Suboxone TreatmentThere are five steps in the Suboxone treatment plan. They include:
Intake - During this initial part of the plan, your addiction doctor gets to know you. He or she will do a medical and psychosocial history, learn your medical and surgical problems and history as well as any past mental illnesses. Blood tests will be done to assess organ function, especially that of the liver. A urine drug screen will also be a part of your lab work. The doctor will ask you questions about your opiate use, assessing the type, the amount, and the frequency of your opiate use. Finally, the doctor will explain how Suboxone is used, its potential side effects (which are often constipation and headache), and what will be expected of you when Suboxone treatment is initiated.
When your doctor asks about your opiate use, be completely honest. Without total honesty, the Suboxone treatment plan can't and won't be successful.
Induction - The goal of this step is to transition you from the opiates you currently take to Suboxone.
In order to transition in the most comfortable way possible, you must be experiencing mild to moderate withdrawal symptoms when you arrive at your doctor's office on the day of induction. Suboxone can cause intense feelings of withdrawal if you are not having those symptoms at the time of your first dose.
Your first dose will be given under the observation of your doctor. Suboxone tablets are placed under the tongue and allowed to dissolve. You should begin to feel better after about an hour. Depending on how well your first dose suppresses the symptoms of withdrawal, a second dose may be given by your doctor.
Suboxone must be allowed to dissolve under the tongue. If it is chewed, crushed or swallowed whole, less drug will be absorbed so the full therapeutic affect of Suboxone will not be achieved.
The induction phase of treatment can last a day or two to about one week. During this time, daily visits to your doctor are not uncommon. Urine drug screens may be included in these daily visits as well.
- Stabilization - It's during this stage that the dose of Suboxone is adjusted to the lowest dose that suppresses withdrawal symptoms. Your doctor will discuss the plan for your recovery and how Suboxone will fit into that plan. You and your doctor will decide if Suboxone will be used long term as a maintenance therapy or whether Suboxone will be gradually tapered and discontinued.
Maintenance - For some, Suboxone will be used at a maintenance dose during recovery. During this phase, addiction counseling is important. In fact, the success of your treatment can be greatly improved by attending some sort of professional counseling after you have stopped taking opiates. If maintenance dosing is chosen, the Suboxone will be prescribed at the lowest possible dose that is effective in stopping any withdrawal symptoms or opiate cravings. For some, this phase can last months or even a year or more.
Be aware that because Suboxone is a partial opiate agonist some dependence can result from long-term use. While withdrawal from Suboxone use has been reported to be less difficult than most opiates, this fact should be considered by you and your doctor when deciding upon maintenance dosing versus medically supervised withdrawal from Suboxone therapy.
- Medically Supervised Withdrawal - For some, Suboxone treatment will not be long term. But because the drug is a opiate agonist, the Suboxone must be tapered slowly over the course of several weeks. If the drug is stopped abruptly, withdrawal symptoms similar to what was experienced at the time of induction can occur. During this phase your doctor will slowly decrease your dose, being careful to do so in a manner that produces the fewest withdrawal symptoms or opiate cravings. The eventual goal of this phase is to stop Suboxone treatment altogether.
Counseling Improves Your Chance of SuccessWhile Suboxone can help with the physical issues of recovery, professional counseling will help with the emotional aspects. Counseling is highly recommended during and after your Suboxone treatment. Counseling can help develop coping mechanisms and teach you the tools to minimize the risk of opiate relapse. Studies have shown that counseling does greatly improve your chances of successful, long-term recovery from opiate addiction or dependence.
Can My HIV Specialist or Family Doctor Get Me Started?Because of the complexities of opiate addiction, doctors who wish to prescribe Suboxone as a part of opiate recovery must attend an 8-hour training session. Any licensed physician can take the training course if they so desire. However, because of the complexities of opiate detox and recovery most experts suggest being treated by an addiction specialist. They are experts in the field of addiction and are often part of a multidisciplinary team of doctors, addiction nurses, and certified addiction counselors. Because opiate addiction is both a physical and psychological illness, treatment should include professionals that specialize in both. A multidisciplinary team provides treatment of the entire person, physical and psychological. When choosing a doctor, ask if he or she is part of a multidisciplinary addiction treatment team. If you feel you could benefit from Suboxone, a doctor certified to prescribe the drug can be found at the Suboxone manufacturer's website. Or find an addiction treatment program by contacting the hospitals or mental health agency in your community.
- Marley, D.; "Opiate Addiction and Abuse"; Pain.com; 1 Jan 2000.
- Miller, M.; "Addiction and the Brain: Memory's Link to Recovering From Addiction"; The Harvard Mental Health Letter; Harvard Medical School; Jan 2007.
- The Government of Scotland; "The Scottish Drug Misuse Guide"; 18 Oct 2007.