EXPLANATION OF TREATMENT
Intake
You will be given a comprehensive substance dependence assessment, as well as an evaluation of mental status and physical exam from your Suboxone Doctor. The pros and cons of the medication, SUBOXONE, will be presented. Treatment expectations, as well as issues involved with maintenance versus medically supervised withdrawal will be discussed.
Induction
You will be switched from your current opioid (heroin, methadone or prescription painkillers) on to SUBOXONE. At the time of induction, The Suboxone Doctor will ask you to provide a urine sample to confirm the presence of opioids and possibly other drugs. You must arrive for the first visit experiencing mild to moderate opioid withdrawal symptoms. Arrangements will be made for you to receive your first dose in your doctor’s office. Your response to the initial dose will be monitored. You may receive additional medication, if necessary, to reduce withdrawal symptoms. Since individual tolerance and reactions to SUBOXONE vary, daily appointments may be scheduled during this time so your dose can be adjusted to where you no longer experience withdrawal symptoms or cravings. Urine drug screening is typically required for all patients at every visit during this phase.
Intake and Induction may both occur at the first visit, depending on your needs and your doctor’s evaluation.
Stabilization
During Stabilization, your Doctor prescribing SUBOXONE may “fine tuned,” your dose to about once a week, if needed. You and your Suboxone Doctor will discuss your treatment options from this point forward.
Maintenance
Treatment compliance and progress will be monitored. Participation in some form of behavioral counseling is strongly recommended to maximize your likelihood of treatment success. Appointments are usually scheduled on a weekly basis, however, if treatment progress is good and goals are met, monthly visits will eventually be considered sufficient. The Maintenance phase can last from weeks to years—depending on what best suits your individual needs—as determined by you, your doctor, and, possibly, your counselor.
Medically Supervised Withdrawal
As your treatment progresses, you and your doctor may eventually decide that medically supervised withdrawal is an appropriate option for you. In this phase, your suboxone prescribing doctor will gradually taper your SUBOXONE dose over time, taking care to see that you do not experience any withdrawal symptoms or cravings. You can always return to a previous dose if you experience uncomfortable symptoms or cravings at the reduced dose.
How Do I find a Doctor that is able to Prescribe Suboxone?
Not all Doctors are qualified to prescribe buprenorphine for opioid addiction. They must become certified by taking an eight-hour training course to obtain a waiver. (This course is now offered online, see naabt.org.) Even once they have become certified to prescribe, the law restricts Suboxone Doctors to a 30-patient limit per physician, or 100-patient limit for those who have had waivers for one year or longer.
The NAABT website provides two ways to find a Suboxone prescribing Doctor at: www.Patient-Doctor - Connection.com. The first – “List of Certified Physicians” – generates a list of prescribing physicians in a specified mileage radius of the zip code entered. However, not all doctors opt to be on this national list originating at SAMHSA (Substance Abuse and Mental Health Services Administration). Alternately, we have the Patient/Physician Matching System. This free-of-charge online service is available 24/7, and allows patients to reach out for help anytime and with complete privacy. It serves as a non-intimidating first step for those seeking treatment.
How it works: The patient registration process consists of a short list of questions to help match patients to physicians. NAABT does not ask for patient’s name, address or telephone number. After a patient submits the application, alert emails go out to physicians. Once an area Suboxone Doctor has the capacity to treat an additional patient, the NAABT Patient/Physician Matching System allows the physician to contact that patient confidentially by email to discuss treatment availability. Counselors or advocates can register on behalf of patients who do not have computer access.
Buprenorphine/Naloxone Combination Tablets — What do They Mean for You?
Your physician has prescribed buprenorphine/naloxone combination tablets Suboxone for you. here are a few things you should know about this tablet before you begin taking it.
What is buprenorphine? Buprenorphine is a type of drug called an opioid, similar to heroin, methadone or Oxycontin. Taking buprenorphine will prevent you from going into withdrawal and should stop you from craving other opioids.
What is naloxone? Naloxone counteracts opioids —including buprenorphine. If you take naloxone while you have an opioid in your system, or if you are dependent on opioids and find that you go into withdrawal without them, naloxone can trigger withdrawal.
That doesn’t make sense — why would my doctor prescribe a drug which will send me into withdrawal? Your buprenorphine/naloxone combination tablets will not send you into withdrawal — provided you take them as your doctor prescribes!
If you dissolve the tablets under your tongue, or if you accidentally swallow one, the naloxone will not affect you — your body breaks the naloxone down too quickly for it to take effect! However, if you inject a combination tablet, the naloxone will take effect. You will probably not feel anything from the buprenorphine, and you could go into withdrawal. So —always take your Suboxone as your physician prescribes it. Don’t inject it, and don’t allow others to inject it.
Suboxone - Frequently asked Questions
Suboxone is easier and safer than methadone and It should also be cheaper, but not yet. I like the convenience of picking up two month’s worth of medication without all the hassle of going to a methadone clinic daily. I’ve tried Methadone for almost a full year and it was a huge hassle. For people hooked on Vicodin or Oxycontin, Subutex is a cheaper, safer, and legal alternative than both Vicodin and Oxycontin, not to mention the doctor shopping.
I frequently get asked if you have to stay on Suboxone for life, and the answer is no. After 6-8 weeks of stabilization, I’d encourage a gradual taper. Of course, this only works when people are doing the work they need to do to get their lives back on track. they must get a stable job or they must really want to be clean before a change can happen.
