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I went to a conference where virtually every public and community health agency in the area where I live was represented. There is a change...

Showing posts with label suboxone. Show all posts
Showing posts with label suboxone. Show all posts

WHAT IS SUBOXONE? WHAT IS SUBUTEX? WHAT IS MAT & OBOT?

Suboxone is the name of a combination medication: buprenorphine and naloxone. I comes in different strengths. It is made into "films" that get absorbed in your cheek or tablets that get absorbed under your tongue. It is confusing to hear since when you hear naloxone, one thinks of the naloxone used to reverse opioid overdose.  It is all in the properties of each medication. When in film or tablet form AND absorbed via cheek or under tongue, the buprenorphine is the stronger of the two medications, when absorbed through the GI tract. The naloxone properties are different and it is weak in the GI tract and doesn't interfere with the buprenorphine combining with the opiate receptor site, in fact it might help it stick better. But, if misused and abused, and given nasally or IV somehow, the naloxone is stronger and prevents the buprenorphine from adhering to the opiate receptor site. The naloxone takes over the site and nothing else can enter since this med is very strong when given through nose or IV. Strange, but that is how it works in a nutshell.  That is why buprenorphine is usually given as a combination medication. To minimize abuse and prevent harm.

Subutex is a brand name for buprenorphine alone without any naloxone. It used to be that pregnant women received Subutex to minimize any chance of miscarriage. But nowadays, since it is only a danger if abused, Suboxone is often given to pregnant woman with the proper education on the chance of miscarriage if abused. Subutex might also be used for those switching from methadone to Suboxone. It makes for a smoother transition. I heard Subutex is becoming a more popular med in general for treatment but I am not certain on the actual facts. If it is true, then the only reason would be to get more people into treatment.

As I said in a previous post, suboxone is good for those with short history of opioid abuse, with the daily use not too great. If you experience cravings despite all else becoming stable then you need methadone.

Besides cravings, the biggest complaints I have heard from those who tried Suboxone Treatment is that they could not fall or stay asleep. Some complain of a constant headache. Others, it was muscle cramps in their thighs and calves. As with all narcotics constipation is the #1 complaint.

With the Opioid Crisis, Suboxone is becoming a focus point for treatment. Doctors take a course and become certified. Medication Assisted Treatment (MAT) or Office Based Opioid Treatment (OBOT) is what it is being called and you will be hearing a lot more about this. They are generally Suboxone Treatment. Some states already have many physicians participating. Physician participation does vary by state or area. All medication is given by an RN and the patient is assessed and progress monitored properly. Since it is office based, the stigma of a clinic is not there to interfere with any progress. It is a great way to help those newly addicted and a great way to get someone in treatment. As with any treatment program, there is drug testing and addiction counseling or group addiction counseling. It won't work unless you change your thinking AND your behaviors. If Suboxone doesn't work, there is methadone. Still treatment just different med for different needs. The downfall of methadone are the rules: so far, only a hospital or clinic setting may dispense methadone for addiction. I feel a change coming in the near future....


LIST OF MEDS RECOMMENDED AND OK TO ***FLUSH***

Source is FDA.GOV so this is the official word on this subject! 
As you will see, narcotics of all kinds are on this list along with one benodiazepine:
DIAZEPAM OR VALIUM

WHY FLUSH?
In past the concern was all about the water. Now, with the opioid crisis, it was determined that it doesn't affect the water supply enough to make a difference compared to the lives SAVED by flushing all pain medications. You see, once you cross over from tolerance to dependence to addiction, you are willing to do anything to get your next fix. This includes dumpster diving and trash hunting. Nurses used to crush it and mix with kitty litter and detergent. But even this measure is not good enough. The addiction is stronger than any offense from detergent or garbage! To do this properly it is recommended to crush the tablets then flush them twice. Whether they are capsules or tablets, put them in a bag, put your boots on, and STOMP them to powder then flush them twice. If it is just a couple and you have a pill crusher or hammer then you can use that. **If it is a fentenyl patch then *PUT GLOVES ON*, TAKE THE PATCH APART AND CUT IN TINY PIECES THEN FLUSH MULTIPLE TIMES. A fentenyl patch is made to be absorbed through the skin over a period of time such as 24 hrs or more. If a child, pet or maybe even an adult were to ingest part of this patch by mouth then it would definitely be deadly! Here is the official list from fda.gov., A-Z

