need assistance

I am on 90 mg of methadone for about 3 years now. I've been off for 30 hours come morning when I'm due to start a suboxone regimen for 3 weeks. I have to do this for financial reasons so I dont lose my job. I have a family that depends on me and this is my last shot at my firm. What I need to know is will I go into withdrawals right away when I take the suboxone or do I stand a chance of getting through this ordeal with mild discomfort since I am already feeling mild withdrawal symptoms. Please respond with your most honest opinion as soon as possible.  My appointment with the clinic is at 9 am and I am pressed for time. I have been searching all week online and just came across your site. I look forward to hearing back from you. If for some reason I don't hear back by email I will call the numbers provided before my appointment. Thank you

Hello and welcome

I'm so sorry I didn't get back to you before now.

I can tell you my experience was that I was in mild withdrawal
When I started my treatment of Suboxone. I it went fine.

Please update us and keep us posted as to how your induction went.

Again I'm sorry I missed your post and ultimately Your question.

Blue

I did the induction I almost died, not literally but I did wish for death a few times. Some wrote on other sites about withdrawals but I could never have imagined what I felt. The only nupside was that after the six hours of hell I was allowed to do some heroin to get thru my symptoms until my next dose. Not lots of H mind you just enough to get some sleep. Now Im on day 2 and even though I still got the urge and I did attempt to get high I felt nothing and I am doing alot better. Hopefully this helps someone else trying to get off methadone. its not easy, it will hurt a bunch,but it can be done.

I'm really sorry to hear that your induction didn't go well.

Are you doing this with doctors supervision ? When you said you were "allowed to do heroin to get through" Did you take that prior to your first suboxone dose?
You mentioned trying to get high, but if your on Suboxone, that will block any feeling of being "high"
so that's why that didn't work.

I'm just trying to understand how your doing this so I can try and offer some help at this point.

I'm hoping by today your feeling better and totally inducted onto Suboxone. It's a wonderful tool to have during your recovery from Opiates.

Stay in touch.

Blue

Yes im doing this in a controlled setting with doctors. The heroin they told me would get me through the worst of the process. Now I can say they stopped my first dose at 8mg since I went into such violent wd. Yesterday I was split dosed and monitored by Dr. And given 16mg. Now today I go up some more but I do feel better. I would like to offer anyone who wants off methadone to seek out suboxone help. It isnt easy but it can be done. Ive got a great support system in my family and that really helps. Thanks for your input also it does feel good to talk to someone who might understand what I am going through.

They didnt double my dose and the 16mg isnt helping im still anxious nauseous and have the jumpy joints with sweats so again I find myself doing heroin just so I can b normal around my kids. Will a higher dose help me or will I br screwed all over again. I only ask because I get take homes tomorrow and if I can add to it and stop the dope I will today is day 3 and im still shooting dope. Please assist

Idiaz,
It is good to have you here with us. My name is Dee and I will do whatever I can to help you get to where you need to be.
I see you have already met Blue.

I know when coming off methadone doctors will tell you that 30 hours should do it but in my past experience and the experience of others that is not long enough for someone who has been taking methadone long term. Methadone is a very long acting drug with a half life of methadone going up to 59 hours but usually about 36 hours. So after 36 hours you still have half of your methadone dose in your system. I always tell people coming off methadone for the switch to wait at least 72 hours. Some people do not agree with me and that is their right. But why take any chances?

Common mistakes are:
Dosing too soon after last dose of methadone or too high of the first Suboxone dose.

There is something to remember. Every time you take a dose of suboxone after heroin the suboxone will remove the heroin from your system.
The way it works, your take heroin and it's in your system. Then you dose suboxone which pulls the heroin out of your system therefore putting you back into full withdrawal.
You have to be free of opiates before taking anymore suboxone. You will feel like crap and I hate suggesting that you start over but that is what it sounds like what you have to do.
What does your doctor say?

Exactly that I got dosed but the dose just doesnt hold me all day. Not even half da day im jumping like a fish by 11 am just after dosing and I cant keep my self still. Forget about the shakes im like a train with no grease EVERYWHERE! I can tell u it was the Dr that told me if I needed to do something to limit it to heroin but now is day three and im at 16mg do you believe in your opinion that my dose needs to be brought up or spread out more during the day to control my urges. Im weak and I cant function sik so I get the smallest shiver and I use ive always been this way its my nature. Thanks for posting your help is most appreciated.

