Remove this ad
avatar

zenith

Senior Member

Posts: 1,662 Member Since: 02/21/10

Lead

Feb 21 10 9:07 PM

Tags : :

Many folks seeking Medication Assisted Treatment for opioid addiction wonder whether to choose Suboxone (Buprenorphine) or Methadone. While this decision can only be made by you and your doctor, we can offer a few general pointers.

Methadone and Bupe are not interchangeable. They are targeted at two different patient populations, with some overlap. So, it's not just a matter of eenie meenie miney moe choose one--the choice is based on several different things.

Bupe (Suboxone) is intended for those with lighter addictions and/or shorter histories of addiction--usually those who are abusing Rx painkillers.  Methadone is intended for those with heavier addictions and/or long histories of opioid use/abuse.  The average needed dose of methadone is 80-120mgs, with some needing more and others less. It has been determined that Bupe works best for those who can stabilize at 60mgs of methadone or less. Those who require larger doses of methadone are unlikely to do well on Bupe, though it has happened. 

Bupe is usually prescribed by specially licensed physicians in their own offices. It can be prescribed for up to one month at a time and you can (theoretically) get this amount right away, though usually the doctor will want to see you more often in early treatment to determine the right dose for you. You can get your Rx filled at any pharmacy and take the medication in the privacy of your own home. 

Methadone can only be dispensed by clinics (unless it is for pain). There is a lot more "red tape" surrounding methadone treatment and it is heavily regulated by the government. It is dispensed from the clinic ONLY--you do NOT get a prescription, though with time you can earn take home doses. There is a higher risk of overdose with methadone, though both drugs are opioids and both cause physical dependence. 

Suboxone includes an addition--an opiate antagonist called Naltrexone. This drug is supposedly inactive unless you attempt to crush or inject the tablets. If you do, the naltrexone is released, blocking the euphoric effects of the drug. Some patients have complained that it seems to block their own natural endorphins as well--others do not.  

There is a version of Bupe--Subutex--that does not have the Naltrexone addition. Doctors often use it in pregnant patients or those with liver disease, as Naltrexone can be hard on the liver. 

Both drugs can be taken for the short or long term.

Question Authority!

Quote    Reply   
Remove this ad
Remove this ad
avatar

davehunt10

Posts: 6 Member Since:04/06/10

#1 [url]

Apr 16 10 4:10 AM

The naltrexone will put you into precipitated withdrawals only if you shoot it or insufflate it . Buprenorphine molecule binds to the (for lack of a better term) your opiate receptors blocking all other opiates and at the same time partially activating the opiate receptors so you feel normal and your cravings are keep nominal. Buprenorphine is a partial antagonist drug so the naltrexone is only there if you try and abuse the drug like Zenith said....Dave

Quote    Reply   
avatar

ltomczak

Senior Member

Posts: 789 Member Since:02/22/10

#2 [url]

Apr 16 10 8:34 AM

Zenith:

Just as an aside; I had been told that once you are considered a "stable" Suboxone patient a Doctor could technically write a prescription for up to 90 days at a time.

I am unsure if that is still true or not; and I do believe the standard is to be seen by the Doctor for once a month prescription refills.

lindsaytomcat@yahoo.com For those in and around the Chicago area - feel free to contact me if you need help with your treatment.

Quote    Reply   
avatar

methadoneangel

Full Member

Posts: 12 Member Since:02/22/10

#3 [url]

Jun 30 10 9:55 AM

Hi to all , its been awhile since I posted... Anyways I have been considering trying to slowly taper down off the 130 mg dose Ive been on for 10yrs and try Subox.  I have some concerns about the subox. treatment.  The main concern is I do have pain issues from a back injury and from degen. disk disease.  At this time I do not take anything but Aleeve and my dose of methadone. This covers 90% of my pain as long as I am not on my feet or trying to  walk more than 20 min.  The other reason I am concerned about subox. is I have heard that if you have unexpecpted acute pain, like if I was to be in a car accident(God forgid) or say I have a severe toothache the subox would block out any attempts to control the pain for 48hrs (until the subox wears off). Is there anyone that has been in a situation like this?   Another thing I was wondering is does subox make you want to eat sweets like methadone does? Methadone as made me crave sweets something terrible. And the last question I have, Is it safe to take small doses of diazepam with subox or is the same dangers as methadone and benzo`s?  I would be grateful to anyone that can give me some guidance.  


