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 donâ€™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 sheâ€™s not the only one, as you can see from JenWâ€™s reply and as you will see from others who will join in supporting you here.
I was a pill popper, not an IV user, and Iâ€™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, itâ€™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 methadoneâ€™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 wouldnâ€™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, itâ€™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, Iâ€™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. Hereâ€™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_ind ... _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!