Methadone changed to Buprenorphine

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I have a question.  What happened to me?  I have been taking methadone in varying amounts over the last twenty years.  I am on complete disability and have had over ten surgeries most of which had to do with my skeletal system.  I have been under the treatment of a pain specialist from the beginning (actually three over the years due to relocating).  I have never done anything other than what I was told to do because I would never want to endanger my ability to honestly get treated.

 

So at 80mg of methadone per day, having been at 120mg at the most, my physician and I finally decided to try buprenorphine (Subutex), which he said had certain advantages over the methadone.  And since we are again getting ready to relocate in three months, I wanted to have time to be able to switch back if it didn’t take care of the pain as well as methadone.  Once I got the prescription filled, and had no methadone that day, I took my first dose of buprenorphine 8mg under the tongue.  He told me to take 1 pill the first day and then go to two pills from then on. 

I took my one sublingual pill and at 40 minutes later, I started to feel like I needed to go to the bathroom because something was weird.  I went to the bathroom and sat and went from fairly constipated to liquid diarrhea in less than a minute.  Next I started to feel flushed and thought maybe I was just having a panic reaction to the new medication, thinking maybe it was too strong for me, or that maybe I was allergic to it.  Then I alternated from chills to sweats, and decided this was physical, not mental at all, and had my husband take me to the ER, which was fifteen minutes from my house.  As he got dressed to go, I couldn’t help but move my arms and legs, yawn, or sit still at all, no matter how hard I tried and he dressed fast because he could see something was wrong.

 

On the way to the hospital, time was going by so slow and it was getting worse as the minutes passed, so I had him run a light or two.  I am surprised we made it considering the way my body was punching out and flailing around without my being able to control it.  On arrival, we got checked in, and then while in the waiting room, I had to go have liquid diarrhea twice more.  We repeatedly tried to get my pain doctor on the phone, but couldn’t.  I am unable to walk for very far and use a cane when I do, but I still felt I had to move.  So I had my husband push me around the waiting room and couldn’t tolerate it when he would slow down or stop.  I was not in control of myself and was losing more control all of the time.  We rechecked at triage and they finally had a physician’s assistant come to see me.  She told me that I was in withdrawal.  I was floored.  I just took a new medication over an hour ago that was also narcotic and had had my methadone the night before, so I couldn’t figure out how I could be in withdrawal.  Finally, I was taken to a private ER curtained room where I could lay on a stretcher if I wanted to.  I still kicked the brake off of the stretcher four times and almost fell on the floor due to the trashing extremities. 

Now my symptoms included diarrhea x 2 with the inability to clean myself up.  My nose began to run, and I was softly moaning “ow, ow, ow,  continually and uncontrollably.  Once change of shift finished, I was seen by another P.A. who told me he had been to talk, at length, with a pharmacist.  They said that the buprenorphine had competed with the methadone which I still had on my receptors, and the buprenorphine won.  So a small dose of buprenorphine was now attached to my receptors and was not a match for the pain control I have had for the last 20 years by the methadone.   So the plan was to give me some IV dilaudid to break the cycle of pain and put me back onto my methadone.  A heparin lock was placed and I was given one milligram of dilaudid.  It should have been immediately felt, but I barely felt it.  So they gave me another 1.5 mg of dilaudid, which I felt a little more but just barely.  And it was gone as quickly as it came on.  I was able to sleep, face down on the stretcher for ten seconds (no exaggeration) at a time, when a noise beyond the curtain woke me immediately back up and had to start again with trying to go to sleep.  This was repeated for what seemed like forever.  Now I was feeling as if my organs were going to give out.  I told my husband, who was with me the whole time, except when I sent him to find something or get someone to do something, that I couldn’t take it anymore and that I felt I was going downhill faster.  He told me later that at one point he was going to film me with his phone but forgot with all the things happening so quickly.  I really wish he had.  I would have liked to see myself out of control so that I could know what it would be like to not have my methadone again. 

I was sent up to a room and given a small dose of methadone, I think it was 30mg, that mixed with the exhaustion, helped me sleep about 4 hours.  In the morning, they gave me my usual morning dose of methadone.  When my pain doctor made rounds, all I could say was what happened to me.  He said I had “had some component of withdrawal.”

Can anyone explain all this to me?  I see him on Monday and don’t know what to ask or say or anything.  Please help me.  I am now faced with a life of chronic pain with the knowledge of what happens without adequate methadone and how thick the leash I am on to it is.

