Outpatient detoxification for opiates and medically-managed alcohol recovery is provided for individuals who may be suffering mild to moderate Post-Acute Withdrawal symptoms, or for those with a history or a high risk of relapse.
Dependence on opioids – prescription painkillers and heroin – has been defined as a long-term brain disease by the World Health Organization and the National Institute on Drug Abuse. This disease is caused by changes in the chemistry of the brain. Although it is often not recognized, admitted, or understood, it is a disease that can be treated with medication together with counseling. This medical condition strikes people at all ages and in all walks of life.
Since 2000, when the Drug Addiction Treatment Act (DATA) was passed by Congress, patients with this serious, long-term disease may be treated right in a doctor’s office and through take-home prescriptions using Suboxone. Daily visits for treatment are not necessary after the patient’s dose has been established. In-office treatment with Suboxone offers patients privacy, convenience, and confidentiality.
Suboxone® C-III (buprenorphine HCI/naloxone HCI dehydrate sublingual tablets) is a medicine that, together with counseling, is approved to treat opioid dependence in a doctor’s office and with take-home prescriptions. Buprenorphine has unique characteristics that can help many patients manage their dependence and remain in treatment.
Basically, at the right dose buprenorphine minimizes withdrawal symptoms, decreases cravings, and partially blocks the effects of other opioids
When a doctor starts an opioid-dependent patient on Suboxone, the patient must be experiencing mild to moderate withdrawal. At this point, the opioids from prescription painkillers or heroin have begun to leave the brain’s opioid receptors. As the opioids come off the receptors, buprenorphine moves onto and sticks to them. The patient’s withdrawal symptoms get better as the receptors fill up with buprenorphine, and Suboxone begins to suppress withdrawal symptoms and cravings.
Suboxone attaches to the receptors and partially blocks the effects of other opioids. It is as if Suboxone takes up the opioid parking spaces in the brain, making it very difficult for other opioids to park there. With daily maintenance doses, Suboxone continues to keep the brain’s opioid receptors occupied. Even if the patient uses another opioid at this point, the effects of that opioid will be greatly reduced.
When Suboxone moves onto the opioid receptors in a dependent patient’s brain, it does four important things.
· First, by binding to the brain’s opioid receptors, Suboxone satisfies the dependent person’s need for an opioid. This suppresses withdrawal symptoms and drug cravings.
· Second, because Suboxone excites the brain’s opioid receptors only a little – it is a partial agonist – the patient does not get the same strong effects that are caused by full agonists such as prescription painkillers, heroin, and methadone. It is as though buprenorphine takes the physical aspects of dependence – the brain’s need for the drug to feel satisfied and to prevent withdrawal – off the table.
· Third, Suboxone sticks to the brain’s receptors so that other opioids have great difficulty attaching, and it remains on the receptors for several days.
· Finally, although all opioids lower breathing, when Suboxone is taken alone and as directed, it has an upper limit on how much it does this. This limitation is because buprenorphine is a partial agonist. Although full agonists (opioid painkillers, heroin, and methadone) continue to lower breathing as a person takes more of the drug, Suboxone’s “ceiling effect” makes an overdose death from lowered breathing unlikely, when buprenorphine is used by itself.
Even with this safety feature, however, patients should be very careful about taking Suboxone while also taking other sedatives, especially benzodiazepines. This is because the sedating effects of the buprenorphine will add on to the sedating effects of the other drugs, and the combination may become dangerous. In particular, grinding up Suboxone (which is meant to be dissolved under the tongue) and mixing it with benzodiazepines for injection has caused deaths. Patients being treated with buprenorphine also should not use tranquilizers, antidepressants, or sedatives except under a doctor’s orders, and they should avoid alcohol.
Like all medications, Suboxone does have side effects. These are mild and generally subside after a few weeks. Side effects can include: headache, withdrawal symptoms, body pain, nausea, insomnia, sweating, constipation, and stomach pain.
Let your doctor know if you experience these before or during your treatment with Suboxone. He or she may be able to treat some of these symptoms. There are limited studies to support the use of Suboxone in pregnant women. You must tell your doctor if you are pregnant or become pregnant while taking Suboxone. Your doctor will need to decide if the benefit of using Suboxone outweighs the risks. If you are taking Suboxone, talk to your doctor about whether you should use contraception.
Side effects rarely mean that you should stop taking Suboxone. However, contact your doctor immediately if:
· You feel faint, dizzy or confused
· Your breathing becomes slower than normal
· You experience an allergic reaction (hives, swelling, wheezing or shock)
· Your skin or white parts of your eyes turn yellow (jaundice)
· Your urine turns dark
· Your bowel movements turn light in color
· You lose your appetite for several days
· You feel sick to your stomach or have lower stomach pain
· You have any other unusual symptoms.
Always keep Suboxone out of the reach of children. For more information, visit suboxone.com. See the package insert for more information about other safety considerations and potential drug interactions.
Once you have been inducted onto Suboxone and have stabilized, your doctor will decide what the best daily dose of Suboxone is for you. You will then begin maintenance therapy with a consistent dose of medicine, and your withdrawal symptoms will be relieved and your cravings reduced or gone altogether. Every patient’s needs are different, and most doctors will tailor the length of time that the patient remains on maintenance to the individual’s needs. In most cases you will be able to take your maintenance therapy at home. Your doctor may decide to see you less often at this point and may discuss appropriate counseling options with you.
Although you won’t need to see a healthcare worker every day to receive your medicine, it is still very important for you to keep in contact with your doctor. When you do see your doctor, he or she may request urine samples to see how well Suboxone is working for you. Tell your doctor if you experience withdrawal symptoms, since this could mean you need to have your dose adjusted.
During the maintenance phase, you and your doctor may want to talk about counseling options. Many patients and their doctors find that treatment for opioid dependence works best when medical treatment with Suboxone is combined with counseling.
The length of therapy will depend on your needs, and is up to you, your doctor, and possibly your counselor. Some patients need Suboxone for as little as a few weeks, while others may need it for months or even years. Combining Suboxone treatment with counseling may increase your chances of success. For some patients, short-term treatment with Suboxone may not allow enough time to deal with the emotional and behavioral parts of their disease. Physical dependence is only part of the picture. The risk of relapse often is higher with short-term treatment since patients may not have had enough time to learn how to maintain a drug-free lifestyle.
Don’t stop taking Suboxone on your own. Stopping abruptly can cause withdrawal symptoms. When you do come off Suboxone, your doctor will work with you to lower the dose gradually until you are comfortable without Suboxone. When you finally stop taking Suboxone, throw away any leftover pills so they can’t be used by anyone else.
We invite you to schedule an appointment with one of professional staff and begin a positive approach to achieving your long-term mental health goals.