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Harm Reduction Notes for the COVID-19 Pandemic

Switching from methadone to suboxone

- Sat, 22 Feb 2020 17:23:40 EST eDCRoLMi No.613738
File: 1582410220806.webm [mp4] -(1545573B / 1.47MB, 460x574) Thumbnail displayed, click image for full size. Switching from methadone to suboxone
Hello everyone,

I've been on methadone for around 2 1/2 years I originally was at 80-120mg a day. I maybe having a change in income soon and may possibly lose my medicaid insurance that covers my methadone. I need to know what is the easiest way to transition to suboxone. Many people say either taper to under 30mg or just stop taking methadone or use heroin for around 7-10 days then wait till sick to start taking the suboxone. Also is suboxone covered by most insurance company like work insurance? They job already knows I'm a addict so it doesn't matter and its a guaranteed thing. I'm also pretty sick and tired of the daily trip to the clinic even if i do get like 3 take homes a week. Also do are psychiatrists willing to prescribe benzos to people on suboxone cause thats another major reason why I want to switch aswell besides for the income insurance issue. Thanks
Thants !IZgeXR9w82 - Sat, 22 Feb 2020 18:21:28 EST +fyOnr4d No.613741 Reply
It is hell and very dangerous. I've done it twice. First time I went from 140mg (that breaking my leg, suicide attempt long story..) and my methadone doctor said I was too high of a liability on the juice so he prescribed be 10mg of m eslon for 5 days before my Suboxone induction. The only thing that saved me was I was lucky enough to score hundreds of benzos and practically comatose myself because to go from 140 done' to 10mg morph is a fucking spit in the face. Second time I went into the methadone clinic early and as I was leaving this disabled kid iknew from the streets asked me for a smoke, so I gave him one, then he pulls out this blister pack and starts practically yelling "hey THANTS want to buy some Valium" just as my doc was walking up into work behind me. The next day I was told I would be kicked off 120mg at 10mg a day so by the 5th day it was total hell even with taking my reduced juice. So I figured I would wait two days and self induce myself onto Suboxone.... Well methadone has a super long half life (plus I have a very serious benzo addiction) and I went into precip alone in my apartment and almost died. After that I finally was deemed to high of a risk for both done' and subs and subsequently put on morphine therapy.

If you're in Canada usually they put you on low dose morph for a few days then a few days of nothing before induction. My advice: benzos and sleepers Loads of Them.
Thomas Cranningmere - Sat, 22 Feb 2020 18:45:41 EST aZq709+A No.613742 Reply
I'm located in USA and I've never heard of them actually prescribing morphine before induction to suboxone. We dont have morphine replacement therapy if they did I would have been on it a long time ago. I also forgot to say I'm currently at 50mg of methadone so I think I'm gonna start tapering and go see a suboxone dr to see what they think the best way to deal with this is. Last option is buying a 100 bags of dope to last me a week or so and then go to a suboxone clinic to start after withdrawing 24 hours off the heroin.
m - Sat, 22 Feb 2020 19:56:53 EST vgHBTjMI No.613743 Reply
If I were you, I'd taper down to 30mg minimum, honestly more like ~20-25mg methadone/day, and stabilize on just 20mg methadone/day for at least ~7-10 days before going (if they'll allow you) on a rapid taper of like 3mg, 4mg, or 5mg reduction per day until you completely run out. Personally I'd make the best of it via using a script of ondansetron, clonidine, remeron (at night for sleeping), if they'll give it to you gabapentin or lyrica, and/or benzos and/or z-drugs, as well as an NSAID, loperamide (no huge doses, more like 20mg/day max or ~16mg/day for under a week, spread out in 4mg doses), and a fuck ton of kratom.

Once you hit 0mg methadone, you need to wait a minimum of like 120 hours, honestly more like ~168 hours (7 days) before even considering bupe induction.

There is NO comfortable way to do what you're asking of, there just isn't. Unfortunately this is the situation you knowingly or unknowingly signed up for when you shackled yourself to daily/weekly methadone take homes, not to mention constant healthcare costs.

If you do switch to short acting opioids, you still need to take them for at least ~5-10 days, otherwise it's pointless. And yes, you will be in WD as you taper, in bad WD as you eventually hit 0, and likely will still experience precip WD when you induct suboxone, and will continue to experience WD whilst on daily suboxone until you eventually stabilize.

If you have a doctor that doesn't seem to have their head up their ass, see if you can convince them to prescribe subutex instead of suboxone at least for the first month. I don't want to start a lengthy debate about naloxone, routes of administration and bioavailability differences, and its effect in terms of precip WD, but this is one of the few situations where I'm convinced that naloxone is capable of making precip WD worse no matter what method of consumption.

Just don't have the mindset that there must be some WD-free method to achieve what you seek, because it's totally impossible if you're not willing to slowly taper the methadone for at least like ~60-120 days before transitioning. As a past high dose binge user of the most potent PST on the planet, I can tell you right now that opioids with long effective halflives like methadone and arguably fire UK PST, pretty much blow conventional time charts totally out of the water. I've had like ~8-9.5/10 severity precip WDs from "only" waiting ~5.5-6 days from last PST dose before inducing just 1mg of subutex. One time I waited something like ~8-9 days and I still got fucking precip WD, albeit more like a ~5-6/10 in severity.

