Suboxone is comprised of two ingredients: buprenorphine and naloxone. Buprenorphine suppresses opioid cravings and withdrawal by attaching itself to the brain’s opioid receptors and blocking other opioid substances (like heroin). It activates the opioid receptors enough to relieve symptoms of withdrawal and cravings but not enough to cause the addictive feeling of euphoria. Naloxone is a substance that also attaches to opioid receptors and blocks other substances; however, naloxone does not activate the opioid receptors. Taking naloxone alone would block addictive opioids but not relieve any symptoms of withdrawal. Naloxone is added to buprenorphine to remove any pleasurable effects of abusing the drug illegally with IV use.
No. Addiction is the manifestation of abnormal brain adaptations. These brain adaptations cause cravings, and cravings influence behavior. Reversing these brain adaptations to the extent possible and learning techniques to deal with other triggers is what the recovery process is. When signs and symptoms of a disease disappear, that disease is considered to be in remission. Suboxone suppresses signs and symptoms of the disease, which is consistent with addiction remission rather than switching addictions. This is why people stable in treatment can quickly return to work, care for children, and stop destructive behavior while they make the long-term changes.
Suboxone is not a cure for addiction. It is a tool patients can use to gain relief from cravings and withdrawal symptoms; it helps patients feel physically healthier, which gives them the energy and incentive to initiate the necessary behavioral and environmental changes that will support their long-lasting recovery. Taking Suboxone as prescribed allows patients to quickly stabilize so they begin the process of rebuilding their lives and making long-term changes.
Buprenorphine is a long-acting (1/2 life 32-36 hours) opiate that binds more strongly and tightly to the opiate receptors than almost all other opiates (for comparison, the half-life of oxycodone is less than one hour). Each 8 mg tablet of buprenorphine is similar to 50-80 mg of oxycodone for a 24-hour period. Thus, a patient taking 16-24 mg of buprenorphine daily will get 150-240 mg worth of oxycodone pain relief; the difference is that, unlike prescription opioids, buprenorphine does not cause sickness or cognitive impairment. It only partially activates the receptors so the patient is not impaired. Because patients feel physically and mentally better while taking buprenorphine, their activity level and functioning quickly improves.
Furthermore, buprenorphine has a ceiling effect: after about 20-24 mg, buprenorphine fills all of the opiate receptors and blocks any heroin or other opiate molecules. This means that patients will never develop tolerance and will never need more and more of the drug to feel "normal."
Routine benzo use is not permitted. If you feel like you cannot survive without your benzos, AWS may not the place for you. If you have a valid current prescription and your psychiatrist or family physician is informed of your enrollment in our clinic, we may permit benzos initially. However, patients choosing to stay in treatment must wean off benzos within 60 days. If benzos are present 60 days after the initial consultation, likely discharge will be discussed, with no exceptions whatsoever. We will never write prescriptions for benzos.
Valid prescriptions to stimulants such as Adderall, Ritalin, etc., with legitimate indications may be permitted. However, we will never write prescriptions for your continued use of stimulants. Please don’t ask. Our mission is to get you off addictive substances.
We understand that no one is perfect and that addiction is a chronic disease. We look at each occurrence of relapse individually and decide what to do. We often take one of the following actions:
1) probationary status with increased visits and monitoring, or
2) immediate discharge from the clinic. Addiction Wellness Services reserves the right to terminate you without cause. Obviously, we do not want to do that, but if you are not committed to your recovery, no amount of treatment will help.
If you are pregnant, we will treat you with Subutex (buprenorhpine without naloxone added). Even though both mono and combination product Suboxone are approved for pregnancy, we find it prudent to minimize pregnant women’s exposure to the combination drug.
True, documented allergies to naloxone are extremely rare. A statement from your doctor claiming you are allergic is not enough. A slip from the ER that says you are allergic is not enough. We need valid, observed allergic reactions. After an initial relationship is established with a good track record and approval by the Medical Director, we may allow you to use plain buprenorphine for valid reasons. All Subutex patients have a higher level of screening: more frequent and supervised urine drug tests and more samples sent for confirmation of drug metabolites.
Unfortunately, many bad actors want Subutex to sell for money as it has a higher street value than Suboxone. It gives the opiate treatment field a bad name and impairs our ability to care for patients.
Addiction Wellness Services believes that each patient is unique. The biggest predictor of long term recovery is staying on Suboxone. The answer is very simple: stay on Suboxone as long as you need to be on Suboxone. A general rule of thumb is to stay on Suboxone approximately one half of the length of time you were actively using. Addiction wellness Services utilizes evidence-based guidelines and current best medical practice to determine length of treatment.
We encourage the lowest dose possible and will not prescribe more than 8 mg, two times a day. An exhaustive review of the medical literature confirms that few patients will ever need over two x 8 mg tabs/films. Please do not ask to go over these limits. Doses over the limit of two per day have been strongly associated with drug diversion and selling and are frowned upon. It is never okay to share your meds with friends and loved ones.
Addiction Wellness Services believes in the value of behavioral therapy. In addition, your insurance plan and some prior authorizations for your medication require reliable proof (appointment date and name of counselor) that you are regularly seeing a Illinois licensed Drug and Alcohol counselor that is approved both by your insurance carrier and the Illinois Department of Drug and Alcohol. Every plan differs a bit, but rest assured, it may be required. Dr. Goyal is a Board-certified Addiction Medicine specialist and may qualify for a small number of plans. If needed it is your responsibility to complete and have reports forwarded to our office to submit at the time of prior authorization.
Most insurance or health plans require certain documentation to authorize (approve) your medication. These Authorizations most frequently involve your urine drug screens and evidence that you are going to therapy. Without the prior authorizations, your meds will not be paid for. Our office will often receive prior authorizations within two hours of receiving your insurance information. We aggressively help all our patients.
Sadly, the most realistic option is to go to the pharmacy with cash and ask them for a partial fill of your prescription, as much as you can afford. In general, pharmacists are fantastic at working with patients in need, so talk to them. If you have IL Medical Assistance, you may qualify for an emergency five-day supply no more than every six months at the discretion of the pharmacists. Please do not hassle the pharmacists; they are your advocates, not your enemies.
When you go to any doctor’s office you should bring your insurance cards, appropriate payment, and good photo ID, most often a valid driver’s license. We require two forms of identification. Sadly, things have gotten to the point that without proper identification you most probably will not be seen. Most pharmacies require photo ID to pick up controlled substances. No exceptions.