Methadone to Buprenorphine

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EdSoFlo
Posts: 27
Joined: Tue Jan 06, 2015 4:44 am

Methadone to Buprenorphine

Postby EdSoFlo » Mon Feb 18, 2019 7:18 pm

Hi all -

I currently take 15 mg/day methadone (5 mg 3x) it has been absolutely amazing on my RLS, it’s effectively eliminated it, 24/7 (I’d previous taken oxycodone for the prior 13 years since official diagnosis/treatment, and switched about 3 months ago seeking a longer duration drug due to development of earlier, daytime symptoms). Unfortunately, it’s left me feeling sort of like a zombie all day, fuzzy headed, tired, lazy, sort of apathetic. Possibly somewhat down emotionally as well. In short, not great. So that leads to buprenorphine. Also, my Dr said they have been trying it more lately as I think prescribing requirements have changed, I believe it used to be pretty much reserved for opiate replacement therapy in addiction treatment, for whatever pharmacological reasons). It’s also more convenient as it’s a Clll drug, as opposed to a Cll as the other opioids are, so you can get refills without a new physical script, etc. Apparently there have been very good results so far with some of his other patients, and in Dr Early’s opioid presentation he seemed pretty positive about it as well, so fingers crossed. It seems to be an even LONGER acting med than methadone, so that’s a big plus. As always there are problems, my insurance doesn’t want to cover it, so I’m trying to get that worked out. I’ll need to wait 24 hours after last methadone dose to take as the buprenorphine is a partial antagonist, and if taken too soon after a full agonist opioid can cause precipitated withdrawal which I understand is quite unpleasant indeed. Hopefully 24 hrs will be enough, Dr assured me it will be. Anyway I’d love to hear other experiences with it, and I’ll definitely follow up with mine.

Cheers!

Rustsmith
Moderator
Posts: 4042
Joined: Sat Sep 28, 2013 9:31 pm
Location: Pueblo, Colorado

Re: Methadone to Buprenorphine

Postby Rustsmith » Mon Feb 18, 2019 9:19 pm

I have only heard of results with buprenorphine (Subaxone) from a couple of folks with RLS. One of the longer users goes by Eefall. Dr Earley put him on it a few years ago as a last ditch effort when everything else had failed. He has had some issues with it, but it worked on his RLS. I know of one other user who loves it.

I am like you in that I experienced apathy after being on methadone for a while. I was fine otherwise, but got so apathetic that NOTHING mattered to me anymore. I had no emotions whatsoever. I asked my doctor to switch me to Tramadol ER (Sch IV) and have been on it for six months now. The doctors at Johns Hopkins usually avoid Tramadol because it is the only non-DA that has been reported to cause augmentation, but that usually took more time than I have been on it now.

As for getting off of methadone, my emotions started coming back after 1 day. I felt good the first day off of it, but got and needed zero sleep that first night. I had to go a bit longer due to communication issues and my problems started after being off of methadone for about 48 hrs, which shouldn't be an issue with you.

Finally, you are correct about a change in the regulations for buprenorphine. The old regs only allowed a doctor to write a limited number of prescriptions for it and the doctor was required to go through a special education program to get DEA approval. Part of the Congressional opioid legislation last fall removed those limits since Congress wanted for it to be more widely used for addiction treatment programs. One of the VERY few times that something done for the addicts has actually benefited us.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

QyX
Posts: 462
Joined: Wed Mar 13, 2013 12:53 pm
Location: Berlin / Germany

Re: Methadone to Buprenorphine

Postby QyX » Mon Feb 18, 2019 9:31 pm

Buprenorphine is a great options when it works. I read a lot about this drug and it is commonly used in Germany in opioid replacement therapy and chronic pain management. I had the option to switch to Buprenorphine but decided to stay on Hydromorphone back then.

Here are a few things to know about Buprenorphine who are quite interesting:

- Buprenorphine is not a full agonist but a partial agonist. That means that when you have taken a full agonist like Morphine, Oxycodone, Hydromorphone, Codeine, Methadon etc. You can induce a opioid withdrawal symptom when you don't take a long enough break when taking Buprenorphine too early after taking a full agonists in the weeks before.

From what I've heard 24 hours are normally enough but in some cases ... I guess severe addicts on high doses of Heroine - it sometimes can take between 36 to 48 hours.

- Buprenorphine often has stimulating, activating and antidepressive properties and may cause insomnia in some cases.

That's something I was afraid of. After trying almost all the opioids available, I found Hydromorphone to be the least stimulating and since I already have huge insomnia problems I was afraid that Buprenorphine could worsen them.

- While Buprenorphine is only a partial agonists, it is more potent than most other opioids commonly prescribed for chronic pain and RLS. This also bonds the drug stronger to the opioid-receptors in the brain, giving the drug a long duration of action. In opioid replacement therapy, some patients only need a dose every 3 days when they take a high enough dose.

One of the most annoying things in opioid therapy is that you have to take your medication on time and should not forget about it. Because one dose works only 6 to 8 hours for me, it is very easy to forget about it and have bad symptoms a few hours later ... which then ultimately take a long time to go away. So only having to take one dose in 24 hours would be a very nice thing.

Also what you say about feeling down on Methadon: that is a very common side effect on Methadone and one of the reasons why so many people in opioid replacement therapy on Methadon have trouble functioning. For some people, it can be a horrible drug.

Good luck with the Buprenorphine. I am very curious to see how you will do it.

EdSoFlo
Posts: 27
Joined: Tue Jan 06, 2015 4:44 am

Re: Methadone to Buprenorphine

Postby EdSoFlo » Wed Feb 20, 2019 5:54 pm

Thank you both for your replies. I’ve yet to start it as I’m fighting what looks to be a losing battle with my insurance co. even with a thorough prior authorization from my Dr. They claim the ‘only’ approved use is ‘opioid dependence’ which I’m fairly sure per what my Dr told me, is inaccurate. I’m pretty sure it’s approved for chronic pain as well. Our whole system is laughable really, what can you do. They’re happy to pay for methadone, which is a CII drug, but not this. I’m going to pay cash price it’s not terrible as I’m very curious and hopeful about it. Will let you know how it goes.

stjohnh
Posts: 884
Joined: Sun Feb 14, 2016 3:13 pm
Location: Palo Alto, California

Re: Methadone to Buprenorphine

Postby stjohnh » Thu Feb 21, 2019 12:56 am

EdSoFlo wrote:Thank you both for your replies. I’ve yet to start it as I’m fighting what looks to be a losing battle with my insurance co. even with a thorough prior authorization from my Dr. They claim the ‘only’ approved use is ‘opioid dependence’ which I’m fairly sure per what my Dr told me, is inaccurate. I’m pretty sure it’s approved for chronic pain as well....


Sorry, but FDA approval for Buprenorphine sublingual tablets (under tongue) is only for opioid addiction. Buprenorphine patches are FDA approved for chronic pain. Insurance companies really try to get out of paying for expensive medicines, they are usually happy to pay for cheap ones... exactly the opposite of what people need.
Blessings,
Holland


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