COVID-19: How does it affect Suboxone Treatment In Fort Lauderdale, Broward County, and all of South Florida?
The following notice contains information for patients who are new to Suboxone and patients who are already taking Suboxone or related buprenorphine medications, including Subutex, ZubSolv, Sublocade, Probuphine, and Brixadi.
If you are using opioids now, you may be wondering if medication-assisted treatment (MAT) with Suboxone is right for you. You may want to consider, in light of current events, how important is it for you to recover now and get to work, securing the safety of you and your family. While I believe that Suboxone treatment is quickly becoming the gold standard of treatment for opioid dependence and opioid use disorder, there are alternatives. Other options include methadone, naltrexone, residential rehab, outpatient rehab, and abstinence-based 12-step programs, such as Narcotics Anonymous (NA) and Alcoholics Anonymous. Patients have a right to make an informed decision based on information presented by their doctor. I often recommend Suboxone treatment to patients, especially to patients for whom recovery with a quick return to normal functioning is critical. People who should strongly consider Suboxone treatment include professionals who cannot afford downtime from work, business owners and company founders, parents of young children, workers who cannot afford time off from work for rehab, and others. Now, with current recommendations to minimize contact with others in public, we should include this in our decision making about how important it is to quit drugs now and get back to normal functioning as soon as possible.
How does this relate to COVID-19, the novel coronavirus?
The messages coming to us through the media about the novel coronavirus, COVID-19, are conflicting, confusing, and have caused a great deal of stress. We want to believe the more comforting announcements. Yet, large corporations are reacting by taking unprecedented action, implying that this is something we need to take very seriously.
Large scale closures are occurring quickly.
The Walt Disney Company has closed down all theme parks in California and Florida. Originally, Walt Disney World in Orlando, Florida, was to stay open. Late Thursday afternoon, they updated their announcement to include the Orlando parks. Universal is also closing its large theme parks. News articles have noted that Disneyland in California has only closed for four events in history: JFK’s assassination, the Northridge earthquake, the 911 terrorist attacks, and now COVID-19.
Online school is becoming a reality for nearly everyone.
Schools and Universities are telling students to stay home. Many schools are working quickly to switch their curriculums to be online. Similarly, companies are asking employees to work from home if possible.
Sporting events and other live events: Canceled.
Officials have canceled significant sporting events. For example, the NBA has canceled all basketball games. Even the upcoming Democratic presidential debate has been moved to CNN’s Washington D.C. studio and will not have a live audience. Nearly all cruise lines are canceling cruises around the world. These events are unprecedented.
Travel restrictions and quarantines are becoming an issue.
Travel restriction and quarantine announcements continue to come out from countries around the globe. Politicians and celebrities who have been diagnosed with COVID-19 or exposed are announcing self-quarantine. Additionally, we see stories through social media and the news about nightmare scenarios in affected areas where medical facilities are not prepared to deal with people who are sick.
Suboxone patients must prepare for COVID-19.
If you or a loved one sees a doctor or goes to a clinic for medication-assisted treatment with Suboxone or a related buprenorphine-based medication for opioid use disorder or opioid dependence, you may be concerned about how the global pandemic with COVID-19 will affect the treatment plan. Your concern is justified. Because buprenorphine, the active ingredient in Suboxone, is a controlled drug, doctors have limits to how much they can prescribe at once.
Be sure to manage your prescriptions, so you have enough medication.
When it comes to medications for other chronic conditions, such as high blood pressure, diabetes, high cholesterol, and others, doctors often prescribe a three month supply all at once. With Suboxone, doctors must limit prescriptions to one month or less, giving only enough medication to get the patient through the month. For new patients, doctors will often only prescribe Suboxone for a week or less.
Consider preparing for a possible quarantine event.
So, what can you do to prepare for a possible quarantine event? What if you cannot leave your house for two weeks? How can you ensure that you will have access to Suboxone to continue your treatment? Will your doctor’s office or clinic continue to be open and available? Are you able to contact your doctor to ask questions and make arrangements? What about pharmacies? Will they continue to fill prescriptions?
There is no need to panic. Now is the time for calm preparation.
