Addiction - Pain Pills / Heroin

Addiction - Pain Pills / Heroin:

Everyone's journey is different.

Everyone's timing is different.

Relapses happen.

Do NOT compare your life to others.

I have seen and successfully treated over 500 people with addiction,

YOU need to be ready for the change into a new life.

Relapses happen, they are unplanned.

What helps the most= having a support person.

That support person usually has walked the same path as you and

typically is a "sponsor" you meet from going to regular NA meetings.

Patients are always welcome to see me anytime.

I suggest after a few years of being stable on suboxone,

you get yourself to a low dose 2-4mg daily for life,

although I've seen a variety of doses and time frames.

Suboxone takes on average 3 days, so what you did on Monday, effects Wed.

My rule is to not constantly change your dose, keep a dose for awhile,

go down slowly over many months.

Medication = Suboxone (Buprenorphine- Pain med + Naltrexone).

The goal is to stabilize at the lowest dose needed for pain control and craving control.

This means you can stay clean and function in life.

Examples include functioning as a parent, employee, and partner

without needing to think about the pain or cravings.

The Naltrexone helps to decrease cravings pain, alcohol and food receptors. Naltrexone also prevents the "high" if other meds are taken. If your body already has Mu receptors loaded, it will cause a precipitated (instant) withdrawal which is why you want to start this medication when you are in "moderate" withdrawal.

Vivitrol = Naltrexone only monthly injection

Narcan = comes in daily pill for maintenance or nose spray for overdose.

Pain meds- any overdose of any pain med, especially when mixed with another drug like a benzo or alcohol is very unsafe and kills thousands yearly with respiratory depression, the body slows breathing so much their brain doesn't get enough oxygen and people pass out and pass on.

Expectations working with Digital Clinic:

Always be honest, we cannot help unless there is full honesty.
Medication dispensed is for you only, it is not to go to friends or the street.

Controlled medication will be stored in a safe area or lock box so others cannot get to it, only have 1-2 days of meds on your person or in their purse at a time.
Medication stolen or lost - Please let us know asap via voicemail or acute appointment.
Make your appointments, this is where a follow up of how you are doing and also a refill is done.
Do not take other controlled meds or alcohol while on suboxone/ buprenorphine as it is very unsafe. (I'm good at panic/ anxiety/ PTSD/ Depression- can help with other meds that are much safer).

Appointments -

All patients will start with weekly appointments and weekly urine screens.
As stability is shown appointments will progress from weekly to every other week to monthly to every 2 months.
If at any point patient shows to be unstable, patient will go back to weekly appointments.
A new patient who is getting stable on suboxone will progress at a minimum of every 3 visits.
A stable patient who has been on suboxone for at least 6 months will progress at a minimum of every 2 visits.

Stable has a definition that includes all these points:

A story that makes sense
Appointments are kept
Urine screen is predictable to medication prescribed and not showing other meds.
No alcohol
No medication issues (lost, overtaking, etc)

Urine screens -

2 places - Can be done at quest or at the office (when open).
An unpredictable urine screen does not mean discharge from clinic, it means more attention is needed to help and get the patient stable (weekly appointments).
Random urines will be asked of patients to confirm stability and safety. This does not mean you were singled out in any way.

Hepatitis C

Option to be tested and treated (typically Mavyret x 8 weeks).

Using Morphine Equivalent for MAX Dose:

(MME= Morphine milligram Equivalent).

I will NOT prescribe more then MAX dose listed below. I will not write for buprenorphine except for upcoming surgery.

Suboxone - Max dose is 16mg a day.

8mg = 240MME. 2mg= 60MME

Hydrocodone (Norco, Vicodin) - Max dose is 45mg a day.

45mg= 45MME. 20mg = 20 MME

Oxycodone (Percocet) - Max dose is 30mg a day.

30mg= 45MME. 10mg= 15MME

In Crisis? - Who to call:

- Go to ER

- Your counselor, psychiatrist, or me.

- Others: Hourglass, Cahoots, Women Space, White Bird, looking glass

- Phone number: National suicide prevention lifeline: (800) 273- 8255, (#1 for veteran crisis line)

- Mental Health Crisis Response Program: (888) 989- 9990 (17yr or younger)