Methadone vs buprenorphine/naloxone

[Doctorplacebo]

Hello all.

I am in the "fortunate" position of being offered either methadone or Suboxone (buprenorphine/naloxone) for my refractory RLS. I have been taking a very low dose of methadone --1/4 of a 5mg tab once daily--for only 3-1/2 weeks and I fall asleep quickly and sleep uninterrupted about 5 hours and then wake up and feel restless and unable to get back to sleep. Also my RLS symptoms (involuntary twitching) start to come back around 4 AM and bother me all morning until early afternoon. But my main problem is still extreme tiredness and cognitive dullness, as well as worsening anxiety and depressive symptoms. For most of the day I do very little and I often feel too impaired to drive.

I related the above to my RLS doctor via the patient portal and he wrote back, "if you think the cognitive issues are related to the methadone, rather than sleep deprivation or mood disorder, then it makes sense to try switching to buprenorphine/naloxone."

The problem is, I don't know if the cognitive, and mood, problems are due to the methadone or not. I tend to think not, since the main reason I have been seeking help for years is the extreme tiredness and cognitive dullness due to poor sleep, and just recently with intense anxiety and depression which I feel is secondary to the RLS and poor sleep rather than primary (I never had any anxiety or depression until my sleep deteriorated). I also understand methadone can cause or exacerbate depression, and depression in the elderly (i am 62) can cause "pseudodementia" with impaired memory and cognition.

So it's just as clear as mud.

My thought right now is initially to stick with the methadone and try increasing to 1/2 a tablet daily and see if I get better (more sleep, less restlessness) or worse (methadone side effect), and then get back to Dr. Winkelman.

Any thoughts? Personal experiences?

Also, even if the methadone wasn't "causing my cognitive issues", if one could choose either medication, is there a good reason to choose one over the other?

Thanks in advance for any input.

Paul

[TeddiJ]

hi. I have taken both. My first thought is that you should try taking more methadone one night to see if you get a full night of sleep with no symptoms. Or, does it bring on more insomnia? I took about 5-7 mg’s and it did cover my rls all night (I’m female and 120 lbs). Sometimes I took 10 mg’s. But, I had to add Delta 8 or a piece of ambien to ensure sleep.

After experimenting a bit more, see if you want to try the Suboxone. It’s tricky in that the side effects vary. Personally, I did not love methadone and I would fall asleep on a dime while watching tv, working, etc. I even had to pull over while driving. Plus, there was the itching, sweating, constipation, general lack of motivation, and poor memory. I felt my personality was tamped down, too.

Suboxone carries the risk of fully ruining your teeth, which is just terrible in my book. There is also the discussion about naloxone and whether it complicates potential upcoming surgeries. Shumbah and her doctor say it is a huge consideration; my doctors say it is not (one of whom is Dr. B and the other is an addiction specialist. I think her doctor may have the most knowledge on it, however.) I also get these strange upper stomach contractions when I take Suboxone-bizzare. But, just a small amount cuts the rls quickly.

Right now, I mostly use kratom and find that it is far easier to manage than prescription opioids. The side effects are much less intense and there are no issues getting it. But, I don’t know the long term effects, of course, even sticking with a quality source.

Let me know how it goes and if you have other questions…I’m sure you will get a lot of good advice from other opioid users!

[GuillaumeL]

Hi, I've been using Methadone for a year now. My main thought is that you're at a very low dose, which is good in a way. You shouldn't be getting notable side effects using just over 1mg. Follow your gradual increase in dose until you find respite. In my case, 5mg of Methadone + 150mg of Pregabalin was the best compromise. That being said, Methadone can cause insomnia in some people, but it doesn't seem to be your case. Cross that bridge if you get there. First, you should get respite from your RLS since it's waking you up in the middle of the night.

There's good evidence that Methadone gets more effective the longer you take it because of its neuroprotective effect. After 3 months on Methadone, I personally went from unmanageable RLS symptoms every night with only 4-5 hours of sleep to something more akin to occasional discomfort, 7 to 9 hours of sleep and a bad night of 5-6 hours sleep maybe once or twice a month.

