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Our addiction treatment program is for the purpose of treating drug addiction to opioids, prescription opioids, fentanyl, and heroin. We do NOT permit patients to be treated by other physicians or practitioners for chronic pain with opioids while in our program. We do not retain on site or prescribe any injections of opioids to stop withdrawal symptoms. The primary medication used is buprenorphine and this takes effect to reduce withdrawal effects within 30 minutes.
In order to begin treatment in our program you must be in withdrawal with moderate withdrawal symptoms unless you are already in treatment by a doctor with buprenorphine/suboxone/bunavail/zubsolv or methadone elsewhere.
Our goals are-
** Stop the withdrawal symptoms- get off the roller coaster
** Start and maintain your ability to engage in stable work
** Stabilize your social and interpersonal relationships
** Develop of new social interests and hobbies as part of addiction relapse prevention
** Establishing career and life goals, short term and long term
** Avoid past sources of heroin and prescription painkillers or encounters with those who would provide them
** Eliminating illicit (illegal) drugs from your lifestyle
** Eliminating prescription painkillers
** Adoption of a healthy lifestyle
** Use of Suboxone or equivalent as long as is warranted but with the goal of reduction or elimination of that drug if possible
** Maintenance of discretion and privacy in treatment. Our office visits are scheduled and are specific. You will not encounter sitting in a crowded waiting room to the doctor.
** Maintaining privacy and confidentiality from prying patient employers or others
** Incorporating an encrypted storage system for patient files without using the patient name in the files and not using the internet for file storage. . (Hacker prevention). This is critically important since the information in your files if hacked could be used to blackmail you. Most Suboxone or medication maintenance programs use easily hacked electronic medical records (1/3 of all US citizens had their medical files stolen in 2015).
Our Program
INITIAL EVALUATION
On the first visit, you will be evaluated for appropriateness and type of therapy that will be offered. An extensive drug history and several psychological tests will be performed including COWS (a withdrawal symptom and sign scale). If you are not already taking suboxone (or equivalent) or buprenorphine, you must be in active withdrawal by federal law in order to be induced with suboxone or equivalent. In otherwords, you must have symptoms of "being sick" from the lack of opioids, however this can be for a short time. While this may seem cruel and unfair, it is a requirement mandated by the government in order to prevent severe interactions between the suboxone (or equivalent) and the opioids already in your system. If a person has recently taken heroin or prescription painkillers then takes suboxone, it could land them in the hospital because suboxone can precipitate fulminant withdrawal symptoms and signs. On the first visit, state prescription database check, and physical exam will be conducted. Urine drug screens are random and are provided at no extra charge. Providing you meet the criteria for suboxone/buprenorphine treatment, if you are not already on suboxone, you must be "induced" with a small dose, your response observed, then a larger supply will be prescribed by telephone the following day. The charges for the initial visit are for alternative therapy education, energy therapies, and body-mind therapies for addiction, none of which are covered by insurance carriers or Medicare/Medicaid.
THOSE WANTING TO CONVERT FROM METHADONE TO BUPRENORPHINE: While this is possible, the person taking methadone must have weaned to 60mg methadone a day or less for at least a week before converting to buprenorphine. We cannot convert those taking higher methadone dosages since this would precipitate fulminant withdrawal.
FOLLOW-UP VISITS
In most cases, monthly follow up visits will be used. It is necessary to be seen in formal follow-up in order to obtain prescriptions for medications and counseling will be rendered at each session. On some follow-up a urine drug screen may be used and if positive for unprescribed opioids or contains illicit drugs or xanax/klonopin etc. If aberrant behavior (positive for these substances is confirmed, more frequent follow up visits, mandatory external counseling, or referral to drug rehab may be necessary. Follow-up visit charges are for alternative therapy education, energy therapies, body-mind therapies for addiction, acupressure, acupuncture, and electrical therapies none of which are covered by insurance carriers or Medicare/Medicaid.
MEDICINES TO AVOID WHILE IN OUR PROGRAM: These cause false positives on UDS, necessitating more expensive confirmation testing at your expense
Marijuana- do not use this unless it is legalized for your specific use by the state
Ibuprofen/Advil, Daypro (oxaprozin), Mobic (meloxicam)- causes a false positive on the UDS, necessitating confirmation
Valerian (supplement)
Vicks vapor rub
Ephedrine
Poppy seeds
ALTERNATIVES TO BUPRENORPHINE THERAPY
While buprenorphine/Suboxone remains one of the best options for office based opioid treatment therapy, there are other options.
1. Weaning gradually to abstinence. This is in theory a good idea however many with opioid addiction have already tried this without success. Frequently opioids are started again in times of stress or when the opportunity for use of these drugs presents itself.
2. Cold Turkey. This only rarely results in any protracted period of abstinence due to the severity of the withdrawal sickness.
