Addiction treatment based on compassion and modern medicine
An Article for Healthcare Professionals
The Taub Group - Charlotte, NC
September 2, 2013

Office-Based Treatment for Opioid Dependence

Popular opioid analgesics such as Vicodin, Oxycontin, and Demerol give doctors the ability to effectively manage even severe pain. While proper management of opioid prescriptions helps avoid problems, developing a dependence on the opioids remains a risk. If dependence occurs, the first thing to remember is that this medical consequence should not be stigmatized.  Research shows that treating opioid dependence as a disease or side-effect, not as some sort of transgression, improves outcomes.1 An estimated two million Americans wrestle with opioid dependence.2   

My private practice offers Suboxone treatments for opioid dependence programs. Most patients prefer treatments in a professional medical office setting such as ours.  Suboxone (buprenorphine/naloxone) is a partial mu-opioid receptor agonist. When prescribed appropriately, Suboxone can replace the opioid addiction and then be tapered off slowly with a minimum of withdrawal symptoms. Research shows that buprenorphine/Suboxone treatments reduce the risk of opioid over-taking, reduce the risk of illicit drug use, and increase the likelihood that patients can complete a detoxification program.3-10   

Methadone, which we do not prescribe, has long been the standard in treating opioid dependence.  Suboxone has been shown as effective as low-dose methadone for treating opiod addiction,11 butSuboxone has several advantages over methadone. Suboxone is easier for patients to taper off and has lower risks of toxicity. Since Suboxone does not create an intense high, it has lower risk for over-taking and diversion. 

Suboxone treatment for opioid dependence occurs in three stages: induction, stabilization, and tapering.  The induction phase typically lasts up to a week and involves the initial transition from an opiate medication to Suboxone.  The stabilization phase generally lasts up to 60 days and involves close monitoring of symptoms, cravings, and side effects along with adjustments to the Suboxone dosage. The tapering phase is highly individualized and can last weeks, months, or potentially longer.  During the final phase, we continue to monitor cravings and potential for relapse and work to coordinate any other services that may be needed such as additional counseling and self-help mechanisms. In the final phase, we reduce the Suboxone dosage very, very slowly, easing each patient out of dependence with a minimum of withdrawal symptoms.        

References

  1. McLellan A, Lewis D, O’Brien C, Kleber H. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000; 284: 1689-95.
  2. Pain killers fuel growth in drug addiction. Harvard Ment Health Lett. 2011; 27:4-5.
  3. Steele A, Cunningham P. A comparison of Suboxone and Clonidine treatment outcomes in opiate detoxification. Archives of Psychiatric Nursing. 2012; 26 (4): 316-323.
  4. Gowling L, Ali R, White J. Burprenorphine for the management of opioid withdrawal.Cochrane Database Syst Rev. 2004; (4): CD002025.
  5. Mattick R, Breen C, Kimber J, et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2003; (2): CD002207.
  6. Krook A, Brors O, Dahlberg J, et al. A placebo-controlled study of high dose buprenorphine in opiate dependents waiting for medication-assisted rehabilitation in Oslo, Norway. Addiction. 2002; 97: 533-42.
  7. Fudala P, Bridge T, Herbert S, et al. Office-based treatment of opiate addiction with sublingual-tablet formulation of buprenorphine and naloxone. N Eng J Med. 2002; 349: 949-58.
  8. Ling W, Charuvastra C, Collins J, et al. Buprenorphine maintenance treatment of opiate dependence: a multicenter, randomized clinical trial. Addiction. 1998; 93: 475-85.
  9. Ling W, Charuvastra C, Collins J, et al. Buprenorphine maintenance treatment of opiate dependence: a multicenter, randomized clinical trial. Addiction. 1998; 93: 475-86.
  10. Johnson R, Eissenberg T, Stitzer M, et al. A placebo controlled clinical trial of buprenorphine as a treatment for opioid dependence. Drug Alcohol Depend. 1995; 40: 17-25.
  11. Mattick R, Breen C, Kimber J, et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2003; (2): CD002207.

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