Medication Assisted Addiction Treatment
Shyam A. Jha, MD
- Office Based Suboxone Treatment for Opioid Addiction
- Naltrexone / Campral Assisted Treatment for Alcohol Addiction
- Naltrexone for Weight Loss
- Naltrexone for Other Addictions
- Assistance to chronic pain patients in reducing their pain medications
Opioid Addiction: Suboxone Clinic
I offer an office based therapy to patients who need help with their narcotic/opioid dependence or addiction problem (also known as drug use disorder).
This applies to medications like Lortab, Percocet, Oxycodone, Oxycontin, Opana, Morphine, Methadone, Heroin, and similar drugs. I do not treat other forms of substance abuse, as there are no FDA approved medications for them.
Patients who have an addiction to narcotics/opioids find it very difficult to quit due to uncomfortable withdrawal symptoms. For such patients Buprenorphine (Brand names: Suboxone / Bunavail / Zubsolv) is available as a tablet or a film. This medication is taken by placing it under the tongue, from where it is rapidly absorbed.
This is a long acting drug; a single daily dose is sufficient for most patients. It is very effective in preventing symptoms of opioid withdrawal thus removing the need to seek and use other opioids. This allows the patient to work, attend school, sleep well, look after their family, be a part of their community … in other words be completely normal.
This medication is available by prescription, and is dispensed through pharmacies. Patients are able to carry out this treatment in the privacy and comfort of their home. This medication is gradually reduced by the patient till there is no need for it.
This is a very gentle method, and can be carried out without any disruptions with work or school schedule. It does not require patients to be admitted to a residential facility.
The cost of treatment is much lower than what one spends on buying narcotic drugs illegally. The cost of outpatient treatment is much lower than inpatient/residential rehab.
As of January 12, 2023, the DEA has removed the restrictions that were placed on providers under DATA waiver act of 2000. Now any provider with a certificate to provide controlled substances can prescribe this medication and there is no limit on the number of patients that a provider can treat.
I am not an addiction treatment specialist, or an addiction treatment facility. My practice only accepts self-pay patients, from Dallas-Fort Worth and surrounding areas.
My program does not accept insurance, does not require insurance, and does not require a referral.
It is a self contained program. Any services that are covered by your insurance, for example lab tests, can be obtained through your insurance providers.
If you are planning to go for residential rehab or an outpatient addiction recovery program then ask if they would provide or prescribe Suboxone.
Suboxone will completely stop your withdrawals and you will be able to pay attention to the program and absorb the teaching. If you attend the program while you are in withdrawal … then you will be miserable and will not benefit from the program.
If your rehab program does not provide Suboxone then it is best to avoid it … or enroll with a Suboxone provider before you go to the program.
Alcohol Addiction
Alcohol addiction is treated with Naltrexone, and, or, Acamprosate (Campral). These drugs are known to reduce craving for alcohol, and reduce withdrawal symptoms. Once cravings are controlled patients are better able to modify their behavior with the help of a counselor or behavior therapist.
Alcohol dependence or addiction treatment may also be available to you through your PCP; it does not require any special certification by the DEA.
This program does not require a referral.
When willpower is not enough … medication assisted treatment and counseling can help you with your recovery.
Naltrexone for Weight Loss
Obesity is a form of addiction, … addiction to food.
We gain weight when we eat more calories than we need or spend less calories than we eat. The excess calories are deposited in the body as fat for future use. Unfortunately this fat can only be used if not enough calories are available, for example, during starvation … a situation that never happens in our modern life.
This excess calorie intake poses several risks, … diabetes, high blood pressure, coronary artery disease, heart attack, stroke, etc. The excess fat worsens our appearance, reduces our stamina, prevents us from getting some jobs, destroys self-esteem, and adds to depression. The excess weight increases the wear and tear of our joints and spine, contributes to pain and shortens our life span.
All this is preventable with strict discipline over what we eat and how active we are. The plentiful, ready-made, cheap, and tempting food is difficult to resist. It acts like an addictive drug … giving us short bursts of pleasure, enticing us to repeat it again and again … till it is firmly established as a habit and an addiction.
Obesity from over eating meets the definition of addiction … ” a disease that is manifested by compulsive behavior, despite harmful consequences”.
The primary method to treat obesity is by dieting … controlling the calories consumed. This can be aided with the use of medications that reduce appetite, cause satiety, or interfere with absorption of the excess calories.
Naltrexone alone is an off label use for weight loss. Naltrexone is a component of the FDA approved weight-loss medication Contrave. The other medication in Contrave is Bupropion.
These medications act by reducing the craving for food and causing early satiety thus resulting in reduction in calories consumed.
Naltrexone and Bupropion are not new medications, they have been around for a very long time and have been used for other medical problems. There is no reason to believe that a fixed dose combination is the only method to treat obesity.
I have experience prescribing Naltrexone for alcohol addiction and apply that experience to prescribe Naltrexone for weight loss. I will add a prescription of Bupropion if needed. There are several drugs approved for weight loss, none of them are spectacular in their results, and all of them have some or the other side effects, specially when used over a long period of time.
Naltrexone has several advantages over other medications … low cost, low incidence of side effects, can be prescribed for a longer time, and can be prescribed in conditions where other weight-loss medications can not be prescribed.
Naltrexone is an opioid blocker and can not be prescribed to a patient who is taking opioid medications for the management of pain.
Naltrexone for Other Addictions
Naltrexone is an opioid blocker. Opioid receptors are implicated in pleasure, reward, habit formations … that eventually become an addiction. Naltrexone acts by blocking the opioid receptors in the brain and thus preventing other neuro-chemicals from triggering the cascade of pleasure-reward-reinforcement system.
By taking this medication the pleasure response is diminished … and so is the reward … and that leads to less repetitive action and reduced reinforcement. By instituting additional barriers, and behavioral therapy, the offending behavior can eventually be extinguished.
This theory has seen Naltrexone being used for many different types of addictions. The results have not been consistent and the numbers have not been large enough for the FDA to recommend this medication. That does not mean that there has not been any benefit. There are anecdotal reports by patients who have benefited from this medication.
Relapse is not a failure of treatment … relapse is a hallmark of any addiction, in fact it is a hallmark of any chronic disease, be it diabetes, or chronic hypertension, or rheumatoid arthritis. Treatment should not be discontinued because of a relapse.
Some of the addictions where Naltrexone has been used in treatment are gambling addiction, porn addiction, sex addiction, gaming addiction, shopping addiction, and other compulsive behaviors that are not yet classified as addiction. These conditions are best treated by a psychiatrist. I am not a psychiatrist, but, if you have attempted treatment and failed, and would like to try Naltrexone then I will prescribe it for you.
In fact Naltrexone has been tried in every addiction for which there is currently no established and approved medication for treatment. Its low cost and low incidence of side effects along with behavioral therapy make it worth trying as treatment for many forms of addiction.
Behavioral therapy is not offered at my clinic. I only provide medication management. This program requires that the patient be enrolled in a behavioral therapy program, and be referred for medication management.
Pain Management: Reduction of pain medications
I do not offer chronic pain management anymore, but I do accept patients who wish to reduce their dependence on pain medications.
Patients must be motivated, and agree to reduce their opioid pain medications by at least 10% every month. When the patient has reached a stable point where further reduction is not possible, then they are encouraged to go back to their provider to continue their medications.
This program requires referral and reports from the PCP.
Additional information: