Suboxone is supposed to be the gold standard of opioid addiction treatment. I don’t understand why Suboxone doesn’t work.
Have you had a bad Suboxone experience? You were expecting the opioid withdrawal symptoms to go away. The Suboxone strip or Subutex pill you bought from your dealer was supposed to help. But, all it did was make you feel worse.
Some people describe this effect of Suboxone sickness as being moderately uncomfortable. Others say it is the worst feeling they have ever experienced. If you have taken Subutex or Suboxone and it didn’t work, it probably made you never want to take it ever again.
Doctors spend hours of extra training learning about how to help their patients to avoid Suboxone failure.
At the end of 2020, there was an executive order to change the rules about what kind of doctors can prescribe Suboxone. They were going to open it up so all doctors could prescribe without taking the required eight-hour course.
In January of 2021, that order was rescinded by the new president. This was probably a good idea. Taking an eight-hour course is not a big deal. Doctors can take the course online over a weekend.
One of the great benefits of the course is to explain to doctors the unique nature of buprenorphine induction. Buprenorphine, the main drug in Suboxone, has special properties.
It is an opioid antagonist, or a receptor blocker. And, it is also a partial opioid agonist, which means it activates the opioid receptor partially.
Because of the uniqueness of this medication-assistance treatment drug, doctors need to learn about how to do a proper Suboxone induction. Induction is how patients start Suboxone without getting sick from it.
Buprenorphine induction is not that hard to do.
The induction process is a little confusing at first, but it is not that hard to figure it out. This is why the course is only eight hours for doctors. Doctors are typically smart people and can figure it out during an eight-hour course.
The trick to Suboxone induction is to wait a certain time period after the last opioid use and then to do an assessment for opioid withdrawal symptoms. Another important point to keep in mind is that some opioids are longer lasting than others.
For example, methadone is naturally very long-lasting. I would recommend that a doctor just getting started in treating opioid addiction might want to be extra careful in working with a patient transitioning from methadone to Suboxone.
Oxycontin and other time-release tablets are also longer lasting, though the reason is because of a technological time-release mechanism and not because the drug has a long half-life. If the patient was crushing their Oxycontin, they were turning it into a short acting drug.
Heroin is not the same old heroin. Fentanyl analogs blended into it make Suboxone induction more difficult.
If you are a person who relates to the beginning of this article, where your heroin dealer gave you a Suboxone strip or Subutex pill and it made you sick, you have likely experienced the effects of fentanyl analogs. Normally heroin is a short-acting opioid. It clears out of your system quicly. Pharmaceutical fentanyl is also short-acting.
The problem is that there is something different about the fentanyl that drug dealers are blending into street heroin. In fact, they are frequently replacing heroin altogether with these fentanyl analogs.
Where does the fake fentanyl come from? It often arrives through the USPS in packages from China. Some sources have claimed that fentanyl analogs, cooked up in clandestine labs, come from Wuhan, China. That is the same place COVID-19 originated from. As you can see, there is a lot of fancy biotech work being done over there.
What is it about illicit fentanyl analogs that make induction so difficult?
Experts believe that these molecules tend to get stuck in the fat cells. Then, they release gradually back into the patient’s system. Because of this, street heroin/fentanyl has become just like a long-lasting, long half-life drug. The waiting period between stopping the drug and starting Suboxone often has to be much longer than usual.
For a typical short-acting opioid, Suboxone can be started as soon as 12 hours after last use. Oxycodone, dilaudid, and real heroin are examples of short-acting opioids. With the new, more dangerous street heroin and/or fentanyl, the waiting period may have to be at least two or three days, and sometimes longer.
To complicate things further, the tell-tale signs of opioid withdrawal, which signal the appropriate time to start Suboxone, are not always as clear when it comes to illicit fentanyl. Withdrawal symptoms can come and go, and may not build to the intensity that indicates Suboxone readiness.
How do doctors help their patients get through the transition from fentanyl analogs?
