New Treatments for Opioid Dependence

New Treatments for Opioid Dependence[EXTRACT]
What is A Buprenorphine Doctor?
A buprenorphine doctor is a physician who prescribes Suboxone® which is a combination of buprenorphine and naloxone. According to the FDA, this medication is currently approved for the treatment of opioid dependence. Thanks to the DATA 2000 law which allowed the prescribing of this medication by any physician, since 2003 we have new medication for narcotic addiction.Introduction of Suboxone was a breakthrough.
Prior to 2003, the official treatment for opioid addiction was limited to methadone maintenance. Despite the enormous benefits methadone clinics have brought, they remain problematic for patients. These clinics are often located in remote, inconvenient areas of a city which makes travel difficult. Some patients would have to travel to other towns or cities to find a clinic. The larger problem has been the need to go to the clinic daily to get a methadone prescription. Patient will start lining up at five in the morning to get their dose of medication along with one hundred others. Patient’s didn’t like this, neighborhoods didn’t like it, and is was difficult on employers. This model of treatment remains despite it’s deficiencies.

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There are several advantages for the use of buprenorphine. The first is that is does not require going to a doctor or clinic on a daily basis. After a few weeks of being stabilized on this medication, a patient usually is able to see their doctor once per month at a convenient time. There are now more than 14,000 doctors in the United States who prescribe this medication so patients can easily find one in their area. Appointments are in a physician’s offices and are therefore more private. For many, not having the “stigma” of going to a methadone clinic is so important that they are now willing to seek treatment.How does buprenorphine work?
Everyone has opioid receptors in their body. These receptors are responsible for how we feel pain and pleasure. We all know have well narcotics such as Oxycontin or hydrocodone work for pain. We also know how much of a problem heroin has caused because it is so pleasurable. The two main problems with opioids have been the risk of addiction and the risk of death in overdose. There has been an explosion in the United States with the overuse of narcotic medication by almost every age group; opioid dependence is no longer just for the heroin users.The naloxone component in Suboxone helps prevent the misuse of this medication. If the pill is crushed and injected, it will not work. Buprenorphine itself has some special properties. It has the ability to stimulate opioid receptors enough to reduce pain, stop cravings, and produce a mild elevation in mood. At higher doses, it begins to stop working. An overdose of buprenorphine alone should not cause a person to stop breathing like other narcotics can do. Patients also report not getting “higher” on larger doses of buprenorpine. Rather, they report feeling “bad.” Because of this, there is less overuse.

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A Suboxone® prescription is not completely free of problems. Since it is a narcotic, long-term use of this medication will result in physical dependence. Suddenly stopping it will result in typical opioid withdrawal symptoms. It can be fatal if used in conjunction with other drugs such as alcohol and benzodiazepines (Xanax®, Valuim®, Ativan®).Find a Doctor that Can Provide a Suboxone® Prescription
Finding a doctor that prescribes Suboxone (buprenorphine) is not difficult. There are a number of physician locator services on the web. You should note that not all physicians are registered on theses sites. Some do this so they can limit their Suboxone treatment to selected patients. The first place to start is to ask you own physician if he or she prescribes buprenorphine.

The Solution for Opioid Addiction

The Solution for Opioid Addiction[EXTRACT]
Suboxone Detox: What Is It?Detoxification from a drug involves slowly reducing the amount of a drug in an attempt to avoid severe or dangerous symptoms. Alcohol, benzodiazepines (Xanax, Valium, Klonopin for example), and narcotic are drugs that people will seek medical assistance with detoxification.Physical dependence is when an individual experiences withdrawal symptoms when suddenly stopping a medication. Theses symptoms may include tremors, high blood pressure, seizures, and even death. When a person has taken a narcotic for a long enough period of time, suddenly stopping the narcotic will lead to severe cravings, goosebumps, runny nose, diarrhea, stomach cramps, and sweating. The point in narcotic detoxification is to help limit these symptoms and, more importantly, avoid relapse.Methadone and Suboxone (buprenorphine/Naloxone) are two drugs used fordetoxification from narcotic drugs. They are used if the person has been unable to reduce the drug they are taking on their own or with the supervision of their doctor. Typically, one is switched from the current drug (Oxycontin, Vicodin, or heroin) to Methadone or Suboxone and then the dose of the medication is slowly lowered.Who should consider Suboxone detox?
If you can’t stop using heroin in any form.
If you have becomeaddicted to pain medications.
If you are experiencing dangerous side effects from narcotic pain medications.
If you are injecting narcotics in any form.
If you aresnorting narcotics in any form.

