Medication assisted treatment for opioid addiction.
There are two medications available to manage and treat opioid addiction, Buprenorphine and Naltrexone.
The preferred medication is Buprenorphine. It is available as tablets and films; as a generic preparation, and under the brand names Suboxone, Zubsolv, and Bunavail.
Naltrexone is available as an oral tablet and an once a month injection.
How do these medications work?
Buprenorphine works by attaching to opioid receptors and acting like an opioid. It is a very long acting drug and a single daily dose is enough to prevent withdrawal symptoms for 24 hours.
Naltrexone also attaches to opioid receptors, but does not act like an opioid … it blocks the opioid receptor. Naltrexone is also a very long acting drug and is taken as a single daily dose.
Buprenorphine prevents opioid withdrawal, and is used to treat opioid withdrawal, … that is why it is the preferred drug. However, it is an opioid, and has some of the same disadvantages as other opioids. It is a controlled substance, only certain providers are allowed to prescribe it, it is expensive, and it needs to be gradually tapered to prevent withdrawal.
Naltrexone does not prevent opioid withdrawal and is not used to treat opioid withdrawal. However, once withdrawal has been adequately treated, Naltrexone can be used to reduce cravings, and because it blocks other opioids, it removes the incentive to use them.
Naltrexone is not an opioid, it is not a controlled substance, it is inexpensive, does not cause sedation, … and is also approved to treat alcohol addiction.
Do I have to go to a rehab or specialized clinics to be treated?
Rehabs and specialized clinics do provide treatment for opioid addiction, however, not all rehabs provide Suboxone treatment, and if they do … they only provide it for the duration of the rehab.
A more convenient and less expensive option is to receive Suboxone prescriptions from a doctor in your community. You will have to look for a doctor who has received the necessary training and a waiver certificate from the DEA to prescribe Buprenorphine containing products for the treatment of addiction. It could be your PCP … just ask.
There are more than 100 doctors approved to provide this treatment in and around Dallas Fort Worth. Ask your insurance or do an internet search for Suboxone doctors in your vicinity.
Naltrexone is not a controlled substance and any doctor who is familiar with this medication can prescribe it. However, most do not … so look for Suboxone doctors; because they deal with addiction … they are more likely to prescribe Naltrexone.
Marketed as Suboxone | Zubsolv | Bunavail
Buprenorphine is an opioid agonist, that is, it acts like other opioids. Once taken it reaches the brain and attaches to opioid receptors and prevents withdrawal symptoms and cravings. When patient are assured that they will not have any withdrawal symptoms, it relieves their anxiety, and they do not have any need to search for and obtain opioid drugs illegally.
Buprenorphine was initially approved by FDA for this purpose in 2002. It is a long acting medication, and a single daily dose is adequate to prevent opioid withdrawal symptoms.
By preventing withdrawal symptoms, it allows patients to continue to work, or attend school. If taken as prescribed it does not cause any sedation, and patients can drive and work with machinery.
It is prescribed by a licensed medical provider, and dispensed by pharmacies. It is suitable for outpatient use and eliminates the need for expensive inpatient rehab. It is a better alternative to daily visits to Methadone clinics.
By preventing the discomfort of withdrawal symptoms, patients can work on changing their drug using behavior. This can be done with the help of a counselor, or a behavioral therapist. Other alternatives are group counseling, and recovery workshops. Well motivated patients can also use one of the several self help books, and peer support groups.
Once the drug cravings are in control and the patient has extinguished the drug seeking behavior, then the patient can taper the dose, go through controlled withdrawal at their own pace, and come off the medication.
This is a very gentle method; the patient remains in control of the process, and may take anywhere from one month to several years.
Taking Buprenorphine does not violate Drug Court Probation … if prescribed by a DEA approved provider, through a legitimate medical treatment program.
These programs are available through a doctor in your community. There are two components to the treatment, medical … that is provided by a medical doctor, and counseling … that is provided by an addiction counselor or behavioral therapist.
