The last 2 weeks have been rough...

[Justin]

Justin, if this drug is used to get people off narcotics, why would the addicted patients want it? Why not just stick to the good stuff? I'm just not connecting all the dots

My pain specialist here has mentioned it to me, and indicated that I would be a good candidate. Why are the physicians limited to the number they can treat?

Thanks for the information, as usual

Suboxone has buprenorphine and naloxone in it. Buprenorphine is a partial opioid agonist, while naloxone is an opioid antagonist. This means that the naloxone has the capability to displace the buprenorphine that likes to bind to opioid receptors. Incorporating naloxone into Suboxone means that those patients that are opioid dependent will not be able to dissolve this medication and subsequently inject it to "get high" like is done with oxycodone and heroin. This is from the Suboxone Website:

The naloxone in SUBOXONE is there to discourage people from dissolving the tablet and injecting it. When SUBOXONE is placed under the tongue, as directed, very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine. However, if naloxone is injected, it can cause a person dependent on a full opioid agonist to quickly go into withdrawal.

SUBOXONE at the appropriate dose may be used to:

• Reduce illicit opioid use
• Help patients stay in treatment

by

• Suppressing symptoms of opioid withdrawal
• Decreasing cravings for opioids

Many patients that are on suboxone are those that are dependent on opioids (via methadone, heroin, etc. abuse). Suboxone discourages "fix" behavior, while allowing these patients to safely use an opioid without the possibility of abuse. In this case, abusing Suboxone = painful withdrawal symptoms.

SUBOXONE Certification
In October 2000, treatment of opioid dependence was transformed by Congressional approval of the Drug Addiction Treatment Act (DATA 2000).

Under DATA 2000, qualified physicians may obtain a waiver allowing them to prescribe and/or dispense approved Schedule III-V medications for the treatment of opioid dependence. Previously, this type of treatment was available only in federally approved Opioid Treatment Programs, namely, methadone clinics.

For the first time in more than 30 years, qualifying physicians have the legal right to use approved opioid medications (eg, SUBOXONE) to treat opioid dependence in the privacy of an office-based setting.

To become certified to prescribe SUBOXONE for office-based treatment of opioid dependence (ie, to receive a DATA 2000 waiver), physicians must complete 2 steps:

1. Prove that they are qualified

(In addition, physicians must satisfy BOTH of the following criteria:

• Have the capacity to provide or to refer patients for necessary ancillary services, such as psychosocial therapy
  
• Agree to treat no more than 30 patients at any one time in an individual or group practice)

2. Notify the Substance Abuse and Mental Health Services Administration (SAMHSA) of their intent to treat patients with SUBOXONE

For second notifications:
Use this link to access a blank form (PDF).
Use this link to access a form pre-filled with information from your original waiver notification (HTML).

SAMHSA/CSAT will formally acknowledge your submission of the second notification by letter; however, unless you are notified of the contrary, the "good faith" submission of the second notification permits treatment of up to 100 patients.

This addresses "why" some patients seek Suboxone treatment:

Understanding Opioid Dependence
More and more, opioid dependence is being accepted as a chronic disease, much like high blood pressure or diabetes.

Yet unlike these other diseases, opioid dependence carries a very powerful stigma. (To illustrate: Imagine that you are interviewing for a new job. Would you think twice before asking whether the company's health plan covers costs related to your insulin dependence? Would you also not hesitate to ask about coverage of costs related to your opioid dependence?)

This stigma is rooted in the centuries-old belief that opioid dependence is a moral failure. It was only within the last 20 years that researchers began to realize opioid dependence was a medical condition caused by changes in the brain—changes that didn't go away, sometimes for months, after patients stopped using opioids.

Today, opioid dependence in the United States is growing at unprecedented rates. Sadly, fear of the stigma associated with treatment keeps many people from seeking help.

Removing the stigma of opioid dependence is critical to helping patients receive proper care. A key part of achieving this goal is wider recognition that opioid dependence is a medical—not a moral—issue.

The information here is offered to help promote better understanding of opioid dependence as a medical condition by exploring the prevalence, biological origins, impact on behavior, and symptoms of this disease.

I hope this helps.

[KBear]

Justin, Thanks for the information. I believe that not only opiod addiction is a stigma; but just the use of opiods is stigmatized. I am a child of a recovering alcholic (my dad has been clean and sober for 20 years!), so I take extra steps to ward off addiction. I make sure that my family and close friends know what I am taking, how often and why. I try to be an open book, even though some are critical, I think it is best, so there is nothing to hide.

[Justin]

Justin, Thanks for the information. I believe that not only opiod addiction is a stigma; but just the use of opiods is stigmatized. I am a child of a recovering alcholic (my dad has been clean and sober for 20 years!), so I take extra steps to ward off addiction. I make sure that my family and close friends know what I am taking, how often and why. I try to be an open book, even though some are critical, I think it is best, so there is nothing to hide.

Kathy,

This is a very smart approach on your end, as addictive personalities are deeply intertwined in genetics. I'm so happy that your Dad is clean and sober.

[KBear]

Kathy,

This is a very smart approach on your end, as addictive personalities are deeply intertwined in genetics. I'm so happy that your Dad is clean and sober.

Thanks. Me too. I probably would have 0 relationship with him if he weren't. We have such an awesome relationship and I'm so very grateful for that, as I know it could have been very different. It's sad though, to see his regret, for him to apologize to us kids for all he did wrong when he was drinking. Of course, we have all forgiven him; but don't think he will ever forgive himself.