Answer Addiction

Tag: maintenance medication

  • A Practical and Comprehensive Guide to Finding a Suboxone Clinic

    A Practical and Comprehensive Guide to Finding a Suboxone Clinic

    It took me 10 hours of phone calls, 20 voicemails, 3 chewed fingernails, and many packs of cigarettes before I found a Suboxone provider in my new town. This is the list I wish I had then.

    When I pulled a “geographic” a few years ago, leaving Portland for my home state of North Dakota, I underestimated the stress of starting over. In fact, stress isn’t a strong enough word to describe driving 1,300 miles with my recent ex-boyfriend in the passenger seat and the fear of restarting life without heroin; not to mention I had no full-time job prospect, no health insurance, no apartment, and very few of my possessions. I also had a unique fear that loomed over me like an ominous storm cloud: trying to find a new Suboxone* provider in a rural state. 

    It took me almost ten hours of phone calls, twenty voicemails, ten games of phone tag, three chewed fingernails, and many packs of cigarettes to find a clinic that would dispense the medicine I take to maintain my recovery. 

    Unfortunately, my situation is a common one. Despite our nation being in the throes of an opioid epidemic, finding a Suboxone provider is a widespread problem; only about one-third of addiction rehabilitation programs offer long-term use of methadone or buprenorphine (the active ingredient in Suboxone). And according to the National Alliance of Advocates for Buprenorphine Treatment (NAABT), only about half of all Suboxone providers are accepting new patients.

    Finding this life-saving medication shouldn’t be so hard. When you are committed to getting better, you shouldn’t have to worry about whether or not you’ll be able to find a clinic to dispense your medicine. A person with diabetes wouldn’t have to search hard to find insulin. So I’ve compiled a round-up of tips and suggestions. 

    This is the list I wish I’d had in early recovery:

    1. Find friends and family who are supportive of your Suboxone journey.

    2. Remember that your form of treatment is just as valid as all other types of treatment and recovery.

    Although Suboxone is a widely stigmatized and divisive medication in the recovery community, it has been shown to reduce opioid overdose death rates by 40 percent.

    3. Join online support groups and forums for people on Suboxone.

    Since I lived in a rural area, I couldn’t find any in person groups. So I joined secret social media Suboxone support groups on Facebook, recovery Reddit threads, and peer-support forums such as the Addiction Survivors website and Suboxone Talk Zone.

    4. Allow Plenty of Time to Research, Call, and Locate Providers.

    This was the most daunting and lengthy part of finding a new provider. Dr. Bruce Seligsohn has been a board-certified internist in Southern California for 30 years and practicing addiction medicine for 10 years. Dr. Seligsohn advises: “Patients really need to be very careful selecting a doctor if they have a choice. I would suggest that a patient looking for a new doctor do their due diligence and see what comes up online about the doctor.”

    I have compiled the most current resources available as of August 2018. See the sidebar for a sample phone script for calling providers.  

    Pros: Convenience, ease of navigation. You will be able to easily search for a provider based upon zip code, state, and the distance that you’re able to travel for a clinic.

    Cons: Out of date, inaccurate, not comprehensive. Be prepared for hours of phone calls depending on your location and financial situation. Not all providers are listed on the site. I also found that some of the clinics listed were not accepting new patients, had been closed, or had their numbers disconnected.

    Pros: Ease of navigation, instant results. Similar to the Suboxone manufacturer’s website, this is a good launching point for starting your search based upon zip code, state, and the distance that you’re able to travel. 

    Cons:  Not comprehensive and despite being a government resource, it is not up-to-date.

    Pros: Easy to use, more accurate. Treatment Match only connects you with providers in your area who are accepting new patients, reducing dead ends and calls to providers who aren’t accepting new patients or insurance. 

    Cons: Wait time/ lack of timeliness, not as many provider connections. This is not a straightforward directory and while it’s easy to sign up, you have to wait for a provider to respond to your email. The site claims that doctors respond 24/7, including weekends and holidays, but I only heard from them during normal business hours.

    • Yelp Reviews of Clinics

    Pros: Hearing directly from other patients about their experiences, easy to use, instantaneous, accessible.

    Cons: Questionable trustworthiness. Dr Seligsohn said: “Patient reviews can sometimes be very misleading.”

    • Calling Your Insurance Company

    Note: Insurance companies vary widely, so I can only speak from my experience. For example, in Oregon I was easily able to locate a Suboxone provider through my insurance company, but my North Dakota insurance did not provide referrals. They stated that their preferred addiction treatment was therapy and 12-step based treatment programs rather than medication.  

    Pros: Possible thorough list of doctors certified to prescribe Suboxone. Those Suboxone providers who accept your insurance are required to keep their information listed and up-to-date.

    Cons: Time-consuming and you have to deal with the hurdles of bureaucracy. Plus, some studies have found that only about 50% of eligible Suboxone doctors accept insurance. Some insurance companies like mine will allow you to submit an appeal asking them to cover part of your Suboxone visit or prescription, especially in rural areas. I saved all of my receipts and had my psychiatrist and Suboxone doctors write letters of support. After months of appeals, the insurance company agreed to cover part of each appointment. Each month I sent in a claim and receipt, and then I received a reimbursement check about a month later. 

