What drugs are opioids?

Painkillers such as morphine, methadone, hydrocodone, and oxycodone. Sold under brand names such as OxyContin®, Percocet®, Vicodin®, Tylox®, Demerol®, Fentanyl®, among others.  Heroin is also an opiate and is illegal.

What drugs are NOT treated with Suboxone®, buprenorphine?

Drugs that are opioids such as cocaine, methamphetamines, ecstasy, LSD, ketamine, steroids among others.

What is addiction?

For you to fully understand you must be aware of the difference between tolerance, physical dependenceand addiction. When a person takes opioids for an extended period of time they become less sensitive to it and require more to achieve the same effect. Receptors in the brain become less sensitive.  This means they need more and more opioid to achieve the same effect.  This is called tolerance. When the body can no longer make enough natural opioids to satisfy the less sensitive receptors, the body becomes dependent on the external source. This is physical dependence.  Physical dependence is physiological state of adaptation to a substance, the absence of which produces symptoms and signs of withdrawal.  Physical dependence is the result of physical changes in the brain.  It is not a matter of willpower rather it is actual physiology.

Addiction, in general, is defined as a behavioral syndrome characterized by the repeated compulsive seeking or use of a substance despite adverse social, psychological and physical consequences.  Opiate addiction is included in this category but is also marked by a physical alteration of receptors in the brain. As these changes occur with repeated opioid use, the individual is less sensitive to its effects and requires an increasing amount to achieve the same desired effect. Addiction is a disorder which requires treatment while physical dependence is not. In summary, addiction is uncontrollable compulsive behavior caused by alterations of parts of the brain from repeated exposure to high euphoric responses.

What is withdrawal?

Withdrawal syndrome consists of a predictable group of signs and symptoms resulting from the abrupt removal of, or a rapid decrease in the regular dosage of, a psychoactive substance. The syndrome is often characterized by over activity of the physiological functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug.  In other words, the opposite of what the drug did.  If the drug suppressed depression then the person would be depressed while in withdrawal.  If the substance suppressed pain then the person will experience pain while in withdrawal.

Withdrawal from opioids can be severe and excruciating.  Withdrawal generally begins between 4 to 72 hours after the last dose of opioid use (depending on dose and opioid).   The symptoms are both physical and emotional to include; goose bumps, watery eyes, runny nose, yawning, loss of appetite, tremors, panic, chills or profuse sweating,  nausea, vomiting, muscle cramps, insomnia, stomach cramps, diarrhea, shaking, depression, irritability, jitters and increased sensitivity to pain.

Why do I need to be in withdrawal to start Suboxone®/buprenorphine?

It is important to be in a state of mild to moderate withdrawal when you begin your induction to buprenorphine.  If you have a high level of another opioid in your system, buprenorphine will compete with it and knock the opioids off the receptor sites in your brain, creating instant withdrawal.  If you are already in mild to moderate withdrawal buprenorphine will make you feel better, not worse, and this will help determine the minimal dose necessary.

How long do I need to wait since I last used before I can start Suboxone®/buprenorphine?

In general, you will need to wait until you are feeling the initial sensations of withdrawal before you can safely take your first induction dosage of buprenorphine.  The waiting times vary depending on the drug of abuse.  A rough estimate includes:

  • Heroin - 12 – 24 hours
  • Percocet®, or Oxycodone® - 12 – 24 hours
  • Crushed painkillers - 12 – 24 hours
  • Methadone (less than 30 mg) - 36 + hours

Since Suboxone®/buprenorphine are opiates, isn’t it just trading one addiction for another?

No, with successful buprenorphine treatment, the compulsive behavior, the loss of control of drug use, the constant craving, and all the other hallmarks of addiction vanish.  Since buprenorphine does not have the full effects of an opiate, there is no euphoric high which requires increasing doses to achieve.  In fact, the opposite occurs as the patient is weaned off buprenorphine systematically.  This slow weaning process allows the brain time to heal and for the patient to address, through counseling, the factors that originally triggered the drug use to begin.

Addiction is a brain disease that affects behavior.  This addictive behavior can be devastating to the patient and the loved ones.  It’s not the need to take a medication that is the problem, but rather it is the compulsive addictive behavior to keep taking it despite the harm you are doing to yourself or your loved ones that need to stop.  Whether or not the person takes a medication to help achieve this shouldn’t matter to anyone.  If buprenorphine helps stop the damaging addictive behavior then that is successful treatment and not switching one addiction for another.

Can someone switch from Methadone to Buprenorphine?

Yes. It is best to SLOWLY reduce your therapeutic dose of Methadone to 30 mg a day or less for at least a week, before discontinuing it completely for at least 36 hours before starting Buprenorphine.  You MUST be in mild to moderate withdrawal before you take your first dose of Buprenorphine. If you are doing well in Methadone treatment it may not be advisable to change treatments at all unless you and your doctor determine it is in our best interest.

What if I miss a dose?

If you remember your dose hours later, take it upon remembering it.  If you forget until it is close to the time of the next dose do not take a double dose.  Not because you will take too much but rather you will just be wasting it, due to the ceiling effect.  After being in treatment for a relatively short period of time, you will feel so normal it may be difficult to remember unless you implement taking your medication to a daily activity.

