MEDICATIONS FOR TREATING OPIOID USE DISORDERS
BUPRENORPHINE (Suboxone, Subutex, Zubsolv, Butrans, Sublocade): Opioids attach to receptors in the brain. Buprenorphine works by stimulating the brain opioid receptors but only partially satisfying them by not being a perfect fit. Thus Buprenorphine helps to ease withdrawal symptoms and drug cravings by activating the opiate receptors but not in an intense enough way to produce the heightened feelings of euphoria that heroin would produce. If a person attempts to take another opiate such as heroin while taking buprenorphine, there will be no effect. See below for more information regarding Suboxone treatment in Philadelphia.
Dr. Ascher only treats a select number (usually less than 10) of highly motivated clients with buprenorphine. Each patient must be in individual therapy at least once weekly with a therapist of their choosing. The monthly fee includes urine drug screening and one 45-minute session a month that can be used for individual, couples or family therapy. Dr. Ascher will also arrange a visit with a primary care physician who will perform a history and physical and order appropriate laboratory work. The patient must give consent for Dr. Ascher to discuss the clinical case with other providers on the case (as necessary) for clinical treatment and safety.
NALTREXONE (Revia or Vivitrol): Naltrexone blocks the part of your brain that feels pleasure when taking narcotics. Because it blocks the opioid receptors it prevents the body from responding to opiates. It can be taken by mouth once daily or every other day, has minimal side effects and is not addicting. Vivitrol, a long-acting form of naltrexone, is administered by injection and each shot lasts about a month. Click here to view the brochure for Vivitrol. Click here to view a fact sheet on Naltrexone.
Dr. Ascher can arrange for you to have monthly Vivitrol injections as a part of your treatment for opioid use disorders.
More Information Regarding Suboxone Treatment in Philadelphia
Do you have a problem with pain pills (percocet, oxycodone, vicodin) or other opioids (e.g heroin)? If so, you may want to consider treatment with buprenorphine/naloxone. This treatment program is only offered by doctors with specialized training and is a DEA-monitored program. Dr. Ascher is here to help you with a treatment plan for opiate dependence and help you understand if Suboxone is a good treatment plan for you.
Some facts about Suboxone:
- Suboxone is the combination of buprenorphine (partial opioid agonist) and naloxone (opioid antagonist – Narcan). The combination is either 2mg/0.5mg or 8mg/2mg.
- Subutex and Buprenex are other forms of buprenorphine.
- Suboxone is a sublingual film that dissolves under the tongue.
- Zubsolv is a sublingual pill that dissolves under the tongue.
- Sublocade is once-monthly injectable buprenorphine formulation (available in Q1 2018)
- the only FDA indication for Suboxone is for maintenance therapy for Opioid Use Disorder
- Suboxone has a 37 hour half-life.
- at 16mg daily, 93% of the opioid receptors are blocked in the average person.
- the most common side effect of Suboxone is headache, for which you can take ibuprofen or Tylenol.
- you cannot take opiates (e.g. oxycodone, hydrocodone) or benzos (e.g. Xanax, Klonopin, Ativan, Valium) while taking Suboxone.
The “Ask an Expert” feature on The Fix posed the question: “Should I Go Off Suboxone? If So, How?”
Here is part of the response from Dr. Ascher.
Dr. Michael Ascher: Thank you so much for your question. My first question for you would be how much Suboxone (buprenorphine-naloxone) are you taking?
What may be low for someone may be high for another person. It sounds like you are suffering greatly and the cause may be multiply determined. Your symptoms could be the result of a protracted withdrawal now that you are no longer using illicit opioids. Protracted withdrawal symptoms include insomnia, fatigue, irritability, anhedonia (inability to experience pleasure), and anxiety. Protracted withdrawal symptoms, if left untreated, can last up to two years for some individuals with an opioid use disorder. The emotions you may be currently feeling could also be due to an underlying depressive, anxiety or traumatic disorder that was masked by the illicit opioid use before starting Suboxone. The symptoms could also be due, in part, to an underlying medical condition such as thyroid problems or vitamin deficiencies (B12 and folate).
The most important thing to remember is to find a physician who you feel you can trust to listen to you openly and non-judgmentally. The role of counseling or psychotherapy in the treatment of opioid use disorders is paramount. Suboxone and other relapse prevention medications (naltrexone and methadone) are only a piece of the full treatment that can include individual or group psychotherapy, 12-step programs or other forms of psychosocial support. You may want to consider regularly discussing the role of Suboxone in your treatment with your prescribing doctor. Despite common misconceptions, coming off of Suboxone should be done with the help and oversight of a physician who can personalize the taper based on your needs.
To read the full post on The Fix, including responses by other experts, click here.
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