Methadone or Buprenorphine?

[Jumpey]

I have been on morphine successfully some years for severe RLS. However I'm beginning to think I need a change of meds. Opioid induced insomnia has gradually worsened so that I'm surviving on about 2 hours sleep now. I'm thinking of asking for either methadone or buprenorphine .I 've been thinking about the pros and cons of each option. I'm wondering whether anyone has used both and can share their experiences.

[ChrisColumbus]

As this hasn't been answered after 14 hours, and despite the fact that I've not used either buprenorphine or methadone, I'm going to quote the introduction to Berkowitz et al's article in Sleep May 2023:

"Opioids are a consensus second-line treatment for moderate-to-severe restless legs syndrome (RLS). Due to its partial mu-opioid receptor agonist mechanism, buprenorphine (bup) has lower risk of respiratory depression, euphoria, and dependence than full-agonist opioids. We hypothesize that with long-term administration for severe RLS, bup is both effective and well-tolerated and can facilitate successful weaning off dopamine agonists (DA) for patients with augmentation."

And further supporting buprenorphine:

"Studies have shown that in comparison to buprenorphine, methadone is more likely to cause respiratory depression....... buprenorphine maintenance therapy uses a partial mu agonist in place of a full mu agonist (e.g., methadone)"

ncbi.nlm.nih.gov/pmc/articl...

Having said this, you'll know that while Shumbah, Joolsg etc use buprenorphine, other RLS sufferers have been successful with methadone. And both have similar listed side effects, so either way you will be prepared to combat characteristic opioid effects such as nausea, constipation, sweating etc.

[Jumpey in reply to ChrisColumbus]

Thank you so much for your very thoughtful reply Chris.I really appreciate it.

[lascala32]

My husband started with endone along with Gababpentin and sifrol. When endone doesn't work after a few years, he went on bup for a few years and has just started back on endone. My observation is that he had better quality of life with bup, endone just knocks him out. 45 years + with this beast.

[Jumpey in reply to lascala32]

Thanks so much for your observations and reply.

[Ticki]

hi hon, I just saw this and I want to say I’ve had this condition for a lifetime. I’ve used every medication you can name and I’ve also experienced all the opiates. methadone only worked for me for about a year and I had slowly been climbing up at the end of that year in milligrams, I am currently taking Buprenorphine and I’m at the highest dose, but that’s what it took to get my legs to stop and the insomnia. It’s never changed for me. That’s been the second hell that I’ve had to deal with after stopping the legs,so far I’m finding I can’t stop the insomnia. It’s just as cruel as the other.So I pray for all the, chronic insomnia or opiate induced insomnia folks.

[Jumpey in reply to Ticki]

Thanks for sharing your journey. What a challenge this disease is! Have you tried cannabis oil with thc for insomnia? I find it helpful.

[Ticki in reply to Jumpey]

Yes I use it also.💜

[Jumpey in reply to Jumpey]

Do you mean 1.5mg per day?

[SueJohnson in reply to Ticki]

Have you tried lunesta?

[Ticki in reply to SueJohnson]

Yes all of them. even the new one that came out about a year ago or so that the restless late doc’s had actually put together and it didn’t work.🥹

[SueJohnson in reply to Ticki]

I am so sorry.

[JustVisiting23]

I have been on methadone for about three years. Initially, had to begin with a large dosage of 2g/day. Now trying to manage on 15mg daily. RLS is relatively well controlled and sleep is undisturbed, thankfully. I did experience severe nausea for about a week. Not an exaggeration to say that Methadone saved my life.

[Jumpey in reply to JustVisiting23]

I'm delighted that methadone is life changing.

[ArianeGuerra in reply to JustVisiting23]

Wow! It was so encouraging to read this post. I have been taking methadone for 10 months and I am now on 3mg. My doctor is increasing the dosage very slowly because I have had a lot of side effects. But knowing that you are doing so well on methadone was really good. Because I haven't felt any improvement, I have been sleeping an average of 3 hours a night for a long time and sometimes I lose hope. I wanted to know if you are currently experiencing any side effects and how long it took you to reach your ideal dose? Thank you

[JustVisiting23 in reply to ArianeGuerra]

For almost two years my only RLS meds have been Methadone and Horizant. So, it’s hard to determine which side effects are from what meds. My balance has been affected so I avoid ladders! I also struggle with afternoon drowsiness which can be intrusive- however I suspect these issues are related to Horizant vs Methadone. But I gladly accept these side effects because my RLS is well-controlled. Regarding getting to the best dose, that process took only a few months. Don’t be hesitant to stay with Methadone. I wish you the best.

[ArianeGuerra in reply to JustVisiting23]

Oh, it's great to hear your story, thank you very much! I'm more confident in the path I'm following now, it's going to work out!

[Jumpey]

Thanks so much for your feedback. Do you mean you started on2mg and have ended on 15mg of methadon per day? I'm so glad you have found relief.

[Jumpey in reply to Jumpey]

I'm thinking you are on 1.50m gper day??

[JustVisiting23 in reply to Jumpey]

Oh! I see my error- all doses are in mg, not grams. Apologies.

[TheDoDahMan in reply to Jumpey]

I hate to gainsay what JustVisiting23 is saying, but it makes more sense to me, (a 10mg/day methadone user), to read their post of "2g/day" as meaning "20 mg/day".

[JustVisiting23 in reply to TheDoDahMan]

You are correct- I thought I edited my post but apparently not!