robert’s plan, but I’m a little unsure about how to handle the second day. I left a message with my doctor, but I trust y’all a little more and I also doubt he’ll get back to me on a Sunday.

  14. #14
    Randy35 is offline Platinum Member
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    Quote Originally Posted by Bottlecapbuddy View Post
    So I made it through yesterday with only 1.75mg, I took 1.25mg this morning, but I’m feeling kind of sick today, not w/d bad, just a bit of chills/hot flashes/headache/ nausea. I’m trying to follow Robert’s plan, but I’m a little unsure about how to handle the second day. I left a message with my doctor, but I trust y’all a little more and I also doubt he’ll get back to me on a Sunday.

    Good Day!

    Please provide an update so we know how you're doing. We can usually give you some suggestions that should help the matter. I pretty much know why you're feeling the way you are right now. One reason is because you didn't allow for severe wd's to hit (a 26 on the Cows) and perhaps took the sub too early. Not early enough for PW's to hit hard, but you cheated the plan a bit as you know. Another reason is you probably require more sub to become completely stable. The issue now is that you're experiencing both Methadone wd's and a lack of sub on your system.

    So what do you do about it? What I suggest you do is to take 1.5mg of sub in the am and another 1.5mg (3mg total daily) later in the day about 8-10 hours after the first dose. It's very important to take the sub at the same times everyday to keep a level amount in your system at all times. Taking 3mg daily isn't a lot of sub when you're coming from Methadone believe me. I followed the plan closely taking small doses of sub every hour and it took me 8mgs to become completely stable. But I had a huge Methadone problem (200+mgs daily) abusing it for years so it took me more sub than it might someone else.

    I would try that and give it a couple days for your system to accept that dose. If needed you could even go up to 4mg daily, but see how 3mg feels and we'll go from there. With chills, hot flashes, headaches, and nausea it means you aren't stable yet. You should feel none of that when you're on the right dose of Suboxone.

    I promise you that 3 or 4mg isn't a lot of sub when you're switching from Methadone. The most important thing right now is for you to become stable with little or no wd symptoms. If that requires a biot more sub then so be it. Anyway, that's what I would do if I was in your situation, or I was helpng someone I met in NA or AA. I would immediately have them take more sub and see how they feel in a couple days. I hope you'll agree to try it. I really believe it's the right move for you.

    Take care,
    Randy
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    Bottlecapbuddy is offline New Member
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    Hi,
    Thanks for your response Randy. I took another .5mg this morning (about 90 mind after my first dose) and my physical symptoms dissipated, they were slight to begin with. I’m only having emotional and psychological symptoms atm; anxiety and restlessness mostly. My anxiety isn’t great right now, but I have generalized anxiety and honestly, this induction is bringing up a lot of feelings from when I first got out of my active addiction. So I took 1.75mg this morning total, but it’s been 10 hours since my morning dose and I’m unsure of how much to take. I don’t feel any physical w/d, but I know that could change and splitting my doses will best for me later on. Should I take 1.5 tonight and go ahead with 1.5 morning and afternoon from now on?
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    Bottlecapbuddy is offline New Member
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    Or, since I’m not feeling physical w/d, should I take a smaller dose (.75?) and start the 1.5mg twice a day tomorrow? I’m trying to keep my dose as low as possible, without setting myself up for a longer induction period of figuring out doses.

    As a side note, thank you Cat and Randy for giving advice and taking time out of your day to help me. It means something to talk to people who’ve done this before. I’m 3 semesters away from getting my Bachelors in Psychology with the hopes of working in the addiction community, and this experience has shown me (again) how much it can mean to talk to someone who’s been where you are.
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  17. #17
    Catrina is offline Diamond Member
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    It's important to be consistent both with your doses and with time(s) of day you dose. If you are stable, and it sounds like you are now that you increased your dose a little, then I'd take 1.25 for a total of 3mg for the day. Tomorrow, split that dose evenly and take 1.5 in the morning and the other 1.5 8-10 hours later. Unless you get sick, then consider the 3mg/day your initial dose and stay there for at least four days before you consider a reduction. When switching from methadone, it's sometimes wise to stay at your initial dose for a few days longer so you might stick with the 3mg for 7 days before making a reduction so long as you're good and stable.

    Keep posting and checking in. Let us know how you're feeling. Hopefully, as the sub builds in your system you'll begin to feel much better. Most important thing right now is to not mess with your dose by going up and down. If you feel slight symptoms, do your best to push through them but if they get bad then your dose may need tweaking. You be the judge. You shouldn't be really uncomfortable but on the other hand, don't up your dose because of the minor stuff that should pass in a couple of days as you level out.

    Peace,

    Cat

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    Bottlecapbuddy is offline New Member
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    Thanks so much for the reply Cat! I’ll go ahead and take the 1.25mg for tonight, and then i’ll be splitting my doses evenly 1.5mg 2x p/d starting tomorrow morning. Since I’m not feeling much/any physical wd, I think 3mg will be my initial dose. I’m hoping you’re right and once I have a steady >>>>>> in my system, my psychological symptoms will lessen. I’m sure my brain isn’t super happy with me messing with it’s chemicals so much in the last few days.

    Thanks so much again for your advice and time.
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    Randy35 is offline Platinum Member
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    Quote Originally Posted by Bottlecapbuddy View Post
    Thanks so much for the reply Cat! I’ll go ahead and take the 1.25mg for tonight, and then i’ll be splitting my doses evenly 1.5mg 2x p/d starting tomorrow morning. Since I’m not feeling much/any physical wd, I think 3mg will be my initial dose. I’m hoping you’re right and once I have a steady >>>>>> in my system, my psychological symptoms will lessen. I’m sure my brain isn’t super happy with me messing with it’s chemicals so much in the last few days.

    Thanks so much again for your advice and time.

    I'm not certain if Cat read my last post, but she gave the same advice I did, almost word for word, to begin taking 3mg daily, splitting the doses and take 1.5mg in the am and 1.5mg later in the day, about 8-10 hours after the first dose. So you have the very same suggestions from both of us.

    Keep in mind that you may still have a little bit of methadone wd's but the sub is covering it up at this time. As you remain consistent on doses and dose times you'll begin feeling better and better. It's more difficult to switch from methadone than it is any other substance due to the strength and long half life the mdone has.

    You're right about your brain not being happy with you messing with the chemicals in the last few days. It's expecting a routine of sorts to level itself out. Once you spend a few days taking 1.5mg in the am and 1.5mg later that will happen and you're brain will thank you.

    You'll feel so mcuh better in a couple days so hanf in there.

    Randy
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