"Medicines Recommended for Disposal by Flushing Listed by Medicine and Active Ingredient  There is a small number of medicines that may be especially harmful and, in some cases, fatal with just one dose if they are used by someone other than the person for whom the medicine was prescribed. This list from FDA tells you what expired, unwanted, or unused medicines you should flush down the sink or toilet to help prevent danger to people and pets in the home. 
 [the one with]* These medicines have generic versions available or are only available in generic formulations.
FDA continually evaluates medicines for safety risks and will update the list as needed. Please visit the Disposal of Unused Medicines: What You Should Know page at www.fda.gov for more information.
Medicine Active Ingredient
Abstral (PDF - 1M), tablets (sublingual) Fentanyl
Actiq (PDF - 251KB), oral transmucosal lozenge * Fentanyl Citrate
Avinza (PDF - 51KB), capsules (extended release) Morphine Sulfate
Belbuca (PDF – 44KB), soluble film (buccal) Buprenorphine Hydrochloride
Buprenorphine Hydrochloride, tablets (sublingual) * Buprenorphine Hydrochloride
Buprenorphine Hydrochloride; Naloxone Hydrochloride, tablets (sublingual) *
Buprenorphine Hydrochloride; Naloxone Hydrochloride
Butrans (PDF - 388KB), transdermal patch system Buprenorphine
Daytrana (PDF - 281KB), transdermal patch system Methylphenidate
Demerol, tablets * Meperidine Hydrochloride
Demerol, oral solution * Meperidine Hydrochloride
Diastat/Diastat AcuDial, rectal gel [for disposal instructions: click on link, then go to "Label information" and view current label]
Diazepam
Dilaudid, tablets * Hydromorphone Hydrochloride
Dilaudid, oral liquid * Hydromorphone Hydrochloride
Dolophine Hydrochloride (PDF - 48KB), tablets * Methadone Hydrochloride
Duragesic (PDF - 179KB), patch (extended release) * Fentanyl
Embeda (PDF - 39KB), capsules (extended release) Morphine Sulfate; Naltrexone Hydrochloride
Exalgo (PDF - 83KB), tablets (extended release) Hydromorphone Hydrochloride
Fentora (PDF - 338KB), tablets (buccal) Fentanyl Citrate
Hysingla ER (PDF - 78KB), tablets (extended release) Hydrocodone Bitartrate
Kadian (PDF - 135KB), capsules (extended release) Morphine Sulfate
Methadone Hydrochloride, oral solution * Methadone Hydrochloride
Methadose, tablets * Methadone Hydrochloride
Morphabond (PDF – 162 KB), tablets (extended release) Morphine Sulfate
Morphine Sulfate, tablets (immediate release) * Morphine Sulfate
Morphine Sulfate (PDF - 282KB), oral solution * Morphine Sulfate
MS Contin (PDF - 433KB), tablets (extended release) * Morphine Sulfate
Nucynta ER (PDF - 38KB), tablets (extended release) Tapentadol
Onsolis (PDF - 297KB), soluble film (buccal) Fentanyl Citrate
Opana, tablets (immediate release) Oxymorphone Hydrochloride
Opana ER (PDF - 56KB), tablets (extended release) Oxymorphone Hydrochloride
Oxecta, tablets (immediate release) Oxycodone Hydrochloride
Oxycodone Hydrochloride, capsules Oxycodone Hydrochloride
Oxycodone Hydrochloride (PDF - 100KB), oral solution Oxycodone Hydrochloride
Oxycontin (PDF - 417KB), tablets (extended release) Oxycodone Hydrochloride
Percocet, tablets * Acetaminophen; Oxycodone Hydrochloride
Percodan, tablets * Aspirin; Oxycodone Hydrochloride
Suboxone (PDF - 83KB), film (sublingual) Buprenorphine Hydrochloride; Naloxone Hydrochloride
Targiniq ER (PDF - 48KB), tablets (extended release) Oxycodone Hydrochloride; Naloxone Hydrochloride
Xartemis XR (PDF - 113KB), tablets Oxycodone Hydrochloride; Acetaminophen
Xtampza ER (PDF – 67.6KB), capsules (extended release) Oxyccodone
Xyrem (PDF - 185KB), oral solution Sodium Oxybate
Zohydro ER (PDF - 90KB) capsules (extended release) Hydrocodone Bitartrate
Zubsolv (PDF - 354KB), tablets (sublingual) Buprenorphine Hydrochloride; Naloxone Hydrochloride"


Talk LOUD; Don't Die

                                      Takoda the Rescue Dog Says:  Talk LOUD; Don't Die

Let's talk about
Opiate
Use and
Drug abuse

Takoda the Rescue Dog got a second chance at LIFE......YOU Might NOT......Your KIDS MIGHT NOT.......talk LOUD !!!
     with your kids, your parents and your friends!