Quote    Reply   
avatar

oldnwise

Posts: 177 Member Since:03/06/10

#4 [url]

Aug 13 10 11:55 AM

I don't see that anyone answered the last question....or am I missing something?  Thank you , Zenith as I have had all of those questions about suboxone and this is a nice compact explanation.
My biggest questions/concerns about suboxone is what the last person mentioned, about having a coexisting pain condition or an acute pain situation such as an accident.

Wouldn't/couldn't such a person get the Subutex form, if they are also a pain patient?

to clarify to others ; I am on MMT for over 20 years but need occassional narcotic Rx's , for pain.
I take heavy NSAIDS daily but it doesn't work enough always.

I take enough methadone to keep me stable but it does not one thing for pain; if anything I think I feel pain more than a non opiate tolerant person.

So why only prescribe subutex to pregnant and liver patients?

one last clarification/question/  So does Suboxone harm the liver while methadone does not?
Thanks Z

"When I was 40, I used to wonder what people thought of me. Now, I wonder what I think of them." ~Brooke Astor~

Quote    Reply   
avatar

braygirl23

Full Member

Posts: 49 Member Since:06/09/11

#5 [url]

Jun 9 11 2:48 AM

I trued the sub thing and couldn't stay clean on it it helped to a paint bit I like the counseling and the uas of the Methadome clinic. But if u are on the suboxin they do block out any pain meds u r prescribed supposidly the subutech u can still get the pain meds to help if it is a low dose I think anything under 30 millagrams that's what a dr told my uncle they were taking him off the tabs because he was taking to mny but also kept him on icy 4os for his pain so he was to take a subutech in morning and. Night and also 2 40 s a day. I honestly don't think it helped him because eventually be overdosed and died because the subutech made him feel like he couldn't get pain relief or wanted to get high don't really know which. But u wont know til u try to switch but it didn't work for me or alot of ppl I know but it does work for my boyfriend

Amber

Quote    Reply   
avatar

whiterobot122

Senior Member

Posts: 1,741 Member Since:05/16/10

#6 [url]

Jun 26 11 8:39 PM

I know this is an old thread and such, but one thing I want people to know about Buprenorphine (Subutex, Suboxone) is that NALOXONE, the opioid antagonist, which reverses the effects of opioids does NOT produce the withdrawal effect from taking Suboxone, unless injected and even when injected, it's not fully the Naloxone causing the withdrawal.


To keep it short; Oxycodone, Methadone, Heroin, Hydrocodone, etc are called full agonist opioids, which means the higher the dose, the greater the analgesic effect, there is no 'ceiling' per se.

Buprenorphine on the other hand is what you call an Partial-Agonist/Antagonist, meaning that Buprenorphine DOES stimulate the opioid receptors but only to a certain level, but it also pushes out any other opioids that are on the opioid receptors. So if you take Oxycodone and are dependent to it, then take a Subutex or Suboxone tablet, you will go into withdrawal. But the reason that withdrawal is caused is because the Buprenorphine is a partial antagonist so it is theoretically 'ripping' the Oxycodone off the receptor, causing withdrawal. Naloxone is not orally active, besides in the GI Tract, meaning it will not reach the brain unless injected, so no withdrawal is produced by Naloxone unless it is injected.

Just wanted to clear that up.

Quote    Reply   
avatar

karan

Posts: 147 Member Since:02/23/10

#7 [url]

Jun 26 11 11:12 PM

Methadoneangel,

to answer one of your questions -- about whether the Subs make you crave sweets:

The Subs kind of spoil your appetite for some reason.  I know a lot of people that have lost weight on Subutex/Suboxone, inlcluding myself.  I don't want to lose any more.  I don't crave sweets instead crave fresh vegetables, but that may be because of the summer harvest, and the heat.

I only lost about 8 or 10 pounds and think I'm stable now, but it does seem to ruin appetite.

Karan.

Quote    Reply   
avatar

karan

Posts: 147 Member Since:02/23/10

#8 [url]

Jun 26 11 11:17 PM

Another thing M-Angel,

I think the ability of a full opiate being effective in an emergency would depend on your dose of Sub.

For instance if you were on 2 mg per day, if they gave you a good stiff dose of Oxy or whatever they give in instances of terrible pain from an accident in which you are gravely hurt, I think if they make the dose high enough then it will be felt.

but if you're on 24 mg of Sub, then it probably would be a fairly miserable 2 days but maybe they would put you into a coma until that pain had passed?

