Category Archives: Buprenorphine

Buprenorphine and Liver Health

methadone-safe-for-liverJana Burson is a North Carolina physician who specializes in the treatment of opioid addiction using medications like buprenorphine and methadone. Dr. Burson is a passionate caregiver and patient advocate with considerable experience in the field of addiction treatment. She maintains an informative blog on the topic of opioid addiction treatment and recently posted her comments and observations on a revealing 2012 study.

The 2012 study by Saxon et al is reported in her blog to have followed more than 700 patients over 24 weeks who were receiving either methadone or buprenorphine (the active ingredient in Suboxone). These patients were checked for specific red flag elevations that would suggest emerging liver damage or liver inflammation. None of the patients receiving methadone or buprenorphine had significant abberations in liver functioning. This led the researchers to conclude that neither medication causes liver damage.

A 2014 follow-up study by Soyka and others (published in the American Journal on Addictions) found the same results in their research of 181 patients on Suboxone (buprenorphine + naloxone).

Studies like these help to dispel misinformation around opioid treatment medications and their safety. Dr. Burson expressed that it was once routine to order liver function tests for patients on buprenorphine therapy, but that this is likely unnecessary given the more recent research validating methadone and buprenorphine’s safety in regard to liver functioning.

There are addiction-related illnesses, like Hepatitis C, that can have highly detrimental effects on the liver. According to Dr. Burson, the Soyka study also showed that buprenorphine was not harmful even in patients diagnosed with Hepatitis C.

Thorough research studies like these are important in further legitimizing the benefits & established safety profile of opioid treatment medications. Having access to safe medications helps hundreds of thousands of people find effective treatment for chronic opioid addiction.

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Methadone or Suboxone

addiction-is-treatable-2A common question among those seeking help is whether methadone or suboxone is the best choice for opioid replacement therapy. It reminds me of the age old debate … which is better, Ford or Chevy? Methadone has been used in opioid addiction treatment for about 45 years. Suboxone has been available to the public for 12 years. Each of these medications has been shown, through conclusive research, to be highly effective in eliminating opioid withdrawal. Both methadone and suboxone achieve a similar outcome, but with subtle differences. [view our comparison chart]

When opiate withdrawal symptoms are no longer a daily preoccupation and source of anxiety, individuals are free to invest their energy & time in productive, meaningful activities. Avoiding withdrawal sickness is the single greatest driver of continued opioid use, and often pushes an individual to desperate measures to maintain a supply of opiates so that they will not get sick.

People unfamiliar with addiction sometimes believe that an addicted person “just wants to get high”. To the contrary, most people with a chronic opioid addiction are just trying to get by, to get through the day without becoming sick all over again. Opioid withdrawal sickness is an exhausting roller coaster ride that rarely slows down long enough to allow an individual to escape. Their relief from opioid withdrawal sickness is typically short-lived, and they then begin feeling sick all over again. Quite a vicious cycle.

This is why suboxone (buprenorphine) and methadone are so valuable as a medical treatment for opioid addiction. These synthesized opioid replacement medications have a slow onset, long duration of action. This means that they don’t quickly spike to maximum levels in a person’s bloodstream like heroin. They reach maximum benefit several hours after they are taken. They then remain active in a person’s system for more than 24 hours and consequently keep painful withdrawal symptoms away. With no fear of being sick, a person can finally live their life and refocus their time where it needs to be: work, school, family, home, etc.

Methadone is a full opioid agonist whereas buprenorphine (the active ingredient in suboxone) is a partial opioid agonist. Because suboxone is a partial agonist, it is somewhat less susceptible to causing overdose and is considered easier to taper off of as individuals lower their daily dosage. As a result of methadone being a full opioid agonist, it is typically more effective with severe, long-term opioid addictions. Suboxone has a peak benefit at 24-32 mg per day whereby higher dosages than this will not produce additional withdrawal relief. However, methadone has no such “ceiling effect” and much higher dosages can be utilized as needed to eliminate a patient’s opioid withdrawal.

Welcome Access Recovery Solutions

ars-locationAccess Recovery Solutions (ARS) Delray Beach is a newly opened outpatient opioid treatment program that offers both methadone and buprenorphine. They are a member of Addiction Medical Solutions who have other methadone clinics across the country.

ARS specialize in medication assisted treatment and have a unique Maintenance to Abstinence program designed to assist patients in eventually becoming free of opioid medications once they have experienced a period of stability. The program is built on a two year continuum of care treatment model.