Hey Idiaz20,

If your dose isn't holding you all day, then split it up.
Take 8mg in the morning and 8mg when you feel you need it.
I know it's preferred to dose once a day, but do what you feel comfortable with.

I'm on 4mg a day, and I take 2mg in the morning and 2mg in the afternoon.

Good luck !
I'm glad you met Dee, she's great !

Be well,
Blue

How long have u been on suboxone and how did u manage the first 5 days cause to me these are the hardest and right now im on day three while still using heroin . Day 1 was 8mg with the worst withdrawals I have ever experienced. Day 2 still super restless and used on 16mg. Day 3 still 16 mg but I already shot a little dope to get me right. Mon.Tue.Wed. straight same regimen what can I expect.

Hey There,
I've been on Suboxone for 2 years. 12/31/2011 was the last time I had any opiate.

I was on very strong opiates before I stopped (Opana's and eventually heroin when I couldn't get any pills)

It wasn't very long, however, between stopping the opiates, and starting the suboxone.
That's why I said in an earlier post that it's different for everyone as far as how deep into withdrawal you should be.

BUT ! You did see Dee's post about Methadone. Apparently that's a bit different than a regular opiates, that I and most, are on prior to Suboxone.
So please read that, and ask questions if you have any.

In answer to your question to me, I didn't have any issues when I started. I felt immediate relief. It did take a few days to feel myself again. I had this odd feeling that I just felt "off" - I guess after so many years of taking these pills, my body was off.
I felt like, it was screaming on the inside in withdrawal but on the outside, I was calm, not shaking or sweating or any of the typical symptoms one has when in major withdrawal.
It does take awhile to get the proper dose.
Like Dee suggested, you might want to consider starting over. Most doctors have you start on a low dose and keep going up until your out of withdrawal and feeling fine. Is that how you dosed the suboxone? I'm sorry if I missed that part.

I am gonna give it another go again tomorrow because I am doing this with doctors and they dont know what exactly I am feeling so I have to ask others that have actually been through it so I can get an idea of what to expect. Im out of dope now so ill just hold off till 9am when I go see my doctor and hopefully they will up my dose and that will do the trick. My drug is heroin and methadone but I havent done heroin till these last 3 days because the withdrawals after taking suboxone is unbearable and I know that if I go back to methadone im going to die using it and I dont want that to happen. Methadone has been the worst devil I have evr encountered and I dont wish that on anyone. I like you would like to help anyone that will listen. Thanks again.

your out of heroin now. When did you last use heroin?
Normally when you first go in for induction to Suboxone the provider will give you 4 mg, then watch you for a little bit to see how your doing. If you are still in withdrawal they will give another 4 mg not to exceed 8 mg that first day.

The second day you would start out with what you ended with on day one. If you ended at 4mg on day one then day 2 you would start at 4mg.
If more is needed,as time goes on, it is given and so on.

Earlier you mentioned that you are taking Suboxone because of cost and your job. Is Suboxone being used to detox you off methadone? Or will you be taking it for maintenance?
I will past a copy of the Suboxone treatment protocol below for you to read. But like Blue said, remember, no 2 people are alike

Suboxone Treatment Protocol

The initial daily buprenorphine dose currently recommended is 4 to 8mg, although higher doses have been given. Clinicians generally start with 4mg Suboxone, and if withdrawal signs do not worsen, give a second 4-mg dose in 2-4 hours.  Some clinicians provide an additional dose (2 to 4mg) for the patient to take at home if withdrawal symptoms re-emerge during the first 24 hours.  

Practitioners  should  monitor  for indications of buprenorphine
-precipitated  withdrawal, including sweating, anxiety, cravings
and gastrointestinal symptoms such as abdominal cramps, diarrhea, and/ or nausea.  Such symptoms may appear within 1(1/2) hour after buprenorphine dosing, peak within 1(1/2) to 3 hours and diminish thereafter(Lintzeris et al., 2001).  This differs from withdrawal caused by underdosing of buprenorphine, which can occur during the latter part of a 24-hour dosing interval.

