What dose of methadone = 24 mg of bupe?

[Indy]

Like, say somebody's on 24 mgs of suboxone but now they're going on methadone for pain management (not MMT), what dose would they be put on? Or if you were in a similar situation what dose were you put on?

I read that anywhere from 30-60mg of methadone was equivalent to 8 mg bupe, but bupe is weird and taking twice is much isn't twice as strong, so I'm guessing 3x as much bupe doesn't mean 3x as much 'done? or is it?
edit: this is for pain from back problems, the guy is lower-mid 20's, tried all the other non-narcotic stuff and suboxone, now looking at methadone as an option.

Also if anybody has any idea what kind of breakthrough meds are usually used with methadone? Again, if anybody with a similar experience could share what they were on that'd be helpful. thanks

[TigerFan]

I have wondered this myself and actually asked my sub doctor about it. I was under the impression maybe 10-15 mgs methadone=8 mgs bupe (this is only based on my experiences with both and NOT anything factual).

His answer was that the two really can't be compared like that because you're not exactly comparing apples to apples. One is a partial agonist (bupe) and the other is a full agonist (methadone), that could partially explain too why bupe has a sort of ceiling effect on it and taking anything past 8mgs doesn't do much more than 8mgs dose. Also because of this, bupe withdrawals are a lot milder than methadone withdrawals.

Bupe works for some people and methadone works for others. I've thought about getting on methadone once my insurance runs out in December, but I've heard too many horror stories (especially around here) to want to try it unless it becomes a last resort.

I wonder if comparing methadone to oxycodone or oxymorphone doses would be better. Oxymorphone seemed to last a long time (like 'done, but not to the extent of 'done) and are both VERY sedating.

I didn't think that suboxone could be prescribed for pain. Is this in the US? I thought I remembered reading suboxone info and it saying that suboxone could not be prescribed for pain. However, low dose buprenorphine without naloxone has been used for pain for decades, particularly in Europe.

[Suboxer]

More than 6mg of bupe has NO increased narcotic effect. As far as pain killing, nod inducing properties, 6mg=600mg. The figure I have heard is 25mg of methadone is equal to any "ceiling" dose (6mg or above). Remember to start low (10mg) with methadone, and remember it accumulates from day to day; it is very easy to overdose on even slightly too high of a dosage.

[Anthropioid]

I asked this same question at my clinic and was told that 8mg of bupe is about the same as 60 mgs of done as far as holding people (ie. no cravings or physical symptoms). But like tigerfan said, your not exactly comparing apples to apples because of the partial-agonism of bupe.

As for breakthrough meds, I know a guy who takes 70mgs of 'done/day for back pain and also takes up to 30mgs/day of oxycodone for breakthrough pain. I would think that any 'done doses above 80mgs, you shouldn't really need any breakthrough meds since almost all of the receptors are occupied. You may just need a larger dose of 'done to take care of the extra pain.

[duck]

I'd say around 30-40mgs

[OrangeLude]

Originally Posted by Anthropioid

I asked this same question at my clinic and was told that 8mg of bupe is about the same as 60 mgs of done as far as holding people (ie. no cravings or physical symptoms). But like tigerfan said, your not exactly comparing apples to apples because of the partial-agonism of bupe.

As for breakthrough meds, I know a guy who takes 70mgs of 'done/day for back pain and also takes up to 30mgs/day of oxycodone for breakthrough pain. I would think that any 'done doses above 80mgs, you shouldn't really need any breakthrough meds since almost all of the receptors are occupied. You may just need a larger dose of 'done to take care of the extra pain.

from personal experience of 65mg/day mmt; a 30mg Oxy is nothing; barely audible to my system.

[GOLD N DIEMONDS]

Indy IMHO in one is on subs for ONE purpose
then need to switch to Methadone for PAIN MANAGEMENT
One needs to simply forget comparison between the two (apple/oranges)
and Restart strategy from a PM viewpoint-
which would start at low dose and work up until PAIN is effectively address
METHADONE is an excellent Pain med.
SUBOXONE is a terrible pain med.
and it really impossible to tell where pain relief would be found from person to person
IN GENERAL 30mgs of methadone is very effective for pain issues
Often see individuals get low dose of oxy IR for breakthrough meds

of course tolerance and pain level will be determining factors
At younger age one would want to keep dose low for the long game

[Nonphixion]

Originally Posted by duck

I'd say around 30-40mgs

Hey duck, how did you come up with this dose if you don't mind me asking? Did you just make and educated guess or was there a method to coming up with it?

