Intake
You will be given a comprehensive substance dependence assessment, as well as an evaluation of mental status and physical exam.
The pros and cons of the medication, SUBOXONE, will be presented. Treatment expectations, as well as issues involved with maintenance versus medially supervised withdrawal will be discussed. Induction
You will be switched from you current opioid (heroin, methadone, or prescription painkillers) on to SUBOXONE.
At the time of induction, you will be asked to provide a urine sample to confirm the presence of opioids and possible other drugs. You must arrive for the first visit experience mild to moderate opioid withdrawal symptoms. Arrangements will be made for you to receive your first dose shortly after your initial appointment. Your response to the initial dose will be monitored. You may receive additional medication, if necessary, to reduce your withdrawal symptoms.
Since an individual’s tolerance and reaction to SUBOXONE vary, daily appointments may be scheduled and medications will be adjusted until 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
Once the appropriate dose of SUBOXONE is established, you will stay at this dose until steady blood levels are achieved. You and your doctor will discuss your treatment options form this point forward. Maintenance Treatment compliance and progress with be monitored. Participation in some form of behavioral counseling is strongly recommended to ensure best chance of treatment success.
You are likely to have scheduled appointments on a weekly basis, however, if treatment progress is good and goals are met, monthly visits will eventually be considered sufficient. The Maintenance phase canals from weeks to years-the length of treatment will be determined by you and your doctor, and, possibly, your counselor. Your length of treatment may vary depending on your individual needs. Medically Supervised Withdrawal As your treatment progresses, you and your doctor may eventually decide that medically supervised withdrawal is an appropriate option for you.
Treatment agreements/contracts are often employed in the treatment of addiction to make explicit the expectations regarding patient cooperation and involvement in the treatment process.
As a participant in the buprenorphine protocol for treatment of opioid abuse and dependence, I freely and voluntarily agree to accept this treatment agreement/contract, as follows:
- I agree to keep, and be on time to, all my scheduled appointments with the doctor and his/her assistant.I agree to conduct myself in a courteous manner in the physician’s office.
- I agree not to arrive at the office intoxicated or under the influence of drugs. If I do, the doctor will not see me, and I will not be given any medication until my next scheduled appointment.
- I agree not to sell, share, or give any of my medication to another individual.
- I understand that such mishandling of my medication is a serious violation of this agreement and would result in my treatment being terminated without recourse for appeal.
- I agree not to deal, steal, or conduct any other illegal or disruptive activities in the doctor’s office.I agree that my medication (or prescriptions) can be given to me only at my regular office visits. Any missed office visits will result in my not being able to get medication until the next scheduled visit.
- I agree that the medication I receive is my responsibility and that I will keep it in a safe, secure place.
- I agree that lost medication will not be replaced regardless of the reasons for such loss.
- I agree not to obtain medications from any physicians, pharmacies, or other sources without informing my treating physician.
- I understand that mixing buprenorphine with other medications, especially benzodiazepines such as valium and other drugs of abuse, can be dangerous.
I also understand that a number of deaths have been reported among individuals mixing buprenorphine with benzodiazepines.
I agree to take my medication as the doctor has instructed and not to alter the way I take my medication without first consulting the doctor.
I understand that medication alone is not sufficient treatment for my disease, and I agree to participate in the patient education and relapse prevention programs, as provided, to assist me in my treatment.
FREQUENTLY ASKED QUESTIONS-PATIENTS
1. Why do I have to feel sick to start the medication for it to work best?
When you take your first dose of Suboxone, if you already have high levels of another opioid in your system, the Suboxone will compete with those opioid molecules and replace them at the receptor sites. Because Suboxone has milder opioid effects than full agonist opioid, you may go into a rapid opioid Withdrawal and feel sick, a condition which is called “precipitated withdrawal.” By already being in mild to moderate withdrawal when you take your first dose of Suboxone, the medication will make you feel noticeably better, not worse.
2. How does Suboxone work?
Suboxone binds to the same receptors as other opioid drugs. It mimics the effects of other opioids by alleviating cravings and withdrawal symptoms. This allows you to address the psychosocial reasons behind your opioid use.
3. When will I start to feel better?
Most patients feel a measurable improvement by 30 minutes, with the full effects clearly noticeable after about 1 hour.
4. How long will Suboxone last?
After the first hour, many people say they feel pretty good for most of the day. Responses to Suboxone will vary based on factors such as tolerance and metabolism, so each patient’s dosing is individualized. Your doctor may increase your dose of Suboxone during the first week to help keep you from feeling sick.
5. Can I go to work right after my first dose?
Suboxone can cause drowsiness and slow reaction times. These responses are more likely over the first few weeks of treatment, when your dose is being adjusted. During this time, your ability to drive, operate machinery, and play sports may be affected. Some people do go to work right after their first Suboxone dose, however, many people prefer to take the first and possibly the second day off until they feel better. If you are concerned about missing work, talk with your physician about possible ways to minimize the possibility of your taking time off (e.g. Scheduling your induction on a Friday).
6. Is it important to take my medication at the same time each day?
In order to make sure that you do not get sick, it is important to take your medication at the same time every day.
7. If I have more than one tablet, do I need to take them together at the same time?
Yes and no-you do need to take your dose at one “sitting,” but you do not necessarily need to fit all the tablets under your tongue simultaneously. Some people prefer to take their tablets this way because it’s faster, but this may not be what works best for you. The most important thing is to be sure to take the full daily dose you were prescribed, so that your body maintains constant levels of Suboxone.
