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Methadone versus Buprenorphine: Comparisons?

Discussion in 'Opiate & Opioid addiction' started by Forthesevenlakes, Jan 23, 2007.

  1. Forthesevenlakes

    Forthesevenlakes Platinum Member

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    Feb 26, 2006
    Hello to all!

    I have just created a sticky thread for those wishing to post questions or experiences regarding buprenrophine (and only buprenorphine). However, I have a question which is only tangentially related to that. Does anyone have stories of their lab rat having experience with both methadone AND buprenorphine (Subutex/Suboxone) for maintenance or detoxification from opiates/opioids? Obviously this would not be concurrent administration of both drugs, I would just like to create a thread where people could compare the pros and cons of each drug when deciding what route to take when they want to get off opiates.

    I am wondering about...

    1. The whole of the experience. Which drug seemed to help more with controlling withdrawal symptoms and cravings? Which drug was easier to remain using regularly without slipping up?

    2. What are some pros and cons of each drug? Was You using the drug for maintenance or detoxification, in each case?

    3. How long had You been using opiate prior to treatment? How long did treatment take, in each case?

    Any anecdotes, opinions, etc. on the matter would help too, I want to make this thread a resource for people who want to either get on maintenance or taper off of opiates and make the decision that would be right for them.
  2. cz-one

    cz-one Silver Member

    Reputation Points:
    Aug 10, 2006
    from U.K.
    This story was related to me by me:

    "I've tried coming off with methadone and subutex at different times,and in my experience subutex has worked loads better for me,if i slipped and tried to use on top,the subutex rendered the heroin inefective.With methadone it doesnt and it also messes up your prescribed dosage and you have to go higher after each binge,not to mention you can end up with a dual-addiction. With subutex,my heads clearer,and it does seem to have an anti-depressant effect that seems to make me want to sort everything out to finally get clean.At the clinic i go to,the general consensus seems to be that meth is for those who still want to use but need something to bridge the times when they cant get cash to avoid withdrawals to avoid law trouble cause they had to do crimes,and subutex is for those who want a heroin substitute whilst they set about rebuilding their lives until ready to stop.This is just my experience though."
    Last edited by a moderator: Jan 23, 2007
  3. nancydrew

    nancydrew Newbie

    Reputation Points:
    Apr 5, 2007
    from U.S.A.
    great and very relavent subject of discussion! methadone may be the old "tried and true" or as they like to put it... THE GOLD STANDARD... but suboxone/subetex treatment has been making some waves.

    i can tell you about the experience of a girl and her boyfriend who i know intimately... sorry this is a very long story, but i think it is unique as she and her boyfriend tried both methadone and suboxone and represented a long time opiate and user and someone who was using enough to get sick, but still pretty green:

    anyway, i will put some cliff's notes at the end if you don't want to read my account of their tale. but for those of you in for the long run, here's goes:

    when it came time for swim and her boyfriend to kick their habbit, they looked into each. but first, i think it's important to compare each of the two's history regarding opiates. I had been in chronic pain treatment since she was fourteen, so she has a history of pretty much having been on opiates for solidly a decade. she also had a couple of surgeries that required she be on lots of opiate medicaton and such. she had only used heroin since she was about eighteen, having mostly chipped through college, but always using intravenously. pills such as oxycontin and norcos were used frequently as well, and fentanyl in the form of actiq lollipops. when pharmacueticals dried up and swim lost her insurance, she and her boyfriend started experimenting with heroin. he was somewhat shy of the whole needle situation, so they began snorting dope. the dope primarily available to the two of them was mexican black tar and occasionally a very potent brown powder dope.

    eventually swim's boyfriend decided he was ready to move onto iv use, something which gave her lots of sleepless nights, but that's another subject entirely. but it happened. that became their preffered method of administration at that time and continued to be. after about three months of sniffing heroin, they followed it up with about another year and a half of constantly using iv. they would use approximately one to two grams a day if just using the minimal to get by and be functional to go to work and generally go through about a quarter on the weekends when they wanted to have fun and actually feel that old high they once felt.