Hope I was able to help.  I worry about this too, but my dose is pretty low, and the taper I am going to be forced to do seems like impending doom, but at my last appointment for some reason my doctor said "We aren't going to start it this month; we're going to give you the same dose as last month!" 

Whew! I did not ask why just accepted the prescription.


Quote    Reply   
avatar

wayovermyhead

Posts: 4,350 Member Since:07/16/11

FORUM ADMINISTRATOR

#9 [url]

Jul 16 11 6:08 AM

FYI I decided to sneak and try and see if the suboxone worked took one while I was on methadone ended up in precipitated withdrawal which I did not nor the doctors realize at the time and I was hospitalized for 9 days.  DO NOT TAKE SUB UNTIL YOU HAVE BEEN OFF METHADONE 3 DAYS.

FORUM ADMINISTRATOR
Wishing You Best In Love & Life 
wayovermyhead

Quote    Reply   
avatar

vickilynn046

Posts: 2 Member Since:08/11/11

#10 [url]

Aug 11 11 9:44 AM

I JUST DID A VERY LITTLE CORNER OF A STRIP U THINK ILL BE ALRIGHT

Quote    Reply   
Remove this ad
avatar

the elephantman

Senior Member

Posts: 802 Member Since:08/30/11

#11 [url]

Sep 2 11 6:05 AM

All i have too say about suboxone/subutex is, i was on it for 27 months and although it worked fairly well for the first year, after that first year it slowly went downhill and i eventually relapsed. Now im on methadone an could NOT be happier!! Im doing quite well with it and it works much better than sub EVER did!! Another thing, dont be fooled by the lie a lot of doctors an whoever else try too tell you, and im reffering to people that try an say sub withdrawal isnt as bad because its a partial agonist. Yes, it is in fact a partial agonist, but for me the withdrawal was worse than methadone!! The best advice i can give about buprenorphine is, DO NOT TAKE IT!! I actually believe it should be taken off the market but thats only "my" opinion. Its absolutely useless to me!! I felt like the life was drained out of me all the time when i was on subutex.I wasnt EVER happy but wasnt sad either. Just blah. Now i've got more life in me than ever before!! Actually, i think even better advice i could give about buprenorphine is, make sure you know absolutely EVERYTHING you possibly can about it before you make that choice. I dont even like thinkin about it!! If anybody ever has any questions about it, message me as i'd be more than happy too help any way i can. I have been thru the buprenorphine program so i have a good bit of first hand knowledge as far as its effects an what you can expect from it.

Take care!!

Quote    Reply   
avatar

pigeon

Posts: 58 Member Since:02/22/10

#13 [url]

Nov 17 11 12:36 PM

Here's some good info.  Undestanding the difference b/w agonism, antagonism and affinity for opioid receptors helps one understand the different effects felt from the different opioids.  I imagine this has been posted elsewhere but since the thread was revived I thought I'd put it up again for people looking to learn more who haven't seen the other posts about bupe.

http://www.naabt.org/education/pharmacoloy_of_buprenorphine.cfm

Former user in recovery and a Watchdog member since 2004

Quote    Reply   
avatar

methabenzocet

Full Member

Posts: 47 Member Since:08/05/11

#14 [url]

Feb 18 12 11:21 PM

I agree with what was said above about SUBOXONE (correct spelling) that i works much better for Rx drug addictions..and ppl that havnt been using for 10 years... i tried suboxone about 5 years ago i went on and off it 4 yrs n constantly kept relapsing ovoer and over and acutally get high right threw it, cuz i wudonly take like 2mgs at like 8am and by the time work was over i cud use what ever i wanted n feel it. horrible. ne way methadone worked for me, its been almost 2.5 years sober now.
 
to everyone who reads this : make sure u do ur homework on each substance and dont rule one out untill u tired it. PERSONALY i say if nothing else is helping u, like na, aa or iops and u keep calling and need a crutch try methadone maintnence.
 

 


 

~Kiki

Quote    Reply   
avatar

methadoneangel

Full Member

Posts: 12 Member Since:02/22/10

#15 [url]

Apr 21 12 4:07 PM

Hi to all, I felt like Maybe I should post back about what I had decided about subox. to those that answered me on this thread. I am still on mmt, I ended up not trying the subox.  I talked to the klinik doc and he sais something to me that made sense, He said," why do you want to fix something you have already fixed? If mmt has worked so well for you why would you want to change it?" I told him,   "I am 52 yrs yng/old and I just wonder how I will do on mmt as I age?'  His answer was,"all we can do is see"   To me this wasnt to reassuring because he couldnt answer my question but part of what he had said did make sense.   So for right now Im just moving forward each day on mmt, but still wondering as I grow older one day at a time. Thank you to all that answered me before. 

