Tag: buprenorphine

Why are Federal Agencies Officially Recommending Suboxone & Methadone?

The New Standard for Treatment

In a move that’s sure to raise more than a few eyebrows, SAMHSA has officially endorsed medication-assisted therapies (also known as opioid replacement therapies).

substance abuse and mental health servies adminstration
via

While they’ve long been supporters of buprenorphine (Suboxone and Subutex) and methadone, the Substance Abuse and Mental Health Services Administration recently added wording to their grant application that strongly encourages treatment centers to make use of these medicines – or else.

This new language can be found in SAMHSA’s 2016-2017 block grant application. If you’re wondering, like I was at first, just how much this comes out to – it’s a lot. They have awarded, or still will, just shy of $2 billion this year.

That astounding sum of money certainly ups the ante for SAMHSA’s recommendation. It also brings them up to speed with the rest of the federal government and the majority of the medical establishment.

White House drug czar Michael Botticelli – a man in long-term recovery himself – has pushed medication-assisted therapies for years. He even hinted earlier this year that SAMHSA would be updating their guidelines to reflect what federal drug courts have in place (an emphasis on using opioid replacement therapies).

Find out exactly what SAMHSA changed their grant language to below!

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What SAMHSA is Saying

While it’s a bit long and wordy, the official language of the 2016-2017 block application grant follows. You can also view it directly on the grant portion of SAMHSA’s site.

There is a voluminous literature on the efficacy of [Food and Drug Administration]-approved medications for the treatment of substance use disorders. However, many treatment programs in the U.S. offer only abstinence-based treatment for these conditions. SAMHSA strongly encourages the states to require that treatment facilities providing clinical care to those with substance use disorders be required to either have the capacity and staff expertise to use MAT or have collaborative relationships with other providers such that these MATs can be accessed as clinically indicated for patient need. Individuals with substance use disorders who have a disorder for which there is an FDA-approved medication treatment should have access to those treatments based upon each individual patient’s needs.

It’s important to note a few things before going on to explore just what this means for the future of the addiction treatment industry.

First, as a senior SAMHSA official pointed out, these are recommendations and nothing more. When a state is awarded a federal grant, it’s still up to them to spend it how they want. If Florida, for example, received a 2016-2017 SAMHSA grant, they would be under no obligation to mandate individual treatment centers make use of buprenorphine.

Still, this change in wording makes it appear that SAMHSA’s going to give preference to states that use opioid replacement therapy.

Second, even if federal block grants aren’t directly tied to states using medication-assisted therapies, some discretionary grants are. According to Anne Herron, the senior SAMHSA official mentioned above, the agency has began to include language in their discretionary grants that makes it mandatory for states to use buprenorphine and methadone.

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Does This Mean Everyone in Rehab is Going to Be on Suboxone?

That’s the question that’s being asked by many in the treatment industry. If a national agency like SAMHSA is increasingly making their grants conditional upon opioid replacement therapies – are federal and state funded rehabs going to medicate all their patients?

That answer isn’t as easy as simply saying yes or no, but the short answer is no.

Just because a treatment center makes use of medication-assisted therapy doesn’t mean they’re going to be pumping all their patients full of Suboxone or methadone. While it’s easy to image that as a worst-case scenario, it just isn’t likely to happen.

these pills arent suboxone or methadone but they look like them

Rather, the federal government’s shift towards embracing “science rather than ideology” signals a few things.

First, buprenorphine, methadone, and the like will largely be used during detox. Second, certain patients will likely remain on them throughout treatment and into their long-term recovery. Still, this is probably only going to happen if the patient meets a number of criteria.

In other words – the government isn’t saying that everyone in recovery should be taking buprenorphine. Far from it. They’re encouraging states and treatment centers to embrace what science has shown for some time – that, in certain cases, medication can have a positive impact on an individual’s recovery.

Sounds good to me. What do you think? Let us know on social media!

Are you sober if you take methadone?

Is Suboxone REALLY Effective at Blocking Heroin & Painkillers?

How Long Does Suboxone Last?