    funds were getting low, sanity was wearing thin, and their source was not as reliable, leaving them dope sick for days at a time. I was adamant that they try a clonodine and benzo detox and tried this several times with and without the guidance of doctors. however, swim ended up in the hospital three times that summer they tried to kick because she would just get so ill. dehydration was a bitch for her and one particularly fun time she spent almost two weeks in the hospital because her organs systems had started shutting down after she passed out in a taco bell on break from work. unfortunately, when swim complained of severe pain, the doctors treated her to low dose (4 mg every 2 hours iv) morphine. she had to ask for it though, so even though she had mixed feelings about it, she challeneged herself to try and taper herself off while in the hospital. she was being treated with other drugs, such as the all important promethazine, which really helped her keep stuff down. she wasn't allowed to eat for several days which really drove her crazy.

    swim's boyfriend had his own situation to deal with. he was having horrendous migraines after he would go a day or two abstaining from the use of heroin. unfortunately, the only thing that would end these, was a trip to the emergency room and a large shot of dilaudid. he responded very very badly to imitrex and other such drugs related to it and they were contraindicated for him.

    they really felt like they were up against a wall. I had a friend who used dope, but had insurance and saw a specialist and got suboxone. since he wasn't really intendinging on kicking and only going ot please his parents, she was happy to buy a large quanitity of eight mg tablets off of him.

    swim and her boyfriend waited the nesc 48 hours of hell til they were in full blown wd's before dosing on them. she would titer her dose up accordingly to 32 mgs and was not being held over by the medication at all. she still had full blown symptoms and was on the verge of another hospital trip. swim's boyfriend found that one pill in the morning and a half after work, along with trazadone that his physician had rx'ed him made the days pretty manageable for him. he reduced his dose over a two week period and was feeling pretty good. I was still sick as ever and got one of the side effects from methadone that she has read about: incredibly awful headaches! she was never really a headache person, and just had them now and again, something that tyelnol would always fix... but these were so incredibly bad, she really started to sympathize with her migraine afflicted boyfriend.

    needless to say, I got back on the dope. she wasn't interested in spending another couple days in the hospital. she was a bad influence on her recently sober boyfriend. she used every day, just enough to get by, and he chipped. she was sick of it. her boyfriend overdosed. very scary. but again, that's another story for another post. she decided to look into methadone. she could not be stable on suboxone. she had read that suboxone was not really effective at doses about 24mgs so she could not just increasingly titer her dose up til she felt comfortable. swim's boyfriend was sick again also.

    I will say that suboxone did not allow her to feel high when she did a shot while on it and warns that you still suffer from cns depression. she tried chasing that pink cloud a little too hard and did find that she could eventually get a little high, but there was such significant respiratory depression, she knew she was playing with fire.

    anywho, swim and her boyfriend did their last shot in preperation for their intake at the methadone clinic 12 hours later. they didn't sleep much that night and watched a soprano dvd marathon. yes, swim wanted to strangle herself every time she saw chris get high. even though I have been in treatment for six months she still has a really hard time any time she sees someone shoot up in a movie.

    I would love to tell you about the process of intake at the clinic, but in the interest of keeping the story short, she will say this: they were really lovely people. they accepted her as a maintainence patient and her boyfriend as a detox patient. they took 30 mgs that day and went home and slept really good, practically for the first time in years.

    swim titered up to around 70 mgs and was still feeling kinda shitty. the dose wasn't holding her. she listened to the people that said "oh methadone is WORSE FOR YOU!" I would still get high when she did heroin, and her use had gone from every day to just on the weekends, so swim and her boyfriend were still vastly improved. however, she did some research and some soulsearching and she came to the conclusion that she might just well stay on methadone for awhile. it was really good for her chronic pain! she got up to around 90mgs and then a funny thing happened. even though she had not injected in over a month, she did a shot anyway. she didn't feel it! when you get the therapuetic level of methadone in your body it actually blocks the high. and since she wasn't sick, she didn't care. and she laughed and then she cried and then she pretty much realized that methadone had been the best thing in the world. she's been on her treatment for about six months now and has been completely abstinent with the exception of the aforementioned shot for about three months now. she feels great, she feels normal. she is not depressed. she says, "methadone is to me like how insulin is a diabetic. it allows me to live." she and her counselor agreed that given her long term history, suboxone wasn't good for her.