In some cases, going to a methadone clinic might be the best choice. Methadone is a more powerful treatment drug for opioid addiction. Methadone does not require a waiting period. It can be started on the same day the patient quits opioids.
In British Columbia, Canada, and some other countries around the world, they have unique ways of treating opioid addiction that US officials would have a difficult time accepting. They have prescription heroin treatment and medication-assisted treatment with dilaudid.
The dilaudid is dispensed from high-tech biometric vending machines. A heroin user who is authorized to use the machine can obtain dilaudid tablets from it. This makes it possible for the street user to transition from the very dirty fentanyl analogs to a reliably short-acting opioid.
After the heroin user has moved over to using dilaudid instead of dirty street heroin/fentanyl, they will have less of a problem starting Suboxone. This option is absolutely not available in the US. Doctors in the United States are strictly limited to three drugs for medication-assisted treatment (MAT). Methadone, buprenorphine, and naltrexone.
Methadone and buprenorphine are categorized as opioids. Using any other opioid to treat addiction is illegal in the United States.
Since we are in the United States and not Canada or Switzerland, how can American doctors help their patients through a difficult transition to Suboxone?
Fortunately, there are some great options available to doctors. There are medications that can help to make opioid withdrawal symptoms more tolerable. So, even if the transition time from last opioid use to first Suboxone use is several days, the experience can be made easier using these comfort meds.
Clonidine is an example of a medication that calms the sympathetic nervous system to make opioid withdrawal more tolerable. Lucemyra is an alternative drug that works similarly. Additionally, there are other medications that can be used to help patients get through the transition.
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What about Suboxone telemedicine? How does that work?
Ideally, when you see a Suboxone telemedicine doctor over a video call, it should not be your first experience with Suboxone treatment. Addiction experts agree that the first treatment you get with Suboxone should happen in-person under direct medical supervision.
However, if you have already started treatment with Suboxone and you are looking for a convenient alternative to driving to your doctor every month, you may appreciate the convenience of telehealth services. In fact, if you are returning back to resume treatment, it may be a good alternative for you.
How do telemedicine doctors do drug testing? There are a few options. Your doctor may have a nurse visit you at home with a drug test, or they may use a new, high-tech form of testing that involves DNA matching your urine to prove that you are providing your own urine. The test has additional security features to ensure that your urine has not been tampered with.
While there are Suboxone telemedicine services that assign a random doctor to perform a quick visit and call in a prescription, you may find better success with a dedicated private Suboxone telemedicine doctor. When Suboxone telemed is done right, your doctor should provide a similar experience to the concierge one-on-one programs described above.
You should be able to communicate regularly with your doctor with a direct line of communication. A true concierge Suboxone experience should allow for you to reach your doctor without having to fight through gate-keeper staff members. If you have questions, concerns, or doubts, you should be able to reach your doctor easily. I recommend a telemedicine doctor over a telemedicine service.
Suboxone does work.
As stated at the beginning of this article, Suboxone does not work if it is taken improperly. It is a somewhat complex drug that may work in ways that seem to be counterintuitive. If taken too soon, it can make you feel sick. And, the way your doctor starts you off will depend on what drugs you are using.
The important point to take home from this article is that your drug dealer should not be providing you with Suboxone treatment. Going into precipitated withdrawal because you took it too soon can discourage you from wanting to try Suboxone again.
The best way to take Suboxone is under the care of an experienced doctor. There are many different kinds of doctor who can prescribe Suboxone. You can go to an ER doctor, a rehab doctor, a clinic doctor, or even a concierge telemedicine doctor. There are different programs to meet the needs of different people.
Some patients will do best with daily, in-person, care. Others will be fine going to a weekly or monthly clinic. Even traditional rehabs are starting to get involved in providing Suboxone treatment.
Suboxone can change your life if you are addicted to opioids. It can restore you to how you felt and functioned before you started taking drugs. Suboxone treatment can give your brain a chance to heal from addiction. The fact is that Suboxone treatment does work and it is highly effective in helping people addicted to opioids to recover.