The Suboxone Program

With many practices cutting patients off their narcotics and/or discharging them, folks that were treated with high doses of narcotics are finding themselves in danger of uncontrolled withdrawal. To address this issue, we have decided to offer help. Recall that I entered this field due to my work with narcotic addiction, and we are going to return to those roots in addition to offering certifications as we always have. Marijuana replaces narcotics for many people, now we are going to take direct steps to ease that transition.

Suboxone therapy is very different from many other treatments of opioid addiction.Your body has receptors for opioids which are very much like locks- when you activate the lock, something happens.The keys that turns the lock (opioid receptors) either turn the key one way and trigger the lock (morphine, methadone, heroin ‘narcotic agonists’), or turn it the other way and deactivate the lock (narcan- a narcotic ‘antagonist’).

When narcotics are present in the body, they combine with the locks and cause an effect.There are a set number of locks (receptors) in your body.When you start treatment for an injury or pain with narcotics, they have little trouble filling all the available receptors.As you continue to take narcotics over time, the number of receptors increase, which require you to take more/higher doses to get the same effect.This is called tolerance.It builds over time.

Unfortunately, the dose you must take to start getting significant side effects (constipation, respiratory depression, sleepiness, etc.) is the same regardless of how long you have been taking the medication.Obviously, due to tolerance, over time you will need to take more and more medication to get relief; and eventually these doses will increase to the point you cannot take any more because of the side effects.Then your pain level begins to increase despite the very high doses you are taking.

The next problem occurs due to the number of receptors your body grows in response to chronic use of narcotics.In order to get the effect you need from the pain medication, the receptors must be filled and working.As your tolerance increases to the point you are getting too many side effects, your receptors no longer are all filled.When you start getting empty receptors, you start feeling ill- nausea, body aches, anxiety, and sweating- severe flu like symptoms.This is ‘withdrawal’.

Eventually you get to the point you are taking the narcotics to prevent the withdrawal, not treat your pain.You cannot take enough medication to treat your pain because of the side effects.You are in trouble.

Traditional treatment of narcotic/opioid abuse falls into a couple of categories.The first is simply to stop cold turkey.You get very sick (folks don’t die of narcotic withdrawal, they just wish they would).A variation is ‘weaning’ patients down on the medication they are taking- stopping the medicine over a period of several months.Next comes substituting one narcotic for a second one that is more controlled or ‘socially acceptable’.

Originally the soldiers returning from the Civil War came back addicted to the morphine they got for their wounds.Morphine addiction was a significant problem in the late 19th century.To address this, they came up with a ‘safer’ narcotic to replace the morphine.That narcotic was called heroin. As we know, heroin became a problem so we replaced it with methadone.Most methadone programs now replace the street or prescription narcotics patients are addicted to with methadone.Many times, patients do not know the actual dose of methadone they are taking, so the clinic brings down the dose over time- weaning them off the narcotics eventually.Some end up just being ‘maintained’ on a set dose designed to stop them from withdrawing.

Suboxone is different.Suboxone is not like methadone in that we are not trading one narcotic for another one.Suboxone is a mild narcotic that occupies the narcotic receptors, but doesn’t turn them on or off, it just sits there.If you look at a lamp as an example, there is a socket for the light bulb.Morphine is like a 100 watt bulb.Suboxone fills the same socket, but only is a 25 watt bulb. Because the sockets/receptors are full, you don’t go into withdrawal.Because they are full, if you take morphine on top of the Suboxone, it has no effect because there are no empty receptors and it has no place to go.

The program this clinic uses involves having you come in to the office with empty receptors, in full withdrawal.You are sick and miserable, but as soon as I give you an ‘induction’ dose of Suboxone, those receptors start to fill.You will get just enough to fill all the receptors and you will walk out of the office with no signs of withdrawal 2 hours after you walk in.And you will have your life back.

The first month, you will pretty much stabilize on the induction dose of Suboxone.The second month I will ease that dose down so that by the end of the second month you will be on no more than ½ the induction dose.The third (and if needed forth) month we will wean you completely off the Suboxone and you will be done.You will then be followed for six months and put on a medicine by mouth that will block all narcotics.During the entire program you will take part in counseling to deal with the addiction and any causes that can be identified.The counseling will be through an independent practice and is mandatory for the duration of the program.

This practice is limited in the number of people we can have in the program at any particular time. As a result, we carefully screen our patients and ONLY take those that are committed to stopping narcotics completely.We have rules about how this program is operated; rules which are set up to specifically increase your chances of success.You must follow the rules.If you are not serious about stopping narcotics, or don’t follow the rules, you will be discharged and your place given to someone who will.We have a waiting list.If you are accepted and participate in the program, it means someone else cannot and that carries with it a responsibility that you will do your best.We will be available to you 24/7, we will support you every way we can, and expect the same level of effort from you.

Dr. Bob