The Intake Appointment Final Part 3

You did the business in Part 1. Saw the Addiction Counselor in Part 2. Now the last part is seeing the nurse. It is usually the Nurse Manager, Charge RN or seasoned staff RN who interviews you in this last stretch of the Intake appointment. All this is in preparation to see the doctor for your first medication dose. If you have any prescription medications that ARE PRESCRIBED TO YOU then bring them in for the nurse to log into your chart. Don't bring old bottles from last year and don't dump the new prescription pills into an old prescription bottle to condense it. The nurse needs current prescriptions in the current bottles, if possible. Please don't try to deceive the nurse and bring only some of your medications. Believe me, a nurse just knows! If you doctor shopped, say so. A history of doctor shopping or fraudulent prescription writing will NOT get you rejected from being admitted into the program. This is why you are here, right? Honesty is needed. By the way, programs do NOT report you to the police for such crimes. Consider it in the past. Just don't continue such behavior since it is counterproductive to your recovery and sets a bad example to other patients who are doing their best. Criminal behavior might get you kicked out if you choose to continue and get arrested. It is all about choices. Back to the nurse: the nurse will take a medical history such as diseases, injuries and surgeries. Please be sure to report any heart or respiratory issues, concerns or problems. Detox medications are serious business and the doctor needs to know of any heart or lung problems before prescribing your suboxone or methadone. It is his doctor's license on the line and he deserves to be informed. Methadone in combination with certain medical conditions and medications needs to be given with caution. Methadone and suboxone can affect your breathing and oxygen level in your blood, especially when combined with other prescription medications and medical conditions. If you have a medical history and are followed by a specialist then you will be asked to sign a "release" for that specialist. The same goes for your Primary Medical Doctor, your Psychiatrist and your Pharmacy. Why? It is coordination of medical care. Methadone and suboxone are actual prescriptions and all prescribing doctors need to know what the other doctors are prescribing, for medical safety. You might think it is overboard until something happens, some interaction of medications and medical conditions that go awry, and harms the patient in some way, including death. Most treatment centers also ask you to sign a form saying that you will tell any provider you are on methadone and you agree to use only one pharmacy. That is standard practice. After the medical history the nurse will ask about your mental health history, including asking if  you are suicidal or homicidal. Again, be honest. They are just getting the details to better serve you in your recovery process. Next step is actually seeing the doctor for admission into the recovery program of an outpatient clinic. It could be the same day or most likely it will be a few days later at the next available appointment. Again, do not come in impaired, sedated, drunk or high on anything in any way. **you must be in withdrawal when you see the doctor for admission. Enough withdrawal to make it safe to give you a low dose of methadone (or total withdrawal for suboxone). If it is methadone treatment then be in mild to moderate withdrawals and do not use after 8 pm the night before! Seriously, you might not be medicated if you use too late in the evening the night before. If it is suboxone treatement then you have to be in total withdrawals and not have any opiate of any kind for 2+ days. Sounds terrible, I know, but it is the nature of suboxone. If you do not follow the instructions that the clinic tells you, then you will be putting yourself in the worse withdrawals ever on admission day when you take your first dose of suboxone. You will do it to yourself! It is all about choices.

Recovery: The Intake Appointment Part 2

So you already gave you address, phone numbers, emergency contact, paid your fees and have been told countless of instructions and rules. Don't worry about remembering all that. You can always ask and most likely you will be reminded by both staff and other patients. The mindset of patients in recovery seems to vary according to what state or part of the USA you live. I have been told countless of times by "visiting" patients from other states how this is true. So this is straight from the patients themselves. (By the way, in NH, we are very friendly and helpful to all.)
So the Addiction Counselor is the next professional you will see after the business part. This is a long detailed meeting but it is very important! Please do NOT use right before this Intake appointment and do NOT use in the bathroom in between seeing professionals! You nod off, and you have to reschedule! You are cranked up and can't sit still, you have to reschedule! and that postpones your first medication appointment with the doctor so it is pointless. Now, we don't want you vomiting either so plan accordingly....you know what I mean. The appointment is at least 2 maybe 2 1/2 hours. When you see the Addiction Counselor you will be asked everything from the first day you ever used in your life until present day. Questions about every drug you tested including cigarettes and alcohol. Please be honest but don't embellish. No one will be impressed. They will ask about your childhood, your family, employment, legal stuff etc...all this plays a significant role in your recovery. If Uncle Brian beat you every Christmas morning, we aren't going to ask you how your Christmas was. If your friend overdosed in March, we will be on the alert for depressive behavior and possible alcohol/drug use near springtime. All the questions are for a reason. We don't like paperwork that much. A big thank you for being patient with all the questions! The last professional you will see is the nurse in The Intake appointment part 3.
.

