At The Coleman Institute, we continue to assist people with a medical withdrawal from short acting opiates, but we have a growing number of patients who are seeking our services to help get off of buprenorphine products like Suboxone® or Subutex®.
In an earnest attempt to stop using short acting opiates, we hear from many people who are turning to doctors that prescribe buprenorphine to help them escape the wretched cycle into which addiction to prescription opioids or heroin has sucked them.
It is a huge relief when you are in withdrawal—chills, nausea, perhaps vomiting and/or diarrhea, severe leg kicks and spasms—to receive a simple strip, dissolvable under the tongue in minutes, to absolutely halt these physical symptoms. Many people intend this to be a ‘quick-fix’ and plan never to use an opioid again, but what often happens is the patient continues to be prescribed Suboxone® indefinitely. Patients tell us they frequently hear from these prescribers that they may need to stay on Suboxone® for the rest of their lives.
Just this week we helped three patients get off Suboxone®:
1. A 42-year old man, working as a high level manager in a large communications company, who was put on Suboxone® six years ago to get off street drugs, currently using 2 8mg strips a day.
2. A 26 year old woman who was put on Suboxone® three years ago after trying to detox herself off 60mg of methadone, able to wean herself down from 24mg/day to 4mg, but struggled to get below this.
3. A 32 year old father of two young children who continued to use opioids after initially receiving Vicodin for wisdom tooth extraction; he found multiple opportunities to stay on prescription pain killers until a dirty urine had him kicked out of his practice and suboxone seemed to be his best alternative. He’s been splitting one 8mg strip now for several months.
Suboxone® is a partial agonist/antagonist. It goes to the opiate receptors in the brain and occupies them with a tenacious grip. This ‘satisfies’ the receptors for about 24 hours or longer. But when the buprenorphine in the Suboxone® wears off, the withdrawal can be excruciating. And because of its chemical makeup and long half-life, the withdrawal can last for weeks.
Most of the patients who seek Medication Assisted Treatment (MAT) off Suboxone® never actually thought they would need help to get off this medication when they started. For many, the promise of relief of withdrawal symptoms trumped any other course of action. Often there are no good alternatives nearby to help people get off a short acting opiate and be completely opiate free. And more and more doctors, nurse practitioners, and physician’s assistants are becoming licensed to prescribe suboxone every day. It has become a very accessible alternative.
That’s why Dr. Coleman is constantly working to educate doctors around the country to provide an alternative MAT for people who do not want to replace their short-acting opioid with a long-acting one. While buprenorphine may be the right choice for some people in certain circumstances, the segment of patients we serve are motivated to be opiate-free. For these people, that means there is a commitment to receiving treatment beyond the physical detox and really absorb and live what it means to be clean and sober.
At The Coleman Institute, when we work together with a patient to get off buprenorphine, we use a pure opiate antagonist or blocker called Naltrexone at the completion of the medically-assisted withdrawal. We provide ongoing Medication-Assisted Treatment (MAT) using this non-addictive medicine (Naltrexone). Once the buprenorphine is off the receptors, they are populated by the Naltrexone and physical cravings are gone. We implant a Naltrexone pellet and urge patients to return every periodically for a year to continue this treatment.
If you have any questions about getting off Suboxone® or other forms of buprenorphine, please give us a call.
Joan Shepherd, FNP