What is Suboxone®?
SUBOXONE®(buprenorphine and naloxone) Sublingual Film (CIII) is a prescription medicine indicated for treatment of opioid dependence and should be used as part of a complete treatment plan to include counseling and psychosocial support.*
How do Suboxone® and Subutex work?
“Opioids attach to receptors in the brain, with three main effects; reduced respiration, euphoria, decreased pain. The more opioids ingested the more of an effect. The process of opioids binding to the opioid receptors can be thought of as a mechanical union, the better the fit the more the opioid effect. Buprenorphine is different. It too binds to the receptors, however, without a perfect fit. As a result the Buprenorphine tends to occupy the receptors without all of the opioid effects. The receptor is tricked into thinking it has been satisfied with opioids without producing strong feelings of euphoria, and without causing significant respiratory depression. This, in turn, prevents that receptor from joining with full opioids; therefore if the patient uses heroin or painkillers, they are unlikely to experience additional effect. Buprenorphine tends to stay with the receptors, blocking them, much longer then opioids do. This stickiness, is what makes Buprenorphine last so long, up to 3 days.”
How long will I be in treatment?
“About 10% of all people in the United States will suffer from some type of substance abuse disorder during their lifetime. That’s about the same percentage as people who suffer from diabetes. And like diabetes, not everyone who suffers from a substance abuse disorder will require medication or even treatment. But, a small percentage, even in spite of attempting to quit on their own, going to 12 step meetings and going through “rehab”, still are unable to quit. These are the people with the most severe disease, and will frequently require medication to help them remain abstinent. Much like a diabetic who changes their diet, loses weight and exercises, yet still requires insulin to treat their disease, a person with severe genetic opiate addiction may require lifelong treatment to control their addiction. This should not be seen as a failure. There are many chronic diseases like diabetes, high blood pressure and even depression, where lifelong treatment is accepted and encouraged, and addiction should not be treated any differently. Deciding whether or not to attempt to taper is a joint decision between you and your doctor. Many people who currently come to the Medical Care Clinic were force tapered at another clinic, and relapsed. Force tapering is not the answer. For those who do opt to try tapering, the American Psychiatric Society recommends being on medication for at least 6 months prior to attempting. This allows time for a person to work on issues in their life that may be contributing to their addiction, and allows them to adjust to living clean. Each person is different and each treatment plan is tailored to that individual.”
How much does it cost?
To begin treatment at Medical Care Clinic, there is an initial fee of $150. It is required that half ($75) of the initial fee be paid before an appointment can be scheduled, and the remaining ($75) fee be paid the day of the first appointment. After the first appointment, each week of treatment will be $100 and must be paid on the day of the appointment. For additional questions please contact us at 276-644-9161.
What if I am pregnant?
We offer a Pregnancy Clinic just for pregnant women and new moms. The Pregnancy Clinic consists of weekly group appointments with a Treatment Team present, which includes a doctor, therapist, and case manager. In the clinic, women will learn about Neonatal Abstinence Syndrome (NAS) and how to correctly administer the Finnegan Scale (NAS Assessment Tool), preparing for child birth, fetal alcohol syndrome, hepatitis C, breast feeding, and how to effectively communicate with their medical professionals. Once a month, a representative from the Department of Health visits the clinic to teach the women about programs that are offered, such as: The Help Us Grow Successfully (HUGS) Program, Child Health and Development (CHAD) Program, Children Special Services (CSS) Program, and Safe Sleep. Guest speakers from other local agencies are also invited to help provide resource linkage to the women and their new baby.
*Treatment should be initiated under the direction of physicians qualified under the Drug Addiction Treatment Act.
For a more in-depth explanation, see A Brief Overview of Suboxone and the Treatment of Addiction by Dr. Vance Shaw.
Understanding Opioid Dependence
Opioid dependence is a disease in which there are biological or physical, psychological, and social changes. Some of the physical changes include the need for increasing amounts of opioid to produce the same effect, symptoms of withdrawal, feelings of craving, and changes in sleep patterns. Psychological components of opioid dependence include a reliance on heroin or opioids. The social components of opioid dependence include less frequent contact with important people in your life, and an inability to participate in important events due to drug use. In extreme cases, there may even be criminal and legal implications.
The hallmarks of opioid dependence are the continued use of drugs despite their negative effect, the need for increasing amounts of opioids to have the same effect and the development of withdrawal symptoms upon cessation.
There are a variety of factors that can contribute to the continued use of opioids. Among these are the use of heroin to escape from or cope with problems, the need to use increasing amounts of heroin to achieve the same effect, and the need for a “high.”
Treatment for opioid dependence is best considered a long-term process.
Recovery from opioid dependence is not an easy or painless process, as it involves changes in drug use and lifestyle, such as adopting new coping skills. Recovery can involve hard work, commitment, discipline, and a willingness to examine the effects of opioid dependence on your life. At first, it isn’t unusual to feel impatient, angry, or frustrated.
The changes you need to make will depend on how opioid dependence has specifically affected your life. The following are some of the common areas of change to think about when developing your specific recovery plan:
Physical – good nutrition, exercise, sleep and relaxation
Emotional – learning to cope with feelings, problems, stresses, and negative thinking without relying on
Social – developing relationships with sober people, learning to resist pressures from others to use or misuse substances, and developing healthy social and leisure interests to occupy your time and give you a sense of satisfaction and pleasure.
Family – examining the impact opioid dependence has had on your family, encouraging them to get involved in your treatment, mending relationships with family members, and working hard to have mutually satisfying relationships with family members.
Spiritual – learning to listen to your inner voice for support and strength, and using that voice to guide you in developing a renewed sense of purpose and meaning.
During the treatment process, SUBOXONE will help you avoid many or all of the physical symptoms of opioid withdrawal. These typically include craving, restlessness, poor sleep, irritability, yawning, muscle cramps, runny nose, fearing, goose flesh, nausea, vomiting, and diarrhea. Your doctor may prescribe other medications for you as necessary to help relieve these symptoms.
You should be careful not to respond to these withdrawal symptoms by losing patience with the treatment process and thinking that the symptoms can only be corrected by using drugs. To help you deal with the symptoms of withdrawal, you should try to set small goals and work towards them.
Medical Care of VA Addiction Medicine
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501 Watauga Ave
Johnson City TN 37601