methadone and subutex dose equivalents

[Mister Pharmacist]

hi all,

anyone got any advice as to dose equivalents for subutex and methadone.

I know the literature states that subutex can be introduced, if the methadone dose is 30mgs, however from my experience, the key workers seem to prefer to get clients down to about 20mg before considering subutex.

The trouble is they all seem to use different starting amounts and there seem to be no consistant approach to the starting dose or at what interval clients should br reviewed!

I've spoken to Shering Plough on this a couple of times and they are vague, saying that the initial dose of subutex is 4mg ( they couldn't say what this was equivalent to in terms of an existing methadone dose) and see "how the client gets on."

They didn't seem to appreciate that this patient group are not like other patient groups, in that they are generally not likely to wait to see "how they get on", since if they go into withdrawl because the dose of subutex is not holding them until their next appointment, they will simply go out and use street drugs.

This often sets the clients treatment back months as their additional usage often escalates back up to a level where subutex is no longer a viable treatment.

If anyone has any advice/experience on dose equivalents it would be of great help

thanks

mister pharmacist

[admin]

"As a maintenance agent for opioid dependency, buprenorphine offers advantages such as a lower level of dependence and minimal withdrawal symptoms, due to its partial agonist properties at the micro-opioid receptor. Previous studies have shown 8 mg sublingual buprenorphine to be equivalent to 60 mg oral methadone in terms of retention rate and opioid-negative urine levels. "

I think the partial agonist property of buprenorphine can put a client into bad withdrawel symptoms, and is why they wait until they are on a much lower dose of methadone before starting Subutex.

I found this on the net. Try this link as well: -

http://opioids.com/buprenorphine/bupvmeth.html

Hope it helps