Tapering off methadone, bupe or no bupe?

A quickie question from a youtube viewer:

hiya–  Wondering if you could tell me if this is a good idea.  I’m almost at the end of my taper from methadone from having addiction to oxycontin. been on methadone coming up on 2 years and I’m taking 8 mg a day.  and was thinking of asking my doctor to switch me over to Suboxone when i get down to 2 mg, use suboxone 2 or 3 months to help with the methadone withdrawal, and then taper off the Suboxone.

My doctor brought up Suboxone to me whe n i was at 30mg, but I didnt know anything about it, so I dismiised it.  Now i hear its a better treatment.  Any advice would be helpful.  I want off methadone very bad, I’m just nervous about what comes at the end.  I have to continue working– cant take much time off work– and cant afford to lose my job.  I was hoping Suboxone might be the answer for me.

My subtle answer:

OH MY GOD, NO!!  If you are at 8 mg, you are in the home stretch!!  Bupe would be like going back to 30-40 mg of methadone–  and bupe is hard to taper because of the odd ceiling effect and high potency. 

Good for you for getting off methadone — that is a great thing and you’ve done some greaet work.

Some day we will have a neat way to use buprenorphine as a tapering tool;  things that would help would be a much lower amount of buprenorphine in a pill that is the same size or even larger, or perhaps an injectable product that slowly dissolves, allowing the blood level of buprenorphine to slowly decrease.  But using what is available today, you would need to take a tiny, tiny fraction of a Suboxone tablet in order to take a dose equivalent to only 8– let alone 2– mg of methadone.  You would literally need to take about one hundredth of a tablet!  Remember that buprenorphine is a ‘microgram’ medication;  a dose of 50 micrograms is quite potent, and one tablet contains 8000 micrograms!

I will frequently mention that it is a mistake when people assume that the tapering is the hard part.  Yes, it is very hard– but the hardest part is staying clean AFTER the taper is done.  I suspect that is what is going on in your mind now;  you have done so much good work and come so far, that the ‘addict inside’ is suggesting that you deserve a break at this point.  You DO deserve a break– but you just cannot have one.  At least not THAT kind of break– and as you know, it wouldn’t even be a break for very long anyway. 

If you took a quarter of a tab of Suboxone, you would get a significant opiate ‘buzz’ from it, and then you would feel horrible– you would feel trapped, guilty, ashamed… and as the effect wore off, the withdrawal would seem worse than it has felt for months.  You would have a very strong desire to take another piece of Suboxone, and then you would be ‘on Suboxone’– and back at the tolerance level that you were at weeks ago.  All that work would be for nothing.

Don’t get me wrong– I believe that most people are best off just staying on buprenorphine.  And if you cannot stay clean, then by all means consider using buprenorphine long-term.  But if your intent is to get off opiates completely, taking it now would be a huge step backward.

As for worrying about ‘what happens at the end’– there is no big drop-off at the end of a methadone taper.  With buprenorphine, there often IS such an effect because people ‘jump’ from 1 or 2 mg when they still have  significant tolerance level.  But when you are down to 2 mg per day of methadone, you are home free as far as withdrawal goes.  In fact, you are pretty close right now at 8 mg of methadone per day.

I have to plug my ‘product’– a set of recordings that includes a recording about staying sober after Suboxone.  The tapes are at a site appropriately called (no longer available).  But I can share the ‘gist’ of it:  You want to fill in the empty space once occupied by all that addiction activity– find a new hobby, get another job, fall in love (don’t get married or have kids for a year or so), get interested in school– something.  

Start exercising and taking an interest in your physical health.  Challenge yourself as much as possible to do the RIGHT things (don’t learn how to surf on the hood of a car– learn how to surf for real).  Do things you never saw yourself doing.  Staying clean involves CHANGE– and change is very hard to do, because everything that you do that is true ‘change’ will feel uncomfortable and awkward.  Never act in a play?  Then act in a play.  Consider yourself athletic?  Then do more reading.  Use paper?  Then start using plastic!

And most important, respect the rules that everybody else respects but that addicts tend to think are ‘bogus’ and don’t apply to them.  If the medicine bottle says ‘take one tablet’, take one tablet– unless you call your doctor at an appropriate time and explain why you think you need two of them.  And if the doctor says no, you do what the doctor says.  Always. 

In AA they talk about ‘rigorous honesty’–  knowing that addicts and alcoholics are all BS, all the time.  DON’T LIE– and if you do, apologize and get back to honest behavior.  Relapse occurs WAY before the using resumes;  it starts when the addict starts cutting corners again, and starts thinking that he or she is ‘special’.  After all, ‘special’ people are the ones who get to do what THEY want, and using is entirely self-centered.

Enough lecturing…  You are rocking, so don’t lose your momentum.  Check the folks out on Subox Forum and tell them how you are feeling;  maybe help some others follow in your footsteps.  Be proud of the work you have done.