Do you have a problem with pain pills or other opioids (e.g heroin, methadone)? If so, you may want to consider treatment with buprenorphine/naloxone (Suboxone, Zubsolv). This treatment program is only offered by doctors with specialized training and is a DEA-monitored program. We are here to help you with a treatment plan for opiate dependence and help you understand if Suboxone is a good treatment plan for you. If you choose to participate in our Suboxone program, you will need to follow a structured set of rules and appointments that have been designed to optimize your recovery.

Some facts about Suboxone:

  • Suboxone is the combination of buprenorphine (partial opioid agonist) and naloxone (opioid antagonist – Narcan). The combination is either 2mg/0.5mg or 8mg/2mg.
  • Subutex and Buprenex are other forms of buprenorphine which we do not prescribe
  • Suboxone is a sublingual film that dissolves under the tongue
  • Zubsolv is a sublingual pill that dissolves under the tongue
  • the only FDA indication for Suboxone is for maintenance therapy for Opioid Dependence
  • Suboxone has a 37 hour half-life
  • most of our patients take two films (16mg) a day, the usual dose is between 8-16mg a day
  • at 16mg daily, 93% of the opioid receptors are blocked in the average person
  • the most common side effect of Suboxone is headache, for which you can take ibuprofen or Tylenol
  • you cannot take opiates (e.g. oxycodone, hydrocodone) or benzos (e.g. Xanax, Klonopin, Ativan, Valium) while taking Suboxone
  • if you have insurance your co-pay would be the same of any trade medication
  • out of pocket, an 8mg film costs about $8 (cost at pharmacies varies) and a 2mg film costs about $4

 

What you can expect in Suboxone treatment at CPCH:

Consultation : You will first meet with a board-certified psychiatrist with specialty training in buprenorphine treatment. If you and the doctor feel that suboxone is a good treatment plan for you, you move on the induction phase of treatment.
Induction : To get started, you should not take your first dose of suboxone until you are in significant withdrawal (very uncomfortable). We suggest that you take your first dose while you are in the comfort of your own home. You will first take ½ a film (4mg) under your tongue and if you do not experience precipitated withdrawal within the first 15 minutes, you can then take the second half. We then recommend that you take one film (8mg) twice a day for the first week. You will return to the office in one week to discuss what to do next, in case of any urgent issues you can call your doctor anytime.
Visit #1 : You will return to the office a week after your consultation visit and have a urine toxicology (UTOX) done at this and every following visit. You will meet with your doctor and discuss how the medication is working for you, discuss the results of your UTOX, and decide if you are going to continue with the medication and/or if you are going to change the dose.
Visit #2 : You will continue to meet weekly with your doctor until you establish the proper dose. The proper dose means that you are comfortable (not having withdrawal symptoms), not having cravings, and if you try using on top of the suboxone you should not feel the effects (a blocking dose). So long as you are stable (no substance use of any kind) you can add a week to each subsequent appointment up to 6 weeks.
Maintenance : So long as you are stable, you will continue to schedule appointments with your doctor, take UTOXs, and receive counseling on your substance abuse or other problems you may experience. The longest amount of time between visits is 6 weeks while you are taking suboxone.
Relapse : If you relapse, be honest with your doctor! Relapse is part of the recovery process if we learn from the relapse. If you relapse during the maintenance phase, you will return to weekly appointments and then you can add a week to each subsequent appointment up to 4 weeks.
Taper : Studies have shown that best results with Suboxone maintenance occur after one year clean and sober. After that time, you should start a gradual detox. You will discuss with your doctor what the best taper plan will be for you and how you will be monitored during the process.
Recovery : After you have successfully completed your suboxone treatment, you and your doctor will discuss your options for ongoing treatment. You may choose to take an opioid blocker like naltrexone or you may choose to participate in Narcotics Anonymous (NA) or do some individual psychotherapy to help you maintain your sobriety.

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Some important things to remember about Suboxone :

  • Meet with your doctor regularly and be honest.
  • Keep your appointments – you will be billed for no-shows or cancellations with less than 48 hours. If you miss your appointment and need a bridge prescription of suboxone to get you to your next appointment, there is an additional $75 fee.
  • Pay your treatment costs – this is an important part of treatment compliance. Lack of payment may result in an administrative detox of 21 days (7 days of 4mg, 7 days of 2mg, and 7 days of 1mg, #25 – 2mg films).
  • Try a self-help group for long-term recovery (www.na.org for NA, www.aa.org for AA)
  • Do not give away or sell your suboxone. Diversion is against the law and puts our ability to prescribe suboxone to our other patients in jeopardy with the DEA. The DEA and CPCH check the NC Controlled Substance Reporting System. Filling prescriptions for controlled medications will jeopardize your treatment.
  • Bring all your suboxone film wrappers (used and unused) with you to each appointment for film counts to document compliance and lack of diversion. Protect your supply with a lock-box or safe. Poison Control is 800-222-1222.

 

If you would like to consult with one of our psychiatrists about suboxone treatment, please give us a call at 919-636-5240 option #1 or email office@cognitive-psychiatry.com.