Finally, you're not sleeping. Of course you're gonna be depressed and your mind is gonna be muddy. Sleep is a key determinant of mental health. The only way to see if your problem is something else is to find a stable sleep pattern and keep it for a significant period of time.

Cheers, I hope you find sleep.

P.S. Are you taking a dopamine agonist? If you are, you might be experiencing augmentation. There's a ton of resources about that on the forum. Just use the search function.

P.P.S. Are you monitoring your iron level? There's a ton of resources on the forum about the effectiveness of iron supplementation for treating RLS. Just use the search function.

[Doctorplacebo in reply to GuillaumeL]

Thank you Teddi and Guillaume for the great, helpful advice. Yes, I think I really need to somehow get a solid period of better sleep and see where my head is. In the past, if I got a good night sleep, which was rare, I would feel fantastic the next day. Now I never get a good night's sleep and never feel even okay. So, maybe adding a sleep aid for a few nights to see how I feel makes sense.

But first I will push the methadone dose a bit and see what happens--don't want to make 2 changes at once.

I am concerned about the "general lack of motivation" that Teddi describes, since that is a huge problem for me right now; although that could just be sleep-deprivation since my methadone dose is probably too low to be causing side effects.

Question: What time of day do you think would be best to take the methadone?

[TeddiJ in reply to Doctorplacebo]

sorry-I didn’t see this. Take it close to bedtime. How are you doing now?

[larryggarner2001]

Hi I've been using Methadone for 5 year now, I have not went up and down on dosage of methadone I just stay with 5 mg, In the evening. Sometimes once a week I have to cut a pill in half To help on a bad night but other then that it's been working fine. Before methadone. I was on 8 different medicines over four years, None seem to work well or at all I'm 75 now my weight is about 210 pounds, I sleep 7 to 9 hours just about every night, worst part I have is constipation's which has been okay With the help of high-fiber oat brand 2 to 3 teaspoons full and Mix with vanilla yogurt once a day. We have a men's group's that has hip replacements, Shoulder replacement, knee replacements And of course the virus going around, cloudy memory And other memory problems seem to be quite common. Cannot remember before the virus that there was as many memory problems as there are now.

Hope this helps a little bit

Larry

[SueJohnson]

Safe OTC options for insomnia include: valerian, chamomile, hops, L-tryptophan, 5-HTP, glycine, and GABA. Some prescription medicines include Ativan and Ambien. Some OTC supplements that help anxiety are Ashwagandha, L-theanine and Honokiol. A prescription medicine for anxiety is Buspar (Buspirone) which may actually help with RLS. Trazodone, a prescription medicine for depression also , helps both anxiety and insomnia and also may help RLS.

[Tabookitty5]

I sympathize! No experience with methadone as yet, but I do get noticeable cognitive impairment from opiates and opioid agonists (kratom). It’s a noticeable “dementia”. My closest relatives also have the cognitive decline immediately. So bummed! I’m scared to try buprenorphine because of the physical addiction required, plus the expense. And I didn’t even know about dental issues. I’d rather suffer in misery than try it since drs don’t DISCLOSE the side effects of the subs (suboxone, subutex, buprenorphine, etc). Monthly dr visits and pharmacy expenses and moral judgements…

Use care with the kratom. It’s been the least horrific option but I have some organ damage from long term, low dose use. That comes up SUDDENLY rather than over time. And microdosing kratom is STILL a better (SHORT TERM!) option than some of the others. Yes, I’m an idiot because I don’t tolerate discomfort very well…I’m switching to cbd/thc oil and continuing magnesium supplements and ditching the rest for my holiday celebrations. Improved health wishes to you and me and many others with these conundrums.

Good luck to you.

[Doctorplacebo]

Thanks again everybody. Thank you, Sue, for those suggestions for sleep and anxiety. I was hoping someday to be done with experimenting and just get on with my life, but it appears that day is not here yet. I've been experimenting for literally years an I'm exhausted from it. It's hard to keep all the experiments and results clear when my brain is foggy. hard to know what is causing what. I do keep a diary but rarely refer back to it.