It is usually not difficult to convert a patient’s treatment modality from Suboxone to methadone. The patient cannot be on both medications at the same time, but methadone can be started 24 hours after the last dose of Suboxone as it normally would if a patient was dependent on any other opioids such as oxycodone or morphine.
The process of changing the treatment modality from methadone to Suboxone is more involved. Generally the following criteria must be met for a patient to successfully accomplish the conversion:
- The daily dose of methadone cannot be higher than 30-40 mg per day.
- The patient must not have consumed any methadone for 24 hours prior to starting Suboxone
- The patient must not have used or abused any other opioids such as oxycodone, hydromorphone, codeine, etc. for at least 24 hours.
- The patient must be psychologically motivated.
Essentially, the patient needs to be in clinic opioid withdrawal for Suboxone induction to be successful. If not, Suboxone can act like an opioid antidote (antagonist) and cause what is referred to as “induced withdrawal”, which can be difficult to treat.
Even when the above criteria are met and the conversion is done successfully, The first week after the induction can be difficult and marred by psychological effects such as depression, anxiety and insomnia. This is because methadone is a very long-acting opioid and for it to be completely out of the body, it may take 7-14 days.
Despite these issues and challenges, many patients switch off methadone and to Suboxone with success and are glad to have done so.
Speak to your physician if conversion is right for you and more details on the process.