Medication Assisted Treatment with Buprenorphine for Opiate Use Disorder
There are two “treatment models” for Opiate Addiction, now called Opiate Use Disorder
The first treatment is known as The Abstinence Based Model, and involves having the opiate dependent individual practice abstinence from all drugs of abuse and alcohol, especially avoiding taking any opiates. The problem with this model is, after a person takes high doses of opiates over an extended period of time; they develop a tolerance to opiates meaning that more and more opiates are needed to produce the desirable affect. For example, many of our patients have histories of taking 20 or more Lortabs per day. Some take double or even triple that amount! Then, when the person who has become tolerant to high doses of opiates tries abstain, they can and do develop severe withdrawal symptoms, which are unbelievably uncomfortable to physically endure. In addition, individuals can have extremely strong mental cravings, whereby all one can think about is taking more opiates to relieve the severe symptoms of opiate withdrawal. Some call this Cold Turkey. As one can imagine, the Abstinence Based model is not particularly successful. Relapses with the Abstinence Based Model are common and too often, result in overdoses. And overdoses result in death.
The other “treatment model” for Opiate Use Disorder involves what is called the Harm Reduction Model. Using this model, the idea is to essentially convert an addict into a patient. This is done by treating the patient with controlled doses of a medication called buprenorphine. This Medication Assisted Treatment with buprenorphine is the core of the Harm Reduction Model. The goals of the Harm Reduction Model are really two-fold. First, to not cause harm to the patient (keeping the person alive) and second, to promote functional improvement. Using this treatment model, individuals receive regular outpatient office visits including regular urine drug screening as a part of the supervised monitoring process. The Harm Reduction Model saves lives and is at least twice as effective as the Abstinence Based model in reducing fatalities from non-intentional opiate overdoses. No one has ever died from an overdose of buprenorphine, especially if not mixed with any other drugs.
Starting Treatment with Suboxone
Patients receive education about buprenorphine and are given specific instructions as the proper way to take the medication. Since treatment for Opiate Use Disorder is highly regulated by the government, all patients are required to agree to and sign a treatment contract, which carefully explains what is expected to enter into and remain in the program. The initial appointment generally lasts about two hours. Once the buprenorphine is prescribed, we will be in touch by phone with our patients over the first several days of treatment until the dose is stable and the patient is no longer experiencing any cravings for opiates.
Continuing Treatment with Suboxone
All patients receiving the medication assisted treatment with buprenorphine must be seen at least once a month in our clinic. Each time, patients are drug tested and meet with the doctor. Prescriptions for a one month’s supply of the buprenorphine are given and are expected to last until the next appointment. In most cases, the buprenorphine medication dose is then slowly and gradually lowered down and tapered off over time. In addition to the buprenorphine treatment, other treatment may be prescribed as indicated for various other conditions, such as for Mood and/or Anxiety Disorders. Problems with chronic pain are also addressed on an ongoing basis during the course of the treatment.