It eventually took a 3 week properly followed taper plan followed by roughly 7 days of only being on kratom before 3 days of 0 opioids (~31 days total) before I was able to transition onto subutex successfully, and even then you better fucking believe that the first ~2-4 or 5 weeks on subutex fucking sucked.
Thants !IZgeXR9w82 - Sat, 22 Feb 2020 20:05:22 EST +fyOnr4d No.613744 Reply
Smarter just to wean off the juice and leave the subs out of it my friend.nb.
m - Sat, 22 Feb 2020 20:11:19 EST vgHBTjMI No.613745 Reply
Also, at least from my experience using two separate private psychiatrists who were also bupe docs, both of them had what is basically a pseudo-zero tolerance policy for benzos if you weren't epileptic. When you sign up, they say from day one that they will not script chronic benzos for absolutely any reason, and if they do feel the need to script them, it's only the lowest dose necessary for no more than the equivalent of 2 weeks daily dosage, and that they don't expect any patient to need more than ~14 day's worth of doses during any one 90 day period.

I did receive one benzo script from my current psych sometime around like Thanksgiving of 2018, but he intentionally scripted ativan instead of xanax, insisted that he would never script xanax or kpins for any reason, and only gave me 28x0.5mg tablets, which are roughly equal to just 0.25mg xanax each lol, so it was like getting the equivalent of just 14x0.5mg xanax tablets, or basically just 3.5 2mg xanax bars.

Apart from being useful in terms of legally being able to piss hot for diclazepam or lorazepam itself when tested for employment or legal reasons for at least 1 year, to some degree possibly ~1.5-2 years, it was a colossal waste of time receiving the equivalent of 7mg xanax to last me 3 months. Then after 3 months, even without any signs of improvement, he decided I "wasn't a good candidate" for more benzo scripts, even though all my piss tests at the time were clean.

It seems like you'd be more likely to succeed in getting an adderall script than a benzo one. Benzos and opioids taken together are what kill people, even if benzos+ bupe isn't as bad a benzos+ methadone. Doctors treat it all the same.

Just get a bupe + stimulant script and buy your benzos online. RC benzos are much cheaper than bupe or stimulants, and most lab tests don't even detect for example etizolam use, and definitely much less so clonazolam and possibly flualprazolam use.
Henry Brangertidge - Mon, 24 Feb 2020 01:14:53 EST IxGcrMpY No.613765 Reply
The number of times i've tried explaining to pharmacists who, after seeing my subutex+diazepam+zolpidem, suggest I buy some Naloxone, that it's pointless. Also the naloxone is stupid expensive, fucking pharma big.
m - Tue, 25 Feb 2020 10:02:52 EST vgHBTjMI No.613795 Reply
The saddest part IMO is that naltrexone has a higher binding affinity than bupe and all other common opioids, yet it's not prescribed/used for opioid OD antidote, presumably due to its much longer half-life. While it may not be as common for someone to OD and die on bupe vs. say dope or methadone, or bupe + downers vs. dope or methadone + other downers, it definitely still happens, ESPECIALLY for those inexperienced with bupe and other said downers.

I've got one or two naltrexone pills in my narcan kit, but I haven't gotten around to making a nasal spray/nasal syringe that's much stronger than ULDN, something like ~4mg/ml, as I don't have the proper filters, cold storage space, and antiseptic ingredients necessary to prevent long-term bacteria growth.

Let's be real. If someone is ODing, like they're going to die ODing, I'm more interested in you know, making sure they don't die instead of being worried if they'll be in precip WD for ~4-8 hours. Yeah sure I might be mad in the moment if it was done to be, but I'd just be glad I'm alive the next day.

It sucks that flumazenil isn't popularly available, and that using it safely requires much more medical knowledge than say naloxone/narcan. I wanted to get some, but all my docs said they might be auditing for scripting such things. The guy I narcanned in Cambodia had been drinking I believe and had actually taken like 10-30mg valium earlier in the day before he either ate or snorted "MDMA" that was clearly most likely real china white heroin. I told him as much, but Saudis don't know fuck all about drugs and aren't often capable of removing their ego from unsafe drug use.

Anyways, we got lucky in that just 2mg or 4mg nasal narcan was enough, but if it had been bupe+booze+valium, he could have possibly been a goner. We were on an island that didn't have paved roads, in a pseudo-rave venue that requires a ~30-45 minute light jungle trek from the main dock to even get to. There likely wasn't any narcan, at least in liquid form, within at least several hours by boat that usually only comes once a day.
lol - Tue, 25 Feb 2020 10:16:58 EST IggaRoSW No.613796 Reply
Damn I give you props for saving someone and know what to do, I've been in that situation myself and saw others OD many times and most people are too freaked out to do anything quick so I usually am the one, like you said you wake up feeling HORRIBLE, only time I didn't was few times I took a ton of benzos too so I would just pass right back out but yeah most people don't take too kindly to waking up with potential strangers over them while every cell in your body is screaming, had someone throw a punch at me berfore after. It's not fun

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