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Questions on switching from Methadone to Suboxone

Posted: Sun Aug 16, 2020 4:21 am
by D.K.
When I first started treatment at CARE Clinic for Drug Addiction in Central Mississippi about 3 months ago, I was always bragging about how great the clinic was because of the personalized treatment that I received and the low cost for the office visits and medications. My friend who was on Methadone but hated her Methadone clinic wanted to get on Suboxone. So I called CARE Clinic and asked my doctor if he was able to help her. My doctor told her to stop taking Methadone and come to CARE Clinic in 3 days. My friend stopped taking Methadone and saw my doctor 3 days later. I was shocked that my doctor put her on Oxycodone for a week and then started her on Suboxone after that week was over. I know that my CARE Clinic doctor is a smart guy and he has lots of experience with treating opioid addiction, but I didn't ask him about why he started Oxycodone since my friend (not me) was the patient. Needless to say, my friend was able to transition from Methadone to Suboxone in 10 days without any problems (ie no withdrawals), after taking Oxycodone for the last 7 days of this transition. She has been on Suboxone for more than a month and is very happy that she is so independent now, compared to when she was on Methadone.

Can anybody explain to me the idea of giving Oxycodone to a person who wants to get off Methadone and on Suboxone? Isn't it dangerous to start Oxycodone (or any opioid for that matter) in an addict who has fought for years to get off opioids? I know it works because my friend is on Suboxone now and didn't have any withdrawals, but it seems counterintuitive to give opioids to an opioid addict. Isn't it better to just stop the Methadone and start Subutex (since Suboxone contains Naloxone) when the Methadone is out of the person's system?

Re: Questions on switching from Methadone to Suboxone

Posted: Sun Aug 16, 2020 9:34 am
by jennjenn
My doctor didn’t prescribe the oxycodone to the patient that transitioned from methadone to suboxone but what happened was is it was told that if the patient wanted to use shorter term opiates while waiting the two weeks they were going to have to wait they could.

If someone is taking methadone or fentanyl (or heroin with fentanyl in it) then they have to wait about 2 weeks before starting suboxone once they stop using those medications. Why? Because those opiates stay in your system so long that starting too soon will cause some major precipitated withdrawals. I didn’t think doctors wrote shorter acting opiates like that, I always thought that was frowned upon but I could be wrong about that. Normally it’s up to the patient to just make it through those two weeks and if they take oxycodone or whatever then that’s a good way to keep from being sick for 2 weeks. Anyway yeah, that happens a lot.

Re: Questions on switching from Methadone to Suboxone

Posted: Tue Aug 18, 2020 3:18 pm
by docm2
My friend stopped taking Methadone and saw my doctor 3 days later. I was shocked that my doctor put her on Oxycodone for a week and then started her on Suboxone after that week was over
I'm shocked too. Unless they have a very well documented paper trail of treating her for pain then what they did is illegal. Clinically it makes sense but we still have to follow the law.
I post because I doubt there are more than a handful of practitioners that would be willing to do this and I wouldn't want hopes raised.
I have people continue to work with their methadone clinic, taper to less than 30 mg a day, medicate the withdrawal with comfort meds for at least 72 hours, more if they can stand it, then start Suboxone.
If they find some oxycodone, well... I just act surprised when I review their UDS with them.
PAX