Heroin, which is classified in the group of drugs called opiates, has traditionally been treated with methadone, a long-acting synthetic opiate that has been used for over 30 years.  Taken once a day, methadone suppresses narcotic withdrawal for 24 to 36 hours. However, due to widespread use, and despite state laws monitoring control and distribution, it is often abused.

Buprenorphine / Suboxone / Subutex
Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) are FDA-approved for the treatment of opiate dependence. Subutex and Suboxone treat opiate addiction by preventing symptoms of withdrawal from heroin.
The first of these formulations, Subutex, contains only buprenorphine and is intended for use at the beginning of treatment for drug abuse. The other, Suboxone, contains both buprenorphine and the opiate antagonist naloxone, and is intended to be the formulation used in maintenance treatment of opiate addiction. Naloxone has been added to Suboxone to guard against intravenous abuse of buprenorphine by individuals physically dependent on opiates. Both drugs are supplied in 2 mg and 8 mg tablets which are placed under the tongue and must be allowed to dissolve.

Outpatient Heroin Detoxification

Detoxification is performed in an outpatient setting generally over the course of 4-5 consecutive days and usually requires two (2) in-office visits to start. These office visits are part of the induction process and include:

• Comprehensive History and Physical (H&P)
• Nursing Assessment
• Psychological Assessment
• Labs
• Urine Drug Screen
• All medications during induction
• Take-home medications for completion of the detoxification (generally 2-3 days)
• Aftercare planning
  

Patients can generally expect to spend 5-6 hours per day during the in-office visits and should be accompanied by a sober companion. We take the time to very carefully, and slowly perform the procedure to minimize the effects of withdrawal.

It is important that patients arrive in a mild-medium state of withdrawal. It is extremely important that methadone is not present in the system. Patients who are on methadone maintenance, at our physician’s discretion, should be using no more than 20-30 mg of methadone per day or reduce consumption to that level prior to undergoing detoxification with buprenorphine

Outpatient Suboxone Induction & Maintenance

Induction and Maintenance is intended for patients whose craving levels are generally higher and/or who, in the past, have had relatively shorter periods of abstinence. Our doctors will determine whether the patient is better suited for maintenance.

The process starts with an induction period which is performed in an outpatient setting generally over the course of two (2) consecutive in-office visits to start. In some cases, a third day will be required to properly stabilize the patient. These office visits include:

• Comprehensive History and Physical (H&P)
• Nursing Assessment
• Psychological Assessment
• Labs
• Urine Drug Screen
• All medications during induction
• Take-home medications for the evening

Patients can generally expect to spend 5-6 hours per day during the in-office visits and should be accompanied by a sober companion. We take the time to very carefully, and slowly perform the procedure to minimize the effects of withdrawal.

It is important that patients arrive in a mild-medium state of withdrawal. It is extremely important that methadone is not present in the system. Patients who are on methadone maintenance, at our physician’s discretion, should be using no more than 20-30 mg of methadone per day or reduce consumption to that level prior to undergoing detoxification with buprenorphine

 Upon discharge from the induction phase, the patient will receive:

• An Individualized Aftercare/Counseling Plan
• Prescription for Suboxone
• Appointments for weekly follow-up visits over the next three(3) weeks

How Long Will I Be on Suboxone?
The length of time that a patient is on Suboxone Maintenance will vary. It is important that a person engage in their continued counseling to address the issues that caused them to use in the first place.