Medication assisted therapies, opioid replacement therapies, methadone and buprenorphine maintenance…there are a lot of options when it comes to using medicine to recover from addiction.

how long does suboxone last for
Suboxone packaging via Wikimedia Commons

The most popular option over the past several years has been, by far, Suboxone maintenance. With dedicated buprenorphine doctors and “sub clinics” opening all over the country, it may seem like everyone is on Suboxone.

While this isn’t the case, it is a first line of attack for many in the addiction treatment field. Still, Suboxone doesn’t come without downsides. For the sake of brevity, we’re only focusing on one here – how long does Suboxone last?

This question, while seemingly simple, is actually fairly complex. To figure out how long Suboxone lasts, we need to look at a variety of factor, including Suboxone’s half-life, what other medication a patient is taking, and how long Suboxone blocks opioids for.

This last part, how long Suboxone blocks opioids, is vital to understanding how long it lasts. That is to say – while buprenorphine may work in an individual’s body for hours, how long does it actually block opioids for?

Without further ado, let’s take a look at the half-life of Suboxone and what impact it has on the question “how long does Suboxone last?”

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Suboxone’s Half-Life

Before we get into the scientific stuff, let’s first define half-life (just kidding, this is all scientific…apologies in advance). Simply put, half-life is how long it takes for the body to metabolize and eliminate half of a given chemical. There’s also something called “steady-state,” which is when the amount of a particular substance is balanced fifty-fifty between coming in and going out.

It’s important to note that when someone takes a medicine regularly, say a daily dose of Suboxone, the half-life becomes longer. This is due to the chemical building up in tissues, organs, etc.

So, how long does Suboxone last? How long is Suboxone’s half-life? Well, it ultimately depends on the individual taking the drug. Generally speaking, the half-life of Suboxone is between twenty-four and forty-eight hours. That’s just a ballpark estimate though.

Depending on how long an individual has taken buprenorphine for, the dose, how frequently they take it, their weight, their metabolism, and any other medications (legal or illegal) they may be taking…that number can change.

So, for example, Suboxone may last for longer, and have a greater half-life, if someone is taking eight milligrams daily, has been for years, and is overweight. It may have a shorter half-life if they’re taking two milligrams every other day.

It’s also important to note that Suboxone may still block opioids even if it has a short half-life in a particular individual.

Having explored the basics about Suboxone’s half-life, let’s turn our attention fully to how long Suboxone blocks opioids for.

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How Long Does Suboxone Block Opioids?

How long Suboxone lasts is a tricky question when it comes to blocking opioids. In other words, as mentioned above, it may last for hours, but only block the effects of narcotics for a short period of that time.

How long does Suboxone block opioids for? Well, generally speaking, it blocks them for around one day. This time can be significantly longer, though, depending on a variety of factors. Again, things like dose, frequency, weight, and metabolism come into play.

Suboxone can block opioids for as long as three days. Although that’s rather rare, it has happened. It’s interesting to note that it’s not only the naloxone in Suboxone that blocks opioids for so long. Buprenorphine itself is a potent chemical and binds tightly to opioid receptors in the brain.

So, how long does Suboxone lasts? How long does Suboxone block opioids? It all depends on the individual, but generally speaking it’s one to three days.

If you’re struggling with painkiller or heroin abuse, reach out for professional help. Suboxone maintenance is one way to go, but why not explore all available options? Call Lighthouse today to learn about alternatives to buprenorphine!

People are overdosing and government officials don’t know why…

The Ugly Truth about Suboxone Withdrawal

Suboxone Withdrawal

Getting off Suboxone stinks. That’s the simple truth about coming off this opioid. Suboxone withdrawal symptoms are unpleasant and last for longer than “normal” opioid withdrawal. Subutex withdrawal isn’t much better (I explore the differences between the two below).

I say this as a former addict and someone who now works in addiction treatment. You’ll get a lot of opinions about Suboxone withdrawal. There’s the good, the bad, and the ugly.

suboxone withdrawal symptoms
via Wikimedia Commons

I think it’s important to emphasis the bad and the ugly, as well as the good, to give everyone an accurate picture of what buprenorphine (Suboxone’s chemical name) withdrawal is really like.