First, I recommend that you do not panic over these questions. Do not take mass quarantines around the world and the closing of theme parks to indicate that we will soon not be allowed to leave our homes. As of now, it is most likely that grocery stores, pharmacies, and medical facilities, including private doctors and clinics, will remain open.
Most stores, pharmacies, doctors, and clinics will likely remain open.
The closing and canceling of theme parks and sporting events are to reduce exposure of large crowds of people to potential infection. At a basketball game or a Disney theme park, it is not easy to maintain a significant amount of space between people. Officials are trying to prevent any situation where people get packed in like sardines. When it comes to community businesses, they will likely not be affected by mass closures.
Consider alternatives to going in person to the doctor or pharmacy.
While you will still be able to see your doctor and you will be able to pick up prescriptions at your pharmacy, you may want to enquire about alternate forms of care that can reduce your exposure to other people for the time being. Taking extra precautions is particularly important if you are in a high-risk group.
Take your risk factors into account.
If you are over the age of 50-years-old, there is an increased risk of complications. You may have an even higher risk if you are currently sick or have chronic medical conditions. If you are concerned about being in a high-risk group, I recommend that you ask your doctor if there are any special precautions that you should take regarding your medical care.
The internet is an asset in times of pandemic crisis.
Fortunately, the internet and communication systems have developed quickly in the past couple of decades to meet the needs of a situation where people must self-isolate. Interestingly, experts have blamed the internet for keeping people from getting fresh air, traveling, and having social contact with other people. Now, we find that online services can help us to continue needed services while staying relatively safe from the dangers of this current pandemic event.
Telemedicine: The future of medicine is here today.
For example, doctors are now providing telemedicine, or telehealth, services routinely. While doctors can provide medication-assisted treatment with Suboxone in Florida, there are, unfortunately, limits at this time. As per U.S. federal law and Florida law, if you are going to see a doctor for Suboxone by telemedicine, there is one key restriction. A doctor must have already seen you for the same diagnosis in the past. Ideally, most doctors will want to see you in person for themselves at least once before providing telemedicine Suboxone therapy. Additionally, most doctors will insist on having a comfort level of knowing you as a patient and trusting that you will follow treatment guidelines appropriately.
Pharmacy deliveries are a good idea, especially if you are in a high-risk group.
While not as high-tech as telemedicine, pharmacies have ways to help you avoid going to the pharmacy in person. Unfortunately, when you stand in line at a pharmacy, you may find yourself in close quarters with people who are sick. There is an increased danger of exposure to sick people in pharmacies that have in-house clinics. Ask your pharmacist if they can provide delivery services. If you take Suboxone, a pharmacy courier can hand deliver your prescription. Some pharmacies also offer delivery throughout the state of Florida via UPS or FedEx.
Should you have a “hurricane supply” of Suboxone?
Is it possible to have a “Suboxone hurricane supply?” In Florida, where we have a prolonged hurricane season, we must always think about preparations for being confined at home for days or even weeks. We are used to the rush for cleaning supplies and paper products occurring around the country right now. It happens in Florida every time there is a hurricane aimed in our direction. Because of this, patients often ask their doctors about having a hurricane supply of medications. It is a touchy subject when it comes to controlled meds, such as Suboxone, because government officials would prefer that we limit these medications to only what is needed for a particular period. Yet, it is reasonable to ask your doctor if it would be fine to have at least a few days worth of extra medication.
Emergency Suboxone treatment is available at local ERs.
In an emergency, where you are unable to get your Suboxone prescription from your doctor, you can go to a local hospital emergency room for treatment. While this is not an ideal solution, it is better than running out of Suboxone. Emergency physicians are allowed to prescribe up to three days of Suboxone.
Now is the time to stop using opioids. You must quit street heroin and fentanyl.
If you are still using opioids, such as heroin or fentanyl, you must get help to quit as soon as possible. By using street drugs, you will have a higher risk of exposure to COVID-19, along with the high-risk of other contagious diseases and overdose. Do not use global pandemic as an excuse to put off getting help. Suboxone Doctors and Suboxone clinics are still open. Now is the best time to get clean.
Now, more than ever, your family needs you.
Your family needs you at your best now more than any other time in history. To be best prepared to care for yourself and your family, you must quit drugs and get clean. Getting clean with medication-assisted treatment is the best and safest way to get off of opioids. Suboxone, and similar buprenorphine meds, such as Subutex and ZubSolv, are the best way to get clean. Methadone is an option, but it requires going to a busy clinic every single morning. If you want to get clean from opioids, Suboxone treatment is ideal.