Clinicians  can  achieve the maintenance dose of buprenorphine
by doubling the dose each day up to a maximum of 24 to 32mg (Ling et al.,1998; Ling and Smith 2002).   If induction occurs too slowly, patients might terminate their treatment (Matticke et al., 2003; Petitjean et al.,2001) A number of studies have shown that a target dose of 16mg can be reached in two to three days (Johnson, Syrain, Amass 2003) with minimal withdrawal effects (Johnson et al., 1989; Kuhlman et al., 1998).  To manage the patient's transition from Subutex to Suboxone therapy, the clinician needs simply to replace the dose of Subutex with Suboxone containing the same amount of buprenorphine.

Buprenorphine blood concentrations stabilize after approximately 7 days of consistent dosing (Chiang and Hawks, 2003).    If withdrawal symptoms subsequently emerge during
any 24-hour dosing interval, the dose is too low and should be increased.  

Stabilzation Phase

The induction phase is completed and the stabilization phase (usual duration approximately 1 to 2 months) is begun when the patient is experiencing no withdrawal symptoms, is experiencing minimal or no side effects, and no longer has uncontrollable cravings for opioid agonists.  As with any pharmacotherapy, the goal of buprenorphine treatment is to treat with the minimum dose of medication needed to address target signs, symptoms, desired benefits, and laboratory indices while minimizing side effects. Elimination of objective evidence of opioid use (negative toxicology) represents the key target sign for which to strive. The goal is to reduce self -reported cravings and self-reported use of illicit opioids. One benefit worth achieving is a self-reported increase in opioid blockade such that self-administered illicit opioids induce little or no euphoria. A reduction in opioid-positive toxicology specimens confirms a successful direction in treatment.

Dosage adjustments may be necessary during early stabilization, and frequent contact with patients increases the likelihood of compliance. Until full stabilization is achieved, weekly assessments of patients may be indicated to make necessary dosage adjustments. With stabilization goals in mind, doses of buprenorphine/naloxone may be increased in 2/0.5-4/1 mg increments per week until stabilization is achieved. Nearly all patients will stabilize on daily doses of 16/4-24/6 mg; some, however, may require up to 32/8 mg daily.

Some patients may prefer or may respond better to less than -daily dosing regimens of buprenorphine. It is possible that less -than-daily dosing will most likely be advantageous in an OTP or other directly observed dose setting, where daily visits might otherwise be required. A variety of studies have shown the efficacy of alternate-day or thrice-weekly buprenorphine administration (Amass et al. 2000; Bickel et al. 1999; Perez de los Cobos et al. 2000; Petry et al. 1999). The typical method of determining the dose for less-than-daily dosing regimens was to double (for alternate-day dosing) or triple (for every -third -day dosing) the stable daily dose for the patient. Although all regimens were determined to be safe and, in most cases, effective, several authors noted that some subjects were more likely to have urine samples positive for opioids on the less -than-daily dosing regimens. During induction and early stabilization daily dosing is recommended.

If a patient continues to use illicit opioids despite the maximal treatment available in the physician's clinical setting, the physician should consider referral to a more intensive therapeutic environment.

Maintenance Phase

The longest period that a patient is on buprenorphine is the period of maintenance. This period may be indefinite. It is easy for physicians to lessen their vigilance during this period, but significant considerations still must be addressed. Attention must be maintained to the psychosocial and family issues that have been identified during the course of treatment. Other issues that will need continual monitoring are related to cravings for opioids and to preventing relapse. Some other issues related to opioid abuse that need to be addressed during maintenance treatment include, but are not limited to, the following:

*Psychiatric comorbidity

*Somatic consequences of drug use

*Family and support issues

*Structuring of time in prosocial activities

*Employment and financial issues

*Legal consequences of drug use

*Other drug and alcohol abuse

The   frequent   presence   of  some  or  all  of  these  problems underscores the importance of providing nonpharmacological services  to address  comprehensively the needs of patients and to maximize the chances of the best possible outcomes.

Long-Term Management

The design of long-term treatment depends in part on the patient's personal treatment goals and in part on objective signs of treatment success. Maintenance can be relatively short -term (e.g., <12 months) or a lifetime process. Treatment success depends on the achievement of specific goals that are agreed on by both the patient and the physician. Following successful stabilization, decisions to decrease or discontinue buprenorphine should be based on a patient's desires and commitment to becoming medication-free, and on the physician's confidence that tapering would be successful.