The ARS clinic provides individualized treatment planning for patients, and their counseling approaches include cognitive-behavioral and motivational approaches up to and including an intensive outpatient program (IOP). IOP is a SAMHSA endorsed, evidence-based addiction treatment that is in widespread use across the United States due to its effectiveness in helping patients learn about and apply effective recovery tools.

ARS offer a variety of other programs and services to serve the Delray Beach community including a Speakers Bureau. With advance notice, the company can provide speakers to educate professionals and non-professionals on substance use disorders and addiction issues. Interested parties can reach the organization at: 561-865-2550. The contact person for ARS Delray Beach is Mike Errico.

ars-delray-beach-florida

Family Support of Methadone Treatment

methadone-treatmentWhen patients enter treatment for opioid addiction, their families are usually relieved yet apprehensive. They may have seen previous recovery efforts not be sustained and their loved one return to active substance use. So, families often learn to be cautiously hopeful.

With methadone treatment, there is a new component in the recovery process with the addition of medication assistance. Whether it’s methadone or suboxone, families become curious as to how their loved one will handle this new medication. As most readers know, there is considerable misinformation and misunderstanding about what methadone can accomplish. This leads a patient’s family supports to sometimes have a wary attitude toward methadone or suboxone.

I would like to share two stories that illustrate how family attitudes can shift. The first patient we’ll call Mary to maintain her anonymity. Mary was a local realtor who had developed an opioid dependence. She had been able to conceal her addiction from her parents, but finally reached a point where it became evident that something was seriously wrong. She told her parents that she was entering “treatment” and would be attending counseling. They supported this decision, but were unaware that Mary’s treatment would include opioid replacement therapy.

Mary had one relapse early in treatment, but made the necessary adjustment and remained drug free for the next 12 months. Methadone worked extremely well for her eliminating her opioid withdrawal and erasing her fear of being sick. Through counseling, her coping improved and her perspective on living a full life returned. She blossomed before everyone’s eyes with improved mood and energy, mental focus, and a renewed spirit. She interviewed with several real estate agencies and was hired by a prominent national realty company. Mary was both excited and grateful.

After this first year, she approached our staff and asked for assistance in telling her parents that she was in “methadone” treatment. She was concerned that they may not understand how important a role it had played in her success and she wanted some back-up from professionals who could answer all her parents’ questions. Mary was also considering a switch from methadone to suboxone with the intention of tapering down off suboxone over several months.

Her parents came to the treatment center and met with Mary, myself, and our nurse. Mary reviewed her progress with her mom and dad and then told them that she had been receiving methadone each day as part of her treatment. She explained how it had assisted her and then asked staff to help elaborate. Her parents listened as we discussed how methadone was an approved medication and had been successful for many years in helping opioid addicted people change their lives. Mary’s mother responded saying “We knew something was working for her. We are so grateful she found you. We have no problem with the methadone and we will support Mary with this.” We went on to discuss her thoughts on transitioning to suboxone and how this might be accomplished. Her parents talked that day about the huge change they had seen in their daughter since coming into treatment and how much it meant to them to see her happy again and getting well.

After the meeting, Mary literally beamed with relief that her parents had been understanding and so supportive. Within the next month, she switched to suboxone and began tapering down over the next four months eventually becoming medication free. Methadone and counseling became the roadmap to safety and sobriety for Mary. It also stabilized her to the point that her skills and abilities as a real estate professional could again be used to build a new future for herself by generating significant income.

The next case example is about a woman we’ll call Sarah. Sarah came to our agency seeking methadone treatment after several years of heroin addiction that had recently worsened. Amazingly, she was still working full-time although she was exhausted and emotionally depressed. She began treatment and within three months barely resembled the person that had been admitted to our program. She gained weight. The light returned to her eyes and her smile. Her mental clarity improved dramatically, and both staff and patients remarked how her personality had surfaced. Sarah had been fatigued and depressed for so long that it was as if she was buried inside herself covered by layers of pain, and tired from the battle of fighting her addiction.

We watched her come back to the person she truly was. We discovered that Sarah was actually a human dynamo and a very capable person who had been struggling under the massive weight of a chronic heroin addiction. As she progressed through treatment, she met many milestones of success. In due time, she informed her parents that she had been receiving methadone and explained to them how helpful the medication had been. I had a phone conversation with Sarah’s mom who lived in another part of the state. She explained that she did not know much about methadone, but was very appreciative for what we had done for her daughter. As a great job opportunity had surfaced in the hometown of Sarah’s parents, she relocated to their town and transferred her treatment to a clinic there.

