What is a Suboxone Clinic?

A Suboxone Clinic is where you can receive a prescription for Suboxone, the medication that stops withdrawal symptoms when you are going through withdrawal. Withdrawal happens when some one dependent on opioids suddenly stops taking them.

What is Suboxone?

Suboxone is a combination of Buprenorphine and Naloxone, and was the first brand name marketed in USA. Now it is marketed only as a film. The name has become popular and is commonly used. This is now also available as a generic tablet, and under brand names Bunavail, and Zubsolv.

This medication is to be taken by placing it under the tongue from where it is absorbed. Most of it is absorbed within 10 to 20 minutes. It is very fast acting and its effects can be felt within 10 to 20 minutes.

What is withdrawal and why is Suboxone used to treat it?

Opioids are drugs (commonly known as pain killers) like Lortab, Percocet, Hydrocodone, Oxycodone, Morphine, Opana, Fentanyl, Methadone, and the street drug Heroin. Patients or persons using these drugs over a long period develop dependence on these drugs. Abruptly stopping these drugs will cause the person to go into a state of withdrawal.

Withdrawal symptoms can appear as anxiety, depression, lack of energy, agitation, and progresses to running nose, tearing, yawning, hot and cold flashes, skin crawling, sweating, and diarrhea.

Severe withdrawal will manifest as abdominal cramps, muscle cramps, vomiting, and diarrhea, and poses a risk of dehydration.

Because a person who decides to stop using opioid drugs will have withdrawal, a medication called Buprenorphine is used to stop withdrawal symptoms. This medication is taken once a day, is administered by placing it under the tongue, works for 24 hours, does not have any significant side effects if taken in the recommended dose, and allows patients to function normally.

Buprenorphine has certain properties that make it very suitable in the treatment of opioid dependence and addiction. It is also an opioid, acts as a substitute for opioids, working on the same receptors as opioids, is long acting … a single adequate dose is effective for 24 hours or more, binds much more strongly to opioid receptors … so that if a person takes an opioid after taking Buprenorphine, that opioid will not have much effect.

Buprenorphine when taken in recommended doses does not cause euphoria, the sensation sought by drug addicts, and thus does not have any positive reinforcement that leads to addiction. It also has a better safety profile than other opioids … it does not cause as much respiratory depression as other opioids at similar doses. Respiratory depression is the cause of death in opioid overdose.

How can Suboxone treat addiction?

Suboxone does not treat addiction. Suboxone stops withdrawal … thus keeping patients comfortable, and giving them a chance to modify their behavior.

Patients are instructed to reduce their dose of Buprenorphine at regular intervals. By doing so patients place themselves in mild withdrawal … something that they can tolerate … thus forcing their body to adapt to a lower dose. This is done as tolerated over a long period of time, … several months to several years. This way patients are able to stay at home, function normally, be employed or attend school.

In addition patients attend counseling and workshops where they learn to modify their behavior, stop seeking drugs, and learn to cope with the problems that their drug use has created … health related problems, financial problems, employment problems, domestic relations problems, legal problems.

Buprenorphine is available in combination with Naloxone. Naloxone has been added to discourage intravenous use. This combination preparation is available as a generic tablet and as brand name preparations called Suboxone, Bunavail, and Zubsolv.

How can I find a Suboxone Clinic?

You primary care doctor may be offering Suboxone. Suboxone clinic is not a special clinic though some chose to advertis ethat way.

To make this treatment widely available Congress enacted the Drug Addiction Treatment Act in 2000. This act made it possible for any doctor holding a DEA certificate that permits them to prescribe controlled substances to do a course and apply for a waiver certificate to prescribe Suboxone and similar medications. Many primary care providers hold this certificate and prescribe Suboxone. Other specialists like psychiatrists, neurologists, pain management doctors, have also obtained this waiver. Some advertise their services, most do not.

Not every doctor is willing to treat addiction. Many are already busy providing other services and many do not wish to have drug addicts coming to their clinic … afraid that this will put off their regular patients. Drug addicts are generally non-compliant, have multiple medical and non medical problems, and are difficult to deal with.

Currently Suboxone can only be prescribed by a medical doctor, M.D or D.O. Each doctor is allowed to treat a maximum of 100 active patients at a time.

You can find a list of treatment facilities, and treating physicians from SAMHSA web site: samhsa.gov

Similar lists are maintained by Subxone.xom, Bunavail.com, Zubsolv.com

How much does the treatment cost?

How much do you spend on drugs? Treatment today is cheaper than what you spend on drugs.

