Opiate Detox

EXPLANATION OF TREATMENT SUBOXONE
(buprenorphine HCl/naloxone HCl dihydrate) sublingual tablet.

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 medically supervised withdrawal will be discussed. Our office will provide your SUBOXONE prescription for the duration of treatment; these procedures will be explained in more depth at the first visit. Induction. You will be switched from your current opioid (heroin, street methadone or prescription painkillers) to SUBOXONE or SUBTEX. At the time of induction, you will be asked 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. Your response to the initial dose will be monitored. You may receive additional medication, if necessary, to reduce withdrawal symptoms. Since an individual’s tolerance and reactions to SUBOXONE or SUBUTEX vary, additional 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 on a random schedule during this phase. Intake and Induction may both occur at the first visit, depending on insurance requirements, your needs and your doctor’s evaluation.

Stabilization
Once the appropriate dose of SUBOXONE or SUBUTEX is established, you will stay at this dose until steady blood levels are achieved. You and your doctor will discuss your treatment options from this point forward. The amount of SUBOXONE or SUBUTEX will depend on the amount necessary to saturate all the affected neurons in the brain. No amount of SUBOXONE or SUBUTEX above this level will provide any appreciable benefit and this ceiling effect is beneficial in preventing misuse/overdose potential.

This stabilization period usually last from 60 to 100 days depending on whether you are a fast or slow absorber of the medicine.

Maintenance
Treatment compliance and progress will be monitored. Participation in behavioral counseling is required by Federal guidelines and will help to ensure your best chances for treatment success. Your doctor will monitor your progress, and you will receive your prescription for SUBOXONE only during these regular visits. 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, 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 and where possible the treatment goal to end maintenance on SUBOXONE or SUBUTEX.

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 doctor will gradually taper your SUBOXONE or SUBUTEX dose over time, taking care to see that you do not experience any withdrawal symptoms or craving. Some patients taper down to a small dose and can go no lower without experiencing uncomfortable consequences and withdrawal. Such patient can sign a inexpensive monthly maintenance contract.

EXPLANATION OF 1ST DOCTOR MEETING

Your 1st visit is generally the longest, and may last anywhere from 1 to 4 hours. When preparing for your 1st office visit, there are a couple of logistical issues you may want to consider. You may not want to return to work after your visit, this is very normal, so just plan accordingly. SUBOXONE or SUBUTEX can cause drowsiness and slow reaction times, particularly during the 1st week of treatment until your body adjusts to the medication. Driving yourself home after the 1st Med Management Meeting is not recommended, so you must make arrangements for a ride home.

It is very important to arrive for your 1st visit already experiencing mild to moderate opioid withdrawal symptoms. If you are in withdrawal, buprenorphine will help lessen the symptoms. However, if you are not in withdrawal, buprenorphine will over-ride the opioids already in your system, which will cause severe withdrawal symptoms.

The following guidelines are provided to ensure you are in withdrawal for the visit. (If this concerns you, it may help to schedule your first visit in the morning: some patients find it easiest to skip what would normally be their first dose of the day).

  • No methadone or long-acting painkillers for at least 24 hours
  • No heroin or short-acting painkillers for at least 4 to 6 hours
  • Bring ALL medication bottles with you to your 1st appointment.

Before you can be seen by the doctor, all of your paperwork must be completed, so bring all your completed forms with you or arrive about 30 minutes early. In addition, all agreed contract payments must be current and it is your responsibility if your total cost is partially financed, that payments are made in a timely basis to avoid penalties.

Urine drug screening is a regular feature of SUBOXONE or SUBUTEX therapy, because it provides physicians with important insights into your health and your treatment. Your 1st visit will include a review of urine drug screening,
and blood work. A breathalyzer test will also be done. If you haven’t had a recent physical exam, your doctor ay require one.

To help ensure that SUBOXONE is the best treatment option for you, your doctor will perform a substance dependence assessment and suitability questionnaire. Lastly, you and your doctor will discuss SUBOXONE and your expectations of treatment.

After this portion of your visit is completed, your doctor will give you a SUBOXONE or SUBUTEX prescription. You fill the prescription at the pharmacy and return to the doctor’s office so you can take the medication in a safe place where the medical staff can monitor your response. Your response to the medication will be evaluated after 30 minutes and possibly again after 1 hour. Once the doctor is comfortable with your response, you can schedule your next visit and go home. Your doctor may ask you to keep a record of any medications you take at home to control withdrawal symptoms. You will also receive instructions on how to contact your doctor in an emergency, as well as additional information about treatment.

CHECKLIST FOR 1ST DOCTOR VISIT
Arrive experiencing mild to moderate opioid withdrawal symptoms
Arrive with a full bladder
Bring completed forms (or come 30 minutes early)
Bring ALL medication bottles
Contracted fee or deposit paid in full at time of visit. (Cash, Check or Credit Card)

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