What is Suboxone?

Suboxone is a combination of buprenorphine and naloxone. Naloxone is an opioid antagonist, meaning that it blocks the effects of opioids in the body; for this reason, it is often used clinically to reverse opioid overdoses. Naloxone is used in conjunction with buprenorphine in order to act as a deterrent for misuse. Naloxone is inactive when it is swallowed, but active when injected. If the user injects the Suboxone instead of taking it as prescribed, the naloxone will cause precipitated withdrawal, making the user sick and discouraging them from abusing again.

What does the our Program offer?

Access to buprenorphine and probuphine is available through the Two Dreams admissions department. Our Chicago program includes induction, written prescriptions, and counseling sessions with Dr. David Barthwell, an award-winning psychiatrist and addiction specialist. Dr. Barthwell has years of experience treating patients with addiction and providing insights on the process of recovery. Sessions will take place in our Chicago corporate office, located in the Rush Medical Office Building, 610 S. Maple Ave. Oak Park, IL. The initial visit includes a detailed medical/addiction history, urine drug testing, and office visits for the first month of treatment. We do not accept insurance for the first month of treatment, however we will work with the patient to draw up a payment plan if necessary. Subsequent treatment is scheduled on a monthly basis; for patients with medical insurance we will make contact with your insurance company to determine coverage eligibility. We do not accept Medicare or Medicaid. All patients will be given a prescription for their Suboxone, which will need to be filled by a pharmacy of the patient’s choice. Two Dreams does not provide any medications.

Patients admitted to the Outer Banks  may start or continue Suboxone as appropriate if indicated by our professional healthcare team

What should I expect during my first appointment?

When starting in medication-assisted treatment for an opioid dependence, patients often express fear and anxiety due to preconceived notions or previous bad experiences. It is not uncommon for patients to know someone who had a bad outcome in this type of treatment, and this sometimes prevents patients from seeking care themselves. It is our intention at Two Dreams to make the experience as open and stress-free as possible. It may be difficult to believe that taking a prescribed medication can keep someone free from the debilitating effects of opioid withdrawal, but that’s what we’re here for.

On the first visit, a considerable amount of time will be spent on education. We will talk about buprenorphine’s ability to prevent withdrawal and “dope sickness,” which will help keep you functional throughout the day. We will explain the benefits and the limitations of the medication in detail, emphasizing that even though Suboxone is very useful, it is not a “miracle” drug. We will provide both written and verbal explanations of the desired medication effects, as well an explanation of the unwanted or undesirable side effects of Suboxone. We’ll provide written materials on the safe use of Suboxone with instructions on how to safely manage, store, and take responsibility for the medication. We ask that you carefully read and sign a treatment consent that clearly spells out what we expect from you and what you can expect from us. The treatment goal is very clear and unambiguous: STOP USING. We treat patients 18 years old and older. We welcome pregnant women to our practice. If you have a private physician we ask that you allow us to communicate with that doctor so that all of your treatment providers are aware of your decision to enroll in Suboxone treatment. Your total health and welfare are our main concerns.

What is the difference between methadone and buprenorphine (the active ingredient in Suboxone)?

Methadone and buprenorphine are both approved for opioid maintenance therapy and detoxification. They have slightly different mechanisms of action. Both drugs are synthetic opioids, meaning that when taken they can effectively prevent opioid withdrawal symptoms by stimulating opioid receptors. Methadone is a “full” opioid agonist, whereas buprenorphine is a “partial” opioid agonist. This difference is significant at the receptor or molecular level, however clinically there is little or no difference felt by the patient. Studies have shown that buprenorphine is better tolerated than methadone in terms of side effects and causes only mild withdrawal symptoms long-term. Methadone may cause moderate/severe withdrawal symptoms over a prolonged period of time.

Is one drug (methadone or buprenorphine) better than the other?

Prescriptions for these medications are given on a case-by-case basis after taking into consideration individual patient factors. For example, patients with mild-moderate dependence might consider buprenorphine because of its lower abuse potential. Patients with a move severe dependence might need the structure that methadone clinics provide. Patients with a history of injectable drug abuse may be better served taking methadone. Buprenorphine is a moderately expensive drug, whereas methadone is inexpensive and available from methadone maintenance clinics, so socioeconomics should be taken into consideration before choosing as well. Neither choice is objectively “better,” therefore the decision about which drug to take must take into account patient medical history, patient preference, and physician recommendations.

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