Brain scans have shown that the brain needs a least a year to heal and repair itself after active use. There are chemical imbalances and extensive physical damage to brain tissue. MAT or medication assisted treatments are designed to normalize brain chemistry, relieve cravings, block the pleasurable effects of opioids and alcohol, , separate them from “the lifestyle,” receive counseling and give them time to fix problem areas of their lives. When someone is on MAT they are less likely to over-dose and have to prostitute, commit crimes and deal drugs to support their habit.
*Outpatients will give addiction medications alongside their services and groups.
Suboxone
People in early recovery on suboxone have a lower rate of relapse. Some people choose a trusted person to hold on to their prescription of suboxone so that they are not tempted to overtake it or sell it. Being stable on suboxone can help your loved one not use, develop healthy lifestyle changes, and can give you piece of mind. Using is a full-time job. Because of the cost of having an opioid addiction, people spend much of their time and energy trying to obtain money and opioids, only to have to do it all the next day. Addiction to opioids is a loop of feeling sick and using to feel “normal.” For people deep into their addiction it stopped feeling good a long time ago and they are using only to be able to function in their everyday life. It is especially difficult to maintain the responsibilities of a family, job, bills, etcetera. Suboxone will stabilize a person relatively fast so that they are able to regain stability and rebuild their lives.
Suboxone is: Buprenorphine + Naloxone
Buprenorphine is a partial agonist which means it partially binds to the opioid receptors in the brain. It can create mild euphoria but blocks a person from being able to achieve an intense high if they were to use opioids.
Caution: Great care should be taken when taking suboxone with Benzodiazepines
Street Suboxone/ Diverting Suboxone/ Selling your prescription
There is a high rate of people selling their suboxone script. Some people sell the whole amount and are at risk of relapse. Other people may take as little of their script as possible to feel well or to get a positive screen for their doctor and sell the rest. People use the money from selling their script to pay bills or if they are not in recovery, buy other drugs. There are many reasons people are buying street suboxone. Some people buy street suboxone when they are unable to afford or find opioids. Some people are trying to stop their use on their own and buying street suboxone. Other people are buying street suboxone because their own prescription ran out for whatever reason.
Stopping Suboxone
Suboxone can be taken for years. It has a lower rate of relapse after stopping it than methadone. Someone should only wean off suboxone under the supervision of their doctor when they are stable in all areas of their lives. Someone shouldn’t stop suboxone when they are starting new jobs or relationships or are going through a lot of stress or personal loss.
For more information about Suboxone visit: https://www.suboxone.com/
Or: https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine
What’s methadone?
A synthetic or man-made opioid. It is an agonist which means that it completely binds to the opioid receptors in the brain.
Aren’t we just switching one drug for another?!
Opioids bind to the brain’s receptors and produce euphoria. Methadone binds to the same receptors and blocks the ability of other opioids to produce a high. There is still a mild pleasurable feeling associated with methadone. Methadone causes dependency. People are physically dependent, meaning they can become tolerant and need higher doses sometimes. If they stopped, they would have withdrawal symptoms. It does not necessarily cause addictive behaviors: obsessive thoughts about use, stealing, manipulating, lying etc. To understand the difference between street opioids (addiction) and methadone (dependence) think about other health medications. A person on insulin is physically dependent on it and they cannot stop taking it. A person stable on prescribed methadone, using it as directed, is also physically dependent on it. Usually, they are not exhibiting addictive behaviors and have separated themselves from “the lifestyle.”
Why is methadone making a comeback?
- It is a higher level-of-care in a way. Methadone requires people to show up and it is highly controlled. It is harder to divert and abuse.
- The risk of fatal over-dose on street opioids is so high and people on methadone are not likely to relapse.
- It can help with pain management
- It is long-lasting
- It is inexpensive
What about pregnancy and nursing?
Being on methadone during pregnancy is not ideal and negative side effects can occur. Having active use during pregnancy is much less ideal. The benefits of regularly taking methadone in a program during pregnancy outweigh the risks of being on the streets using unregulated drugs. Women can successfully carry a child and deliver on methadone. If someone were to abruptly stop taking prescribed methadone, they could stress their baby and increase the risk of negative long-term side effects called NAS (neonatal abstinence syndrome). Withdrawal can also trigger pre-mature birth and miscarriage. After delivering, mothers are encouraged to breastfeed because only a small amount of methadone passes to the infant. This can help the baby with withdrawal symptoms. Babies born to methadone dependent mothers tend to stay additional days after the mother is discharged for observation.
Should people really be taking methadone for years?
Many people take methadone for years. This is especially true if they have chronic pain issues.
What are the drawbacks of methadone?
