GEORGE G WESTERMAN, MD, CPE, FACPE, LTD

BUPRENORPHINE – The GOLD STANDARD treatment for Opiate Dependence

Buprenorphine (Subutex or Suboxone) is the best medication that can be used to treat opioid dependence. Opioids are drugs like heroin, opium, morphine, codeine, oxycodone, hydrocodone, etc., which can be used, abused and lead to tolerance and dependence. This means that the user’s body becomes accustomed to ever-higher amounts, and, when the drug is stopped, there are symptoms of withdrawal. Even after the worst physical part of withdrawal is over, some patients still don’t feel right for a long time and may relapse to using drugs again, just to “feel normal". Some medical research shows that after abusing drugs for a long time the brain is thrown off balance, and the goal of treatment is to encourage stability, both in the body and in the patient’s life.

Detoxification (stopping opiate use):

Not all patients who abuse opioids need medication to stop their addiction. Some persons do very well with counseling, or residential therapeutic treatment, or in Narcotics Anonymous (NA) groups. But in many cases these approaches alone are not enough and medication is used. Buprenorphine medication has a slower onset of actions and longer duration of effects on the brain than heroin or other drugs of abuse. This allows for a steadying of brain function that is part of treatment.

Buprenorphine (Subutex or Suboxone) is started when the patient is experiencing the symptoms of moderate opioid withdrawal, and the dose is adjusted over the first several days of treatment. It is given as a pill that dissolves under the tongue. Subutex is pure buprenorphine. The Suboxone pills also have a small amount of naloxone (Narcan) in them, which is an opioid antagonist. The purpose of the naloxone is to discourage illicit injection of the pill.

When one emerges from a period of drug or alcohol dependence, other emotional issues often surface. These include depression, panic attacks, anxiety, & mood swings. This is one of many reasons why an experienced psychiatrist is an excellent choice for your guide to a new life. Emotional problems should be addressed with alacrity and skill so that they do not precipitate a relapse to opiate abuse and dependence.

Maintenance (continued use of buprenorphine following detoxification):

For individuals who have concerns regarding relapse, strong cravings for opiates, want assurance that relapse can be prevented or wish to allow their body to slowly adjust to the lack of strong opiates, buprenorphine maintenance is available. The patient continues on a dose of 8mg to 24 mg daily and is re-evaluated monthly to determine if it is time to terminate maintenance or to continue. The method of ending treatment is a taper, which means a decreasing dose of buprenorphine over several days or weeks. After this time, one no longer needs to be in the buprenorphine program.

Outpatient Treatment:

Continued success in staying free of opiate or any substance dependence is greatly increased when treatment groups are used in conjunction with medication. Tab: CDIOP.