bup to methadone

Buprenorphine Post
sslonim
Posts: 118

Postby sslonim » Tue Mar 09, 2010 3:24 pm

I don't have any protocols, but here's what I would do: Stop Suboxone (don't need to wean), begin narcotics 6-12-18 hours later (when patient feels needs something for pain or w/d). As you know, Methadone takes awhile to build up (and one should increase dose slowly; I start 10mg BID and don't increase for 7 days). Give him/her short acting pain meds to use PRN while building up on Methadone.
If there is a concern for taking po meds (you said cancer patient) consider fentanyl/Duragesic patch.
I've had a number of patients on Suboxone who have surgery (or severe injuries) and my experience is stopping Suboxone and using narcotics/pain pills has been easy - as above, start with PRN use (rather than trying to guess dose needed) and see patient back after a few days. The problem I see is patients like the narcotics and may take longer than expected to go back to Suboxone but that wouldn't apply in this case.

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