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It used to be that people addicted to heroin were the main people needing detox. However, over the last decade, we have seen a number of younger and older patients seeking treatment because of being dependent on their pain medications. Remember, everyone will eventually become physically dependent to narcotics if they are taken long enough and at a high enough dose. However, not everyone becomes a true addict. The people who are physically dependent but not “addicts” do quiet well once they are detoxed from narcotics.Suboxone Detox: An Alternative to Methadone? The nice thing about a suboxone detox is that it can bedone from your doctor’s office. Previously, one had the choice of having anarcotic detox in the hospital or going to a methadone clinic for detox. A Suboxone detox is generally easier on the patient than methadone and takes less time. Many people prefer going to a doctor of their choice, rather than a methadone clinic. If the patient and doctor decide to do a slow detox over many months, there are less office visits with a suboxone doctor. Suboxone (buprenorphine/naloxone) detox is considered a good alternative to methadone detox.Narcotic Detox: How Fast To Reduce How fast the Methadone or the Suboxone is reduced depends on the what is best for each individual. The detox can be as short as five days to longer than six months. The more stable a person is in their personal, work, and social life, the faster the detox can be done. Has the patient relapsed numerous times in the past during or after detox?How long have they been using narcotics? Are they on other drugs of addiction? Do they have other psychiatric problems like depression? How much legal trouble are they have? Theses factors need to be considered by the patient and discussed with their doctor before undergoing methadone detox or Suboxone detox.Suboxone Detox: What to expect The amount of opiate withdrawal symptoms that people experience during Suboxone detox varies from individual to individual. Generally, the higher the dose you are starting from and the faster one reduces the medications, the more withdrawal symptoms that will be experienced. Even with the aid of Suboxone or Methadone, most people will experience significant withdrawal symptoms. During narcotic withdrawal, my experience is people have the most problems with theinsomnia, abdominal cramps, diarrhea, and cravings. The National Pain Foundation has a nice pdf summary regarding the sympoms and ways to help deal with them. This document can be found Here. There are a number of medications that can be used to help deal with the withdrawal symptoms that accompany detox. They can be particularly helpful in getting sleep while going through detox in addition to reducing the diarrhea. Simply using methadone or Suboxone during the detox with a slow reduction will help reduce the cravings and cramping.

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Suboxone Detox: Where Can I find One? Any traditional psychiatric center can provide a suboxone detox. This can be done in an inpatient setting, a partial hospitalization setting, or in an outpatient setting. There are several Suboxone (buprenorphine) treatment directories available on the we that will help you find a center or doctor in your area.Suboxone Detox Summary: Methadone and Suboxone are medications that are used for detoxification in those people wanting to get off their narcotic medications or illicit narcotic drug use. The narcotic withdrawal symptoms can be alleviated with a variety of medications and vary depending on the speed of detox. Suboxone doctors and Methadone treatment centers are readily available and can be found through one of the many doctor and treatment center directories online.

An Exciting New Option in the Treatment of Narcotic Addiction

An Exciting New Option in the Treatment of Narcotic Addiction[EXTRACT]
Narcotics are drugs prescribed because of their effective pain relieving properties. Also referred to as opioids, these drugs which include morphine, codeine, hydrocodone, oxycodone, and others, act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. Taken exactly as prescribed, opioids can be used to manage pain effectively.In addition to relieving pain, however, opioid drugs can affect regions of the brain that mediate pleasure, resulting feelings of euphoria. It is this euphoric feeling that most people who become addicted to narcotics are seeking. Addiction is defined as compulsive, often uncontrollable use of substances such as narcotics or alcohol. Chronic use of opioids can result in tolerance to the drugs so that higher doses must be taken to achieve the same effects.This is the reason that addicts end up taking higher and higher doses as their addiction progresses; this effect is also seen in people who are not addicted, but are taking the pain-relievers for chronic, longterm ailment this person would be classifed as narcotic dependent.When pain relievers are abruptly discontinued, users may experience withdrawal. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and involuntary leg movements. Withdrawal symptoms make it especially difficult for addicted or dependent persons to stop using narcotics.

