The switch from Methadone to Suboxone can be one of the most difficult transitions to make and should not be attempted without the guidance and close supervision of a medical practitioner knowledgeable in the field. Even under the best circumstances you may still end up putting yourself into precipitated withdrawal due to the long acting nature of Methadone. In order to make the switch, it is generally recommended that you taper down on your Methadone dose to at least 30 mg a day and that you don't drop your dose by more than 5 mg a week in order to give your body time to properly adjust to the change in dose. If you drop too quickly then your body may still have feel like it is on a higher dose than what you may actually be taking due to the long half-life of Methadone and tendency to linger in your system. This increases your chance of going into precipitated withdrawal since Suboxone (Buprenorphine-naloxone) has a stronger affinity or attraction to the pain receptors in your body so will displace any Methadone that may still be in your system and partially block the receptors. Therefore, you need to be in at least a moderate state of withdrawal and wait at least 36 hours after discontinuing Methadone before starting Suboxone and I usually recommend waiting at least 48-72 hours if possible. The problem that many patients encounter is that they may feel like they are in the correct state and in a moderate state of withdrawal even if they truly aren't so there is an objective scale called the Clinical Opiate Withdrawal Scale (COWS) which can help aid in this process. Sometimes, I'll even give a patient what is known as "comfort meds" such as Zofran, Clonidine, and Gabapentin to help with the transition.
Why People Switch From Methadone To Buprenorphine
Both Methadone and Buprenorphine products (Suboxone, Subutex, Zubsolv) are classified as medication-assisted treatment (MAT) and are both FDA-approved to help treat opioid use disorder. Methadone has been around much longer and is much more well known although may not be the best treatment option for certain individuals depending on their circumstances. Each has their pros and cons and you should consult your doctor before attempting to make a change. The reason that some individuals may desire to switch from Methadone to Suboxone may be:
* The stigma associated with attending a Methadone clinic
* Inconvenience and/or inability to visit a Methadone clinic on a daily basis at first
* Experiencing increased side effects such as sedation from Methadone compared to Suboxone
* Not wanting the ability to abuse other opioids while on Methadone
* Less severe withdrawal symptoms if a dose is missed
* Lower risk of overdose
* Ability to travel
Whatever your reason may be, ultimately some individuals may do better on Methadone and need the more structured environment for a successful recovery. Also, some individuals just never feel right after the switch even weeks later and may need to switch back to Methadone. In my experience I've only ever had one patient need to switch back and all the others are glad they made the transition.