[duck]

personal experience

[Anthropioid]

Originally Posted by OrangeLude

from personal experience of 65mg/day mmt; a 30mg Oxy is nothing; barely audible to my system.

Oh I agree completely. For me at 165mgs/'done a day, not much of anything is audible to my system.

To my friend, he seems totally happy and likes the oxy more than the 'done. I'm willing to bet part of it is like a placebo effect with the blocking effects of the 'done in his system. I was just stating what he's prescribed.

[bodytec]

Originally Posted by GOLD N DIEMONDS

Indy IMHO in one is on subs for ONE purpose
then need to switch to Methadone for PAIN MANAGEMENT
One needs to simply forget comparison between the two (apple/oranges)
and Restart strategy from a PM viewpoint-
which would start at low dose and work up until PAIN is effectively address
METHADONE is an excellent Pain med.
SUBOXONE is a terrible pain med.
and it really impossible to tell where pain relief would be found from person to person
IN GENERAL 30mgs of methadone is very effective for pain issues
Often see individuals get low dose of oxy IR for breakthrough meds

of course tolerance and pain level will be determining factors
At younger age one would want to keep dose low for the long game

sounds right on,man

[Narkotikon]

I've always thought of 1 8mg Sub as being like the old 40mg Methadose waffers. That could be wrong though.

So, if that is correct, 8mg bupe would be like 40mg methadone.

[Nonphixion]

Originally Posted by duck

personal experience

Oh ok thank you.

Originally Posted by GOLD N DIEMONDS

Indy IMHO in one is on subs for ONE purpose
then need to switch to Methadone for PAIN MANAGEMENT
One needs to simply forget comparison between the two (apple/oranges)
and Restart strategy from a PM viewpoint-
which would start at low dose and work up until PAIN is effectively address
METHADONE is an excellent Pain med.
SUBOXONE is a terrible pain med.

I think he knows this and is asking if the person that is on 24 mg's of suboxone a day for pain mangt.(he started bupe for opiate addiction a while back, but has very real pain issue now due to back problems.) He is being switched to methadone for pain management not MMT. because this is his only 2 options as far as opiate pain meds go for now, being so young and all. SO

So what would be a good starting does of methadone, if the person is on 24 mg of suboxone for 'pain management'?

[Saint]

I was on done for pain (not initially but eventually) and switched to subs about 2 years ago. Tapered from 70 mgs done to 10 mgs done, waited over 80 hours and switched to subuxone. Normally this should be very doable but it was a nightmare. The pain didn't go away and after weeks my doc upped me to 8, then 12, then 16 and finaly 24 mgs of sub. Nothing worked.
After 3 months I switched back to methadone and after having been totally off subs for three days even 20 mgs of methadone had more effect - painwise - than the 24 mgs of subs (which also gave me major headaches and other weird side effects btw).

I guess you just can't compare the two - well, maybe you can when withdrawalsymptoms are at stake, like 10 mgs of methadone equals 1 or 2 mgs of subuxone etc. - but for painmanagement I would never ever consider subs (again).

[Nonphixion]

Originally Posted by Saint

I was on done for pain (not initially but eventually) and switched to subs about 2 years ago. Tapered from 70 mgs done to 10 mgs done, waited over 80 hours and switched to subuxone. Normally this should be very doable but it was a nightmare. The pain didn't go away and after weeks my doc upped me to 8, then 12, then 16 and finaly 24 mgs of sub. Nothing worked.
After 3 months I switched back to methadone and after having been totally off subs for three days even 20 mgs of methadone had more effect - painwise - than the 24 mgs of subs (which also gave me major headaches and other weird side effects btw).

I guess you just can't compare the two - well, maybe you can when withdrawalsymptoms are at stake, like 10 mgs of methadone equals 1 or 2 mgs of subuxone etc. - but for painmanagement I would never ever consider subs (again).

This is almost the same thing that is happing to swIm right now. Can you give him a good idea/guess in ur opinion of what dose of methadone that would be reasonable for one to start on? Switching form 24 mg of subs for pain?(long story why on subs for pain)... When 'you did' switch back to methadone from 24 mg of subs for pain mangt., how many mg's of methadone did they start you on for pain mangt.?? (SwIm would love to get a good idea of what mg of methadone would be suffice/good enough start at? The doc want's to start at 30 maybe 40 mg's of done. Thanks for your ^info too... & if anyone else has any experience in a situation like or close to this one, please share?