So, let’s get right into it. Find out the truth about Suboxone detox below.

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Suboxone Withdrawal Symptoms

Suboxone withdrawal symptoms aren’t pleasant. Truth be told, many addicts continue using simply to avoid the pain of detox. I know that was a driving force for me. After starting Suboxone and Subutex for “management” of my addiction, I found myself just as physically hooked as when using heroin.

Personal experience aside, find a list of various Suboxone withdrawal symptoms below. Remember though, everyone reacts differently to drugs. You may not experience all of these Suboxone detox symptoms.

Common Suboxone Withdrawal Symptoms include:

• Insomnia

• Irritability

• Sweating & Shaking

• Nausea & Vomiting

• Diarrhea

• Restless Leg Syndrome

• Anxiety & Depression

• Muscle, Joint & Bone Pain

• Raised Blood Pressure (Hypertension)

• Raised Heart Rate (Tachycardia)

The best advice I can give for helping manage the above Suboxone withdrawal symptoms is to seek professional help! This can be from a doctor, a hospital, a detox, or an addiction treatment center.

Remember, the actual Suboxone detox is only your first step towards recovery. There’s much more introspection and self-searching that needs to be done. Don’t suffer alone. Help is only a phone call away!

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Suboxone vs. Subutex Withdrawal

There’s an important distinction to make between Suboxone and Subutex withdrawal. Although these two drugs sound similar, and in fact are very similar, they have slightly a different chemical make up and detox symptoms.

Suboxone is a brand name pill made up of a mixture of buprenorphine and the opioid antagonist naloxone (commonly referred to as Narcan). The combination of an opioid and an “anti-opioid” is to deter abuse. Suboxone is available as a tablet, an injectable solution, and a sublingual film.

Subutex, on the other hand, is pure buprenorphine. It contains no other active chemicals. This makes it slightly more addicting than Suboxone, as well as, in theory, harder to detox from.

We’ve laid out common Suboxone withdrawal symptoms above, but what about Subutex withdrawal? How does it compare to its chemical cousin? Does it produce a worse detox or a milder one?

how to get off suboxone
via Wikimedia Commons

Well, having abused both AND used both to help wean myself off heroin, I can safely say that Subutex withdrawal is milder than Suboxone withdrawal. I don’t know why. All signs point to Subutex detox being worse…but it isn’t.

I experienced fewer symptoms during Subutex withdrawal and it was shorter. Probably the most notable difference was my anxiety level. On Suboxone, and detoxing from it, my anxiety was through the roof. With Subutex, on the other hand, I had minimal anxiety. This was true even during the soul-crushing period us addicts call detox.

I couldn’t tell you why. Better minds than mine may be able to. All I can offer is my experience, strength, and hope. Speaking of hope, let’s shift our attention to how to get off Suboxone once and for all!

Why is the government pushing the use of Suboxone in drug courts?

How to Get Off Suboxone For Good!

Having explored common Suboxone withdrawal symptoms and the difference between Subutex and Suboxone detox, the only area left to cover is how to get off Suboxone.

While this question may seem like a no brainer, it’s a bit trickier than simply detoxing and calling it a day. Addiction, be it to Suboxone, heroin, cocaine, or anything else, requires time and treatment to overcome. It requires a physical care component, a mental health component, a life skills component, and a spiritual health component.

In short, it requires something called Comprehensive Addiction Treatment. Thankfully, that’s the banner that we operate under at Lighthouse Recovery Institute. We offer comprehensive addiction treatment in a gender-specific setting. This allows for mental and emotional growth that’s unparalleled.

You want to know how to get off Suboxone? Simple – seek out the best professional help available. Will that make getting off Suboxone easy? Nope. It will, however, make it possible. And possible, ladies and gentleman, is the first step towards health and happiness. Remember, we can all change!

Why are Some People Going to Rehab in the ER?

An Exciting New Way to Treat Addiction!

