Author: SometimeIdiot
Posted: Tue May 01, 2012 2:45 am
Hey Shun!
First, welcome to the forum! I am a new member here as well and have found the support and advice here to be so valuable and important. I feel very fortunate to have found this place and the wonderful people here. I don’t know where she finds the time, but it seems like slipper somehow manages to give a very personal, supportive reply to every new member here (thanks again, slipper!). But of course she’s not the only one, as you can see from JenW’s reply and as you will see from others who will join in supporting you here. 
Important disclaimer: I was a pill popper, not an IV user, and I’ve never been on methadone. My DOC (hydrocodone) has a much shorter half-life than methadone. Reading between the lines, it sounds like you are fearful of something called precipitated withdrawal, which can happen when you start sub without being in sufficient withdrawal. I too was afraid of this, given years of abuse of high levels of hydro. I did my induction when I was about an 8 on the COWS scale. I tried to grade myself strictly so as not to kid myself. I waited over 50 hours from my last ingestion of hydro before I finally inducted.
If you are truly at a 14 on COWS, and you are grading yourself honestly (as Romeo told me in my thread, it’s best to have someone else grade you objectively if at all possible), then perhaps you have nothing to worry about. But I have read that induction for methadone users is more difficult because of methadone’s long half-life.
Because I graded so low on COWS, when I decided to induct, I only took 2mg of the film sub. My hope was that if I had a precipitated withdrawal, it wouldn’t be too bad because of the relatively low amount of sub I took. Within 30 minutes, I felt much more comfortable, about 70% free of w/d symptoms and cravings. That told me that I was okay and would not experience precipitated withdrawals, so I took another 2mg and after that got into my system, I felt no w/d symptoms or cravings. And off I went onto my journey to sobriety.
Since you will be inducting with your doctor, my advice really means nothing (I inducted on my own; my doc prescribed the sub several days before my scheduled induction and just had me call him on his cell phone when I felt ready to start sub). Obviously, it’s best to ask your doctor! But if you are really afraid of precipitated w/d, maybe you could ask your doc if you could begin with just 1 or 2mg to see if you get precipitated w/d? In fact, I’d be curious to know from your doc if taking a small amount of sub (1-2mg) vs. more (4-8mg) at induction can lessen the severity of precipitated w/d. That was the assumption I made at my induction, but maybe even just 1-2mg is enough to trigger complete precipitated w/d?
Finally, it sounds like you already have the COWS scale in hand. Here’s a link to that scale, with a really good, simple explanation of why and how precipitated w/d happens: http://www.naabt.org/documents/cows_induction_flow_sheet.pdf (credit to Romeo for giving me this link).
So there you, my .02 FWIW.
My very best wishes to you with your induction!
SI