Thank you.

pjean

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  • Posted

    Hi PJean -  your physical response to the change from methadone to buprenorphine sounds awful!   First a question, then a couple of observations.  1.   What motivted you and your physcian to decide to switch from methadone, which sounds like it was doing fine for you, to buprenorphine?  The old saying: if it aint broke, dont fix it, seems to apply -  especially for a medical regimen that could have life-and-death consaequences.    Patients of all kinds, with an endless array of medications, find that if they change a regimen for whatever reason the result as often as not is not good.  2. Not clear how your physician responded to those pretty horrendous-sounding symptoms after the switch - - - what did s/he have to say and recommend?   3.  As for comments:  absolutely nothing in the literature gives reason to hope that buprenorphine is easier to discontinue (without relapse!!) than is methadone.  To the extent that was part of the motivation, it was wrong.   4. And finally, you mention a "think leash" -  I can understand that.  But the leash is no less thick if the medication is buprenorephine or methadone . . .AND no thicker than if the medication is insuklin, or anti-hypertensives, or . . . . (just think of renal dialysis!). And when the ;eash, say in a dog, prevents it from running across the street and ghetting killed by an onb-coming bus,  . . .. well, I think you will see the analogy.   AND FINALLY:   Needing medication is not the problem;  the associated stigma, lack of comprehension by others (family, medical care providers, criminal justice authorities, etc.) - - THAT's the terrible associated problem, and one that needs never-ending educaiton.   Good luck -  roberet newman (NYC)
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    • Posted

      In response to your questions . . .  1.  I had been weaning down from 120mg to 80mg of Methadone at which dose I no longer had the quality of life I had at the higher dose (i.e. I was no longer active, I would wake up crying, etc.) so he recommended buprenorphine to see if it would provide better pain relief, so it was kind of broke, an in need of a fix.  2.  He asked me what I wanted to do and I said that I wanted to get on and stay on the Methadone without ever trying another change, and all he did was apologize.  3.  I was taking the Methadone for chronic pain, not addiction.  The motivation was to get adequate pain control.   Thank you for the analogy, it will help me to remember that it is a necessary evil.   I don’t worry about the stigma with the Methadone because it is an excellent pain medication and has given me a life again.   I can’t let someone else’s ignorance cause me to suffer more.  Thank you for your insight.

       

       

       

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  • Posted

    Sounds to me like withdrawal symptoms. That is high doses of Methadone that you have been taking for many yrs. Gradually lowering your dose of Methadone is warranted here vs abruptly switching to a new medicine. Your new medication was hogging up the receptor sites which is the equivalent of going from your high doses of Methadone to possibly none. Even though Methadone was in your system, your body couldn't use it. Methadone should never be abruptly stopped even in smaller dosages. And...your daily dosage amounts are very high. If need to go off Methadone, always wean off under your physicians care. 
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    • Posted

      Thank you for your response crystal63405.  I wish my pain specialist/pharmacist would have known that the Methadone should have been weaned down instead of telling me to start the very next day with the buprenorphine.  You brought up a point I hadn’t thought of though . . . I had the Methadone in my system even though I couldn’t use it.  Does that mean that if I took matters into my own hands and took the Methadone I had in my purse all along in the ER to try to fix it myself, I could have died from respiratory depression or some other effect of the Methadone?  Anyway, I would never have done anything with my pain meds without my physician’s instruction for fear of no longer being able to get the pain relief I need in order to live.  
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    • Posted

      Your symptoms were from withdrawal ( diarrhea, inability to sit still, uncontrollable body movements) With respiratory depression you would have been less responsive. "Free" (unable to attach to receptors)Methadone in your system could cause respiratory depression as you mention because you could have a cumulative effect that takes longer to leave the system...but doubtful this would have occurred by swallowing 1 dose in the ER. This problem happens over several doses. Luckily you didn't have to worry about that because your body let you know it didn't like what was happening....withdrawal.
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  • Posted

    It's called precipitated withdraws. Look it up and you can read about it. In a nutshell methadone has a very long half life which means it's stays in your body sometimes up to 5 days. You said you were on 80mg that's crazy that your pain doc did not taper you down to a lower dose I mean 30mgs or more THEN you have to wait 3 days from your last dose of methadone. Because that's the least amount of time you can wait. Then your are supposed to be inducted WITH YOUR DOCTOR PRESENT where you take a tab of subutex see how you feel, this is of course after they have scored you on the COWS perimeters which tells doctors how much you are in withdrawal by scoring you etc...after you get the 1st dose and you have no withdrawal symptoms then you will be sent home on that dose twice a day depending on how your doctor does. If you take one 8mg pill and still feel bad they should bump up does to 16mgs. I'm really maddened and shocked to hear a pain doctor who knows all about how long methadone's half life is and didn't even taper you down to the lowest dose and the induce you the CORRECT way by scoring your withdrawl with COWS scorecard and physically being there with you to induct the meds cause it is dangerous as you have no doubt seen. Another thing is that you should have waited 3 days until you took the subutex. I've been thru precipitated withdrawals not as bad as that and I was pooping liquid diarrhea in the toilet and throwing up violently in the bathtub same time. You need to look into all this stuff I've told you. Your doctor was negligent and after some reading about precipitated withdrawl you will see what I mean. I take subutex and it's good for pain but it had to be started off right. Good luck!!!
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  • Posted

    Hi jean,

    Briefly, you went into major withdrawal. Your pain doctor was very naughty doing what he did. After 20 years on Methadone, which is a full agonise like heroin, he put you onto a semi- agonist WITHOUT hospitalising you. That was, in my opinion, quite negligent. You must have been frightened & extremely distressed.

    Good luck & God bless.

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