    • Asking for a referral from your primary care provider, psychiatrist, or hospital.

    Another note: This is also difficult to give specific advice on because they vary depending according to location and providers, among many other factors.

    Pros: In-person support and assistance, more direct medical guidance and advice. 

    Cons: Stigma, lack of education about Suboxone, judgement, lack of timeliness. 

    5. Be Persistent!  

    6. Moving? Set Up an Appointment Months in Advance.

    Dr. Seligsohn advises finding a doctor and setting up an appointment prior to moving. “Patients need to find out as much information about how their perspective new doctor runs his practice…They also need to find out what the doctor’s philosophy is about long-term vs short-term Suboxone. If I was a patient I’d be reluctant to move to an area where there’s a shortage of Suboxone doctors.”


    Sidebar: Sample Phone Script for Calling Suboxone Providers

    I remember being so nervous, overwhelmed, and frustrated while also dealing with the symptoms of opioid withdrawal. Make sure you set aside a few hours for making calls in a quiet, safe place. I know some of these tips might seem like common sense, but when you’re in crisis and everything feels overwhelming, it can be a relief to have a guide.

    1. Introduce yourself and tell them that you’re looking for a suboxone provider.

    2. Where are you located?

    3. Are you accepting new patients?

    • If yes- when is your earliest available appointment?
    • If no- don’t hang up just yet! Ask: do you have a waiting list? Can you give me an estimate for how long it would take me to get an appointment? 
    • Do you have a cancellation list and if so, can you please add me to it?

    4. How often do I need to come to the clinic or office? 

    • Most clinics and offices require monthly or bi-monthly visits, but some require daily visits and dispense suboxone in a similar manner to methadone.

    4. Do you accept my insurance? 

    5. If the clinic does not accept insurance, how much does each appointment cost?

    • How much does the intake appointment/ first visit cost? This is an important question to ask because initial intake appointments can cost anywhere from $100 – $200 more than a regular visit.
    • Some clinics require pre-payment to reserve your appointment and prevent cancellation. Do you require a down payment before the appointment?
    • What forms of payment do you accept? (cash, credit, check?) Note that most clinics do not accept checks.
    • Do you allow payment plans or is payment due on the day of the appointment? A majority of clinics will not allow patients to do a payment plan and payment is due on the day of the appointment.
    • Are there any additional costs or required fees? Some charge additional fees for mandatory counseling, drug screens, etc.

    6. What are the counseling requirements?

    • You may be required to do weekly or monthly therapy groups with others at the clinic, and/or meet with an addiction counselor. This varies depending on how long you’ve been clean and your insurance coverage. (For example, one of my previous clinics had no counseling requirement, but my new clinic requires me to meet with an addiction counselor for one hour each month. Other clinics require weekly or bi-monthly group support meetings.)

    Quick Resource List:

    The Substance Abuse and Mental Health Administration (SAMHSA)’s Buprenorphine Treatment Practitioner Locator

    Suboxone Website’s Treatment Provider Directory

    Buprenorphine Matching System on Treatment Match on The National Alliance of Advocates for Buprenorphine Treatment (NAABT)

    Addiction Survivors

    Suboxone Talk Zone

      

    *(Writer’s Note: Suboxone is the most common brand-name buprenorphine medication, but this article is also applicable for patients seeking any form of buprenorphine treatment including: Subutex, Zubsolv, Bunavail, and Probuphine).  

    View the original article at thefix.com

  • Suboxone: A Tool for Recovery

    Suboxone: A Tool for Recovery

    With medication-assisted treatment (MAT), people with opioid addictions are given the chance to rebuild their lives—often from the ashes and debris of drug-induced destruction—without having to fight cravings and withdrawal.

    Suboxone is a prescription medication that treats opioid addiction. It contains buprenorphine and naloxone, active ingredients that are used to curb cravings and block the effects of opioids. Although a major player in addiction recovery today, and often referred to as the gold-standard of addiction care, many in the recovery community remain resistant and even wary, including a large portion of rehab facilities and many members of the 12-step community.

    How does Suboxone work? When an opioid like heroin hits your system, it causes a sense of euphoria, reduced levels of pain, and slowed breathing. The higher the dose, the more intense the effect. Buprenorphine and heroin are both considered opioids, but the way they bind with the opioid receptors in the brain differs. Heroin is a full agonist, meaning it activates the receptor completely and provides all of the desired effects. Buprenorphine is a long-acting partial agonist. While it still binds to the receptor, it is less activating than a full agonist, and there is a plateau level which means that additional doses will not create increased beneficial effects (although they may still cause increased adverse effects). In someone who has been addicted to opioids, buprenorphine will not cause feelings of euphoria—the sensation of being “high.” Naloxone is paired with the buprenorphine to discourage misuse; if Suboxone is injected, the presence of the naloxone may make the user extremely ill.