Treatment related costs are:

  1. Cost of doctor visits. Initial visit $300-$500. Induction $200-500. Weekly, biweekly, or monthly visits. This cost is very variable and will depend on whether you want a doctor with at least three degrees, an office with a marble foyer and fountain, touting evidence based practice and gene therapy … or are ok with a no frills country doc.
  2. Cost of medication $8 to $10 each 8mg Suboxone tablet or film. For one to two tablets or films a day it comes to $8 to $20 per day or $240 to $600. One tablet or film a day is sufficient to stop withdrawal for 90% of the patients. Some may begin at a higher dose but quickly come down to one a day. Some need just 2mg a day … which translates to $2 a day. Bunavail and Zubsolv cost the same as Suboxone at equivalent dose.
  3. Cost of counseling or addiction workshops. Varies from $50 to $150 per session. Group counseling programs may be less expensive.
  4. Peer support programs like Narcotics Anonymous, Celebrate recovery, Smart recovery, etc., are free to attend.
  5. And there are luxury rehab centers where you can breakfast with the rich and famous for $1000 per day. These come in packages $25000 and up.

How long does the treatment last?

It is up to the patient and how much withdrawal they are willing to tolerate. It generally corelates with how long a person has used opioids and how much every day. Prolonged opioid use alters your brain chemsitry and its ability to produce its own opioid like substances called endorphins.

Some patients have treated their opioid addiction “Cold Turkey” or forced to do so … when imprisoned, so it can be done.

Some patients have done it in one month, some in three, some in six. Most patients in my clinic drop out so I do not know if they have been successful or not. Most take longer than a year. I have one patient who is in his sixth year, taking 2mg once a week.

Does insurance cover Suboxone treatment?

Ask your insurance. You have the phone number … your call is very important to them.

Medicare and Tricare does not cover outpatient addiction treatment. Medicaid and Tenncare does cover this treatment.

If your insurance coverage includes behavioral therapy then it may be covered. If it is covered then it is only covered through certain contracted /network providers. They may require preauthorization. They may have a waiting list.

Your prescription plan may be different from your insurance plan. Some cover prescriptions, some will cover it after preauthorization. They are likely to have a duration and quantity limits, and will cover only a certain brand.

Most insurances cover in-patient detox for up to three days.

Can I get Suboxone at the ER.

No. Most Emergency Rooms do not prescribe Suboxone. They may give you other medications to control withdrawal, will start an IV and treat dehydration, may refer or admit you for Detox. At an average bill of $3000 for an ER visit I do not know why they can’t give you a $10 Suboxone.

Why will someone suddenly stop taking opioids and go into withdrawal?

Because they can not get it, … usually it is not voluntary.

Because they were buying drugs off the street … they do not have any money to buy drugs … or their drug dealer does not have enough … or went to jail without notice … disrupting their supply.

Some times patients who were getting these from doctors will face this problem when the doctor discharges them from their practice for aberrant behavior that suggests inappropriate use of medications; like running out of prescription before it is due, losing their medication, urine drug screen being positive for drugs not prescribed, or urine drug screen negative for drugs prescribed, etc.

State and Federal Govt regulations that have been recently enacted in response to the increase in opioid deaths … are aimed at reducing the supply of opioids by prescription, so it is no longer as easy to get … as it used to be.

Some times patients have changed their insurance and there is a gap in finding a doctor who is a part of their new insurance network.

Some times patients have lost their jobs and their insurance, or have been dropped from their insurance plan … common with Government benefits like Tenncare, and can no longer afford to see a doctor or get a prescription.

And rarely they were stealing from a family member who was getting it for cancer … now that the person has died, there is no more prescription.

Suboxone Clinic is different from Methadone Clinic.

Methadone clinics in USA are run by private contractors with assistance from the Government. Methadone clinics dispense Methadone tablets; dispense means actually give it to the patients. Patients have to go there every day to receive Methadone. Methadone clinics do not prescribe Methadone, that is, you do not get a prescription to take to your pharmacy to receive Methadone.

Methadone clinics do not treat addiction, they offer Methadone Maintenance Programs to reduce criminal activity in the society. Essentially the Government’s approach is … we know your are addicted to opioid drugs … you do not want to get better … we accept that. You do not have to engage in criminal activity to get your drug … we will give it to you.

Some Methadone clinics encourage patients to come off Methadone, asking them to reduce their daily dose progressively, but still give what the patient needs, no one is forced to taper their dose.

More and more Methadone Clinics have started offering Suboxone … now you can get Suboxone instead of Methadone from the Methadone Clinic.