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Recently Buprenorphine has become available in the United States for treatment of addiction to prescription opioids as well as heroin. Buprenorphine is a semi-synthetic opioid with properties of a partial agonist, and partial antagonist. Agonists are drugs that cause an opioid effect such as morphine. The agonist property of the buprenorphine tricks the opioid receptors in the brain into thinking that they have received opioids, and therefore prevents withdrawal symptoms without making the user feel euphoric. Antagonists are drugs that block and reverse the effects of agonist drugs. The antagonist property of buprenorphine makes it virtually impossible for other opioids to attach to opioid receptor sites because they are blocked. Therefore, even if the patient decides to take opioid drugs after taking Buprenorphine, he or she will not receive any additional effect. In other words, he or she cannot get “high”.Buprenorphine also has a ceiling effect adding to its safety. Other opioids continue to provide more effect as more is taken; eventually, if enough drug is taken (overdose) respiratory depression and death can occur. Buprenorphine is different; its effects level off at a relatively low dose. Therefore, even if more is taken, there are no increased effects. Because of this, users are much less likely to overdose, and in the event of an inadvertent overdose, respiratory supression is much less likelyBuprenorphine can be prescribed in several ways. Some drug and alcohol treatment centers use Buprenorphine to quickly wean addicts off of narcotics, while minimizing the withdrawal symptoms. This allows addicts to become drug-free and begin recovery programs much more rapidly than traditional detoxification techniques. Some addicts may benefit from a maintenance program of Buprenorphine. Maintenance programs can be managed in the doctor’s office without need for hospitalization. Usually the drug is combined with counseling and self help programs such as 12 step programs to maximize effectiveness. A third use for Buprenorphine is for treatment of chronic pain, such as low back pain or fibromyalgia. Pain relief can be achieved without as much sedation as with traditional narcotic drugs.

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Although buprenorphine is a really helpful drug, there are two major problems with it. One is that prescription by doctors of Buprenorphine is strictly regulated and it can be quite difficult to find a doctor. Initially doctors who were certified to prescribe Buprenorphine were only allowed to prescribe it for 30 patients at a time. Now restrictions have been relaxed and that number has increased to 100 patients per doctor. Still, doctors must have special training and certification to prescribe the drug, which limits its availability. The second problem with Buprenorphine is that many insurance plans cover its cost only partially or not at all. Because it is a new medication, it is quite costly, and many cannot afford the price.For someone who has or thinks he may have a problem with tolerance or addiction to narcotic medications, Buprenorphine can be a God-send. The type of doctor that usually prescribes Buprenorphine is a Psychiatrist or Addiction Medicine Specialist. More information can be obtained at and

Opioid Maintenance In Pregnancy: Information for Patients and Providers

Opioid Maintenance In Pregnancy: Information for Patients and Providers[EXTRACT]
There are several options for treatment of opioid addiction during pregnancy. The ones of importance include: methadone in pregnancy, Suboxone (buprenorphine/naloxone) in pregnancy, and buprenorphine alone during pregnancy. This is an important topic for mothers who have an opioid addiction and face the choice of whether to continue their opioid maintenance treatment during their gestation or whether to discontinue the medication. As always, only individualized treatment with your own physician can adequately assess your situation and the following are general guidelines.The current thinking for mothers with an opioid addiction is to continue their maintenance medications. Suboxone carries a Pregnancy Category C indication by the FDA which means that a risk to the fetus can’t be ruled out. Since Suboxone is a combination of buprenorphine and naloxone, mothers are many times switched to buprenorphine alone (Brand name Subutex) to decrease exposure to one medication rather than two.There are a number of risks to discontinuing the methadone, Suboxone, or buprenorphine. The main concern is the risk of the mother going back to using illicit drugs. If this happens, the fetus will be exposed to cycles of the mother getting on and off the drug based on what they can obtain on the streets. The fetus may also get exposed to HIV as drug use and promiscuity are related. The mother is less likely to receive proper healthcare for herself or the fetus, resulting in premature birth, low birthrate children, and the possibility the child will be removed from the home eventually.