Do not give up on treatment. It is important to stick with it and make it work for you.
If you are just starting Suboxone or Subutex now and you are having difficulty in transitioning from heroin, fentanyl, or another opioid to your buprenorphine treatment medication, do not give up. You mustn’t go back to using opioids again. In some cases, patients will have an issue with precipitated withdrawal.
Precipitated withdrawal may be more likely with today’s street heroin, but you can get past it.
If you have precipitated opioid withdrawal, it means that if you take your first Suboxone too soon, you will feel worse with withdrawal symptoms rather than better. Precipitated opiate withdrawal symptoms are not usually dangerous, but they are unpleasant. Please do not be discouraged if your Suboxone does not work as expected the first time you take it. Whatever you do, do not give up. It may take some time, but you will get past this if you are determined. Stay in touch with your doctor for guidance if you are having any trouble.
Your doctor may prescribe medication to help with opioid withdrawal symptoms.
When you use your first dose of Suboxone, you must be opioid-free for some time. In most cases, this waiting period is around 18-24 hours. While this applies to most short-acting opioids, such as oxycodone, and even heroin, it may not be true of others. When it comes to street heroin, contaminated with Chinese fentanyl analogs, the wait can be significantly longer. Sometimes, even waiting two to three days is not enough. Do not let this discourage you. Your doctor can help by prescribing medications to help reduce withdrawal symptoms. Lucemyra and clonidine are examples of such medicines.
If you are experiencing opioid withdrawal for the first time, it may feel like the flu.
If you have been using opioids continuously for a long time without any break, you may not have experienced withdrawal symptoms before. Typically, withdrawal symptoms include cold sweats, muscle aches, runny nose, sneezing, fatigue, upset stomach, nausea, among other symptoms. People often describe these symptoms as being flu-like, but worse. To start Suboxone, you must be in a mild to moderate withdrawal state before starting. Then, the Suboxone starts to work, and the symptoms get better.
Take universal precautions against spreading infection at all times.
So, if you are going through opioid withdrawal for the first time, keep in mind that even though the symptoms are flu-like, they are not necessarily a sign that you are sick with any kind of infection. Still, you should take precautions, such as avoiding unnecessary contact with people and washing your hands frequently. When your Suboxone starts to work, you will see that the withdrawal symptoms resolve as the medicine takes effect.
The implant is an interesting long-lasting alternative to Suboxone.
Are there other options that are longer lasting than Suboxone? Is it possible to avoid going to the doctor even every month? There is a buprenorphine implant, called Probuphine, that lasts for six months at a time. While not widely used yet, changes in the world may lead to increased use of this long-term implant technology. Doctors who prescribe the Probuphine implant still usually ask that their patients follow up with visits at least every month. However, in light of a global pandemic, doctors may be willing to conduct these visits via telemedicine.
When it comes to the Probuphine implant, there are some concerns regarding potential adverse reactions. The implant can migrate to a new location, making it harder to find it when it comes time to remove it. It is also impossible to get an infection and even to have nerve damage from the implant surgery. Scar formation is another possibility. While there are concerns regarding Probuphine, it may grow in popularity soon.
Monthly injectable buprenorphine is another alternative.
Brixadi and Sublocade are two injectable buprenorphine treatments. Sublocade is also known as subcutaneous buprenorphine because it is injected just under the skin. While doctors give Sublocade monthly, it is long-lasting and may last beyond a month if you are unable to get in to see your doctor. Also, it is delivered to your doctor, so visits to the pharmacy are not necessary.
Be safe and keep informed about COVID-19.
For more information on COVID-19, the novel coronavirus, please visit this CDC faq: https://www.cdc.gov/coronavirus/2019-ncov/faq.html. And, please do not panic. Stay informed and make informed decisions. Here is a link to CDC instructions on handwashing: https://www.cdc.gov/handwashing/when-how-handwashing.html. It is essential to wash your hands frequently, avoid touching your face, keep a distance of several feet at least from other people in public whenever possible. If you are in a high-risk group, as described above, consider taking additional precautions.