Med-Assisted Therapy (MAT) is now the evidence-based treatment of choice for opioid addiction. It describes a treatment philosophy of using FDA approved medications to help stabilize recovery for a period of time. As patients are treated with medications to prevent relapse on opioids, they have the capacity to restore healthy relationships, build a recovery network, improve work performance or school functioning, and delve deeper into psychotherapy.
The available medications offered through my practice for opioid addiction are Suboxone (buprenorphine) and Vivitrol (injectable naltrexone). These medications both have a large effect size in preventing opioid relapse and are generally safe for maintenance treatment. This clinic will be offering each of these treatments in efficient and protocol-driven ways. I will overall offer 3 primary treatment paths and we can discuss the pros/cons of each path.
- Suboxone stabilization and maintenance program
- Suboxone taper protocol
- Vivitrol injection program (This can be started immediately provided a patient is appropriate for Vivitrol, or can be bridged on following a Suboxone taper)
Suboxone is the brand name of buprenorphine medication that I most commonly prescribe for opioid replacement therapy. This medication is FDA approved for the treatment of opioid dependence. Suboxone has shown considerable efficacy in reducing relapse on heroin or opioid painkillers, treating withdrawal, helping patients stay connected to clinicians (treatment retention), and preventing overall death, either by opioid overdose or other causes. If you are struggling with opioid addiction, this is a preferred form of MAT that we can consider.
- New Patients – Please see the following materials regarding Suboxone maintenance treatment. Prior to your first appointment, you will need to avoid use of heroin or opioid painkillers for about 24 hours. This will require you to endure a brief amount of opioid withdrawal. The following is the new patient checklist that will need to be completed for us to proceed:
- Completed opioid addiction questionnaire
- Signed consent form for Suboxone maintenance treatment
- Signed consent form for clinic policies and protocols. This will discuss the standards you will be expected to meet while in this clinic, procedures for problematic or misuse of the medication, and boundaries for me to continue to provide Suboxone treatment through this clinic.
- Urine drug screen at first appointment
- Completed insurance information for me to submit a prior authorization for this medication if needed.
- Appointment fee as outlined in fee schedule
- Returning Patients – After starting on Suboxone medication, it will require a brief adjustment period for us to determine your maintenance dose.
Vivitrol is the brand name of injectable naltrexone medication. This is an opioid blocker med which prevents heroin or opioid painkillers from binding to receptors in the brain. It is an abstinence philosophy for treatment rather than a replacement approach (such as with Suboxone). Vivitrol comes in the form of a month-long injection. This injection functions somewhat as a ‘vaccine’ for opioid over the month. It is important to know that the barrier it provides can be overcome by someone very intent on abusing opioids, so I recommend this for patients who are interested in recovery. It also only acts for one month, which is often not enough time for a patient to make lasting life changes. It is for these reasons that I am recommending a one-year course of Vivitrol injections (12 monthly shots) to reach some baseline stability. Also, this treatment is only approved for a patient who has been opioid-free for 7-10 days. The injection will cause opioid withdrawal for somewhat who still has been using heroin or opioid painkillers.