Getting off methadone can be extremely difficult. Luckily, there is an alternative to tapering all the way off. Switching from methadone to Suboxone can be the perfect transition plan if done properly. When I worked as a counselor at an opiate treatment program, many of the patients asked me, “can you switch from methadone to Suboxone?”
The answer is yes. However, there are certain criteria that must be met in order for one to do so. In this article I’m going to explain to you what these criteria are. I’m also going to teach you step-by-step how to switch from methadone to Suboxone.
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Methadone and Suboxone
Some people are confused about the differences between methadone and Suboxone. These differences must be understood before you make the transition. Methadone is a full opioid-agonist. This means that it completely mimics the effects of heroin, morphine, Vicodin, and other opioids. It’s the most powerful medication available to treat opioid dependence.
This can be a double-edged sword. Since it’s so powerful, it can work wonders at eliminating opiate withdrawal symptoms and cravings. On the flip side, coming off methadone can be hard due to it’s strength. This is where switching from methadone to Suboxone can help.
Suboxone is composed of buprenorphine and naloxone. Buprenorphine is only a partial opioid-agonist. This means that it still mimics the effects of opioids, but it’s not as strong as the full-agonist methadone. Naloxone is a partial opioid-antagonist. This means that it blocks the effects of other any other opiates.
Often I had patients ask me, “is Suboxone better than methadone?” Neither medication is better or worse. Furthermore, they’re used to treat different levels of opioid addiction severity.
Here’s a brief description of their pros and cons:
- Strongest medication
- Least expensive
- Can be difficult to come off
- Horrible stigma associated to it
- Often have to attend a clinic daily for the first several months until you start earning take-home privileges
- Not as strong of a medication as methadone
- Very expensive
- Can still be difficult to come off
- Not as much stigma associated to it as methadone
- You can get a prescription from a doctor
Note: Only people with the most severe cases of opioid dependence should be placed on methadone.
Reasons for Switching from Methadone to Suboxone
There are a few reasons one might consider switching from methadone to Suboxone:
- To feel less medicated
- To experience less side-effects
- To not have to come all the way off methadone
- Family pressure
- Wanting to avoid the stigma associated with methadone
Everyone is biochemically unique. Some patients feel better on Suboxone than they do on methadone. Conversely, many patients feel better on methadone than they do on Suboxone. I had two patients that switched from methadone to Suboxone and didn’t like the transition. They both ended up getting back on methadone, and feeling much better as a result.
How to Switch from Methadone to Suboxone
Switching from methadone to Suboxone needs to be done correctly. If you’re thinking about switching from methadone to Suboxone, you must first talk to the doctor who is prescribing the medication to you.
At the opiate treatment program where I worked, we offered both of these medications. This made switching from methadone to Suboxone very convenient.
If you attend a methadone clinic that doesn’t offer Suboxone treatment, you can have your counselor help you find a treatment center or private doctor that can prescribe it to you.
If you’re taking methadone prescribed by your doctor or pain management clinic, they too can help you make arrangements for transitioning to Suboxone at another location.
After meeting with the doctor, you’ll be put on a methadone taper schedule. This means that you’ll be decreasing the amount of methadone medication over a period of time. It’s best to taper slow, or at least moderately slow, to avoid shocking your system. This could lead to severe physical and psychological symptoms, opioid cravings, and a possible relapse.
The taper will end at about 30-40 mg of methadone. This is where you will begin switching from methadone to Suboxone. The transition point is entirely up to the doctor prescribing your Suboxone. The doctor where I worked had patients taper down to 30 mg before switching from methadone to Suboxone. This is pretty standard, although some doctors might have you stop at 35-40 mg.
Doctors have you get down on these low doses because anything higher makes switching from methadone to Suboxone much more difficult. This is because Suboxone is a weaker medication. So 30-40 mg of methadone is considered equal to a regular dose of Suboxone.
Once you’ve successfully tapered down to the amount of methadone your doctor has established, you’re now ready for the hard part! Unfortunately, you’re probably going to have to wait approximately 72 hours after your last dose of methadone before switching from methadone to Suboxone.
If you’re not in at least partial opioid withdrawal, the agonist buprenorphine could send you into precipitated withdrawal. I’ve heard some serious horror stories of opioid abusers taking street Suboxone too early and ending up in the hospital. Don’t let this happen to you!
Note: Subutex can also put you into precipitated withdrawal. This is because buprenorphine has a high affinity but low intrinsic activity at the mu receptor, the partial antagonist displaces agonist opioids from the mu receptors, without activating the receptor to an equivalent degree, resulting in a net decrease in agonist effect, thus precipitating a withdrawal syndrome.
*It is a common misconception that the Naloxone in Suboxone initiates the precipitated withdrawal. This is false. The naloxone can only initiate precipitated withdrawal if injected into a person tolerant to opioids. Taken sublingually the naloxone has virtually no effect.
As long as you do everything your doctor asks you should be fine. On the day of your switch, your doctor will do some tests to see if you’re in enough withdrawal to give you Suboxone. If the doctor thinks you’re ready, you’ll most likely be given a small dose of Suboxone to see how you respond. If that goes well then CONGRATULATIONS! You’ve successfully switched from methadone to Suboxone.
My Clinical Observations of Patients Switching from Methadone to Suboxone
I observed many patients switching from methadone to Suboxone. As I explained earlier, only twice did I witness patients getting back on methadone. All the other patients I saw switching from methadone to Suboxone reported that they felt good. Many stated that they enjoyed more energy and less sweating after the transition. Furthermore, they often reported being happy to not feel so medicated anymore, as the methadone can have this effect.
The two patients who ended up switching back to methadone told me they liked the feeling of being medicated. Everyone is different. If you’re thinking about switching from methadone to Suboxone I suggest you set up an appointment to talk to your doctor about it.
Based on my clinical observations, switching from methadone to Suboxone can be an awesome transition plan. I should warn you, however, that coming off Suboxone is still not easy. Don’t underestimate the power of buprenorphine. Yes, it’s only a partial-agonist. But it’s still a powerful medication that exacerbates imbalances in biochemistry.
While tapering methadone or tapering Suboxone, you should work on natural ways of increasing your endorphins to promote physical and mental well-being. If you do this, you’ll be well on your way to being medication and opiate free.
If you have any questions on switching from Methadone to Suboxone, please don’t hesitate to leave it in the comment box below.