Two months after Sarah moved, we received a huge fruit basket in our office from her parents thanking us for being a support to her and informing us that Sarah was doing beautifully.

These are true stories and examples of methadone’s beneficial role in recovery as well as illustrating that family fear can be replaced by understanding & family support. These examples show a stark contrast between what a person looks and feels like when they first arrive vs. how far one can go once they become stable on methadone and moving forward on the path of recovery.

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Methadone Treatment Services

methadone-treatment-resourcesWhen one thinks of methadone treatment, they usually consider the power of methadone to eliminate opiate withdrawal and the value this has to someone fighting off withdrawal sickness.

Methadone treatment actually consists of more than just the “medication assistance” component. Real treatment always addresses the underlying lifestyle, thinking, and behavioral elements that are a significant part of the addictive process. These areas are specifically addressed through counseling. All opioid treatment programs providing methadone in the United States are required to also offer counseling to their patients in order to help them achieve true and lasting success.

Some patients will need more counseling & emotional support than others. But all patients new to the recovery process will need to receive basic education on addiction as an illness, how to build a personal recovery program, and to have an opportunity to develop new coping and relapse prevention skills.

Methadone clinics in the U.S. vary in the ways that they deliver counseling services. Some programs are heavy on individual counseling while some focus more on a group therapy model. Often, programs will provide a blend of the two with optional family or collateral participation available as needed.

There is another important consideration with methadone treatment pertaining to the need to also treat “co-occurring disorders”. Co-occurring disorders consist of other psychiatric symptoms that merit special interventions and additional care. For example, many individuals dealing with an opioid addiction may also have struggled with chronic depression or anxiety. Unless these disorders are treated effectively, they can become stumbling blocks on the road to recovery, and can undermine a person’s sobriety success.

A number of methadone programs have in-house psychiatric services to address co-occurring disorders and to provide additional medications and/or therapy if required. Opioid treatment programs that do not have psyc services will typically refer a patient out to the local mental health center or a private provider who specializes in psychiatric care.

Methadone treatment has at times been presented as a harm reduction approach to dealing with severe addiction. In other words, reducing a person’s risk of overdose or exposure to other illnesses is a worthwhile goal. However, “harm reduction” alone does not represent all that recovery truly offers. There are many people who have found life long recovery through their introduction to methadone treatment. After becoming drug free, they went on to have families, start businesses, develop new careers, and enjoy a full life in the best sense.

The possibilities are limitless in recovery. Addiction is treatable. Methadone can be an important piece of the recovery journey. For many thousands of patients, it was the new start that they had hoped for.

Suboxone Facilitates Safety and Recovery

suboxone-doctorSuboxone is a leading medication in the treatment of opioid dependence and has been available since 2002 when the FDA approved Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride).

Suboxone tablets have since been replaced by the thin sublingual suboxone film that is also dissolved under the tongue. While methadone has been highly successful for several decades, suboxone has expanded the range of options for those suffering with opioid withdrawal.

Fighting off opioid withdrawal is at the core of opioid addiction and is chiefly responsible for the stress that addicted individuals feel as they try to function normally each day. Suboxone not only helps patients eliminate opioid withdrawal sickness and associated cravings, but it also brings the opportunity to function again as an employee, a parent, or a spouse.

Many patients report not only feeling relief from the welcomed absence of withdrawal sickness, but recapturing the focus necessary to make strides in other important areas of their lives. This illustrates the profound advantage that some patients derive from opioid replacement therapy.

There are an increasing number of physicians now providing opioid addiction treatment services and utilizing suboxone due to its effectiveness and patient convenience. Additionally, some traditional methadone clinics are adopting buprenorphine (suboxone) as a second option for their patients.

Suboxone therapy ultimately increases safety for opioid addicted patients since they are less prone to secure opiates illicitly. It may also save them from having to rely on heroin or other potentially high-risk medications (like benzodiazepines) in order to “get by”. Patients are better able to cut ties with those that have provided them opiates illicitly and this is extremely helpful to the recovery process.

If choosing suboxone, it is important that individuals go the proper route and enroll in therapy with a buprenorphine-approved physician. This cannot be overstated. A doctor specializing in the administration of buprenorphine (suboxone) can provide the necessary assistance to make suboxone therapy effective and to help patients taper down successfully should they decide to discontinue suboxone therapy.

For more on this topic, visit our Suboxone Doctors information page.

You can also perform a comprehensive search of Suboxone Doctors by clicking view the complete list on our Search Clinics By State page.