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

[krishug]

do NOT take subs when taking methadone. you have to be in withdrawall before you take them.meth is long acting and is in ur system for much longer than smack.be VERY carefull

[Sir_Dispensalot]

do NOT take subs when taking methadone. you have to be in withdrawall before you take them.meth is long acting and is in ur system for much longer than smack.be VERY carefull

thanks for the tips krish - most of us are familiar with the actions of methadone and its incredibly long (for an opioid) half-life.

Avoiding subutex until in the early stages of withdrawal is quite wise - i'm guessing about 48 hours from last dose of methadone before switchover to subutex.

Tony's the man in the know about this though thanks to the drug team / detox work he does and his prescribing work.

I'm guessing from your use of the 'lingo' and your profile that you're a member of the public - it's nice to see someone who is well informed on a subject giving 'lay' input!

[Pharmacologic]

Subutex/Suboxone is a very unusual drug in many ways. Due to it's partial agonist/antagonist nature it can also be a double edge sword. When transferring to Bupe (Buprenorphine) of any formulation from a drug like Methadone (with an enormous half life) you must tread very lightly. Even mild withdrawals are not safe for some people. Usually this depends on the amount taken and the regularity of dosage. I have thrown myself into deep precipitated withdrawals when in moderate withdrawal from a drug like morphine (24 hours after last dose)

An interesting side note for Subutex/Suboxone that many in the medical profession are completely unaware of is the ability to transfer from Sub to Morphine or Heroin for a short period of time and then take Sub again within 48 hours with no precipitated withdrawal. My theory on this is that while the Bupe is still strongly bound to receptors (ie 24 hours after last dose) it's possible to take Morphine or similar drugs (at appropriate doses) and have enough bind to receptors to have significant effects. When the morphine recedes the Bupe is still in the system and bound to large numbers of receptors. Then 24 hours after the dose of morphine, Bupe can once again be taken, not bring on precipitated withdrawals due to the Bupe in the system already being bound to large numbers of receptors. (ie not pushing full agonist drugs with all those pleasurable feelings off receptors)

Conversely if Morphine or other agonists are administered for more than 48 hours after the last dose of Bupe uncomfortable withdrawals and the danger of precipitated withdrawal (even more uncomfortable..) exist. Choosing an opiate with an appropriate half life for this type of treatment/use is obviously important given the 48 hour window.

I have experienced all the above observations on my own body and there is in fact some research to back it up.

Ref: Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy, Daniel P. Alford, MD, MPH, Peggy Compton, RN, PhD; and Jeffrey H. Samet, MD, MA, MPH

Also of interest to the original poster: PCSS Guidance, Transfer from Methadone to Buprenorphine, Author: Paul P. Casadonte MD. This is a well referenced guide to what your inquiring about.

(just another member of public that want's to share first hand experience with these drugs that those in the medical profession, sadly will always struggle to understand without experiencing themselves)

[DavidS]

(just another member of public that want's to share first hand experience with these drugs that those in the medical profession, sadly will always struggle to understand without experiencing themselves)

That's quite a first post. Thank you.

[Tesh]

Quite an apt username too!

[Fleegle]

(just another member of public that want's to share first hand experience with these drugs that those in the medical profession, sadly will always struggle to understand without experiencing themselves)

Thank-you for your overly-large copy and paste. May I be the first to inform you that no-one within the medical profession has even the slightest notion of experiencing, first-hand, your drug(s) of choice.

Post sense or go away.

[johnep]

Shipman certainly had experience of taking pethidine.
johnep

[Jeff]

May I be the first to inform you that no-one within the medical profession has even the slightest notion of experiencing, first-hand, your drug(s) of choice.

Bollocks

SMMGP - Library - Newsletters - Network 14 (May 2006)

BBC NEWS | Health | Addiction service to help doctors

Careers advice

And who was it just said

Post sense or go away

Jeff