Quote    Reply   
avatar

mike75

Senior Member

Posts: 660 Member Since:03/25/12

#16 [url]

Apr 21 12 4:35 PM

My mom 60 recently got on suboxone for about a month and she did not like it at all.She eventually wants to get on methadone but money is scarce right now.She said she has tried methadone before and likes it way better than suboxone.She said you could not pay her to get back on suboxone it was that bad.

Quote    Reply   
avatar

sweetskullzgraphics

Senior Member

Posts: 181 Member Since:07/16/12

#17 [url]

Jul 18 12 6:51 AM

Yes, that is true. I was prescribed my subutex for 90 days at a time when I was pregnant & on it. Even before I was pregnant I'm pretty sure I was prescribed for about 60 days.

Quote    Reply   
avatar

kylea

Posts: 671 Member Since:12/31/11

#18 [url]

Jul 19 12 3:54 AM

u think sub wd work if 1oo mdone does the job prob 80 would????do want klinik life forever thats y im wonderin

YOU gota FIGHT to LIVE

Quote    Reply   
avatar

wayovermyhead

Posts: 4,350 Member Since:07/16/11

FORUM ADMINISTRATOR

#19 [url]

Jul 23 12 4:17 PM

Hi to all, I felt like Maybe I should post back about what I had decided about subox. to those that answered me on this thread. I am still on mmt, I ended up not trying the subox.  I talked to the klinik doc and he sais something to me that made sense, He said," why do you want to fix something you have already fixed? If mmt has worked so well for you why would you want to change it?" I told him,   "I am 52 yrs yng/old and I just wonder how I will do on mmt as I age?'  His answer was,"all we can do is see"   To me this wasnt to reassuring because he couldnt answer my question but part of what he had said did make sense.   So for right now Im just moving forward each day on mmt, but still wondering as I grow older one day at a time. Thank you to all that answered me before. 

-methadoneangel

I bet if you ask the sub doctor the same question
"I am 52 yrs yng/old and I just wonder how I will do on mmt as I age?'  His answer would be,"all we can do is see"  

FORUM ADMINISTRATOR
Wishing You Best In Love & Life 
wayovermyhead

Quote    Reply   
avatar

etaipo

Posts: 4 Member Since:08/14/12

#20 [url]

Aug 24 12 9:13 AM

Hi wayovermyhead,my real name is peter but I post as etaipo,that's opiate spelled backwards,lol. I was on mmt some 20 years ago. Well,that's when I left mmt. Got off it successfully and stayed clean for 13 years. About 7 years ago I fell of a 2 story roof,and was dead set on never going back to methadone. So after my accident I tryed all kinds of nsaid's motrin,asprin,advil you name it i was taking handfulls. after about 2 maybe 3 months of that i started peeing blood.Went to see a doctor and he told me to go stright to a hospital ER. So I did and they operated on me that weekend had both knees scopped and that didn't help a bit.The sergon gave me percs to go home with and told me to resume my daily routeen in 4-5 days. Needless to say the percs didn't last too long and I was back at me pcp's office in a week. I told him i had a drug problem before and that it had been 13 years since I had taken anything like percs or even worse.So I was not about to start taking anything that in my own words made me sleepy or even anything like that kind of drugs. So he perscribed me a drug called kadian,50mg 2 x a day.4 years later I was on 400mg a day and could just not handle the drugs or the pain I was still in. It was a livivg nightmare. I went into rehab and after 12 days of feeling like shit I thought i was going home because when I first got to that place they told me We would work with you on pain mangaement before relese.But I refused methadone after 3 days.That was the first time i ever heard of suboxone. been on it for 3 years this month and may stay on it for the rest of my life. the reason I'm telling you all this is don't let life pass you by without at least giving suboxone a try.I too am 53 i'll be 54 in 10 days the freedom sub has given me( I see my doctor once every 8 weeks) is amazing. Dont be worried give it a try.you can always go back to mmt. hopes this gives you some new persperctive on sub and a different way of life...peter aka...etaipo 

Quote    Reply   
Remove this ad
Add Reply

Quick Reply

bbcode help