3. 12 Step Programs. While these actually do work for a minority of participants, the NA programs on their own frequently are not enough to maintain opioid sobriety.
4. Outpatient counseling. Counseling should be a component of any opioid therapy since it gives you the tools to cope with the cravings brought on by a stressful situation. However in and of itself, it results in abstinence only a minority of the time.
5. Use of other opioids instead of buprenorphine or methadone. It is illegal in the US for a doctor to prescribe opioids other than the two above (and one other LAAM that is no longer used) to treat addiction.
6. Methadone clinics. Methadone clinics provide a valuable service to those that are unable to continue in a buprenorphine/Suboxone program or for those beyond the reach of dosage needed to control patients with buprenorphine/suboxone. However, some of the methadone clinics (known as MMT or methadone maintenance treatment) have a mercenary nature to them, requiring patients to make long journeys to the few clinics there are in each state, wait for many hours, at the clinics, and then be administered the entire 24 hour amount of methadone all at one time under supervision. Patients then get into their car and drive home, sometimes quite erratically, invoking the scrutiny of police at times, with some being arrested for DUI as the methadone massive dosage kicks in. However, they may be the only choice available to some patients.
7. Continuing heroin and/or prescription painkillers. This choice is expensive with some patients spending up to $500 per day for these drugs. It is risky, with undercover cops sometimes waiting to bust those buying these off the streets, has health risks including sudden death, and may cause the loss of employment due to missed work while sick from withdrawal or spending time finding these drugs. Those injecting may develop hepatitis or AIDS.
COUNSELING
Counseling is an integral part of our program and is critically important to short term integration into our program. It may be internal or external. If you are already in counseling, we strongly advise you to continue with your current counselor. If not, counseling will be given during your visits with us. The types of useful counseling (and the types we employ if you do not already have a counselor) include:
- Cognitive Behavioral Therapy (CBT)
- Contingency Management
- Relapse Prevention
- Motivational Counseling
- Counseling on drug use during pregnancy and Neonatal Abstinence Syndrome (NAS) implications
NARCOTICS ANONYMOUS/ALCOHOLICS ANONYMOUS
These organizations can be either very useful to those in opioid maintenance therapy programs such as Suboxone. However, they can also be less than optimal if not downright judgmental towards those continuing to take buprenorphine/Suboxone. This is because they are abstinence based programs that adopt the mantra of total cessation of the use of all drugs and alcohol. While an admirable goal, statistics on those addicted to opioids show a very low rate (<10%) maintain abstinence long term after sudden discontinuation and only 1/3 are abstinent long term after gradual withdrawal from opioids including Suboxone/buprenorphine.
However, these programs can be useful if those entering their sessions do not divulge they are addicted to opioids and that they do not divulge they are taking buprenophine/suboxone to anyone in the group. The approprate answer if asked what you are addicted to is: I am an addict, period. By not discussing specifics of your addiction, you will not face the sometimes profound judgmentalism of those that are (or claim to be) abstinent.
NA and AA program involvement is strongly encouraged given the caveats above. They can be a stabilizing force in your life.
AVOIDANCE OF EXPOSURE TO OPIOIDS
Suboxone/buprenorphine is an excellent way to avoid "being sick" from withdrawal from opioids, and provides a stable platform of receptor partial activation (see the video on the first page of the website). However the habit of seeking out an occasional "high" from using other opioids including heroin is always present just under the surface in the weeks and first several months after stopping these drugs.
Of paramount importance is immediately cutting yourself off from all contact with those who in the past supplied, gave away, or sold you drugs, even if they are family. Sometimes moving to a new community can help in extreme cases or finding another job where the workplace coworkers are not trying to get you hooked on drugs again. While cutting off former friends and non-supportive family members, at the onset of treatment it is critically important to long term success. If you remain in a toxic environment, it will consume you, therefore eliminating all former destructive contacts by changing phone numbers is very important. Changing the places you used to hang out is also equally important. It may be painful to take these draconian measures but it is necessary.
RAT PARK
The Rat Park experiments were very telling about what engenders success in avoiding heroin and other opioid usage. Isolated rats with an unlimited supply of opioid would continue dosing themselves until they died. However when rats were introduced into an environment that had other rats, play toys, and places to exercise, none of the rats used the opioid. Ostensibly this is due to the socialization aspect of drug abuse and addiction prevention. For humans, the experiment was replicated in the Vietnam War experience. Veterans coming back from Vietnam were addicted to heroin in large numbers. However by one year later, almost none of the veterans were using heroin. Why? Because they had jobs, responsibilities, caring families, etc. The socialization aspect of reducing drug addiction cannot be over emphasized in the importance. Therefore isolation promotes addiction whereas engaging in social activities drastically reduces the use of opioids.