Each medical provider implements the program based on their interpretation of current recommendations, their own experience, and the resources they have. Patients are usually seen once a week, bi-weekly, or once a month. Some providers include counseling in the services provided, but most allow patients to engage their own counselors.
Typically patients receive 8mg to 16mg/day at the beginning of therapy (one to two tablets or films) and then taper to a dose of 8mg/day or less as maintenance. Well motivated and disciplined patients can complete the program within a few months, but most patients take a year or longer. No matter how long it takes … patients still save money, their careers, their marriage … their life.
You do not need to purchase the entire prescription … the pharmacy will let you purchase one or two tablets/films at a time, at a cost of $10 to $20, making it very affordable. Many insurance/prescription plans now cover this medication.
You can read my Suboxone treatment protocol here.
Buprenorphine is cheaper than the street drugs you use, … it is available as a fast acting tablet and film, that you can take in the privacy of your home … without having to go to rehab … without disrupting your work or school … and it is available from a doctor’s office in your community.
Recently other forms of Buprenorphine have become available. A once a month injection called Sublocade, and a six month implant called Probuphine. These preparations are expensive and are administered by a limited number of qualified providers.
You can read about the various formulations of Buprenorphine here.
Naltrexone for opioid addiction
Naltrexone is available as as generic tablet (50mg), and once a month depot injection (380mg) called Vivitrol.
Naltrexone is currently not the preferred drug for treating opioid addiction because Naltrexone does not prevent or manage opioid withdrawal. Naltrexone can only be started after the patient has been through opioid withdrawal, and has been abstinent for 7 to 10 days.
Naltrexone is not an opioid, … it is an opioid blocker. Once taken it attaches to opioid receptors in the brain and prevents other opioids from attaching to those receptors, thus preventing their action. Over time patients have reported reduced cravings and diminished desire to use drugs.
Naltrexone, is generally not prescribed to patients with liver failure or acute hepatitis. It is used with caution in patients who have elevated liver enzymes, and may be stopped if serum enzymes indicative of liver injury continue to rise.
Naltrexone is not an opioid, is not addictive, does not cause any cognitive impairment or sedation, and is safe for patients who have to drive or operate machinery. It is not tested for on the urine drug screens.
Average duration of use is three to six months. By that time patients are expected to have changed their behavior … so as to not seek and use drugs. It can be prescribed for a longer time if desired.
Addiction is not cured by a pill. Naltrexone is not a good choice for patients who are not motivated and do not have the self discipline to abstain from drugs. Such patients can beat the treatment process by not taking Naltrexone or taking too much opioids to overcome the block … in that case they risk overdose death, because after using Naltrexone for some time, their brain becomes very sensitive to opioids.
Medication cost: Cost of Naltrexone tablets is $1 to $2 per tablet. It is prescribed as one tablet per day, 30 tablets per month … the medication cost comes to about $30 to $60 per month.
Naltrexone is now the preferred drug for use in the treatment of alcohol addiction. It is now also approved for weight reduction in the treatment of morbid obesity in combination with Bupropion.
Vivitrol is the injectible form of Naltrexone. It is given as a once a month injection. It is expensive ($1100 to $1600 per injection) and currently it can only be obtained through a specialized program.
I do not provide Vivitrol injection. You can find a Vivitrol provider through your insurance or through the manufacturer’s website https://www.vivitrol.com
Caution: Once patients have been abstinent from opioids and used Naltrexone for some time, they become very sensitive to opioids. If the patient decides to use opioids again … their usual opioid dose can cause overdose … and death.
A word about Methadone.
Methadone is not used to treat opioid addiction. Methadone is offered through government contracted Methadone treatment programs or Methadone maintenance programs.
This is an effort by the government to offer opioids to patients who are addicted to opioids, so that they do not have to indulge in criminal activity to obtain them. This is only available in major cities. Some Methadone programs now offer Suboxone.
In USA medical providers in private practice are prohibited from prescribing Methadone for opioid dependence or addiction.