Common Buprenorphine side effects:

  • Headaches – Common remedy for headaches is over-the-counter pain remedies such as Tylenol® or non-inflammatory steroids drugs i.e. ibuprofen with a glass of water. Water alone may be all that’s needed. Opioids can contribute to dehydration and one of the first signs of dehydration is a headache.
  • Constipation – Many medications can cause constipation, especially opioids.  First, try increasing your water along with high fiber.  Stool softeners such as Colace® or Miralax® are options.
  • Dry Mouth – Opioids induce dry mouth which can have expensive consequences.  Preventative oral care along with over-the-counter products such as Biotene®, which has natural enzymes to help normalize mouth conditions, may help to save tooth enamel and prevent costly restoration or infection.

What is Naloxone?

Naloxone is a pharmaceutical ingredient used to treat opiate overdose. It is present in Suboxone® to prevent misuse through diversion.

Why is counseling/therapy an important tool in the treatment process?

Physical connections create pathways in the brain that can be altered when we learn something new.  These changes to the brain can even be documented with medical imagery.  With complex learning activities, such as learning to play a musical instrument, these changes can be permanent.  Addiction is a learned behavior that changes the brain as well.  Through counseling and other behavioral modifications, the brain develops new neural pathways. Changing one’s environment, developing new hobbies and friends, and learning new coping mechanisms will alter the brain in this beneficial way, thereby undoing some of the detrimental changes that occurred while addicted.  Therapy can help recondition the brain closer to its pre-addiction state… helping prepare the patient for a time when they no longer require medication.

Counseling/therapy helps the patient rebuild relationships, repair finances, get a job, assume responsibilities, decrease stress, anxiety and depression and helps the patient make other meaningful changes in their lives.  This will allow you to achieve and maintain addiction remission.

How soon can I return to work?

It is recommended to take the first day of treatment off.  You should be able to return to work the next day with greater attentiveness and clarity than before starting treatment.  The transition from addiction to Buprenorphine is usually painless and most patients experience no adverse physical effects.   In fact, most say that for the first time in years they feel normal again.

What if I need pain medication for surgery or acute pain?

You will be able to be treated for pain with elective dental or surgical procedure.  It is imperative you inform all your physicians you are in a buprenorphine treatment program and give consent for them to contact your buprenorphine provider.  Together they will develop the best pain management plan for you.

Does buprenorphine show up in an employer drug screening?

Buprenorphine has to be specifically tested for and still isn’t commonly included on standard drug screen panels. Buprenorphine will not cause a positive result on tests for other opiates.

Is my medical information confidential?

The confidentiality of alcohol and drug dependence patient records maintained by a program are protected by federal law and regulations.  Generally, the program may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as being alcohol or drug dependent unless:

  • The patient consents in writing;
  • The disclosure is allowed by a court order, or
  • The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or practice/program evaluation.

Are you having legal issues regarding alcohol or substance abuse?

Addiction Recover Center of Virginia is recognized by the Virginia Court systems as a proven and effective treatment option for those individuals that are dealing with the legal ramifications caused by their disease of addiction.  Once thought of as a behavior of choice, substance abuse is now fully understood by the medical and legal community to be in fact, a chronic, even fatal,  disease. As with any disease it must be medically treated and the most effective treatment option for addiction is a combination of a Medically-Assisted Treatment (MAT) Program which is combined with behavioral therapy.

Buprenorphine has to be specifically tested for and still isn’t commonly included on standard drug screen panels.  Buprenorphine will not cause a positive result on tests for other opiates.

Proper Compliance Letters and Paperwork

Patients which follow our program, and are often mandated by the courts or by the recommendation of their counsel or lawyer, will be able to prove their compliance with personal letters completed by our physician. We provide this at no extra charge to the patient.

Our physician, as well as our staff, know what you are going through. Often times, successful treatment is the best option in lieu of incarceration.

Frankly speaking, our courts and jails are inundated with non-violent individuals with substance abuse charges.  Jail is rarely the best answer. A specialized and medically proven treatment for addiction always is.

If you would like to know more please do not hesitate to contact us. Our courteous Administrator or Patient Advocate can help with any questions you have and most appointments can be made the same week.  We look forward to helping you as we always have your “Success In Mind”.

How can Addiction Recovery Center of Virginia help you and your legal issues?

First, your recovery is the most important objective period.  Once you begin our program, you will start to see things in your life return to the way they used to be before your addiction.

Patients that are compliant with our program are required to have one-on-one counseling sessions with our physician each visit.  They are required to attend weekly meetings and you will be required to provide urine drug screens on each visit while in our care.

Some of our patients include:

  • Persons that are pre and post-trial for DUI, alcohol and drug related charges
  • Patients fighting for visitation and custodial rights of their children
  • Individuals that are awaiting the sentencing phase on court charges
  • Employees and business professionals that are facing sanctions at the workplace
  • Spouses that understand the value of a safe and substance free relationship and home
  • Employers that value the importance of a co-worker affected by addiction

Why Medication?

Medication is known as the “tool” which helps reduce or eliminate the cravings associated with drug and alcohol and also provides a safe mechanism to help with the painful withdrawal symptoms of coming off of using.

Why Behavioral Therapy?

Once a patient has started a MAT Program, this is where therapy such as counseling plays a pivotal role in understanding WHY you are addicted and how you can make the changes necessary to finally obtaining the long lasting recovery you deserve.

Did you know that strong evidence, over several decades, has proven that using ONLY traditional abstinence and faith based therapy has an over 95% relapse rate?  Yes, the overwhelming majority of traditional programs including expensive in-patient rehabs have proven to be only short term solutions.

Why do I only see “Success in Mind” on your signs?

To protect your privacy.