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  • Barbara Hoefener NP

Suboxone Treatment for Heroin/ Opioid Addiction

Updated: Aug 27, 2021

Written by Barbara Hoefener, FNP 11/2020, edited 8/2021

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Suboxone (Buprenorphine - Naloxone)

Suboxone is a federally supported MAT- Medication assisted treatment option for people with opioid dependence. This opioid dependence can be from chronic pain or from addiction to pills or heroin or a combo.


Benefits:

  • Federally supported, making it easier find a new provider as they are willing to write this medication.

  • Longer acting pain medication, so instead of getting highs and lows with norco, oxy or methadone. you get a stable dose of buprenorphine, typically dosed at twice a day to control pain or cravings for the next drug.

  • Its considered a Level 3 narcotic/ Controlled drug, with added benefit of repairing the neurotransmitter damage in your brain caused by level 1 (heroin) and 2 drugs (Norco, oxy), including the dopamine desensitization. So you will start to feel joy again as your dopamine receptors start to work again.

  • You feel better and more balanced while on this compared to other substances.

  • The recovery drug. The naltrexone piece helps keep the cravings at bay, allowing you to maintain "clean and sober" for years. If you abuse drugs while on suboxone, you will not get the same effect as your MU receptors are already occupied w suboxone.

  • Suboxone helps to stabilize you and decrease your cravings but also helps to rewire your brain to prior to your drug use. The neurotransmitters, mainly dopamine and serotonin, start to balance out to a more natural way of responding to events. Thus, you will start to feel good and you will start to feel more balanced as you did before you use drugs. This process takes years, not months. Which is why you will be on this medication for years.

Cons:

  • Something different to try

  • Stigma of recovery drug, but you are addicted to opioids.

  • You need to dissolve the tab or film to get the medication - it tastes "gross"


Other parts of Recovery from Addiction: These 2 pieces have proven statistics to keep you clean and sober for the rest of your life. You get another chance; your life can be different.

  • Formal= Outpatient rehab with psychological counseling

  • Casual= NA/AA programs to reinforce good habits and also provide other people who are on the same journey, some have been clean for 20 years, some 1 week.

    • I highly suggest being an active, regular and participating participant. Finding a sponsor and one day, being a sponsor. Sponsors are the "key," as this new best friend will truly help you stay clean in the years to come. The intention of a sponsor is to talk with them weekly, most of the time you will not have much to say. However, when you have a difficult day and a decision is up for you to decide to try drugs again, and you end up debating for hours on end about taking a drug you call your sponsor to work through that. There is a diverse group of people in recovery at these meetings, some folks will not be clean, some folks will be clean a week or two, some will be clean for five months, some clean for 5 to 10 years, others 30+ years. This gives you a great experience level and cohort of people to talk with, you can all grow together and have many discussions and decisions. The person you click with, you can ask them to be your sponsor, preferably they will have been clean for many more months or year than you. They would have already gone through what you were currently going through.


Dose/ Timing.

MME = Milliequivalents of morphine

  • 4mg Suboxone/ Buprenorphine = 120 MME

  • 8mg of Suboxone/ Buprenorphine = 240 MME

  • 16mg Suboxone/ Buprenorphine = 480 MME

    • More than 16mg daily has been proven to not be significantly different as all your receptors are loaded. Thus, taking more is either related to diversion or anxiety.

  • Suboxone is intended to be taken long term over the course of many years, not weeks or months. The shorter you use it, there is a higher likelihood of relapse, but everyone's situation is different.


How to take it and find your dose

  • Dissolve the tablet/ strip under your tongue/ in your check to activate the medication, spitting is ok. Cutting the strips 2,3,4,5 times is ok.

  • Day 1 = Start in moderate withdrawal, not mild, not severe. Start with 1/4 the dose you think you need, then 3 hours later take 1/4 dose again, analyze and see how you feel, then 3 hours later take that same 1/4 dose. Repeat.

  • Day 2= Take the dose you landed at yesterday and cut in half- take AM and PM

  • Day 3 = continue to titrate your dose slowly. It takes days/ weeks sometimes to get on the right dose for you. The best advise is to not jump around the dose, pick a number and stick with it, as it may take 3 days for your to feel the effect.

  • Remember - You want to get off drugs and start to have a level head, so you want the proper dose, not the biggest dose. The longer you are on Suboxone and stabilize your mind and cravings, the better you rwill feel and you may decide that 3/day can go to 2/day or even every morning. .


Transition off the Buprenorphine part

  • If you decide it has come time in your life to get off the narcotic portion of this drug, either because you feel stable or you have a job that doesn't allow controlled meds. I do suggest you stay on the naltrexone part for at least 6 months. You can do this via daily pills or monthly injection, vivitrol. Since you will no longer be on buprenorphine, your urine tests will be 100% clean and no-one will be the wiser.


Appointments

Since you will be new to me, we will start with weekly appointments for close follow-up and weekly urine drug screens. As you show you are stable, we will increase the time between visits. Appointment spacing is 100% dependent on how stable I feel you are and ability to follow the program.

You must be seen in person for a physical within the first month of starting with me.


Other Substances

I will encourage you to not be using meth or alcohol with a controlled drug as this is proven to be unsafe daily. If you continue to use these substances, I will assume you are NOT serious about improving your health or circumstance and will ask you to find another provider.

I'm very proud of you for reading this.

I’d love to be part of your team to help you towards your first steps of being clean and sober.

This is a huge step, your life will fundamentally change, I'm very proud of you, you can and will defeat drug addiction while also managing chronic pain.


Book an appointment to be seen this week at DigitalClinicians.com




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