Suboxone to Methadone?

Question by Pat: Suboxone to Methadone?
Hi,
I am a recovering heroin addict and have been clean for a couple of months now; my life has improved greatly and I owe much of that to Suboxone. That being said, I am still having cravings frequently. I talked to my social worker who specializes in drug addiction and recovery, and she said the cravings I have been having are more than usual even for a newly sober addict. She suggested I talk to my doctor about an increase in Sub dosage…I am presently on 12 mg a day. My question is, would I find more success with Methadone? I know nothing about Methadone and how succesful people generally are on it, ect. Or would an increase in my Suboxone dosage be worth a try first?
Thanks in advance for the help, I greatly appreciate it.
-Pc

Best answer:

Answer by J Miller
I would definitely try increasing the dose of Suboxone first. It may just work and you can stay on Suboxone. A dose increase often does the trick when it comes to cravings. However, Suboxone isn’t right for everyone and some do better on methadone. Suboxone has a ceiling effect so for those who need higher doses methadone would be the better option. The only way to know which is best for you is to try. I would always recommend that people try Suboxone first simply because it’s less regulated, carried less stigma, is often covered by insurance and can be easier to taper off (there is some disagreement on that point though).
If I were you I’d get a couple of increases and give it some time. If you still don’t feel it’s helping try finding a methadone clinic in your area. Methadone does work wonders for a lot of people, me included. You should be informed before you get on it though. Just like there are a lot of pros there are a lot of cons. One of the main cons is how it’s regulated. You have to go to a clinic (assuming you’re in the US) and in the beginning you would have to go 6 or 7 days a week depending on the clinic. After 30 to 90 days you will start earning takehomes as long as you do well. After about 9 months you can come once a week and after a year or longer twice a week. After two years some clinics allow you to come monthly. Because of this being on methadone requires more commitment than Suboxone and if there is no clinic nearby the time and gas money for getting to the clinic may be an obstacle. The first few months on methadone maintenance is a drag but it does go by fairly quick and imo it’s worth it to get your life back.
Another con is that a lot of insurance companies don’t cover MMT (methadone maintenance treatment) and very few clinics accept insurance anyway. If your insurance covers it you have to submit the claims yourself and be reimbursed. The weekly cost for MMT is $ 50-$ 100 depending on where you live.
Methadone does cause some side effects. They are similar to those of Suboxone and varies from person to person. Some go away over time and most are not too bad. Nothing you can’t live with for the most part.
You have to start on a low dose and go up. The average dose is 80-120mg and it can take you a couple of months to get there depending on the clinic. Some will take you up much faster. Some people need doses much higher than that so you want to make sure that the clinic you choose does not have a dose cap. Having a dose cap is against best practice guidelines but some clinics do it anyway. Make sure you ask.
Most clinics only require monthly counseling sessions but some require much more than that in the beginning. You may have to go to groups or individual counseling weekly at first. For many people this is helpful though.
The hours at methadone clinics are a bit funny so if you work make sure that it works with your schedule. Most clinics open early, like 5am, and close before noon. A few have afternoon hours.
You do not get high from methadone once you’ve taken it for a few days despite what some claim. If your dose is too high you may experience nodding and tiredness but it’s nothing pleasant about it.
Another major con is the time it takes to get off methadone when and if you decide to do that. Because of the long half life of methadone withdrawal symptoms will last for a long time so it’s important to never go cold turkey but taper it slowly like you would with Suboxone. For a proper methadone taper that would keep you comfortable throughout you should expect it to take as much as a year or more depending on the dose. Going faster is a recipe for disaster.
Ideally, you should stay on MMT for at least 2 years. The longer the better. Because addiction is a chronic disorder some need to stay on it for life or very, very long times. Everyone is different. You should expect it to be a long term treatment though.
Another thing is – methadone tastes like crap! Bring candy to take after you dose to get the nasty taste out of your mouth!

If you have any other questions about MMT please feel free to email me (click on my name). I’ve been on MMT for several years and I consider myself to be fairly knowledgeable about it.

Good luck!

Answer by Tang
I would definitely try increasing the suboxone dosage first. I know a guy on 24mg daily, and while that’s not an ideal situation, I’m just saying that 12mg is far from the maximum possible dose for you. Another thing is methadone can’t be prescribed out of a doctor’s office for addiction treatment, at least not legally. You’d have to enroll at a clinic, and let me tell you it’s a lot nicer going to a doctor’s office for suboxone once a month than it is going to the methadone clinic daily. And while neither drug is pleasant to get off of, methadone is widely considered one of the most difficult opiates to stop using, perhaps the most difficult. There’s a reason why junkies call it “liquid handcuffs.” My advice would be to keep trying with suboxone, and only start methadone if you’re reached the maximum possible suboxone dose and still have strong cravings.

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