You will be given a brief substance dependence assessment, as well as a brief evaluation of mental status and a physical exam. The pros and cons of the medication will be presented. Treatment expectations, as well as issues involved with maintenance and medically-supervised tapering off the medication will be discussed.
Treatment begins here. You will be switched from your current opioid of misuse (heroin, methadone, or prescription painkillers) to your treatment medication. You will be asked to begin taking buprenorphine only after you are in a moderate state of withdrawal. Being in a state of moderate withdrawal is vital to having the medication work well. If you are not in moderate withdrawal, the medication might actually make you feel worse rather than better (intensifying withdrawal symptoms). This is called precipitated withdrawal and can be dramatic. We generally recommend starting with tiny doses of Suboxone once you enter withdrawal. We will instruct you to break or cut an 8 mg Suboxone tab or film into quarters, place one of these crumbs under your tongue, and allow it to completely dissolve. If you feel better, continue taking a quarter of a Suboxone every 15-30 minutes as you continue to feel better, up to 8 mg the first hour or two. If you start feeling sick, nauseated or any withdrawal symptoms, stop immediately, rinse out your mouth, and wait 1-2 hours.
It is important to be truthful with your doctor about the last time you used an opioid, which opioid it was, how much you took, and which other drugs or medications you used. Your doctor needs this information to determine the timing of your first dose.
Once you take your first dose, you should begin to feel better within 30 minutes. Your doctor may choose to have you take an additional dose the first day. Be sure to tell your doctor how you are feeling during induction so he or she can find the appropriate dose for you.
When you leave the office, the doctor will likely give you a prescription that will last until your next appointment. The doctor may also want to discuss counseling with you, since medication plus counseling has been shown to produce better results. At the same time, your doctor may suggest enrolling in the Here to Help® Program, which can provide you with an added support system.
Since an individual’s tolerance and reactions to the medicine vary, frequent 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 treatment, and many may be supervised by our staff. We are an honest clinic and expect our patients to tell us everything. There is no reason to lie. Our staff cares, and we understand all of the reasons that addicts have trouble. We can tell when our patients fake urines, shave pills, and otherwise try to manipulate treatment and staff. Stay well hydrated, because we will require a urine drug sample at every visit. It is unlikely that you will be given a script if you cannot give a sample.
This is the second phase of treatment. During this phase, your doctor may continue to adjust your dose until you find the dose that works for you. It is important to take your medication as directed. To evaluate the effectiveness of your dose, your doctor may request urine samples from time to time.
During this phase, you may also begin working on your treatment goals with your doctor and counselor. At times when you feel stressed, or experience triggers or cravings, your doctor may suggest a dose adjustment, or there may be a need to change the frequency of counseling and/or behavioral therapy.
Occasionally, as you achieve your treatment goals and feel confident about your progress, your physician may suggest a dose decrease. During these times, you are “restabilized.” This is why stabilization and maintenance go together.
There are no time limits for treatment with this medicine. Length of therapy is up to your doctor, you, and sometimes your therapist or counselor. If you and your doctor agree that the time is right for a medical taper, your doctor will slowly lower your dose (also known as a taper), taking care to minimize withdrawal symptoms. If you feel at risk for relapse during a taper, let your doctor know. You can be reevaluated and continue maintenance if needed.
Please note: Suboxone is a narcotic medication indicated for the maintenance treatment of opioid dependence, available only by prescription, and must be taken under a doctor’s care as prescribed. It is illegal to sell or give away your medicine.
Here to Help® is a registered trademark of Reckitt Benckiser Healthcare (UK) Ltd.
Please see your doctor or pharmacist for full Product Information and Medication Guide.