| Subject: Re: Buprenorphine |
Author:
Lil' Chilly
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Date Posted: 12:52:59 09/01/03 Mon
In reply to:
Leslie
's message, "Buprenorphine" on 11:19:19 10/10/02 Thu
>On October 8, 2002 buprenorphine in the form of
>Subutox and Suboxone were finally authorized to be
>prescribed via a doctor's office for opiate agonist
>treatment. Physicians need to have training and are
>limited to 30 clients. But this is great news! People
>can now be treated for heroin addiction at a
>physician's office and can get a 30 day presription.
>Clients currently on methadone will need to decrease
>their current meth dose to below 30 mgs. to be able to
>go on the buprenorphine. You can check out the current
>news at www.jointogether.com.
HERE IS AN INFORMATIVE PAPER ON BUPRENORPHINE (SUBOXONE/SUBTEX) FOR MAINTENANCE TREATMENT OF OPIATE ADDICTION:
The Eaton T. Fores Research Center:
Suboxone Resources
Background Information
Suboxone® (buprenorphine with naloxone) is now available for the maintenance treatment of opioid addiction. Suboxone is an orange, hexagonal tablet which is placed under the tongue and allowed to dissolve until it is gone. For it to work, it must dissolve entirely under the tongue. If it is swallowed, it won't work. Furthermore, if it is sucked on, and the saliva swallowed, it won't work. It takes a while for some people to get the hang of taking it sublingually. When you're doing it right, it will usually take about 10 minutes to dissolve. Some people find that it takes 20 minutes, or even more. But it's crucial that it be taken correctly; otherwise, it won't work at all.
Suboxone® comes in tablets of 2 mg and 8 mg, but virtually no one will respond to the 2 mg dose. In general, 8 mg or 16 mg is the optimal dose. Remember, the point of maintenance treatment is for you to be comfortable and free of drug craving – not simply to stop you from feeling utterly horrible, or to control withdrawal symptoms just enough for you to white-knuckle it home. Until you feel truly okay, the dose still needs to be increased. If your doctor does not see things this way, then find another doctor.
A formulation of buprenorphine without the added naloxone exists and is called Subutex®. As of this writing, Subutex® had not been released for shipment and couldn't be bought with a prescription. This is entirely irrelevant, because the Suboxone® formulation, if used as directed, is indistinguishable from pure buprenorphine. The manufacturer's motive for making two different formulations is a matter of conjecture; however, the manufacturer is a large corporation, so you can rest assured that your health had nothing whatsoever to do with its decision.
Suboxone® treatment is supposed to begin with a supervised "induction" phase, during which you take the tablets under the doctor's supervision until you are comfortable. Different doctors do this differently; it is easiest if you can find a doctor who will do it in one visit, allowing you to return to the office about a hour after each dose to see how you are doing. It only takes about four or five hours to find the correct dose. Again, if your doctor wants you to increment the dose only once a week when you visit, find another doctor. You should go home from your first appointment feeling okay, and with enough Suboxone, or a prescription for enough, to hold you until your next appointment. The doctor will initially want to keep the prescriptions small and the appointments close together. This is entirely proper. As time goes by and you continue to be stable, the appointments will get farther apart and the prescriptions larger. In time, you'll get refills and only have to visit occasionally. Buprenorphine is a Schedule III drug, which means that the doctor is allowed to authorize up to five refills in six months. It doesn't mean he has to do this, though, and seeing the doctor only once every six months is something that's not likely to happen. Don't worry about it. Just keep in mind that you will never have to wake up sick again. That's the most important thing, isn't it?
Although Suboxone® can be used for detoxification, its intended use is for maintenance. If your doctor has a problem with the idea of maintenance, and is going to insist on detox, again – find another doctor (unless, of course, detox is your goal). The ideal candidate for maintenance treatment, in most doctors' eyes, is someone who is older, has been on drugs since early in life, has a job, has tried and failed detox, NA, rehab, and other things, and simply wants to lead an ordinary life, free from having everything center around getting and finding drugs. Many long-time druggies will be stunned at first to discover that Suboxone® is the first prescription for a controlled substance they've ever had which still has some left in it when it's time for the next prescription.
How To Locate A Doctor
Not every doctor can prescribe Suboxone®. The doctor needs to be specially certified, and to have a special DEA number, and each doctor is only allowed to have a maximum of 30 patients on Suboxone®. Below is a link to the Substance Abuse and Mental Health Services Administration's (SAMHSA's) physician locator. This page will allow you to click on any State on the map and get a list of doctors in that State who are certified to prescribe Suboxone.
Remember that you may have to go through a few doctors before you find one you are compatible and comfortable with. Some listed and certified doctors don't believe in maintenance treatment at all, which makes one wonder why they are listed and certified in the first place. All things considered, however, finding a good doctor is not nearly as difficult as it has been made to sound in some places.
How To Find A Pharmacy
So, you've found a good doctor, gone to your appointment, gone through being induced, and now you're feeling comfortable and leaving the office with a prescription in your hand. How are you going to fill that prescription? If you're an older person, whose drug habit is a secret, you might not want to go to the pharmacy that fills your kid's Augmentin and hand them the script. Why not? Well, Suboxone® is only allowed to be used for one thing – handing that script to the pharmacist is like handing him or her a note that says, "I'm a heroin addict." Depending on your feelings about privacy, you may or may not want to do this. Perhaps you'll see a doctor a bit of a drive from home, and fill your prescription near his office. This can get tiresome too, when you have to travel so much just to get your medicine. Best of all is if you're able to not care, and simply fill it at a regular pharmacy near home. But some people, despite their addiction, may have attained a place in the community from which they'd be justly afraid to have word of their condition spread around – and confidentiality, alas, is never what it's supposed to be (ever been in line at the pharmacy when the pharmacist screams out, "MRS. WILLIAMS, YOUR PROZAC IS READY?" Maybe you don't want to risk such a scene). You just have to make the best arrangements you can about these matters.
Then there is the question of simply finding a pharmacy that can fill your script. Regardless of what anyone tells you to the contrary, any pharmacy can order your medicine and have it be there the next day, if the pharmacist is willing to do it. If the pharmacist won't fill it because he thinks junkies are scum, go to a different pharmacy. If he can't fill it because he's never heard of it and has no idea where to order it, then just have him call the toll-free number the manufacturer has set up to direct pharmacies to wholesalers who can supply Suboxone®. That number is
1-877-SUBOXONE
Below are some useful links on the subject of buprenorphine and maintenance:
Suboxone® Complete Prescribing Information
FDA Questions and Answers about Suboxone®
"FDA Talk" Paper on Buprenorphine for Opioid Dependence
Information for Pharmacists Regarding Suboxone®
Summary and Complete Text of the Drug Addiction Treatment Act of 2000 (DATA)
ETFRC Political Comments on the Drug Addiction Treatment Act (DATA)
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