Factors to be considered when determining suitability for long -term medication-free status include stable housing and income, adequate psychosocial support, and the absence of legal problems. For patients who have not achieved these indices of stabilization, a longer period of maintenance, during which they work through any barriers that exist, may be appropriate. Data suggest that longer duration of medication treatment is associated with less illicit drug use and fewer complications.

References:  (1) Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction (TIP 40) Chapter 4
                      (2)  Practical Considerations For The Clinical Use of Buprenorphine  Hendree' E. Jones -Science Practice Perspectives August 2004

Thanks for the information. I was started on 2 and then given another 6 1.5 hrs after and I went into the craziest withdrawals I have evr encountered. I totally lost it I threatened evrything but death for the next four hours until I was let go and I used day one. Day two I dosed 16mg and as soon as I left I wasnt feeling good so at 5 pm I got high again. Today I dosed at 16mg also and it did nothing for my withdrawals and I ended up wasting more money on dope and even though I dont get high I do get cured and that was at 1 this afternoon. Now tomorrow I'm hoping they either up the dose so it takes or give me a way not to withdraw. I was on a high methadone dose 90mg daily and I only waited 24hrs before induction and thats why I got so ill. But you live and learn now im trying suboxone but its not taking like many in the forums claim. I still get crazy withdrawal symptoms and I cant survive like that. Your advice is really needed. I dont want a long drawn out process but I dont wanna be sick either and I definitely don't want to go back to the methadone. Feel Me?

I hope your feeling ok this morning.
Let us know how it goes at the Dr. I hope your dose gets worked out and that you start feeling
better.

Yes, please let us know how it goes at the doctor today. I am praying for a better day for you.
I have read the forums about going from methadone to suboxone and what they say. I also know that when it is done right it can be done. I am proof of that.
I did high amount of heroin a day for years before going on methadone myself. I was on methadone for almost 5 years. When I switched I really didn't want to...
I moved to a state where at the time we only had one clinic and the waiting list to get in was almost 2 years. I couldn't wait that long. When I left the clinic the director had arranged for me to have a months supply and i was to use that to taper down over time in order to either find a clinic in a nearby state or find a private physician to prescribe it for me for pain.
Neither happened and I eventually ran out.
It took me a month of being without methadone to find a provider to take me on as a patient. Everyone said that since I had been on methadone for almost 5 years I would not be able to do it and honestly in the beginning all I wanted was to be back on Methadone.

The day I found my provider I had made up my mind I was tired of feeling like crap. After a month of no methadone I still felt like crap and that was on a good day. I couldn't think, had no appetite and every muscle and joint in my body hurt like hell. I was going to find something to use. Anything.
But it had been a month and I kept telling myself that if I could go that whole past month without using I could make a few more phone calls. So I kept calling until I got in the next day.
When I took my first dose of Suboxone i had not had anything in my system so I promptly threw up.
Once my stomach settled down later that day I was ok.
I have been taking Suboxone since 2006. A lot longer than a lot of other people I know but it is where I am today that counts. Not how long I have been taking a medication.
We now have 7 clinics in my state and one just opened in our small town.

It takes a lot to get to where you want to be. A lot. Some days are better than others. I attend one on one counseling every 2 weeks and attend a women's group each week.
I am not mandated to do either, I do it because I want to keep what I have and the only way I can do that is to keep sharing with others take each day as it comes.
You have a great future in front of you and it is not worth loosing over trying to use a bump of heroin to get you through the day. If you feel like shit you embrace it because you feel and you know that you are that much closer to where you need to be.

There are many horror stories on the internet. I sometimes wonder how many are repeats and additions of what others have gone through. We never know. But know this. This forum is real and we really do care about you and every member that comes through here. Some of our members stay and some find their way to other forums. Blue, Marie, myself and a few silent others have walked in some nasty old shoes. But we have come out the other side.