    thankfully, the taper worked really well for swim's boyfriend. he titered up to a dose around 60 and then reduced his dose 10 percent every week until he was clean. because his taper and subsequent withdrawl was medically supervised, he felt no ill effects except for maybe the occasional bout of diarhea and a little bit of very minor leg pain. he agrees that methadone worked better for him than suboxone because he was able to continue his treatment as long as he needed. but again, your milage may vary versus swim and her boyfriend's because they were not using the suboxone under doctor supervision. anyway, swim's boyfriend has been off the methadone for over 3 months, and she still goes to the clinic every day.

    anyway, as promised if you didn't want to read all of that, here's how i would sum it up really nicely.... some cliff's notes if you will....

    suboxone is worth a try. it is expensive though. if you have the means to go to a doctor, that would work better i think than a DIY detox. however, that said, if the environment had been different, the boyfriend says he could have probably stayed clean, but he found the longer 90 day methadone taper to just be easier. it gave him a lot more time to acclimate than the two weeks on suboxone. but you do have to ususally have tried a few things before going to a methadone clinic, so he says give it a shot. different buprenorephrine-rxing doctors do different things. some give you a year, some give you only a few pills. make sure you let the doctor know how you want to do things. sadly, some do this just to make money. you have the option of finding a practitioner that is there to help you and care about you and really get you through this. vote with your feet if you have to. I would say some methadone clinics are the same way!!!

    swim however couldn't have done it without methadone. she had a much longer history with opiates than her boyfriend. getting to the right dose for her was everything though. if she could do it differently, she wouldn't be afraid to increase her dose. she requires the occasional 5-10 mg adjustment now and again, but is otherwise doing really well. some people give her a lot of shit about her decision, saying she's just getting fucked up on something else, but methadone just makes her feel normal. it's not a high at all, except it lets you feel the natural high that one feels just being healthy and having all their ducks in a row! sometimes she doesn't like going to the clinic every day, but it's what she has to do.

    i guess ultimately what i would say, is try suboxone first. try to stabilize and taper off of that. if that doesn't work, try to detox on methadone over 90 days, and if you are a really good candidate for maintanence, don't be afraid to go that route, but just keep in mind, it's a big decision to make and isn't suited for everyone.
  4. somniferic

    somniferic Newbie

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    May 15, 2007
    There was a time in SWIM's using career that he wouldn't have thanked you for buprenorphine! Now, he sings its praise. The points about methadone by nancydrew's friend certainly are correct, its different for everyone. SWIM managed to knock a 10-year heroin habit on the head using Sub. Methadone just gave him too much lee-way! Being able to use on top, despite the therapeutical dose dichotomy, just didn't work, the days SWIM wanted skag he wouldn't take his Meth. I remember the days when he used to score meth amps, and mix them with all kinda drugs....anyway! Everyone will have their favorite 'getting off the junk' drug, SWIM know's people who swear by doing without a substitute, with a stockpile of Benzo relatives, everyone is different! It depends on an individual's situation. If a person is surrounded by other users in their home, like I was, then methadone is shit, it can bump a person's habit sky-high, I know! Good post though nancydrew! I hope your friends are doing ok.
  5. ojos_de_brujo

    ojos_de_brujo Silver Member

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    Dec 31, 2006
    Classic outpatient heroin detox treatment in Swim's country is to put people on methadone. Doesn't matter how long you have been using or how bad your addiction is.
    I know of a 16 year old with a 3 month heroin addiction being put on methadone when he asked for psychological help with his problem.
    In Swim's opinion (just an opinion) this should not have happened.
    The different ways of detoxing from heroin (and staying of it) should happen in a certain order IMO.

    Why substitute heroin addiction with methadone if cold turkey Withdrawals hasn't even been tried?
    If that fails, one can try Buprenorphine, if that doesn't work either try Methadon, and if all that fails the government should provide prescription heroin. (fat chance in most countries, but that is what should happen)
    Alternative treatments like Iboga can be tried at any given time.

    I am putting this way too simple, she knows. Some people will have to try all these different methods to try and stop using heroin -and it will take years-, some will never stop, but on the other hand, some will be able to stop using without having to take a substitute. Everybody's different, and everybody's addiction is different.
    Every addiction requires individual attention, a generalized approach just does not work.

    Apparently that is difficult to understand for some professionals who work with addicts.