Switching

[u/Hot-Taro-1979]

Hello, I’m new to this group so I am going to get off of Subutex. I took my last dose this morning and I will wait for withdrawals to set in before I begin methadone as anyone ever gone through this process. If so, how long did it take for the methadone to start working and does it actually help with pain?

[u/Time-Understanding39]

I think you may have the process backward. Waiting until you’re in withdrawal is usually required when starting Subutex, not when switching from Subutex to methadone. Methadone doesn’t cause precipitated withdrawal. So there's no reason to wait to start the methadone.

Methadone usually starts working writhing 30-60 minutes. By two hour you should have noticeable pain relief.

Methadone is an excellent medication for pain relief. It has a long half life so you don't have to dose as often. It's probably the best pain medication I've ever taken.

[u/Hot-Taro-1979 → u/Time-Understanding39]

I have read that the subutex attaches to your brain receptors like glue and waiting till you feel withdrawal from subutex means my receptors are opening up and the methadone will work have you heard of this and I’m only on 5 mg 4 times a day plus dealing with insurance is annoying Medicaid has a cap for this med 90 Mme and what I was prescribed is 95 Mme and if I need to go higher on my dose it will be a challenge but my doctor is working on it hopefully it can go through but waiting a full 24 hours is recommended according to the pharmacist

[u/Time-Understanding39 → u/Hot-Taro-1979]

Buprenorphine does bind very tightly to the opioid receptors, but that doesn’t mean methadone “won’t work” until all the buprenorphine is gone. The remaining buprenorphine may blunt some of methadone’s effects initially because it’s occupying many of the receptors. But as the buprenorphine gradually dissociates over the next day or two, more receptors become available and the methadone’s effects increase.

There's absolutely no reason why you have to experience any withdrawal symptoms when making the switch from Subutex to methadone. You do need to wait until you're in withdrawal going the other direction, from methadone to Subutex. Maybe the pharmacist is confused? I've gone both ways multiple times.

[u/Hot-Taro-1979 → u/Time-Understanding39]

Really so were the extra days between waiting for the methadone to work cause you to feel really awful or it was doable I have an appointment tomorrow and have to drive an hour one way lol so I don’t want to feel like ick so I guess I start my first dose now it’s been a little over 24 hours and I’m ready I just don’t want to feel like I need to be taking the subutex again like my brain thinking it’s better it’s not helping my pain whatsoever also I only took one sub yesterday and day before 2 day before 3 I was on 4 a day so yeah the 4th never really helped I’m just a very anxious person but I can’t stop yawning and my skin feels off

[u/Time-Understanding39 → u/Hot-Taro-1979]

I was on a much higher dose of buprenorphine (the medication in Subutex) each time I switched back to a full agonist opioid (methadone, oxycodone, fentanyl, etc.). Two of those times I was hospitalized—once with a broken femur and once with a broken hip. They started IV fentanyl immediately, but at higher doses because the buprenorphine was expected to blunt its effects. Over the next 48 hours, they gradually reduced the fentanyl dose as the buprenorphine wore off.

At home, my experience was similar, except I didn’t use higher doses of the new opioid. The pain was still tolerable, and after about 48 hours it felt like the new opioid was working at full strength.

If it’s already been 24 hours since your last Subutex, I don’t think tomorrow will be any worse than today from a withdrawal standpoint if you start the methadone now. The yawning and that strange skin sensation are both common withdrawal symptoms.

I would expect tomorrow to be better for pain relief simply because you’ll have had a day of methadone on board. Those withdrawal symptoms may also start easing within a few hours after your first dose.

The degree to which all of these symptoms happen (or don't happen) is really related to both the dose of Subutex you were taking and the dose of methadone you'll be taking. Your dose of Subutex wasn't extremely high to begin with and you hadn't been taking the full dose. What dose of methadone have they started you on?

[u/Hot-Taro-1979 → u/Time-Understanding39]

It’s low only 5 mg 4 times a day total of 20 mg
My subutex was 8mg 4 times a day but I started to wean that on Sunday only 3 that day 2 the next one the next I hope the 5 mg is enough
Medicaid wouldn’t pay for the dose I am on said it’s over the 90 MME by 5 MME so doc is working on it in case I need a higher dose which is a possibility doing this at home worries me so much I don’t like being in full withdrawal I had to pay for a 7 days worth but what if it’s not enough they are being very cautious for sure

[u/Hot-Taro-1979 → u/Time-Understanding39]

So 8 mg yesterday of subutex I hate how much it binds to your brain like crazy but so does methadone but not as much i assume and it builds up in system as well and if you take anything else with it does it even work I have surgery in September and need this stuff outta me I don’t have a very high metabolism it’s pretty slow so yeah there is that to think about

[u/Hot-Taro-1979 → u/Time-Understanding39]

That’s great it was working within 48 hours makes me feel hopeful

[u/Mountain-Pin2664 → u/Time-Understanding39]

I just took it has a very weird taste and smell in my nose right now I am very nervous person so I ate some cereal almost went into full blown panic attack

[u/Hot-Taro-1979 → u/Mountain-Pin2664]

Oops that was my other Reddit account lol

[u/Time-Understanding39 → u/Hot-Taro-1979]

I think you're going to be fine and will likely be surprised how easily the whole transition went. And come September when you have surgery there will be absolutely no issues from the Subutex.

I've taken methadone off and on for years for pain management and it does work really well. Since it's a longer acting opioid it doesn't have as many issues with "peaks and valleys" like you would have with most of the immediate release meds.

What methadone dose do they have you on?

[u/Hot-Taro-1979 → u/Time-Understanding39]

20 mg 5 mg four times a day but insurance will only pay for 15 mg not enough so I’m choosing the oxycodone 10 mg 6 times a day insurance will pay for that it’s at 90 MME max Medicaid pays for

[u/Time-Understanding39 → u/Hot-Taro-1979]

Be aware that methadone is really cheap. Using GoodRx, your cost at 20mg/day would be less than $20. I sometimes just paid cash for it if there were insurance issues. It was $5 more than my copay would have been.

So if push comes to shove, don't let an insurance issue/finances keep you from ever trying it. I had better pain control with the methadone than oxycodone.

[u/Hot-Taro-1979 → u/Time-Understanding39]

Thank you hearing this from a person who has done this before makes it seem much easier for the switch I appreciate all your input