Should I be treated with buprenorphine or methadone?
Buprenorphine (Suboxone) is better. So much better.
Methadone is a dangerous medication with serious side effects. Because it is potentially dangerous it has to be given one dose at a time under a doctor’s supervision, which means you have to go to a methadone clinic every day to get your daily dose. In addition, people can actually get high on methadone – which means that taking it every day keeps the addiction alive rather than treating it.
Buprenorphine on the other hand is much safer. You can’t get high on it, and you can’t overdose on it. Because it is so safe, doctors are able to give you up to a month’s supply of it at a time, so you can take your daily dose from home and spend your time doing more important things like working at your job or spending time with your family.
How does buprenorphine work?
Buprenorphine (also known as Suboxone, Subutex. Zubsolv or Sublocade) is in the opiate family, but just barely. You can’t get high on it and you don’t build a tolerance to it. It works by fooling your body into thinking that it has the “harder” opiates in your system. Think of it like drinking a diet soda – the artificial sweetener fools your taste buds into thinking that you are drinking a sugary beverage even though there are no calories in it. At the right dose of buprenorphine you won’t have any withdrawal or cravings – you will be able to go back to your life and feel like your old self again.
The best part about buprenorphine is that it acts as a blocker against other opioids. This means that if you have buprenorphine in your system and you were to slip up and use pain pills or heroin, nothing would happen – you can’t get high. This is important because it stops the relapse cycle; even if you have a rough day and slip up you will still be able to get right back on the wagon again without missing a beat. Think of buprenorphine as the protective fence at the edge of the relapse cliff: it stops you from going over the edge if you lose control of your car.
The ultimate goal of buprenorphine is to take the medication so that the addiction symptoms and behaviors go away, giving you the opportunity to make the necessary lifestyle changes and rebuild your life. Then when you are ready, you will slowly taper down the medication until you are either at a very low dose or off the medication completely. If you taper down slowly over several months then your body won’t even realize what’s going on, until one day you are opiate-free, walking on your own two feet again, feeling good and in control of your life.
How long should I be in treatment with buprenorphine?
Most people need to be in treatment for at least six months to a year. This is how long it takes to begin to straighten out some of the wires that get crossed in your brain when you abuse opiates. Some people need to stay in treatment even longer than that. Everyone is different, and there is no one-size-fits-all approach when treating addiction. Our doctors will listen to your goals and then help you figure out a plan to get you feeling better and rebuilding your life in no time.
How often will I be seen?
We will see you as often as you need to be seen, at no additional monthly cost other than the cost of a drug test. Usually patients are seen three times the first month, then once a month thereafter (assuming things are going well in your treatment). If you are having a rough month or need to be seen more often, simply call the office and we’ll get you in with a doctor right away at no extra cost to you.
Do you take my insurance?
We DO accept most major insurances, including Medicare and Medicaid
- If you have insurance, we will submit the charge for your visit and exam to your insurance plan. Your insurance plan will determine if you have a co-pay or if you are responsible for any portion of the visit charge (depending on if your plan has a deductible).
- For uninsured patients, we offer some of the lowest prices for the best medical care offered anywhere in the state. We will work with you to help you get the care you need.
Will I get addicted to buprenorphine? Am I trading one addiction for another?
No. Remember that even though you can’t get high on it, buprenorphine is technically in the opiate family. It works by fooling the body into thinking that it has the “harder stuff” (like heroin, Percocet, oxycodone or hydrocodone) on board so your body stops looking for the drugs. Think of it like a band-aid that masks the underlying opiate addiction so you don’t have to worry about it. If you were to stop taking buprenorphine cold turkey, then as it gradually leaves your system you would begin to unmask the underlying opiate addiction that was there all along. You would begin to have mild withdrawal symptoms, not because you are addicted specifically to buprenorphine, but because you are still addicted to opiates. If you stick with your treatment and work with your doctor, your dose will gradually be tapered down and by the end of treatment you will be off all opioids including buprenorphine.
Does buprenorphine show up on a standard employer drug test?
No it does not. Buprenorphine has to be specifically tested for in a drug test, and is not part of the standard panel of substances that an employer would test for.
I have legal problems. How will treatment affect this?
Buprenorphine treatment is almost always viewed positively by the legal system. It shows that you are taking responsibility for your problems and aren’t afraid to ask for help. The court system knows that if you are being treated with buprenorphine then you are significantly less likely to use drugs. We will provide you (free of charge) all the documentation you may need for your lawyer, judge or probation officer. Even if your legal problems are unrelated to drug use, you will not be penalized for being in treatment. It is not a crime to have an opiate addiction as long as you are getting treatment for it.
Do you require me to go to counseling?
Additional counseling is not required but is strongly recommended. During your clinic visits you will regularly do counseling with your doctor, however if you want to truly make permanent and significant life changes then you will likely need to participate in a more intensive counseling program. We have in-house therapists that work in a number of our clinics and we also work with a number of therapists in the community that we will be happy to put you in contact with if you are interested.
What if I need pain meds for surgery or a dental procedure?
Talk with your doctor in advance about any upcoming surgeries or procedures. Buprenorphine itself is an excellent painkiller. If you need something stronger, we will stop your medication for a few days prior to surgery and coordinate with your surgeon or your dentist ahead of time.
What happens after I taper off the buprenorphine? Am I cured?
For many people, addiction is a lifelong disease. When you are ready to stop taking buprenorphine, you still have a number of options to help keep you safe from relapse and safeguard the life you have built for yourself.
Naltrexone: Our physicians can prescribe you naltrexone, which is a daily pill (much like taking a multivitamin) that acts an opiate blocker and will protect you from slip-ups. Naltrexone is a safe, non-narcotic, non-addictive substance. It does not stop the cravings for opiates however, so it is important for most people to first use buprenorphine for a period of time in order to stabilize themselves before switching to naltrexone.
Vivitrol: Another option is the Vivitrol shot, which we also offer at our clinics. Vivitrol is another form of naltrexone but it is a once-a-month injection that will keep you safe from relapse without you needing to remember to take a pill every day. Vivitrol is especially good for people who want to reassure their loved ones that they have not relapsed – after getting the shot there is no way to relapse even if you wanted to for the next 30 days! You will be essentially bulletproof against opiate abuse. We will be happy to give you documentation when you get the Vivitrol injection so you can reassure your friends and family that you are staying clean and sober.
Buprenorphine monthly injection: A third option is the new slow-release buprenorphine shot. This is a monthly dose of slow-release medication injected painlessly into your shoulder that will allow you to get all the benefits of a low-dose of buprenorphine without requiring daily medication. You insurance will pay for the injection and once you receive it you will be able to go for a month without cravings, without fear of relapse, and without requiring any further medication or needing to worry about the hassle of taking a daily medication. Our clinic is one of the few clinics in the area with physicians trained and certified in this exciting new therapy.
For others, once they have completed buprenorphine treatment they find that they are able to stay clean simply by using the new coping skills they learned in counseling or therapy, avoiding triggers for relapse (people, places and things), and by using supports in their communities such as supportive friends and family members, counselors, 12-step groups such as NA or AA, and social or religious groups.
And remember, if you have been clean and are starting to struggle again, you are always welcome back at one of our clinics. We have your back, no matter what.
I don't want anyone to know I'm in treatment. How can I protect my privacy?
We legally cannot release any of your information without your written consent or a court order. Everything we talk about in treatment is confidential.