A team of researchers from Yale University may have just discovered the magic bullet in treating opioid addiction! Okay, that’s a bit over the top, but a recent study from Yale does highlight a new and highly effective type of addiction treatment.

opioid addiction treatment emergency room-min

Dr. Gail D’Onofrio, the Chair of Emergency Medicine at the Yale School of Medicine, and Dr. David Fiellin, a Professor of Medicine, led this study published in the Journal of the American Medical Association. They examined over 300 patients seeking emergency medical attention for addiction related reasons (things like overdoses or abscesses).

Normally, when an individual ends up in the ER for these reasons, they’re stabilized and given a referral to an addiction treatment center. Maybe they’re kept overnight, or even for a day or two, but that’s it.

Dr. D’Onofrio and Fiellin’s study, however, kept patients in the ER for an extended period of time, gave them the maintenance drug buprenorphine (also known as Suboxone or Subutex), and then followed up with time in rehab.

What was the outcome of this varied approach? Was it effective in helping individuals recover from addiction? More importantly, how does it compare to the “traditional” emergency room experience? Find out below!

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The Surprising Results

The results are in and it looks like Dr. D’Onofrio and Fiellin may have changed how opioid addiction is treated in America. Again, that’s a bold claim and perhaps a bit hyperbolic. The numbers don’t lie though and these numbers are looking good.

D’Onofrio took patients in emergency rooms for opioid related reasons and divided them into three groups. The first group received the traditional ER response – stabilization and a list of local treatment providers. The second group received a more personalized response – stabilization, a “motivational consultation,” and a referral.

In the third group, however, things got interesting. These patients received a “brief intervention,” were introduced to buprenorphine treatment, and continued this treatment in a primary care setting. They were also involved in various forms of addiction treatment (residential, partial hospitalization, and outpatient levels of care).

So, which group did best and how, for that matter, do we even measure “best?” Well, the classic test is abstinence from illicit opioid use. It’s important to remember that this doesn’t mean only using heroin or illegal opioids, but also abusing painkillers or even abusing the buprenorphine they’re prescribed.

As for which group did best, Dr. D’Onofrio had the following to say, “The patients who received ED-initiated medication and referral for ongoing treatment in primary care were twice as likely as the others to be engaged in treatment 30 days later…They were less likely to use illicit opioids of any kind” (Yale News).

Twice as likely! In a world where sobriety is measured in single digit numbers, “twice as likely” is pretty amazing. Now, it’s important to remember D’Onofrio isn’t talking only about sobriety, but rather about patients continuing to seek addiction treatment.

Still, this certainly shakes up the world of addiction medicine and treatment. Dr. Patrick O’Connor, a Professor of Medicine and Chief of General Internal Medicine at Yale, had the following to say about these developments,

“Effectively linking ED-initiated buprenorphine treatment to ongoing treatment in primary care represents an exciting new model for engaging patients who are dependent on opioids into state-of-the-art care” (News Medical).

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Too Good to be True?

Dr. D’Onofrio and Fiellin’s research may well herald a new approach to treating heroin and painkiller addiction. That being said, let’s take a closer look at what exactly is going on. After all, buprenorphine treatment isn’t without its critics.

This study measured the percentage of patients who sought addiction treatment after a drug related ER visit. Of the three groups studied, the group that received buprenorphine was most likely to end up in treatment and maintain abstinence.

The two immediate questions this raises, in my mind anyway, are how important is seeking treatment and can time spent on buprenorphine be considered abstinence?

suboxone in the er-min

So, how important is seeking treatment for drug or alcohol addiction? Very important! Perhaps a better question would be – is this a valid way to measure “success?” I’m not so sure it is.

Success should be defined by how well an individual responds to whatever type of treatment they’re receiving. After all, thousands, even hundreds of thousands, of people end up in treatment each year. Are they all “successful?” In some ways certainly, but in many others they’re not.

This brings us to the second question, is someone sober if they’re on buprenorphine? Again, I’m not so sure. Yes, buprenorphine is very different from most opioids. It’s still an opioid though. Those on it are still having their opioid receptors saturated by the drug.

