Medication Assisted Treatment for Heroin Addiction
Heroin is an opioid, and Heroin addiction is treated the same way as other opioid addictions.
The medication assisted treatment method uses the combination drug Buprenorphine + Naloxone, which is available as tablet and film, under the brand names Suboxone, Bunavail, and Zubsolv. This medication is very effective, … one single daily dose completely stops all withdrawal.
This medication is dispensed by pharmacies, on being prescribed by a DEA authorized provider, without having to go to a rehab.
Heroin is the most addictive opioid available on the street and even though heroin addiction is easy to treat with Suboxone, the relapse rates are very high. Do not use it … and if you do, the sooner you seek treatment the easier it is to give up. Heroin is frequently implicated in overdose deaths specially when injected or if used along with other drugs.
Of all the recreational drugs available, Heroin is ranked 1st in dependence, physical harm, and social harm.
Depending on the age of the user, how frequently one uses, and in what quantity, … the withdrawal can happen in as little as 4 hours. Usually the withdrawal peaks in 12 to 24 hours, and is very intense.
Once in withdrawal the user is so miserable that they would do anything to get Heroin.
It is only after some personal crisis does the user think of seeking treatment. Suboxone and similar medications are very effective in preventing withdrawal, and the treatment can be successful … but only if the user would follow the treatment long enough.
In my practice the success rate for Heroin users has been very low … most drop out within the first month, they never come back. But the few patients who do remain in the program, their success rate is 100 percent.
Heroin overdose is one of the leading causes of overdose deaths in USA. There has been increase in these overdose deaths because Heroin is being mixed with Fentanyl and Carfentanyl. Fentanyl is 100 times more potent than Morphine, while Carfentanyl is 10,000 times more potent than Morphine, … merely inhaling it is enough to kill.
By taking two simple steps you can avoid overdose deaths.
- Do not inject and
- Do not use more than one drug at the same time.
Treatment protocol for Heroin Addiction
Enrollment in my Suboxone program for Heroin users is usually a two day process. I am not willing to see any Heroin patient who presents to my clinic in withdrawal. Enrollment in the program takes one to two hours, … patients are required to provide medical history, read and sign consent forms, have a medical exam, and understand the treatment plan. All this is not possible when a patient is going through withdrawal.
I have a two step process to make it easy on patients:
Step 1. Come and complete the paperwork, medical exam, and discussion … when you are neither high nor in withdrawal.
Stop using heroin and start using a longer acting opioid, even Lortab or Percocet, just one tablet once every 12 hours is sufficient to prevent significant withdrawal. This way you will be normal enough to complete the enrollment process.
After the enrollment process I can prescribe you Clonidine and Diazepam for one day, you will stop taking all opioids, and be ready for in-office induction the next day.
Step 2. Come to the clinic the following day and have an in office induction, … that is, your withdrawal status will be confirmed, you will take the first dose of Buprenorphine in the office and you will be observed and monitored for side effects or allergic reaction for half an hour. Most patients feel completely normal within an hour and can even go to work that day. If there are no problems on induction then you will be prescribed Suboxone for 30 days and will follow-up in the clinic once a month.
Patients who have been prescribed Suboxone before do not need in office induction. They can start Suboxone after they go into withdrawal
In selected cases I allow self-induction at home. It is an option for patients who have a responsible care giver at home, who can monitor the patient and take the patient to the nearest ER if necessary. In addition patients should not have any significant medical problems or be taking any medications that can cause drug drug interaction.
There are other alternatives too. You can complete the enrollment process with an outpatient Suboxone program, and go for an inpatient detox, if your insurance covers it. Most insurances cover it for one to three days of inpatient stay. If not then it costs about $1000 per day for inpatient detox. During inpatient detox you will be kept relatively comfortable and hydrated with the use of IV fluids and sedative agents. A real detox facility will also give you Buprenorphine during detox so that you will not need an in-office induction.
Or you can do this whole process in a longer inpatient rehab which varies from 7 to 30 days, and costs $500 to $1000 per day (that is $5,000 to $30,000 for the whole program), and on discharge continue with an outpatient Suboxone program.
There are also state funded programs where if you qualify then you can get the detox and rehab for free, or, at a very low cost.
You do have to be in withdrawal before you can start Suboxone. Do not let this fear of withdrawal stop you. Every drug user has gone through worse in their life time. During treatment the withdrawal is supervised, help is available, and the withdrawal is only for 12 to 24 hours.
Benefits of longer period of outpatient treatment
A short term rehab generally does not solve the problem. Patients have to be on Suboxone for quite some time to prevent relapse. This long treatment time is used to attend counseling or behavioral therapy to change the drug using behavior, to address the problems caused by drug use, and to reintegrate into the society and workplace. Once this normal behavior is established, once the mood swings are gone, and the sleep pattern is restored, then the patient can slowly taper Suboxone and come off it.
Suboxone maintenance in my program costs $20/day or less.
Depending on how motivated a patient is this process can take 3 months to several years. The secret is not to start on a high dose of Buprenorphine. Ninety percent of my patients are on 8mg/day or less and are doing well, … attending school, or working. Patients are allowed to taper at their own pace, however it is my job to hammer them at every visit. Long term patients may have to remain on 2mg/day or less, if they find themselves in chronic opioid withdrawal.
Chronic opioid withdrawal is a long, mild form of withdrawal, … the patient feels depressed, has lack of motivation, and is unable to get restful sleep. This can be relieved by very small doses of Buprenorphine, 2mg/day, may be 1mg/day, or even 1mg every other day.
One of my patients is in his eighth year of treatment. He takes about 2mg/week, comes to my clinic once a year, is saving about $30,000 per year by not doing drugs. He saved his business from bankruptcy, saved his marriage … and far more important; he will not be leaving behind a widow, or orphans, or a sullied reputation from an untimely overdose death.
Bottom-line is … there is no recovery without withdrawal. When a patient is in mild withdrawal, the brain is adjusting to lower blood levels of opioids and is reversing the changes that it had to make when it was being fed high levels of opioids.
Outpatient treatment of Heroin addiction with Suboxone allows patients to be in control of their recovery. Patients decide how much withdrawal they are willing to have, and when. There are times when they do not wish to have any withdrawal. For example, when students are taking exams, when a woman is preparing for a wedding, … when workers are put on long shifts, when a person is afraid of relapse and violating the terms of his probation.
Heroin addiction is not difficult to treat at all, as long as the patient is motivated and sticks to the program. It is the first month that is difficult. Once you are beyond that hump … then it is easy and smooth.
Outpatient treatment is affordable, it is cheaper than doing drugs, … the treatment pays for itself. It does not interfere with work or studies. When taken as recommended it does not cause sedation, does not interfere with driving and does not cloud the mind, and if it does then you simply reduce the dose.
Outpatient treatment enables patients to continue to live with their family and be a productive member of the society. The treatment is available from a doctors office within your community. The medication is taken in the privacy and comfort of your home.