QUALIFICATIONS FOR TREATMENT

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MEDICATION MAINTENANCE/ADDICTION OR SUBSTANCE DEPENDENCY TREATMENT

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NOTE: You cannot be treated in our clinic with prescription buprenorphine in combination with either prescription  opioids for pain control or in combination with prescription marijuana.

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FOR ALL TREATMENTS: We accept online credit cards only as the form of payment for the office visits.  Payment is made in advance of the scheduled appointment, otherwise the appointment will be cancelled. WE DO NOT ACCEPT ANY MEDICAL INSURANCE AND DO NOT ACCEPT MEDICARE OR MEDICAID.  However, we will give you the codes you need to file an insurance claim (except Medicare/Medicaid) with your own health insurer, and some will partially reimburse you for the cost of the treatment. In virtually all cases, the combined cost of our office visits plus medication will be far less than is being spent on heroin or buying prescription painkillers on the street. 

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Sublingual Buprenorphine for Addiction (Suboxone, Bunavail, Zubsolv, Subutex, generic buprenorphine)

• Must be addicted to opioids (moderate or severe scores on DSM-V and DAST under the RX Tab)

• Must be in moderate, moderately severe or severe withdrawal on COWS (under the RX Tab) prior to induction with buprenorphine (initiating therapy).  However, if you are transferring from another suboxone/buprenorphine program, no withdrawal is necessary as long as you are in active treatment and received buprenorphine in the last 2-3 days.  

• Willing to participate in the step program that includes in-house counseling (included in the price), NA or AA, socialization improvement, avoidance of past contacts that were subversive or in the drug culture

• Understand that urine drug screen failures or unapproved use of opioid narcotics requires escalation of monitoring, testing, will involve external counseling, and may result in referral for rehab or methadone maintenance, all at additional cost to the patient

• The cost of the medications may not be covered at all or only partially covered by insurance.  We WILL precert these medications at no cost. 

• Buprenorphine sublingual tablets and Subutex are primarily reserved for pregnant women.  They may be used at the physician's discretion if there has not been any IV drug use in the past 6 months. 

• Lab tests or EKG may be necessary depending on several factors- if you have any lab tests or EKGs from the past it is helpful to acquire those and bring to your first appointment. 

• Conversion from methadone to suboxone/buprenorphine is difficult to achieve without causing withdrawal.  We are willing to work with you to make this possible, but it is not a smooth transition, and we do not prescribe methadone. Consequently, during the methadone taper (methadone provided from external sources) we will provide adjunct medicines to help with the withdrawal symptoms or convert to buprenorphine all at once. A person tapering off methadone and using no narcotics subsequently (including buprenorphine) will have symptoms of dysphoria, fatigue, insomnia and irritability, for 6 to 8 months. (Dialogues Clin Neurosci. 2007 Dec; 9(4): 455–470). 

• We do not allow alcohol use during our program of buprenorphine/suboxone.  The deaths associated with suboxone/buprenorphine use have primarily occurred when alcohol was used within 24 hours of taking suboxone/buprenorphine 

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Probuphine Implants

• All of the above plus continued monthly visits with counseling

• Stable sublingual buprenorphine dosing at 8mg or less a day for 6 months

• Insurance coverage for the implant

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The Bridge

• Designed for patients taking heroin or prescription painkillers, this is an electrical stimulation device with electrodes placed into the ear.  It is worn for 5 days to significantly cut down on withdrawal symptoms or eliminate withdrawal, the most dreaded part of addiction therapy.  Since by the end of the 5 day period, the COWS score would not be sufficiently high to begin buprenorphine based therapy, the only therapies possible will be abstinence treatment with oral naltrexone or Vivitrol.

• Not appropriate for those already taking buprenorphine or methadone

• This device is FDA approved but not covered by insurance.  The device itself costs $500 but we hope the price will come down through competition.

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Naltrexone Oral or Vivitrol Injections

• Abstinence from all opioid narcotics for at least seven days, and 2 weeks for methadone or buprenorphine products including suboxone.  If you are in active withdrawal or continue receiving opioids beyond the time periods above, administration of naltrexone oral or Vivitrol can precipitate severe withdrawal that may require hospitalization and sometimes ICU stabilization

• Compliance requires oral Naltrexone be administered by another person at home and will confer with the physician and document this.  If compliant (via urine drug screens), bimonthly visits will be used.  Injectable naltrexone (Vivitrol) must be administered once monthly in the office. 

• Understand these drugs are designed to at least in part block the effects of oral, snorted, smoked, inhaled, or injected opioids including heroin.  This is not the appropriate treatment if opioids are anticipated to be needed in the near future (major surgery, etc.)

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Methamphetamine, Cocaine, Marijuana Treatment

     Treatment will be tailored to the individual since there are no FDA approved medications available, however there are off label uses of FDA approved drugs that are available. 

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WITHDRAWAL TREATMENT

Depending on the specific drugs being used that have precipitated withdrawal, we use adjunct medications to treatment for the symptoms of withdrawal.  The most difficult to treat are those who have been taking high doses of methadone.

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PAIN MANAGEMENT

Algos Treatment Group does not treat acute or chronic pain with Schedule II opioids (hydrocodone, methadone, morphine, hydromorphone, oxycodone, fentanyl, meperidine, or oxymorphone).  Although acute pain is the reason most people began using opioids (including heroin) in the first place, long term prescribing of Schedule II opioid narcotic pain medications is not indicated for most patients, and in most cases if weaned off the opioids, there is no measurable difference in pain.  However, people are frequently psychologically dependent on opioids, and mistake the acute withdrawal symptoms from sudden cessation of the opioid with an increase in pain, thereby deducing that the pain medications are necessary long term.  However, a gradual taper of the opioids accompanied by medications used to treat withdrawal allows the person to get off the opioids without a spike in pain.  Doctors and midlevel practitioners such as nurse practitioners and physicians assistants and dentists prescribe 80% more medication nationwide than is necessary to control the long term chronic pain for the few that need opioids long term. Surgeons and family physicians grossly overprescribe opioid narcotics for every little bump or bruise, and in such amounts that most people that take the medications for more than 2 weeks are already becoming addicted to the drugs.  There are many studies showing opioid narcotics are needed for only 1-3 days after surgery and in many cases, not at all since several NSAIDs have equal pain killing properties for dental and surgical pain.

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However, if a person is addicted to opioids by formal testing and receives buprenorphine as a treatment for such addiction, it does have opioid properties that help relieve pain in those with a dual diagnosis of chronic pain and addiction.  Those addicted or with substance abuse but without chronic pain may in many cases be converted over to naloxone or Vivitrol.

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