- It can accumulate in the body and cause overdose. If a person uses alcohol or benzodiazepines while on methadone they are at risk for respiratory failure.
- Methadone causes dry mouth which can cause plaque and dental decay.
- It can decrease a person’s sex drive
- Can cause constipation
- It requires that a person is transported to the MMTP clinic. Some insurances must pay a cab for an hour ride every day. This also takes a person away from their family or work obligations.
- Some people relapse on crack, meth, or other substances while on methadone. It is important to get therapy and go to meetings to change thoughts and behaviors. Also, if the lifestyle of people- places- & things doesn’t change a person is at risk of relapse. “If nothing changes, nothing changes.”
- It takes 6-12 months to be taper off methadone.
Naltrexone
Naltrexone is an antagonist which means it binds to the brain’s opioid receptors and prevents them from being activated. It has been compared to closing the piano cover over its keys or plugging a keyhole so that the key cannot fit. If a person uses opioids while on naltrexone, they won’t feel an intense high. It also reduces a person’s cravings for opioids and alcohol. Someone on Naltrexone is at reduced risk for opioid overdose. There have been cases of people attempting to use high amounts of opioids to “shoot through the naltrexone.” This is dangerous and can cause overdose. People who stop taking naltrexone and use are at increased risk of overdose because their body is “clean” and more sensitive to opioids. This is true for anyone who has been clean and returns to active use.
Vivitrol is the brand name for “the shot.” It is Naltrexone given monthly in alternating sides of the butt muscle. There is also a pill form under the brand name Revia. Some doctors give the pill form before the shot to gauge how a person’s body responds to the medication. Oftentimes, people are given the Vivitrol shot immediately before release from inpatient rehab or incarceration to minimize the risk of relapse and overdose.
Advantages of the pill form is that it is less expensive, and some people are nervous about needles. Some people experience nausea when they start taking the pill form. The advantage of the Vivitrol shot is that it cannot be stopped if the person is planning to use briefly and it cannot be diverted/ sold. When the medication is injected, less chemicals can be used because it is not passing through the digestive tract in pill form. The medication is distributed more evenly throughout the day and month in the body. A person on Vivitrol needs special consideration to manage chronic pain or to treat pain from an injury. Opioid pain medications will not be effective when on this medication. People who choose naltrexone will not have to attend as many appointments with a clinic as people who dose daily with methadone or suboxone. Some people feel naltrexone is better than methadone and buprenorphine because it is not “substituting one drug for another.” Everyone is different with different needs and that is why there are many options for addiction medicine.
Injectable Buprenophine:
Sublocade is the brand-name of the injectable form of buprenorphine. It is given monthly on alternating sides of the abdomen. It can be felt as a tubular bump under the skin. The injection hardens when it is placed under the skin and time releases during a month. The medication has similar results as oral suboxone. It is given in varying amounts depending on the person. It can be used with oral suboxone. There is minimal risk of diversion/ selling.
This medication is just starting to be used by health professionals. It is expensive and must be refrigerated. It is also person specific and ordered on an individual basis.
Acamprosate:
Acamprosate, brand name Campral is useful for people a few months into their recovery from alcohol to limit the post-acute withdrawal symptoms of: restlessness, irritation, sleep disturbance and cravings. Acamprosate helps stabilize the brain systems that are damaged by alcohol use.
Providers:
Hudson Headwaters: Suboxone Provider
*They are not a treatment program, but most sites have a provider who can prescribe
*must be a primary care patient
*all insurances accepted, sliding fee program
*will maintain with pregnancy
*Telemedicine appointments are available
*Harm reduction, will meet the patient where they are at, even if they struggle with abstinence/ recovery
*Treats patient with respect and dignity, Emphasis on FAMILY medicine, reducing stigma of the disease of addiction
*Offers training/certification for administering for doctors and nurses
ACCA Addictions Care Center
Mobile Recovery Unit- Joseph Cavallo CRPA
Cell: (518) 410-5285 or 518-419-1578
*Working to help people to get mobile services, telehealth in van for M/H meds and MAT
*Coordinates to get Warren or Washington County Jail for inmates medication
*Meets clients around town, example: Stewarts
Community Health- part of Saratoga Hospital
Joshua D. Zamer, MD, DABAM
24 Hamilton Street Saratoga Springs, NY 12866
(518)886-5600- Phone
(518) 886-5880- Fax
*Suboxone, Sublocaid (suboxone injection), vivitrol, needs to come for MAT, does not need to come there for treatment
*Responsible provider, careful with patients
*Hudson Headwaters also has responsible providers
This person represents sublocade and does company presentations.
Kristen Czajkowski INDIVIOR 518-466-3014 kristen.czajkowski@Indivior.com