8. Why does Suboxone need to be placed under the tongue?
There are two large veins under your tongue (you can see them with a mirror). Placing the medication under your tongue allows Suboxone to be absorbed quickly and safely through these veins as the tablet dissolves. If you chew of swallow your medication, it will not be correctly absorbed as it is extensively metabolized by the liver. Similarly, if the medication is not allowed to dissolve completely, you won’t receive the full effect.
9. Why can’t I talk while the medication is dissolving under my tongue?
When you talk, you move your tongue, which lets the undissolved Suboxone “leak” out from underneath, thereby preventing it from being absorbed by the two veins. Entertaining yourself by reading or watching television while your medication dissolves can help the time to pass more quickly.
10. Why does it sometimes only take 5 minutes for Suboxone to dissolve and other times it takes much longer?
Generally, it takes about 5-10 minutes for a tablet to dissolve. However, other factors (e.g. the moisture of your mouth) can effect that time. Drinking something before taking your medication is a good way to help the tablet dissolve more quickly.
11. If I forget to take my Suboxone for a day will I feel sick?
Suboxone works best when taken every 24 hours, however, it may last longer than 24 hours, so you may not get sick. If you miss your dose, try to take it as soon as possible, unless it is almost time for your next dose. If it is almost time for your next dose, just skip the dose you forgot, and take next dose as prescribed. Do not take two doses at once unless directed to do so by your physician. In the future, the best way to help yourself remember to take your medication is to start taking it at the same time that you perform a routine, daily activity, such as when you get dressed in the morning. This way, the daily activity will start to serve as a reminder to take your Suboxone.
12. What happens if I still feel sick after taking Suboxone for a while?
There are some reasons why you may still feel sick. You may not be taking the medication correctly or the dose may not be right for you. It is important to tell your doctor or nurse if you still feel sick.
13. What happens if I take drugs and then take Suboxone?
You will probably feel very sick and experience what is called a “precipitated withdrawal.” Suboxone competes with other opioids and will displace those opioid molecules from the receptors. Because Suboxone has less opioid effects than full agonist opioids, you will go into withdrawal and feel sick.
14. What happens if I take Suboxone and then take drugs?
As long as Suboxone is in your body, it will significantly reduce the effects of any other opioids used, because Suboxone will dominate the receptor sites and block other opioids from producing any effect.
15. What are the side effects of this medication?
Some of the most common side effects that patients experience are nausea, headache, constipation, and body aches and pains. However, most side effects seen with Suboxone appear during the first week or two of treatment, and then generally subside. If you are experiencing any side effects, be sure to talk about it with your doctor or nurse, as s/he can often treat those symptoms effectively until they abate on their own.
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Understanding Opioid Dependence
Opioid dependence is a disease in which there are biological or physical, psychological, and social changes. Some of the physical changes include the need for increasing amounts of opioid to produce the same effect, symptoms of withdrawal, feeling of craving and changes in sleep patterns. Psychological components of opioid dependence include a reliance on heroin or other drugs to help you cope with everyday problems or inability to feel good or celebrate without using heroin or opioids. The social components of opioid dependence include less frequent contact with important people in your life, and an inability to participate in important events due to drug use. In extreme cases, there may even be criminal and legal implications. The hallmarks of opioid dependence are the continued use of drugs despite their negative effect, the need for increasing amounts of opioids to have the same effect and the development of withdrawal symptoms upon cessation. There are a variety of factors that can contribute to the continued use of opioids. Among these are the use of heroin to escape from or cope with problems, the need to use increasing amounts of heroin to achieve the same effect, and the need for a “high.” Treatment Treatment for opioid dependence is best considered a long-term process. Recovery from opioid dependence is not an easy or painless process, as it involves changes in drug use and lifestyle, such as adopting new coping skills. Recovery can involve hard work, commitment, discipline, and a willingness to examine the effects of opioid dependence on your life. At first, it isn’t unusual to feel impatient, angry, or frustrated. The changes you need to make will depend on how opioid dependence has specifically affected your life. The following are some of the common areas of change to think about when developing your specific recovery plan: Physical-good nutrition, exercise, sleep and relaxation. Emotional-learning to cope with feelings, problems, stresses and negative thinking without relying on opioids. Social-developing relationships with sober people, learning to resist pressures from others to use or misuse substances, and developing healthy social and leisure interest to occupy your time and give you a sense of satisfactions and pleasure. Family-examining the impact opioid dependence has had on your family, encouraging them to get involved in your treatment, mending relationships with family members, and working hard to have mutually satisfying relationships with family members. Spiritual-learning to listen to your inner voice for support and strength, and using that voice to guide you in developing a renewed sense of purpose and meaning. During the treatment process, Suboxone will help you avoid many or all of the physical symptoms of opioid withdrawal. These typically include craving, restlessness, poor sleep, irritability, yawning, muscle cramps, runny nose, tearing, goose-flesh, nausea, vomiting and diarrhea. Your doctor may prescribe other medications for you as necessary to help relieve these symptoms. You should be careful not to respond to these withdrawal symptoms by losing patience with the treatment process and thinking that the symptoms can only be corrected by using drugs. To help you deal with the symptoms of withdrawal, you should try to set small goals and work towards them..