methadone or buprenorphine

[Mongolia2020]

After augmentation and the horrors of withdrawal, I started on methadone in Feb this year and have titrated slowly up to 7.5 mg . I am now sleeping around 5-7 hours per night but very broken sleep with breakthrough RLS during the night. I think I may still be feeling some effects of augmentation. On methadone, I am very sleepy during the day and have to have either a morning or afternoon nap ( sometimes both), yet I still need to go to bed around 7:30 pm. From being a very active 60 year old, albeit with severe RLS, I feel like I am now living the life of an elderly person, yet am only 61.

I have been reading on this site about buprenorphine and wondering if I should give that a try, or if I should stay on methadone. Any other recommendations?

I am also wondering about whether a short dose of tramadol might up-refgulate thThanks in advance - I am so very grateful for the information available on this site - thank you to Sue and Chris and others who clearly spend so much time helping others.

[Mongolia2020]

sorry pushed post in error

I am also wondering if a short (2-3 week) trial of tramadol might up-regulate the down- regulated D2and D3 receptors and reverse augmentation?

Any thoughts anyone?

[Marlayna67]

hello. In the last several years, I have tried many drugs that eventually don’t work for me. I used to be drug-free. Then I was able to take a Valium every third night to get a good nights sleep. Then I started taking oxycodone 5 mg which worked for a couple of years. On my doctors suggestion, I switched to buprenorphine which worked well. I decided to go back to oxy during the last month. and that was a big mistake. I am now a huge and solid fan of buprenorphine. It works 100% for me with no breakthrough RLS during the day or night.

[Joolsg]

You could try Buprenorphine to see if the daytime tiredness is still an issue. We seem to all get different sidw effects.I take 0.4mg Buprenorphine and get no breakthrough RLS at all.

It can take months for the dopamine receptors to settle after withdrawal from dopamine agonists. So let it settle

I was on tramadol during Ropinirole withdrawal and a few weeks afterwards. I then switched to pregabalin and Oxycontin for 5 years and had very severe RLS.

So, by all means 'experiment' with tramadol, but it made zero difference to me and you might put yourself through another 3 or 4 weeks of suffering for no reason.

[Mongolia2020 in reply to Joolsg]

Thanks so much for sharing your experience with me.

I think I will wait a little longer to see if the daytime fatigue settles a bit more. If it doesn’t, I will consider trying buprenorphine ( if we can get it in NZ?). Regarding switching from methadone to buprenorphine - do you know if I could do a straight switch, or would I need to taper off methadone and titrate up buprenorphine?

[Joolsg in reply to Mongolia2020]

With opioids, you can make a staight switch. But, as 707twitcher says, finding the exact equivalent dose is trial and error. So start lower, and you can titrate up. I agree that it's sensible to switch to 0.4mg Buprenorphine pills and increase by 0.2mg a night until it covers all your RLS.Good luck.

[707twitcher]

as Joolsg says, we all react differently to different meds. I have taken buprenorphine for 5 months and it works wonders for my RLS. Because of the constipation side effect, I have tried diprydimole and tramadol recently. Neither controlled my RLS effectively, even with increasing doses. I just discovered recently that my constipation was made much worse by the combination of buprenorphine and cannabis. So stopping cannabis has helped a lot.

My understanding is that one can switch between different opioids without having withdrawal issues, as long as the dosage is roughly equivalent. The attached opioid equivalent chart would say that 7.5mg of methadone is equivalent to 1mg of buprenorphine sublingual. But I believe from what I recall from other posts that this is likely more buprenorphine than needed. Because it’s fast acting (30-60 minutes), I’d suggest starting lower - maybe .4mg, and add more if needed to get the RLS relief. Once you find the minimal effective dose for you, you can then see if the side effects are better.

communitycarenc.org/sites/d...

[Mongolia2020 in reply to 707twitcher]

Thanks so much

[mitziblue in reply to 707twitcher]

I’ve been through the methadone ordeal. It’s terrible, I couldn’t sleep but minutes at a time. Methadone is Meth and is a stimulant to keep you awake. Since it’s also addictive I stopped taking it and went into withdrawal again. Later when I could no longer stand the pain I was put on opiates and then it was a problem because apparently people don’t understand we don’t enjoy taking it, but need it to function. It doesn’t make me high. Anyway I finally tried the Suboxone the Buprenorphine, it’s working great and the only side effect is constipation. I have fibromyalgia, RLS, Degenerate Disc Disease & Arthritis among other things like autoimmune disease. I urge you to try it. It’s also much cheaper too. Good Luck!

Michelle Gordon

[JustVisiting23 in reply to mitziblue]

Hi Mitzi:

I was alarmed to read that Methadone (which I take) has any similarities to Methamphetamime. Fortunately, they are quite different chemically. Just FYI.

[mitziblue]

They’re not the same but they have a lot of the same properties and the Methadone made me stay awake just like a form of Methamphetamine. When I was younger I tried it and I didn’t care for it then either. Plus I wasn’t plagued with illnesses or syndromes.