Recovery Program: The "Intake" Appointment part 1

You made the phone call and have your first appointment. It is commonly called the "Intake" appointment. This appointment is the most important! From my experiences, this appointment is where all info on you is gathered by MULTIPLE healthcare/addiction professionals. These professionals have heard every story so don't leave out any details and please BE HONEST & precise. After all, this is YOUR life! First piece of business is getting your address and a reachable phone number such as your cell number. If you give a second phone number, please specify if it is OK to leave a message. Don't worry, no one will call you mindlessly or call to check on you. It is needed in case your counselor has the flu and has to cancel counseling, in case of fire and the place of business is in a temporary location etc....in other words, for something very important. You will also be asked for at least one emergency contact name and phone number. This is in case you have a medical emergency or injury, so someone close to you can be told. Otherwise, an emergency contact is NEVER called. Confidentiality is taken seriously. The other piece of business is the payment. Programs can't run on love and good intentions. There should be an "intake" fee or it could be called an administrative fee for the admission process. You will also be asked for the first week's payment up front. Yes, that is a big blow to someone who spends all their money, and other people's money on drugs. But it is necessary for two reasons: 1) It is common for addicts to act on impulse by being admitted to a program then not showing up or paying. It is a lot of work to admit someone into a program. It is considered a waste of time and money when this happens. Someone else who is ready for recovery could have come to that appointment. and 2) If you pay a week in advance with your money or borrowed money, you will be sure to show up that first week to get your money's worth, right? Commitment it what it is. That commitment of one week in treatment opens the door to maybe another week, maybe even another month and bingo! You are on your way to a BETTER life and loving it!

"I'm getting clean...now what....I still have problems!"

Problems, problems, problems! You had a problem and turned to drugs/alcohol to fix it, then got addicted. You had a problem and did drugs to distract you or numb you, then got addicted. You did drugs/alcohol, you got addicted, and it caused problems in your life. Addiction ruins every aspect of your life: personal, family, social, employment, legal. It is a vicious cycle: problem....drugs, drugs....problems...back to drugs etc...Your mind makes up excuses and reasons to continue using drugs. In the old day it was called, "Stinkin Thinkin". Your mind wants to win, and your mind is strong! That's where Addiction Counseling comes in with Addiction Focused Problem Solving to break the cycle. It is a specialized approach to .....everyday shit.  You need Addiction Counselor to show you how it works. With focus and 100% effort it can be done!

HOPE


Like the Phoenix, the addict can rise from the ashes of  the old self into the new self!

Misconceptions



"I can detox myself"
If you take another person's methadone or suboxone, you buy it off the street (it is probably diluted or altered somehow). You try detox yourself slowly so you don't go into withdrawals. So, intentions are there...but....can you really do this and wean yourself completely off, and stay off ... off ANY narcotic or alcohol? NO. I know because addiction is an official disease. and even if you don't believe that, think about it: How many addicts have tried but couldn't stop on their own? or if they did, how long could they maintain that? When an addict sees how it destroys their life, they don't WANT to do it but they MUST so they don't get physically ill and can function normally at work, at home etc... and even when an addict physically weans off the drug, there is a psychological component that is not addressed. Therefore the cycle eventually starts over and continues until addressed. That is where outpatient treatment centers come in. Could be methadone or suboxone. The "medication" is an actual prescription by a certified psychiatrist. It is dispensed by Registered Nurses who are trained in Addiction. Yes, you are usually routinely drug tested to check your progress and there is Addiction Counseling. The physical addiction part is easy. It is the psychological component that a person normally cannot do on their own without guidance, monitoring and support. It is the only way to change your thoughts and behaviors long term. Remember, Addiction is a disease and needs to be treated seriously as a disease or it will come back as that awful problem and cause problems.