Since the year 2003 physicians have able to treat Opioid dependence in an office setting instead of a methadone clinic. Suboxone is the first Opioid medication approved for such treatments. Suboxone works on the same mu receptors in the brain as other Opioids. It is called a partial Opioid agonist because it does not produce the full narcotic effect of other Opioids. Once it attaches to those mu receptors, it blocks other Opioids from working in the brain.(Clinic offers Suboxone, Bunivail, and Zubsolv. Not just Suboxone)
Suboxone is a combination of buprenorphine and naloxone. Naloxone is a medication that is used to reverse overdoses of Opioids. When Suboxone is placed under the tongue as prescribed very little of the naloxone is absorbed into the bloodstream. The naloxone in Suboxone is there to deterred people from dissolving Suboxone and injecting it or snorting it. When Suboxone is used incorrectly its naloxone component can cause rapid withdrawal symptoms.
How do you begin Suboxone Therapy?
- You must be in withdrawal before beginning Suboxone.
- You must be in withdrawal from your Opioids for at least 12 hours (preferably 24 hours) before you begin this treatment program.
If you are taking Methadone, you must be two days away from your last dose of 20 mg before you begin a Suboxone program.
If you take Suboxone and Methadone at the same time you can experience acute Opioid withdrawal and become very ill.
- Induction: Suboxone Treatment programs begin with what is called the “Induction phase.” During this time your first dose of Suboxone is administered in the physician’s office. You will be observed and monitored while your withdrawal symptoms disappear.
The official FDA and manufacturer’s induction recommendations involve a 3 day cycle of slowly taking Suboxone once a day to achieve your optimal dose.
This office also offers an “off label” “rapid induction” method which involves titrating your final Suboxone dose in one day. This method typically requires your presence in our office for one morning or one afternoon.
How is Suboxone Taken?
- Suboxone is taken first thing in the morning. The film or tablet form is to be taken underneath the tongue. It dissolves and is absorbed slowly like nitroglycerine.
- Suboxone lasts in your body at least 24 hours. Splitting the dose does not change the levels in your blood stream. Although dividing your Suboxone dose throughout the day will not hurt you, those patients who do so are just imitating behavior from their addiction period of their lives.
What happens if you “shoot” or “snort” Suboxone?
- Suboxone has two components: buprenorphine (a narcotic) and naloxone (a substance often used in a hospital setting to reverse the affects of narcotics). If Suboxone is shot or snorted, the naloxone component will precipitate an immediate and violent withdrawal.
What happens if you “fall off the wagon” and take a narcotic while on Suboxone?
- If your brain’s mu receptors are correctly saturated with Suboxone, there will be no place for any narcotic to attach and the narcotics will have no affect on you.
What happens if I end up in the Emergency Department and need pain medications for a broken leg, a kidney stone etc.?
- Narcotics typically given in an emergency department setting do not work if you are on Suboxone, even if they are administered intravenously.
- Advise your physician you are on Suboxone. Fentanyl, a powerful narcotic, can be given while you are on Suboxone and will be effective.
How long must I stay on Suboxone before I’m no longer addicted to narcotics?
- Addiction is a lifelong issue.
- Successful Suboxone treatment programs typically lasts a minimum of 6 months to a year.
What else must I do?
- Counseling is critical to your success.
- Without counseling your success rate is often lower than 30%
- With counseling your success rate may be as high as 90%
- Counseling can be either group or private.
I understand you have an executive Suboxone program. What is that?
- Our executive Suboxone program involves a more intense approach to addiction therapy with a greater participation from both you and this office.
- You commit to weekly visits and intensive counseling.
- We will make Saturday and/or evening appointments available to accommodate your working schedule.
Can I take Suboxone if I’m pregnant?
Can I take Suboxone and drink alcohol?
- As with all narcotics, deliberately mixing Suboxone with other CNS depressants such as benzodiazepines (Valium, Xanax) and alcohol can make you very ill and can be potentially fatal.