All patients who agree to participate in the Suboxone Treatment Program at RMIM must agree to strictly adhere to the Policies and Protocols of the program.

What is Suboxone?

Suboxone is the first oral medication that has been approved in the U.S. that physicians can prescribe in an office based setting to people who are dependent or addicted to opioids such as pain medication, heroin, or methadone. Suboxone is an effective medication for opioid addiction that does not require daily or weekly visits to a clinic after the initial Induction period. Suboxone blocks the effects of other opioids. This eliminates cravings and prevents withdrawal symptoms such as pain and nausea. Patients can be maintained on Suboxone or go through detoxification. Suboxone is a different type of opioid than pain pills, heroin or methadone. Because this medication leaves the brain cells more slowly than typical opioids, the withdrawal process is milder and detoxification is generally easier to accomplish. Patients work with a monitoring physician to meet their goals.

Suboxone is composed of two separate medications: buprenorphine and naloxone. Buprenorphine, which is a partial opioid, has opiate affects that are significantly reduced compared to that of full opioid agonists, such as vicodin or heroin. Naloxone, which is not absorbed by the digestive track when Suboxone is taken orally, is added to Suboxone in order to prevent the misuse of the medication by injection drug users and those who are looking to replace their illegal addiction with a legal one.

Explanation of Treatment

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 will be presented. Treatment expectations, as well as issues involved with maintenance and medically supervised tapering off the medication will be discussed.

Transfer from another Suboxone Program/Physician

If you are currently taking Suboxone with another Program or Physician, we regret to inform you that we cannot transfer your treatment. If you do wish to begin treatment with us, you will be required to undergo an Induction session as a new-treatment patient.

Induction
Treatment begins here. You will be switched from your current opioid of misuse (heroin, methadone, or prescription painkillers) to your treatment medication. You are asked to arrive at the doctor’s office 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.

It is really 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 give you additional doses while you are in the office. Be sure to tell your doctor about how you are feeling during induction so your doctor 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, daily appointments may be scheduled and medications will be adjusted until you no longer experience withdrawal symptoms or cravings. Urine drug screening is required for all patients at every visit during this phase and throughout treatment.

Intake and Induction may both occur during the first visit, depending on your needs and your doctor’s evaluation. Call your doctor if you have any questions or concerns.

After your Induction is complete, your monitoring physician may still require you to come for Follow-Up Visits every week, or every two weeks until they are sure your dosage level is effective and safe. After this, your Follow-Up Visits might be scheduled less frequently such as every four weeks; but again this is at the discretion of your monitoring physician, and is typically based on the results of your urine screening.

Stabilization & Maintenance
This is the second phase of treatment. During this phase, your doctor may continue to adjust your dose until you find, and continue on, the dose that works for you. It is important to take your medication as directed.

During this phase is when 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.

Tapering Off
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, he or she 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 restabilized and continue maintenance if needed.

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