Dennis, what is suboxone treatment?
Suboxone is a treatment that is used for treating patients who are addicted to opiates. The FDA approved Suboxone, which is the brand name for the drug buprenorphine, in the year 2000. This drug is used on an outpatient basis; it is prescribed from individual practitioners. Patients come back from week to week, some cases on a monthly basis to be prescribed this drug. This drug can be used for two purposes: one, for the detoxification or maintenance.
Is is addictive?
Suboxone is addictive. It is a partial agonist, in other words, it does not have the full range of attributes as a full agonist opiate such as heroin, morphine or methadone. It is addictive. If you stay on this drug for a long time you will become dependent on this drug. However, used in a brief period of time, managed properly, this drug can very gently help a patient go from a full agonist opiate on an all out dependency slowly detox and then in that case, the drug is very useful.
Dennis a lot of patients come from pain management clinics and have been put on very high doses of narcotic medications to control their pain. Is is effective in treating pain?
Yes it is, it's actually a very powerful analgesic. The drug buprenorphine is used currently in the form of buprenex which is an injectable form that is used preoperative situations. It is not approved in tablet form currently for pain. However in Europe for 20 years, buprenorphine has been used for pain.
What is it like coming off?
I might add on that previous question that suboxone can be used to treat pain actually very effectively because it is much more stable than short-acting opiates because of the fact that it has a long half life. Many patients that we have treated at our clinic that have had chronic pain conditions and used full agonist opiates such as oxycodone have found that suboxone is a much easier drug to be managed on, there are not the up's and down's. Again, the long-term picture is that dependency can happen, but when you put it next to full agonist opiates it can be very useful in a pain management situation. Suboxone in long term usage typically is not as intense as full agonist opiate withdrawal. However, both types of drugs have two periods of withdrawal: an acute withdrawal period and a post-acute withdrawal period. Typically, buprenorphine, or suboxone does have a longer post acute withdrawal period and a level of intensity in those post-acute withdrawal symptoms can be more severe; however, they can be managed with proper medications.
What medications are used in this detox?
There are medications to control every aspect; again what we are focusing on is post-acute withdrawal syndrome, or PAWS as it's called, and I will add that post-acute withdrawal syndrome is what most patients relapse on because they succumb to the temptation, the not feeling well and the symptoms that seem to linger. The primary focus of post-acute withdrawal syndrome is to treat the patient's inability to sleep. Insomnia is probably the worst symptom. And when patients don't sleep, the whole aspect and dimension of the withdrawal during the day seems to be amplified because of this lack of sleep. We use a host of different medications; if one doesn't work, we try two or we switch medications. Drugs such as Ambien, Remeron, Trazodone are drugs that can be used to help induce sleep. Other medications that we may use are Valium, diazepam, seems to be an amazing ability to control withdrawal symptoms during the day. Obviously a patient will have to be mildly sedated, so we will have to take that into consideration. We use a therapy of amino acids; there are various amino acids that work to build the brain back up. Amino acids being protein building blocks that promote neurochemistry health, or neurohealth. We use amino acids from the beginning of the detox period and all the way through and well after the suboxone has been used. We may even use some mild opiate-like substances in the initial periods such as tramadol, darvocet… You actually distance the patient from the suboxone. And then there are certain vitamin deficiencies that happen, and we seek a vitamin regimen that will replenish what has been depleted. So there's lots of tools that we have today to use, at the doctors disposal, and when you're making your choice of clinics you want to make sure that the doctor is well versed in treating post acute withdrawal symptoms. The last thought on post acute withdrawal is that this is a syndrome that can last almost up to a year. Some patients found this to be very debilitating; some of the post acute withdrawal symptoms that are most identifiable are insomnia, anxiety, inability to handle stress, depression. Depression is something that has to be handled with various antidepressants; that's something that we would possibly consider prescribing for patients. So this period of post acute withdrawal is critical for the patient to get through.