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Suboxone Induction Help
  1. #1
    Emily1389 is offline New Member
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    Default Suboxone Induction Help

    Hi! I am new to the forum, I had posted a thread earlier, and it appears to have been deleted... Probably my mistake!

    Anyways, I could really use some help and advice!

    Hi, my husband is trying to switch to suboxone and we need help!

    Basically, my husband had been using opiates regularly and heavily for about 5 years.. He was also on methadone. I know about waiting to prevent precipitated withdrawal. He tapered to 30mg of methadone and took his last dose Saturday (5 days ago). He did his last dose of opiates on Tuesday night. Wednesday morning he took one mg of Xanax and another mg at about 4pm. We waited until it had been about 24 hours since his last opiate use to give him the suboxone. He took one 8 mg sublingually (at about 2am) and then another 4mg about an hour and a half ago. We waited until he scored a 24 on the COWS scale.

    Only problem is that he's still feeling awful!! Throwing up, sweating, shaking, the whole nine yards! Did we do something wrong? What should we do now? We have access to more suboxone, does he need a higher dose since he was such a heavy user? I know the forum typically recommends a much lower dose (1-2 mg) but I didn't see that until this morning. Help!!

    Thank you so much in advance guys!

    Also -- on my previous thread someone had suggested the Xanax may have caused precipitated withdrawals, but I thought only opiates could cause that?
    Last edited by Anonymous; 05-25-2017 at 03:44 PM.

  2. #2
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    Hi Emily- switching from methadone to subs is tricky. The dosage seems high. In my opinion the dose is too high- often less is more. Read the sticky note above. Start small couple mg and then increase the dose slowly after a couple of hours to evaluate the symptoms. Often doctors try to induct people on very high amounts of subs. The most around here on day 1 is 4-6 mg. Then a couple days in taper by 25%. What's hard to get your head around at first is that due to the half life, what your husband would have in his system is the accumulation of 3 days of the doses he took the last 3 days in his bloodstream. So he took 12 mg in one day- that would mean 36 mg in 3 days. Trust me the process is doable. Not without discomfort but better than CT. Stay strong and be sure he's drinking lots of water.

  3. #3
    Emily1389 is offline New Member
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    Thanks! I'm just worried because the suboxone doesn't seem to be helping his withdrawal symptoms...


    I'm at work right now, but according to him, he is still vomiting and feeling terrible. This is about 18 hours after he took 8mg and 10 hours since he took another 4mg. I'll update again when I get home and can actually see how he is doing.

  4. #4
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    I am a little confused about the 10 and 18 hours but. When did he last have each medication and how much? Was he vomiting during the induction process?

  5. #5
    Randy35 is offline Platinum Member
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    Default

    Quote Originally Posted by Emily1389 View Post
    Hi! I am new to the forum, I had posted a thread earlier, and it appears to have been deleted... Probably my mistake!

    Anyways, I could really use some help and advice!

    Hi, my husband is trying to switch to suboxone and we need help!

    Basically, my husband had been using opiates regularly and heavily for about 5 years.. He was also on methadone. I know about waiting to prevent precipitated withdrawal. He tapered to 30mg of methadone and took his last dose Saturday (5 days ago). He did his last dose of opiates on Tuesday night. Wednesday morning he took one mg of Xanax and another mg at about 4pm. We waited until it had been about 24 hours since his last opiate use to give him the suboxone. He took one 8 mg sublingually (at about 2am) and then another 4mg about an hour and a half ago. We waited until he scored a 24 on the COWS scale.

    Only problem is that he's still feeling awful!! Throwing up, sweating, shaking, the whole nine yards! Did we do something wrong? What should we do now? We have access to more suboxone, does he need a higher dose since he was such a heavy user? I know the forum typically recommends a much lower dose (1-2 mg) but I didn't see that until this morning. Help!!

    Thank you so much in advance guys!

    Also -- on my previous thread someone had suggested the Xanax may have caused precipitated withdrawals, but I thought only opiates could cause that?

    Hi Emily.

    I wrote you a reply yesterday and see that it's been deleted along with your thread. I'm sure it's because you mentioned an illegal and illicit drug by name. It happens and is against the forum rules.

    I'll cut right to the problem....your husband is definitely in precipitated withdrawals. DO NOT take any more sub right now as that will only make him sicker. The only reason you go into PWD's is because you take the Suboxone too soon after stopping the drug of choice. And it's HORRIBLE. I know this from personal experience. I too made the switch from Methadone to Suboxone and it took me 3 treis to get it right. It's difficuly and a tricky thing to do. The difficult part is how long you must wait in wd's before you can safely take the subs. It can take several days. Because of this we always suggest using what is called the Cows.