Thank you so much for your encouraging wrds. This to me has been the hardest trnsitin ever because there is no euphoric experience and since I am new to suboxone I have no idea how to handle it. I aways had access to heroin I started very early on at 14 and now I am 41 and even though I have had some clean time in there its been When ive gone to prison and even that was easier cause I knew I couldnt do it unless I spent a shitload of money. Now im on day 4 of my meds and I find that I cant make it a whole day without a little help but its scary because I feel like im screwing up my system. I am glad that I have been able to meet some good honest people on this forum that truly understand what I am going through.

Morning Idiaz,

I hope your feeling better today.
Didn't you have a doctor's appointment yesterday ? How did that go ?
How are your Suboxone doses going? Do you feel more stable?

Dee opened up to you in that last post, I hope you read it carefully and try to see that she's coming from a good place. We both are. We do care.
I hope to hear from you

Be well,
Blue

I feel even worse I think I Mightve done this too fast because I cant stopp the damn withdrawals. Its day 5 andbi sstill have to use a little something to take the edge off. Im on 20mg now but in your opinion should inup the dose to get past this hump. That methadone is the devil I guess that 90mg daily wqas way too much to try to kick. I hate thinking of going back on methadone but if I cant taake more subs for relief than I might neeeed to. Please advise.

The doctors appointment went well and I told him my concerns and thats why they upped the dose but it stillbdoes not take or hold. Im struggling and haaving really bad thoughts

Good morning Idiaz20,
When you first posted you asked people to be honest with you and that is what I am going to do. Please don't think I don't care. It is because I care that I say what I do.
Day five of induction you should be feeling so much better. But here you are stuck worse off than day one.
I am not a doctor and I have to say that right up front. Make no mistakes I don't think of myself as one. I couldn't handle being one. Honestly I couldn't because they have to watch people suffer every day. They can't afford to get attached to their patients. Some do but it makes it harder for them to say the things they need to if they are.

You need to stop and be honest with yourself. I asked you before if you are going to use Suboxone for maintenance. I ask because if you aren't you do need to also know that by the time you taper off of Suboxone your body will more than likely become dependent on this medication. So you will have to taper and there will be some sort of withdrawal. I can't tell you how much because no 2 people are alike. You can't just stop it in 3 weeks. It is a process. Did your clinic tell you that?
You can't keep doing heroin and expect this to work. It won't. I don't care how high you take your Suboxone dose. As long as you are putting heroin into your body, then take Suboxone your going to suffer.
You are going through so much withdrawal right now. From not only Heroin but Methadone as well.
Unless you can see yourself going 72 hours without anything, then starting Suboxone over again. I would suggest you remain on Methadone.
What kind of job do you have that is going to require you to be off of Methadone? I know it's costly but so is your life and if you keep going the way you are that is what this will cost you.
Think about what you want to do. We are behind you and yes, we do still care.
Dee

Thanks Dee. I understand what your saying and I appreciate your honesty. I am in advertising and da cost isnt the issue as much as the dependancy. So taking more subs wont help then huh. So I did jump on this too fast I figured that since I went through the PWs that all the methadone was out of my system. I refuse to go back to the methadone so if I can I'll try and take some time to clear my system now that the weekend is here. I already dosed today so its pointless to say I will start now but I will try to stay sober all weekend keyword try. Well thanks again for your great advice. I understand that you are not a Doctor but Doctors go by trial and error not by experience so only good advice I can get is from someone who has been through the same or similar process. Your the best Dee ;-)

Just one more question if im already in withdrawals in the morning then why doesnt the suboxone take. This medication does great for blocking but its crap for feeling well. Ive been in withdrawal 5 days now and my Doc doesnt have a clue what to do. Thanks for your input.

I am thinking it doesn't take because even though you are in withdrawals, you still have some of the opiate in your system.
You CAN do this. You have been here all week and you do have the determination. I hate withdrawal. I really do. It is the worst thing I've ever been through so I do understand the temptation. Let me ask you something.
Explain your withdrawal symptoms to me. I am wondering if it is withdrawals or symptoms (side effects) of Suboxone.

I got the sweats insomnia RLS super bad my body wont stop twitching if I try to lie down for more than 10min irritable anxious as hell GI problems but not to the point of diarrhea nasty smelling sweat and taste in my dry mouth some tearing and yawning and the worst part is the cravings I never wanted to get high so bad I try to wait till after 11 to even look at a clock so I dont get tempted to go dose on methadone.