I only use Subutex for detox. Naloxone, the opiate blocker in Suboxone is supposedly not absorbed orally. This is why Suboxone is supposed to be placed under the tongue until the pill is disolved, It is a problem if it is injected, at least 30% of the people on Suboxone complained of nausea, headache or decreased efficacy. These symptoms usually will disappear after the first week of dosage.
“Subutex is easier and safer than methadone” Other Questions I’ve been asked:
Does Suboxone show up on Drug Tests?
No not unless they test specifically for buprenorphine.
What’s the difference between Subutex and Suboxone?
Both contain buprenorphine but Suboxone has an added ingredient called Naloxone, which if injected will precipitate withdrawal. The theory is that this decreases the desirability of selling Suboxone to get high.
Is it addictive?
Yes, it is addictive, although somewhat less so than other opiates. However, due to the longer half-life of buprenorphine, it can take more time to get through the detox period when you do decide to stop. Most people report that quitting buprenorphine is easier than quitting pure opiates. Do I need to go to rehab to do it?
Do I need to go to rehab to do it?
No, However Subutex and Suboxone is prescribed in inpatient settings.
Suboxone a Revolutanary Alternative To Opiate Addiction
Suboxone is taking a completely new approach in treatment of opiate addiction. My experiences with suboxone make me wonder if we are at the verge of an entirely new approach to opiate addiction, and in turn to other addictions as well.
The traditional approach to drug addiction treats all substances as essentially the same. Yes, the addict does develop a ‘love relationship’ with his/her substance, but the substance’s sister, brother, aunt, or uncle can easily step in and take the place of the drug of choice in a process called ‘cross addiction’. This is one reason why traditional treatment demands sobriety from ALL substances, but there is a more complicated reason as well. The addict, over time, becomes hyper-aware of his/her mood, comfort level, and anxiety. The addict constantly ‘checks in’ somatically, asking ‘am I going up? Or ‘am I (oh no!) coming down? Every bead of sweat may portend the pain of withdrawal. Every ache is a new excuse to use. The addict takes comfort in the ‘4-hour schedule’ of use; an internal clock becomes all-important, and eventually the only thing that really matters. Sobriety and recovery demand that the addict learn to take life on life’s terms, and give up the obsession with symptoms and medications. Sobriety will ‘extinguish’ the learned obsession with symptoms over time—sometimes a great deal of time. As the obsession fades, the addict takes steps away from relapse. But if the addict uses a new substance that changes perception, even a substance like diphenhydramine that is not addictive, the old attention to feelings and symptoms returns. Many addicts are aware of an ‘addict’ frame of mind and a ‘sober’ frame of mind; a drug that causes the addict to look inward and focus again on symptoms can trigger the addict mindset to re-appear. And once the addict is back, it can be very difficult to return to the mindset of sobriety. Suboxone often refered to as buprenorphine can help to block the “addict’s mindset.” Suboxone is a revolutionary alternative to traditional opiate addiction treatment and consistes of two drugs; buprenorphine and naloxone.
Suboxone Treatment
Just recently I subscribed to a newsleter written by a Suboxone Doctor. When I say newsletter it actually was a 5 part mini course into Suboxone Treatment. The course was pretty interesting and while some of the course was not related to my circumsatnce alot of it was.
In this mini course the doc talked about people’s initial fear and anxiety about entering treatment. Why would there be fear and anxiety, you may ask. Well, most doctors will want to make sure that you are off you opiate of choice for at least 18 hours before even prescribing suboxone. That means that you are going to experience mild withdrawal symptoms, and if you have ever experienced withdrawal syptoms then you already know what type of fear and anxiety the doctor is speaking of. When I started Suboxone treatment the Doctor did ask me, “When was the last time you took Oxycontin.” (Oxycontin along with other painkillers such as vicodin was my opiates of choice.) It had only been a couple of hours since I last did oxy’s, but I told him 2 days and that I was experiencing withdrawal symptoms when i was not. I was ready to start my treatment and I was sick of taking painkillers everyday just to keep my withdrawals to a minimum.
It is a common understanding that starting Suboxone Treatment while you still have opiates in your system may throw you into very strong and uncomfortable withdrawal syptoms. This did not happen to me and I have never personally heard of it happening. Ever person’s situation is different and I have heard of people having negative effects to suboxone. Suboxone is a strong drug, and just like all other drug’s there are chances of side effects from Suboxone. I have exerienced mild side effects from this drug but the side effects are nothing compared to the withdrawal symptoms.
Tommorow I am going to be talking about some of the side effects of Suboxone and will continue with some common mistakes people make when entering treatment.
Starting Treatment with Suboxone
This is where I will go over all the crucial steps that you will need to take to successfully detox with Suboxone. I will also discuss common mistakes that individuals make during Suboxone treatment.
The first mistake people make when entering treatment is that they want a quick detox. They want to be done with the pain and miscomfort that opiate withdrawal causes. A quick detox without any counseling or meetings of any type may work if you have only been on opiates for a short amount of time.
If you have been addicted to opiates for an extended length of time then you need to discuss the different treatment options with your doctor. Suboxone will take away the cravings and the pain associated with withdrawal symptoms. But, you must learn to deal with your addiction in terms of what your triggers are. You must learn how to unlearning the patterns of addiction that you have experienced with opiates, and Suboxone can’t help you unlearn your addiction behaviers. Detox is a life changing event. For many individuals it may take some outpatient counseling that your doctor can provide. It may even take an inpatient detox program to help you in this life changing event. In the next few day I will discuss some more mistakes common mistakes people make during suboxone treatment. So, check back.