    The Cows gives numbers to different wd symptoms. You add them up and once you get to a score of 26 or higher it's safe to induct. Take the sub before you hit that 26 score and PWD's can definitely happen, and usually does. Here's a link to the Cows below....

    https://www.drugabuse.gov/sites/defa...rawalScale.pdf

    The scoring must be done honestly and accurately. Having you score him would be best.

    Once you do get to that score the induction should begin with SMALL doses of Suboxone every hour until he's stable. Taking 8mg is NOT the way to do it. For those coming from Methadone he would take 1mg as the first dose and wait at least 1 full hour. Sub workls slower for some than it does others. After that he would take either .5mg (1/2 of 1 mg) or perhaps another 1mg dose and again wait an hour. Then he would take .25mg (1/4 of 1mg) or .5mg every hour until he's stable with little or no wd symptoms.

    The goal is to be on the LOWEST dose of sub, not the highest. Suboxone works differently than other opiates. Less is better. Suboxone is extremely strong and a little bit goes a long way.

    Here's the link to our sub plan below....

    https://www.drugs.com/forum/suboxone...apy-66109.html

    The plan explains things in easy to read detail. It's basically as I just said above. The plan takes around 6-8 weeks from induction to final jump give or take a couple weeks. Suboxone saved my life. I was on it long enough to deter my addictive thinking and actions. I then tapered off the subs and now have alomost 3 years clean. He can certainly do it too!

    What do you do now? He should STOP taking any Suboxone and redo the indution process correctly. He should use the Cows and follow the sub plan as outlined. During the time he's waiting in wd's to induct again he should not take any kind of "comfort" meds and that can and usually will delay the Cows score. things like Xanax, Tylenol, motrin, etc will make a difference in how he scores and should not be taken during this period. The only exception is if he's been on the Xanax (or other benzo) under doctors orders he should NEVER stop that abruptly as it can be extremely dangerous. If he's taking the Xanax on an "as needed" basis he should stop it for the induction.

    Remember....he only has to do this once if he does it right.

    Hope this helps you get things sorted out and him feeling better. He'll get there, you just have to be patient and willing to try again. I realize it's no fun going through wd's again, but I promise you it's necessary.

    I'll do my best to check back soon to see if you've responded. Take care.

    Randy
    Last edited by Anonymous; 12-13-2017 at 07:41 PM.
    UncleLeo and Ming23 like this.

  6. #6
    Ming23 is offline Platinum Member
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    Hey Emily
    Hang in there! I also went through precipitated wds coming off methadone. It happens when u take the subs too soon after last dose. Remember--no xanax etc if u want to get a true assessment on the Cows scale.
    Your husband is lucky to have u helping him! Just do what Randy suggests. He guided many of us from the doorstep of despair to freedom! Hell--i was past the doorstep stage--i was waiting to die. But i took Randy's advice at every turn and here i am, a year and a half later, doing well. Better every day!
    Perservere! You and the husband will never regret getting free!

  7. #7
    Emily1389 is offline New Member
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    Hi guys, just wanted to update. He is feeling and looking much better today. He still hasn't been able to sleep for the past few days, but no more vomiting and he's not stuck in bed miserable.

    He took 2mg this morning and was able to go to work today even though he's not feeling 100%. Thanks for all the advice, I really appreciate it!!
    Ming23 likes this.

  8. #8
    ginatheartist is offline New Member
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    Question hELP WITH DOSAGE OF SUBOXONE

    My Dr. prescribed 8 mg/2 suboxone and told me to wait 24 hours then take one pill 8mg/ 2mg 3x a day . That is it . I see everyone has different ideas . Less is more.
    I have been on 4mg hydromorphone x6 a day and ms contin 60 mg 2 Xa day total hydro 24 mg + ms 120 mg a day for the last 9 years. I was on a lot more at one point and a dr. got me to lower my dose. I have never abused it or felt I was addicted [I] have just been afraid of withdrawal . Due to all the legal and abuse problems with opioids my dr decided to get out of business and I needed to find a new dr. which was impossible so I am going off the opioids with a dr. that told me to take this dose. I have been reading to take 1mg or a .50 mg every hour and to be at 26 on the COWS scale I am at 5 and very uncomfortable .It has only been 10 hours since my last dose. How can this dr. be so far out of touch ? What should I do?

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