If Your on Methadone and Switch to Suboxin Too Early Do You Go Into Withdrawls?
Question by jasonzane2001: If your on methadone and switch to suboxin too early do you go into withdrawls?
My husband was at 64 milligrams of methadone quit cold turkey for 40 hrs, his doctor switched him to 8 milligrams of suboxin and now he is on the floor in withdrawels….Is this normal???
Best answer:
Answer by Rickydotcom
It’s not that he was switched too early, he was started too late. Contact the prescriber immediately. He’ll probably increase the dose for a short period of time. Also make sure he’s dissolving the tablet under the tongue. If he’s swallowing the pill, it’s inactivated by the liver in what’s called the “first-pass effect.”
Rick the Pharmacist
(work in a drug treatment center part-time)
Addendum
Nalxone when taken orally has absolutely no pharmacological activity. It is only active if injected. It does not survive the liver’s “first pass effect.” I’ve seen patient need as much as 24mg the first few days. Subutex would be an option, too.
Naloxone when administered orally at 0.5 mg has no pharmacologic activity. Naloxone hydrochloride administered parenterally at the same dose is an effective antagonist to pentazocine and a proof antagonist to narcotic analgesics.
Physiologic and subjective effects following acute sublingual administration of SUBOXONE and SUBUTEX tablets were similar at equivalent dose levels of buprenorphine. Naloxone, in the SUBOXONE formulation, had no clinically significant effect when administered by the sublingual route, although blood levels of the drug were measurable. SUBOXONE, when administered sublingually even to an opioid-dependent population, was recognized as an opioid agonist, whereas when administered intramuscularly, combinations of buprenorphine with naloxone produced opioid antagonist actions similar to naloxone. In methadone-maintained patients and heroin-dependent subjects, intravenous administration of buprenorphine/naloxone combinations precipitated opioid withdrawal and was perceived as unpleasant and dysphoric. In morphine-stabilized subjects, intravenously administered combinations of buprenorphine with naloxone produced opioid antagonist and withdrawal effects that were ratio-dependent; the most intense withdrawal effects were produced by 2:1 and 4:1 ratios, less intense by an 8:1 ratio. SUBOXONE tablets contain buprenorphine with naloxone at a ratio of 4:1.
Answer by Arleigh
There is no such thing as normal when it comes to opiates. Every single person in this world has a different brain and receptor topology. Some people can be in withdrawal for 12 hours, feel only slight discomfort, and have no problems at all switching to Suboxone. Others wait over 40 hours, feel like absolute crap and wait until major withdrawal (or so they think), yet when they switch to Suboxone, they go into worse withdrawal. The best advice, no matter how many answers you may get or how many sites you read, is to wait as long as possible. Some people who take methadone are told that they can’t switch to Suboxone until greater than a week! Methadone is a long lasting opiate and there are literally dozens of factors which will influence how fast it is removed from receptors in the brain, the bloodstream, and the liver, such as metabolism, other drugs taken, etc.
In addition, make sure he took it correctly. Suboxone contains Naloxone, which is used to deter illegal use and if taken incorrectly (not under the tongue), it could induce severe withdrawal. Also, there have been many circumstances where people think they are ready and yet still go into withdrawal, as I stated above. There are even people who CAN absorb Naloxone through the sublinqual veins, even though it is only supposed to be minimal absorption.
So my final answer would be that it may not be normal, but does that matter? The important thing is that he is probably feeling like total crap and you need to do something. Ask the doctor to maybe try Subutex, which does not contain Naloxone. That way, if your husband for some reason does absorb Naloxone by some weird avenue, this would not be an issue.
Also, I do have one question out of curiosity. Why did your husband decide to switch to Suboxone? Was the methadone not working anymore? Does he not like going to a clinic every day?
You could increase the Suboxone, but like I said, if he is having a reaction to Naloxone, then that could be even worse!
If you would like to email me personally, feel free to do so and perhaps we could talk in much more detail as I would love to help him.
And one last thing – if he is currently feeling terrible, tell him to take some quick acting opiates, like maybe a couple of Percocets or something. I am NOT a doctor so please take that advice with some hesitation. However, because the Suboxone is now occupying the receptors, you need to knock it out of there in order for him to feel better. Suboxone has a long half-life so it takes a while naturally (about 8 hours or so if he only took 8mg as you describe). The absolute best choice, as I hinted (I think), is to go right back to methadone, as you know he can handle that and it will fix him for the time being, which is the MOST important thing. Then after a couple of weeks, maybe he can go for it again, but this time, wait much longer than 40 hours.
Unfortunately, your husband has learned the hard way that his brain is not “normal” as you say, and maybe he is going to need a lot longer than 40 hours to get all the methadone out of his bloodstream, liver, brain, etc. It lives in a lot of places, including being stored in the liver, so sometimes it takes a lot longer than 40 hours.
One of the worst issues with Suboxone is exactly what happened to your husband. Since every person is different, there is no ONE answer to how long a person should wait. It is a trial and error kind of thing, and unfortunately, as you have witnessed, NOT one of the more pleasant trial and error situations.
Area hospitals see increase in infants born dependent on drugs
Wells said she doesn't have any statistics, but she's seen a definite increase in babies going through neonatal abstinence syndrome – or withdrawal – in the last year or two, enough to cause the hospital to rewrite some of its policies. Some months …
Read more on Utica Observer Dispatch