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QUESTIONS AND ANSWERS INFORMATION SHEET
- What is Narcotic dependence?
Narcotic dependence is a medical condition where the patient has been taking narcotic drugs (Opiates, Heroin, Methadone, or other painkillers) and the patient’s body has become physically dependent on these drugs. Drug dependence can happen as rapidly as 1-2 weeks after starting use since tolerance builds up rapidly. After tolerance is developed, if narcotics are not taken the patient will go through a very painful withdrawal. Usually withdrawal takes 5-10 days and is characterized by extreme discomfort and pain, diarrhea, sweats, sleeplessness, and abdominal cramps. Most people are unable to tolerate it without help.
- What is Suboxone?
Suboxone is a medication that has some opiate properties and therefore relieves withdrawal symptoms. It attaches to the endorphins or opiate receptors in the brain and stimulates them and is therefore like an antagonist, similar to the other opiates including Heroin, Methadone and Oxycontin. However, it also has some antagonist properties like Naltrexone. It seems to block the endorphin receptors and is there for termed a partial antagonist. Suboxone contains two medicines, Buprenorphine and also Narcan. The Narcan is our pure antagonist and is added to make sure that the drug is not used IV. One of the unique features of Suboxone is that it has an extremely long duration in the body. It takes a long time to wean off the brain receptors and therefore only needs to be given once a day and seems to provide a very stable blood level, avoiding the ups and downs of most other opiates.
- Why is Suboxone used to treat Heroin and other opiates?
The active ingredient in Buprinorphine, which is the active ingredient in Suboxone, has been available since 1982. In 2003, the Federal Government approved Suboxone as a treatment that could be given in doctor’s office after the doctor has completed some special training. The drug can be prescribed to help patients stay off street drugs.
- How well does it work?
Suboxone is a powerful opiate and it works very well. When patients take it on a regular basis it does fill most of the opiate receptors in the brain and therefore patients lose their cravings for other opiates including street drugs or Methadone. People report that they have very little cravings. They report very low incidents of mental effects or any other side effects
- Are there problems with Suboxone?
Suboxone tends to have very few side effects that we are aware of. One of its biggest downfalls is that it is an addictive drug and patient’s who have been on it for a period of time will have withdrawal as when they come off of it. This withdrawal syndrome tends to be fairly mild but tends to last a long time.
- Who is appropriate for Suboxone maintenance?
Patients who have an opiate dependence problem can be treated with Suboxone. At The Coleman Institute, we believe that the optimal treatment for patient’s who have substance abuse problems is complete abstinence from all drugs, combined behavioral and mental change so that they can deal with the factors that cause them to get on drugs in the first place and stay on drugs. We believe that Suboxone can be a useful treatment for people who are in the process of making those changes. Generally speaking we believe that patients do better if they become abstinent as soon as possible and start working on their behavioral and mental changes. However, we recognize that for some people the cravings are just to high or their lives are just to disrupted and the chances of them staying abstinent even with Naltrexone therapy is quite low. For patient’s like this can enter our Suboxone maintenance program and use this time to make the changes necessary for them to become abstinent in the future.
- What other features of the Suboxone maintenance program?
The first step is to come in for a consultation with the physician to determine if you are an appropriate candidate for the treatment program, and for you to determine whether this is a program that you would like to be involved with. Patient’s need to transfer from the opiate that they have been using onto the Suboxone. This is usually fairly routine but sometimes it can be difficult. It usually takes 3-5 days. During this period we see the patient’s daily, provide medicines in order to help make the transfer as smooth, painless and comfortable as possible following the transfer. Regular visits are set up. These may be twice a month for the first month and then monthly when everything is stable.
- Other than taking Suboxone what do I need to do?
At The Coleman Institute, we insist that patient’s on the Suboxone maintenance program are abstinent from all other drugs including alcohol. We believe that when patient’s have substance abuse problems they do better if they are abstinent from all mood altering chemicals. We also insist on regular support groups, usually AA or NA. We also insist on regular therapy. This can be an intensive outpatient program or some other appropriate therapy that the patient and the physician will agree on as part of their comprehensive treatment plan. We also insist on regular urine drug screens to make sure and document that patient’s are indeed compliant with their treatment plan.
- How long should I be on the Suboxone maintenance program?
The length of time on the Suboxone maintenance program varies from patient to patient and will be decided by your physician. For some patient’s this is a short a period, some for 1-3 months. For other patient’s the maintenance program may need to last over a year.
- How difficult is it coming off of the Suboxone when it is time to become abstinent from all drugs?
Some patient’s have no problem coming off of the Suboxone but for other patients it can be somewhat difficult. Generally speaking we wean patient’s down for an extended period of time to minimize withdrawal symptoms. Even with this some patient’s still have considerable withdrawal symptoms and some patient’s will have considerable withdrawal symptoms after their Suboxone is gone. We sometimes refer to this to as Post Acute Withdrawal Syndrome (PAWS) and for Suboxone it can sometimes last from 1-6 months, although usually it is fairly mild and tolerable. Some patients will decide to do a different detoxification process that we have available called an Accelerated Detox. In this way we can detoxify off even large doses of Suboxone over a 5-7 day period. Following detoxification we recommend Naltrexone therapy, usually in the form of a Naltrexone implant.
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