Buprenorphine and methadone

[JenniferBut]

Hi there everyone I am now seeing dr Stephen Gibson pain specialist and Anesthesiologist.

Dr prof yee referred me to him for low dose opioids.

I started on 5mg Buprenorphine patch- zero relief.

He has added 5 mg methadone - instant relief.

Any thoughts as to why the mix and not just the methadone?

I see him again tomorrow.

Thanks

Jen

[Jumpey]

I've never taken either but have used opiods for years. If it were me I would want to try the methadone alone to see if that worked.Good luck.

[SueJohnson]

Buprenorphine will block the methadone and any other opioids from fully working. It is used to get addicts off opioids. I would take only one of them. Either are very effective.

[JenniferBut in reply to SueJohnson]

Doc started with the bup. It didn't work. So he added the methadone.I'll ask why both today when I see him

The methadone works well

Thanks Sue

[Joolsg]

5mcg patch is too low AND it delivers an even dose over 24 hours, rather than the higher dose when you most need it at night.I would stop the patch and stick methadone. You can increase the methadone by small amounts if needed.

[JenniferBut in reply to Joolsg]

I agree but this dr is another god. I'll ask why both today.It seems like overkill with the bup.

I'll fill you in later today

[707twitcher]

to add on to Joolsg’ s comments:

The buprenorphine patch takes at least 48 hours to fully take effect, and 5 mcg is the lowest dose. I would strongly recommend using buprenorphine sublinguals that take full effect within 30 minutes or so. The primary reason to use the patch would be to minimize side effects, as you can typically get by with less medication via the patch, so side effects would be less. But finding the optimal dose first via sublinguals is much quicker. If .2 mg doesn’t resolve your symptoms right away, just take another pill.

I’d suggest switching the patch for a Rx of .2mg sublinguals. Then you could experiment by trying buprenorphine vs methadone to see which works better for you. They are both opioids that are interchangeable, so there is no weaning down period necessary when switching. Sue’s point, I think, is that the sublingual form of buprenorphine (suboxone) includes naloxone, which blocks other opioids. So you wouldn’t want to take them together. But taking on alternate days shouldn’t be a problem. I don’t think the patch contains naloxone.

Staying on methadone is an option, but if your doctor is open to your experimenting with both, that would enable you to see which one’s side effects are more tolerable for you.

[davchar23 in reply to 707twitcher]

Dear 707Twitcher,

I was surprised to read your reply which I found all good and useful except do you really know it takes 48 hours for the patch to be fully effective? I have been using patches now for several months and believe, although difficult to prove, that the full effectivity is reached within 12-24 hours. I have heard this from several members of the forum and so if you have found some research to change that view i would appreciate access to it?

I remember discussing the half life of BUP with you sometime ago and this also seemed to be a gray area? I agree it is all about side effects and mine now is all about the side effect of sweats.

I believe I need approx 0.4mg/day to block RLS but this seems to exceed the level at which severe "sweating" breaks through in 3-4 minutes periods every 1-3 hours approximately. i I am therefore trying to use tow patches (5mcg/hr & 10 mcg/hr) and taking a quarter of a sublingual tablet (200mcg) to top up and block RLS s needed.

Te problem with the above simplistic assessment is a half life " ie how much BUP is left over each time causing a build up and "sweating"

i would appreciate your comments

Best regards

Davchar

[707twitcher in reply to davchar23]

In the context of starting on the patch initially, I have found it takes me 48 hours to be fully effective. Once you are on it, there isn’t a lag once you know when to change it - five days for some, six for me. But every time I return to the patch after some period on sublinguals, I need to supplement it with sublinguals during that first 48 hours.

Here is the only thing I’ve found discussing effectiveness over time of the patch - a chart showing what happens over course of three weeks, changing patch every seven days.

Https://ars.els-cdn.com/content/image/1-s2.0-S0885392412003715-gr3_lrg.jpg

I understand what you are saying about half-life and residual medication. But it sounds like you are minimizing the medication you get - just enough to relieve the RLS. So I don’t think there is anything else to be done….

[Horses7]

I would think the methadone by itself would be enough, not sure why he is giving you both?