Suboxone with Carb/Levo?

[Fishbizak]

I’m at the start of swapping from methadone to Suboxone. My question is whether or not I can add Carb/Levo as an emergency med during the transition? My doctor told me to add some methadone if/when my legs act up during the transition until we get the dosage sorted out, but because Suboxone blocks opioids, it doesn’t make sense to me to add methadone. I’d rather use Carb/Levo, if necessary.

What say you all? Thank you!

[Rustsmith]

Your doctor's recommendation makes sense if you remember that methadone not only interacts with the opioid receptors in the brain but also with the dopamine receptors. Methadone is therefore doing something during the transition that is similar to what carbidopa/levodopa would do without adding dopamine to your treatment.

That said, I admit that I use a small dose of pramipexole to supplement my methadone. I found that a small dose of pramipexole allows me to keep from having to increase my methadone dose to the next level where I start to feel mental fuzziness from the methadone. That would be something like you using carb/levo as a emergency supplement during your transition. Just don't use it too much since regular use (like my pramipexole) could push you back toward augmentation.

[Fishbizak]

Thanks, Steve. I’m concerned that taking methadone with Suboxone would trigger precipitated withdrawal. I guess that once one is taking Suboxone one has already cleared the withdrawals hurdle and Suboxone is in control of the receptors. Obviously, I don’t understand quite how this all works or I wouldn’t be asking the question, right?

I really appreciate the comeback though!

[Rustsmith]

If you were taking a "normal" low dosage of methadone that is used for RLS (usually 5 to 15 mg/day), then methadone withdrawal probably isn't what you have envisioned from videos of heroin addicts sitting on the floor, back against the wall shaking uncontrollably and sweating profusely. Their morphine equivalent is probably ten or more times what you were taking and heroin has a short half life, so the "end" comes quickly and hits very hard.

For different reasons, I have been through methadone withdrawal at least twice. I won't say that it was enjoyable, because it wasn't. However, my primary symptoms were mild nausea and a flu-like feeling. Both times, I immediately went to bed and tried to sleep it off. In both cases, I felt much better in the morning after as full a night of sleep as is possible because as the methadone wore off, my RLS was becoming untreated and started to return. I can't be sure, but the return of very severe RLS might have been worse than methadone withdrawal.

I never went through the stereotypical heroin shakes during methadone withdrawal. I cannot be certain, but I believe that one time it was chilly outside, so I went out and spent the night walking around our neighborhood park. That kept my legs moving for my RLS and kept me cool. Yes, my stomach was upset, but my legs bothered me more and took my mind off my stomach.

What I can say is that in both cases, a bout of flu or Covid felt far worse and lasted many days longer than methadone withdrawal.

These days, I occasionally forget to take my methadone at my normal lunchtime. Around three or four hours later, my stomach starts to feel queasy and I feel like I need to take a nap. Most of the time I realize the problem before I fall asleep but sometimes I sleep for a few hours and feel just as bad (but not worse) than when I went to bed. When I tell my wife that I don't feel like eating dinner, she asks if I took my meds at lunch and we both realize that I am going through withdrawal.

[debbluebird]

I changed from methadone to suboxone and honestly I don't remember having a hard time. I now take 1mg at 9am and 1 mg at 5 pm. I still take gabapentin 600 mg three times a day.
Good luck