I think the choice about whether to take buprenorphine comes down to, ultimately, an individual, their doctor, and a God of their own understanding. That is to say, what’s right for me may not be right for others. Still, it’s usually better to try true abstinence first. If that doesn’t work, then perhaps buprenorphine will.

Regardless of the questions raised above, I think we can all join together and view this new research as positive. After all, anything that can help fight the opioid war is a good thing.

Narcan helps fight overdoses…but is it enough?

Federal Government in Favor of Suboxone

A New Approach to Drug Court

In a move that’s sure to ruffle some feathers, the federal government is throwing its weight around to make Suboxone mandatory in many drug courts.

According to Michael Botticelli, the Director of the White House’s Office of National Drug Control Policy, the government will begin to cut off federal funding to drug courts that ban Opioid Replacement Therapies. These are things like methadone and Suboxone maintenance.

government suboxone regulations

Botticelli is quoted as saying,

“Part of what we’ve been working on at the federal level is to strengthen our contractual language around those grants…if you are getting federal dollars that you need to make sure that people, one, have access to these medications [and two], that we’re not basically making people go off these medications, particularly as a participant of drug court” (Huffington Post).

Meanwhile, Pamela Hyde, a senior administrator from SAMHSA, is quoted as saying, “We’ve made that clear: If they want our federal dollars, they cannot do that [ban opioid therapy] … We are trying to make it clear that medication-assisted treatment is an appropriate approach to opioids” (Huffington Post).

The White House’s collaboration with SAMHSA is the first step in an expected widespread reform of US drug policy. Targeting drug courts that have banned Suboxone and the like is the beginning of a new chapter in how addiction is treated in America.

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The Current State of Suboxone

Suboxone, which goes by the chemical name buprenorphine, is a semisynthetic opioid that behaves in interesting ways. It’s both an opioid agonist and antagonist. This means it simultaneously activates and deactivates the brain’s opioid receptors.

In layman’s terms, buprenorphine eliminates cravings, while at the same time preventing withdrawal and the euphoric effects of opioids (if someone tries to relapse while on the drug).

It’s currently tough for addicts to get a prescription for Suboxone. This is based on federal regulation of the drug, which is classified as a Schedule III narcotic. In order to prescribe buprenorphine, doctors must have a special certification. They’re also limited to treating 100 medication assisted therapy patients at a time.

According to a prosecutor from Ohio, who spoke to the Huffington Post, changing Suboxone use in drug courts is more complicated than the federal government updating funding regulations. The prosecutor said,

“…whether we permit Suboxone use or not [by defendants] is irrelevant if no local doctor is willing or able to prescribe it. And our clinicians feel that Suboxone is unlikely to be effective in this community with the lack of integration in the health care system. Even if we were to allow participants [in drug court] to use Suboxone, there would have to be significant structural changes before it would be recommended” (Huffington Post).

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A Shifting Landscape

So, how are these “significant structural changes” going to be made? Well, in some cases, Washington is receiving help from state governments.

drug court

Minnesota State Senator Chris Eaton has picked up the torch of Suboxone reform on a state level. Senator Eaton’s daughter passed away from a drug overdose in 2007. Since then, Eaton has been campaigning to change regulations around Opioid Replacement Therapy, both in drug courts and on a statewide scale.

Further evidence that “significant structural changes” must be made comes from the very way drug courts are funded. In some instances, drug courts may not have to implement new government policies regarding buprenorphine due to the fact that many drug courts are state funded, rather than receiving federal dollars. These courts can choose to implement or ignore federal guidelines at their own discretion.

Will the federal government ever be able to impose new regulations around drug courts and the therapies they allow? That remains unclear. What is clear, though, is the change that does need to be implemented.

It’s no hyperbole to say America is in the midst of an opioid epidemic. The federal government is attempting to change that. They’re attempting to shift the tide in the fight against painkillers. And everyone, regardless of politics or personal beliefs, can appreciate that.

Learn more about Opioid Replacement Therapy

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