What Comes After Methadone?

[Oozz]

I had the same issue with methadone (after about a decade of highly effective use of oxycodone, it's efficacy diminished quickly, and subsequently went to methadone.) Knocked out my severe RLS, but I felt absolutely awful...sluggish, nauseous, cranky and mildly depressed 24/7. Went to buprenorphine after that, and for the past three years it's been a fantastic medication for me. Reduces RLS to virtually imperceptible level, and close to zero side effects. it also has the advantage of being a CIII controlled substance, so can have scripts called in, refills, etc. Absolutely worth asking about. Unfortunately can be oddly difficult to obtain as sublingual tablets are only officially approved for opioid abuse disorder, but it can be prescribed off-label for pain quite easily if dealing with sane and reasonable Drs. and pharmacies (hardly a given in 2023.)

Best of luck!

Are you saying the oxycodone stopped working for RLS, switched to methadone and that worked?

[Rustsmith]

It can be difficult to compare doses between oxy, methadone and buprenorphine due to the different half lives. The longer half lives for the latter two meds make them difficult to integrate into a morphine equivalence calculator. So it is very possible that the doses were not "equal" even if put on a daily basis.

[debbluebird]

I get back steriod injections every 3 months, which really helps me. They usually last about 6 weeks before I'm allowed to another one, and my RLS becomes worse. I was noticing this time, it's not the case. I'm only having occasional and light RLS, which goes away after getting up for a few min. Then back to bed. Several nights of no RLS. The buprenorphine has worked the best for me after taking Methadone.

[ratfancy]

I have been on methadone for about 2 months. It works, but I'm having significant cognitive issues - not on every day, but enough days that I'm concerned. I'm 70 years old and don't want to lose my mind! My doctor is switching me to buprenorphine and also gave me a nausea drug. How many of you have nausea with buprenorphine? Is there any difference regarding mental acuity?

[debbluebird]

I took methadone 10 mg for 9 years. I had nausea for about 1.5 months and then it went away.
I now take buprenorphine 1 mg. twice a day.
I started out with just about an 1/8th of a 2 mg film. I slowly increased the dose, to try to prevent side effects, but still had some nausea at first, but it didn't last long and it wasn't that bad. Not as bad as the methadone was.
I think it works better than the methadone did for me. My RLS is gone.
The tablets come in 2 mg. I take the film. It comes in 2 mg also, but it's easy to cut with little scissors.
I don't have any side effects now. I have never had any mental acuity issues.
I'm 72.

[Bridgercan]

Bannia—hoping you’ve found something to work in the months since you OP’d. It certainly sounds like you went through an utterly wretched period there—far worse than anything I’ve experienced with this d@mn syndrome.

Ratfancy-for me, difference between methadone and buprenorphine was night and day: methadone=gloomy days, black nights; buprenorphine=brighter days, calm nights. I went from a 24/7 human stain on the couch to a functioning human being again. If I’ve brain fog in the morning it’s from lack of sleep, not the drug. Mental acuity has returned, though I’ve seemed to have lost some, but that could be for any number of reasons. After having tried just about every drug in all kinds of combinations, “bu” is the best yet. Not perfect but perfect enough. Libido has returned, though the physical aspect often requires some male “vitamin V” as my spouse and I refer to it but hey I’m 60. Testosterone and serum ferritin levels are normal so my PCP recommends what she tells all her older male patients: good sleep habits, cardio & weight training, eat well, get vitamin D on board. Easier said than done for us RLS folk, but I’m lucky they are (mostly) achievable goals.

[tea4one]

Thanks for the suggestion. It went beyond the apathy and lack of emotion. I had a weird problem develop where I felt like complete garbage every single morning. It started around 2 months in and got progressively worse. From around 20 minutes after waking until around noon, my head felt disoriented and sometimes my legs hurt. Thought it might be minor withdrawal, so I increased my dose, which only made it worse. Tried cutting my dose and it didn’t get better. Changed the timing of my dose, and tried splitting my dose, both to no effect. We went to Maui in July, which is 6 hours behind us, which naturally pushed my dose time to first thing in the morning. First day, I felt ok. 2nd and third days, I started feeling bad. It was the weirdest thing. My doctor ran every single blood test on me, thinking I might have an adrenal problem or something else, and everything came up normal. After all that, I had to make a lose-lose decision, and this was the choice I made. I can’t be out of it for half my workday.
I took Suboxone previously and I had major issues with that, as well. It just seems like long acting opioids and me don’t agree. Very disappointing, because methadone really did a good job on my RLS.
I appreciate all your input. I am meeting with my doc on Monday, and we’ll see what he says.

Hi Bannia, I also have difficulty in the mornings with strange depressive symptoms. I've decided to cut back on the methadone dose and there is no question that methadone is the cause. On the therapeutic dose of 10mg I have these strange dream-like states in the mornings (hypnogogic?). It is truly disturbing to the say the least. After two trials of reducing the methadone there is no question that it is exacerbating or causing depressive symptoms. I can't return to the therapeutic dose. So, I'm paying for it. Maybe my doc will prescribe something else.
I hope you're doing better. Keep fighting the good fight.

[debbluebird]

I tried to keep my methadone dose at 10 mg and added gabapentin. It worked for me for awhile. Then I had to switch to buprenorphine because they wouldn't prescribe methadone. I'm doing much better.

[tea4one]

Hi Bannia, I struggle with taking methadone as well. I admire your fortitude of deciding to completely stop it, but I wonder how you have managed. Please let us know how your doing. Thanks.

Jayson