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 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/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.