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It is believed that because of these risks, the majority of opioid dependent mothers should maintained on their medication through pregnancy and after. There there is a 30-40% chance the newborn will undergo an abstinence syndrome at birth, but this is easily managed with proper warning to the treatment team before the birth. Buprenorphine appears to carry a lower risk of neonatal abstinence syndrome compared to methadone. Since there is minimal drug in the breast milk, mothers are allowed to breastfeed.The American Psychiatric Association sponsors webinars on buprenorphine treatment and the latest update on pregnancy can be viewed here. The webinars are primarily designed for healthcare providers, but have great value in answering questions about Suboxone and Buprenorphine to the person who is taking or is considering taking Suboxone (buprenorphine/naloxone) during pregnancy.I found this lecture on pregnancy very helpful from a medical perspective. Providers of Suboxone in pregnancy will find the information in the lecture invaluable. The lecture is clear, to the point, and contains updated information on prescribing Suboxone in pregnancy. I think the video could easily be understood by most anyone.What If One Still Wants To Get Off Their Maintenance medication despite the risks?Getting off a opioid maintenance regimen is a big deal, let alone to a pregnant mother. It should involve at the very least one physician who can monitor the one’s progress. A pregnant female should not rush to get off the medication without professional assistance. I have seen patients alarmed by their pregnancy who get off their medication without a proper discussion. They usually end up wanting to get back on their medication to remain stable.It is thought that if one is going to wean from the medication, it should be done prior to 32 weeks pregnancy. This will prevent complications of withdrawal (premature baby) prior to the planned delivery date. After delivery, one should consider with their physician, getting back on the maintenance medication as quickly as possible. Preferably immediately.Opioid Maintenance and Pregnancy: Other PointsFollow up with your physician every one to two weeks.
Continue drug counseling during pregnancy.
It is common to need an increase in the Suboxone, Methadone, or buprenorphine during pregnancy. Expect about a 25% increase in dose.
Epidural analgesia is effective while on maintenance therapy during pregnancy.
Nalbuphine and Butorphanol are contraindicated while on maintenance treatment during pregnancy as both can precipitate withdrawal.
IV and oral narcotics are used to supplement the maintenance dose of methadone, Suboxone, or buprenorphine during labor.
Breastfeeding is recommended unless HIV positive.
There appears to be a problem with medication compliance with mothers at about 3 months post partum. Prepare for this possibility.
There is almost always more of a benefit in having the pregnant mother quit smoking than to get off the methadone, Suboxone, or buprenorphine in pregnancy.

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Opioid Maintenance In Pregnancy: SummaryMothers on opioid maintenance treatment should usually continue their treatment during pregnancy and after delivery. The risk of weaning from maintenance opioid treatment is usually greater than continuing treatment. The mother can best benefit by quitting smoking and receiving proper prenatal monitoring to have the best chance of a good outcome.

How Does A Pain Center Treat Patients With Opioid Dependence?

How Does A Pain Center Treat Patients With Opioid Dependence?[EXTRACT]
It’s all over the headlines about the misuse of opioids and the addiction epidemic we have in this country. As such, general primary care doctors are struggling how to treat their patients with chronic pain these days and not contribute to or start them down the path of addiction. Pain center specialists are quick to admit that they have a delicate balance with their patients who are dependent on these drugs and how they treat them.One of the biggest challenges that all doctors have is the lack of being able to estimate of how common problematic opioid for chronic pain patients can develop. The biggest majority of those who have chronic pain don’t go on to develop such an addiction.But because so many have, creating the current epidemic, the medical industry needs to get a better understanding on how to effectively manage the risk of drug abuse.A pain center doctor should take precautions and look for any potential risks of substance abuse before prescribing any medication to any patient with chronic pain. This would include looking at the patient’s medical history, their family medical history including any type of psychiatric disorders or substance abuse.

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If any of these are present in a patient’s past, it doesn’t mean they should be automatically denied medication. But they should be educated and informed about the risk of drug dependence and then monitored closely for potential abuse.Medication Isn’t Always The AnswerWhat more doctors and patients need to realize is that medication doesn’t always have to be the answer for chronic pain. There are the false assumption and misunderstanding that medication makes the pain disappear. But when it comes to chronic pain situations, that isn’t necessarily so. For many people, it only will reduce their pain. And this is where referral to a pain center is important.Treatment Without OpioidsFor those patients that have a substance abuse history, or psychiatric disorders, a pain center can provide many other ways to get that pain relief without using opioids. A pain center that works with a multidisciplinary approach can treat patients with chronic pain regardless of their history.And there are medications that can be prescribed that are non-opioid drugs to go along with the other methods as well. Like antidepressants, anti-arrhythmic drugs, and anti-epileptic drugs, all of which are effective to treat chronic pain.A pain center also offers physical therapy, psychological therapies, as well as occupational therapy. There are so many people suffering from chronic pain that is not receiving the services of a multidisciplinary pain center because it usually requires academic medical center resources and not all doctors have these resources. They can, however, collaborate with doctors that do.After a doctor has taken in all the information about a patient and considers all the possible options that are available and believes an opioid treatment is needed, but the patient is opioid-dependent, there are some other medical options. Both buprenorphine and methadone have the benefits of being a strong analgesic and may be just what the patient needs.

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When a pain center treats patients with chronic pain and has a substance abuse disorder, they will also include psychological counseling in the treatment plan. It may be group therapy or individual therapy, but when substance abuse overlaps with treatment for chronic pain, the behavioral and psychological skills are the same.For pain doctors that work independent or with a pain center, an opioid contract is a common thing to request patients sign before they begin treatment. It is an effort to establish a clear understanding between the medical team and the patient that opioids are only allowed that the doctor prescribes and can only come from the pain center’s pharmacy or a designated pharmacy.