Substance Abuse Treatment

We are now offering Sublocade injections for Opioid Dependence and Vivitrol injections for Alcohol and Opioid Dependence in our office.

In our Center we offer a

Comprehensive Treatment for Alcohol and Opioid Dependence!!

Consisting of extensive Substance Abuse Evaluation by the Addiction Psychiatrist, regular medication management appointments, treatment with oral medications or monthly injections as part of the medication-assisted treatment, therapy referrals and mandatory in-office urine toxicology screening.

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Our office is following the guidelines established in Federal Health Insurance Portability and Accountability Act (HIPAA) regulations addressing the privacy of health care information, found at 45 CFR §§ 160 & 164, 42 CFR part 2 – Confidentiality of Substance Use Disorder Patient's records and Maryland's Confidentiality of Medical Records Act (MCMRA), codified at Health-General § 4-301 et seq. HIPAA and MCMRA both establish a general rule of confidentiality for health care information. MCMRA requires a health care provider to keep the medical record of the patient confidential and disclose information only as provided by the act itself or as otherwise provided by law. HIPAA enumerates permitted disclosures slightly more specifically by allowing disclosures: to the individual (patient); for treatment, payment, and health care operations; incident to a use or disclosure permitted by the act; and pursuant to authorizations, agreements, or certain public use exceptions. The 42 CFR Part 2 regulations serve to protect patient records created by federally assisted programs for the treatment of substance use disorders (SUD). Part 2 has been revised to further facilitate better coordination of care in response to the opioid epidemic while maintaining its confidentiality protections against unauthorized disclosure and use.

Information about Buprenorphine/Naloxone Treatment

Suboxone®, Zubsolv® (buprenorphine/naloxone) are FDA-approved medications (tablets, films) for the treatment of people with opioid addiction. A combination of Buprenorphine/Naloxone can be used for detoxification or for maintenance therapy. Maintenance therapy can continue as long as medically necessary. There are other treatments for opiate addiction, including methadone, naltrexone, and some treatments without medications that include counseling, groups, and meetings.

Sublocade®, Brixadi™, and Vivitrol® are FDA-approved injectable medications for the treatment of people with opioid addiction.

If you are dependent on opiates — any opiates - you should be in as much withdrawal as possible when you take the first dose of buprenorphine. If you are not in withdrawal, buprenorphine can cause severe opiate withdrawal. We recommend that you arrange not to drive after your first dose, because some patients get drowsy until the correct dose is determined for them.

Some patients find that it takes several days to get used to the transition from the opiate they had been using to buprenorphine. During that time, any use of other opiates may cause an increase in symptoms. After you become stabilized on buprenorphine, it is expected that other opiates will have less effect. Attempts to override the buprenorphine by taking more opiates could result in an opiate overdose. You should not take any other medication without discussing it with the physician first.

Combining buprenorphine with alcohol or other sedating medications is dangerous.

The combination of buprenorphine with benzodiazepines (such as Valium®, Librium®, Ativan®, Xanax®, Kionopin®, etc.) has resulted in deaths.

Although sublingual buprenorphine has not been shown to be liver-damaging, your doctor will monitor your liver tests while you are taking buprenorphine. (This is a blood test.)

The form of buprenorphine you will be taking is a combination of buprenorphine with a short-acting opiate blocker (naloxone) in a 4 to 1 ratio (4 mg of buprenorphine to 1 mg naloxone). It will maintain physical dependence, and if you discontinue it suddenly, you will likely experience withdrawal. If you are not already dependent, you should not take buprenorphine, it could eventually cause physical dependence.

Buprenorphine/naloxone tablets must be held under the tongue until they dissolve completely. It is important not to talk or swallow until the tablet dissolves. This takes up to ten minutes. Buprenorphine is then absorbed over the next 30 to 120 minutes from the tissue under the tongue. Buprenorphine is poorly absorbed from the stomach. If you swallow the tablet, you will not have the important benefits of the medication, and it may not relieve your withdrawal.

Most patients end up at a daily dose of 12/3-16/4mg of buprenorphine. (This is roughly equivalent to 60mg of methadone maintenance). Beyond that dose, the effects of buprenorphine plateau, so there may not be any more benefit to increase in dose. It may take several weeks to determine just the right dose for you. The first dose is usually 2/0.5-4/1mg.

If you are transferring to Buprenorphine/Naloxone combination from Methadone maintenance, your dose has to be tapered until you have been below 30mg for at least a week. There must be at least 48 hours (preferably longer) between the time you take your last methadone dose and the time you are given your first dose of buprenorphine. Your doctor will examine you for clear signs of withdrawal, and you will not be given buprenorphine until you are in withdrawal.

Patient Instructions for

Initial Opioid Dependence Treatment Appointment

1. Bring completed Forms or come early.

2. You should be in withdrawal as much as possible.

If addicted to Methadone, it must be at least 48 hours (preferably longer) since your last Methadone dose; if addicted to heroin or short-acting opioids (Vicodin, Demerol, Dilaudid, Morphine, Oxycontin, Percodan, Codein and other); it must be at least 24 hours since your last use.

Physician will examine you for clear signs of withdrawal and you will not be given Suboxone until you are in at least moderate withdrawal.

3. Come with a full bladder since you will be urine drug tested.

4. Bring ALL pill bottles.

5. Bring a Valid photo ID.

6. Will be breath tested for alcohol.

7. We recommend that you arrange not to drive after your first dose, because some patients get drowsy until the correct dose is determined for them.

Patient's Instructions for Follow-up Suboxone Appointments

1. The patient must bring Buprenorphine / Naloxone pill bottle to every appointment so that the remaining supplies can be counted.

2. Mandatory urine drug testing (done in office) will be done with each Buprenorphine appointment to confirm the use of alcohol, prescription/street drugs as well as Buprenorphine intake (come with a full bladder to every appointment).

3. Lost Buprenorphine / Naloxone prescription or medications will not be replaced until the next appointment and based on circumstances of the incident; the patient might be discharged from the program.

Patient will be Discharged from the Program if:

- urine is positive for alcohol, prescription drugs, street drugs, or negative for buprenorphine.

- refusing urine or breath testing.

- refusing to attend mandatory Suboxone group therapy.

- missing more than one appointment without significant reason.

- reporting lost or stolen medications on more than one occasion.

- running out of medications too soon more than once.

- not responding to phone calls or neglecting to mention changes in address or phone number.

- appearing intoxicated or behaving inappropriately during an appointment.