    Jail Physician and Addiction Specialist Dr. Jonathan Giftos, M.D. offers this analogy: “I describe opioid receptors as little ‘garages’ in the brain. Heroin (or any short-acting opioid) is like a car that parks in those garages. As the car pulls into the garage, the patient gets a positive opioid effect. As the car backs out of the garage, the patient experiences withdrawal symptoms. Buprenorphine works as a car that pulls into the same garage, providing a positive opioid effect—just enough to prevent withdrawal symptoms and reduce cravings, but unlike heroin, which backs out after a few hours causing withdrawal—buprenorphine pulls the parking brake and occupies garage for 24-36 hours. This causes the functional blockade of the opioid receptor, reducing illicit opioid use and risk of fatal overdose.”

    Critics and skeptics of medication-assisted treatment (MAT) believe that using Suboxone is essentially replacing one narcotic with another. While buprenorphine is technically considered a narcotic substance with addictive properties, there are important differences between using an opioid like heroin or oxycontin and physician-prescribed Suboxone. Similarities between using heroin and Suboxone are that you have to take the drug every day or you will experience withdrawal and likely become very ill. Aside from the physical dependency, which is without a doubt a burden, Suboxone offers people in recovery the opportunity to live a “normal” life, far removed from the drug culture lifestyle they may have been immersed in while using heroin.

    People are dying every day from heroin overdoses, especially now in the nightmarish age of fentanyl. People in recovery from opioid addiction are living, free from the risk of overdosing, on Suboxone. Suboxone is a harm reduction option that while initially raised some eyebrows is gaining more traction, and considered an obvious choice for treatment by addiction medicine professionals. While someone using heroin is tasked daily with coming up with money for their drugs, avoiding run-ins with police or authorities, meeting dealers and often participating in other criminal activity, someone using physician-prescribed Suboxone is not breaking the law. They are able to function normally and go to school or get a job, and they are often participating in other forms of ongoing treatment simultaneously. People are given the chance to rebuild their lives—often from the ashes and debris of drug-induced destruction—without having to fight cravings and withdrawal.

    There is a common misconception about Suboxone, and medication-assisted treatment in general, that it is a miracle medication that cures addiction. Because of this idea, many people use Suboxone and are disappointed when they relapse, quickly concluding that MAT doesn’t work for them. When visiting the website for the medication, it reads directly underneath “Important Safety Information” — “SUBOXONE® (buprenorphine and naloxone) Sublingual Film (CIII) is a prescription medicine indicated for treatment of opioid dependence and should be used as part of a complete treatment plan to include counseling and psychosocial support.”

    So, as prescribed, Suboxone is intended to be only part of a treatment plan. It is but one tool in a toolbox with many other important tools such as counseling or therapy, 12-step meetings, building a support system, nurturing an aspect of your life that gives you purpose, and practicing self-care. It is medication-assisted treatment, emphasis on the assisted.

    With that being said, the type of additional treatment or self-care a person participates in should fit their own individual needs and comfort level and not be forced on them. Like a wise therapist once said, “Everybody has the right to self-determination.” Twelve-step meetings, although free and available to everyone, are not the ideal treatment for many people struggling with addiction. Therapy is expensive. People using Suboxone or other MAT shouldn’t be confined to predetermined treatment plans that have little to do with an individual’s needs and more to do with stigma-imposed restrictions.

    It’s unlikely that you’ll find a person claiming that simply taking Suboxone instead of heroin every day saved their life. It is not the mere replacement of one substance for another that is saving lives and treating even the most hopeless of people who have opioid use disorder; it is the relentless pursuit of a new way of life, a pursuit which includes rigorous introspection and a complete change of environment, peers, and daily life. Through the process of therapy, 12-step, using a recovery app, or whatever treatment suits you best, a person can face their demons, learn healthy coping mechanisms, and build confidence without the constant instability of cravings and withdrawal. Suboxone is giving people a chance that they just didn’t have before.

    So why is there such a stigma tied to the life-saving medication? Much of it comes from misinformation and is carried over from its predecessor—the stigma of addiction. It is hard for people who have a pre-existing disdain for addiction in general to swallow the idea that another “narcotic” medication may be the best form of treatment. In addition to addiction-naive civilians or “normies” as 12-steppers might call them, many members of the Narcotics Anonymous community are not completely sold on Suboxone’s curative potential either. Some members of the 12-step community are accepting of MAT, but you just don’t know what you’re going to get. You may walk into a meeting and have a group that is completely open and supportive of a decision to go through the steps while on Suboxone, or you may walk into a meeting of old-timers who are adamant that total abstinence is crucial to your success in the program.

    Another reason people are unconvinced is the length of time Suboxone users may or may not stay on the medication. Again, there is a stigma that shames people who use Suboxone long-term even though studies have shown long-term medication-assisted treatment is more successful than using it only as a detox aid. If Suboxone is helping a person live a productive life in a healthy environment, without the risk of overdose, that person should have the right to do so for however long they need without the scrutinizing gaze of others. While their critics are tsk-tsking away, they may be getting their law degree or buying their first home.

    Suboxone is a vastly misunderstood and complex medication that has the potential to not only save the lives of people with opioid addictions, but also allow them to recover and rebuild lives that were once believed to be beyond repair.

    View the original article at thefix.com