-
Opioid Dependence Treatment
 
 In our Center we offer a
Comprehensive Buprenorphine/Naloxone Program 
 
Consisting of  extensive Opioid Dependence Evaluation by the  Psychiatrist, regular  Buprenorphine/Naloxone medication  management  appointments, group therapy and mandatory in-office Urine Toxicology Screening.
 
Information about Buprenorphine/Naloxone Treatment
 
Suboxone®,  Zubsolv®,  Bunavail® (buprenorphine/naloxone) is an FDA approved medications for treatment of people with heroin or other opioid  addiction. Combination of Buprenorphine/Naloxone can be used for detoxification or for maintenance therapy. Maintenance therapy can continue as long as medically necessary. There are other treatments for opiate addiction, including methadone, naltrexone, and some treatments without medications that include counseling, groups and meetings.
 
If you are dependent on opiates — any opiates -you should be in as much withdrawal as possible when you take the first dose of buprenorphine.
If you are not in withdrawal, buprenorphine can cause severe opiate withdrawal. We recommend that you arrange not to drive after your first dose, because some patients get drowsy until the correct dose is determined for them.
 
Some patients find that it takes several days to get used to the transition from the opiate they had been using to buprenorphine. During that time, any use of other opiates may cause an increase in symptoms. After you become stabilized on buprenorphine, it is expected that other opiates will have less effect. Attempts to override the buprenorphine by taking more opiates could result in an opiate overdose. You should not take any other medication without discussing it with the physician first. 
 
Combining buprenorphine with alcohol or other sedating medications
 is dangerous. The combination of buprenorphine with benzodiazepines (such as Valium®, Librium®, Ativan®, Xanax®, Kionopin®, etc.) has resulted in deaths.
 
Although sublingual buprenorphine has not been shown to be liver-damaging, your doctor will monitor your liver tests while you are taking buprenorphine. (This is a blood test.) 
 
The form of buprenorphine you will be taking is a combination of buprenorphine with a short-acting opiate blocker (naloxone) in a 4 to 1 ratio (4 mg
of buprenorphine to I mg naloxone). It will maintain physical dependence, and if you discontinue it suddenly, you will likely experience withdrawal. If you are not already dependent, you should not take buprenorphine, it could eventually cause physical dependence.
 
Buprenorphine/naloxone tablets must be held under the tongue until they dissolve completely. It is important not to talk or swallow until the tablet dissolves. This takes up to ten minutes. Buprenorphine is then absorbed over the next 30 to 120 minutes from the tissue under the tongue. Buprenorphine is poorly absorbed from the stomach. If you swallow the tablet, you will not have the important benefits of the medication, and it may not  relieve your withdrawal. 
 
Most patients end up at a daily dose of 12/3-16/4mg of buprenorphine. (This is roughly equivalent to 60mg of methadone maintenance). Beyond that dose, the
 effects of buprenorphine plateau, so there may not be any more benefit to increase
in dose. It may take several weeks to determine just the right dose for you. The first dose is usually 2/0.5-4/1mg. 
 
If you are transferring to Buprenorphine/Naloxone combination from Methadone maintenance, your dose has to be tapered until you have been below 30mg for at least  a  week.  There must be at least 48 hours (preferably longer) between the time you take your last methadone dose and the time you are given your first dose of buprenorphine. Your doctor will examine you for clear signs of withdrawal, and you will not be given buprenorphine until you are in withdrawal.
 Patient Instructions for
Initial Opioid Dependence Treatment Appointment 
 
1.    Bring completed Forms or come early.
2.    You should be in withdrawal as much as possible.  
       If addicted to Methadone, it must be at least 48 hours (preferably longer)  since your last Methadone dose; if addicted to heroin or short-acting opioids (Vicodin, Demerol, Dilaudid, Morphine, Oxycontin, Percodan, Codein and other); it must be at least 24 hours since your last use.
Physician will examine you for clear signs of withdrawal and you will not be given Suboxone until you are in at least moderate withdrawal.
3.   Come with a full bladder since you will be urine drug tested.
4.    Bring ALL pill bottles.
5.    Bring a Valid photo ID.
6.    Will be breath tested for alcohol.
7.    We recommend that you arrange not to drive after your first dose, because some patients get drowsy until the correct dose is determined for them. 
 
  Patient's Instructions for  Follow-up Suboxone Appointments
 
1.   Patient must bring Buprenorphine / Naloxone pill bottle to every appointment so that remaining supplies can be counted.
2.    Mandatory urine drug testing (done in office) will be done with each Buprenorphine appointment to confirm the use of alcohol, prescription/street drugs as well as Buprenorphine intake (come with a full bladder to every appointment).
3.   Lost Buprenorphine / Naloxone prescription or medications will not be replaced until next appointment and based on circumstances of the incident; the patient might be discharged from the program.
 
   Patient will be Discharged from the Program if:
 
-   urine is positive for alcohol, prescription drugs, street drugs or   negative for buprenorphine.
-   refusing urine or breath testing.
-   refusing to attend mandatory Suboxone group therapy.           
-   missing more than one appointment without significant reason.           
-   reporting lost or stolen medications on more than one occasion.           
-   running out of medications too soon more than once.
-   not responding to phone calls or neglecting to mention changes in address or phone number.
-   appearing intoxicated or behaving inappropriately during an appointment.
-   refusing to pay visit bills.
 
 
Mandatory  Psychoeducation Groups
 
Monthly ongoing, mandatory, psychoeducation groups are required of all Opioid Dependence patients. These groups are an important part of your treatment plan and are structured to present you with the opportunity to discuss some of the most common issues arising for patients during the maintenance phase of your opioid dependence treatment. Every month  groups addresses a different topic. It is your responsibility to make sure you attend monthly psycho-education groups.  Attendance will be taken at these groups and after you have participated in monthly psycho-education groups, you will have fulfilled the mandatory psycho-education part of your Opioid Dependence Treatment.           
 
 
 
Mandatory Psychoeducation Group Times: 
Tuesday 4:00 - 5:o0 PM
Thursday 4:00 – 5:00 PM.    
 
One to One Individual Psychotherapy Sessions and  Ongoing Process Groups
 
            In addition to monthly mandatory psycho-education groups, we are offering monthly one to one individual psychotherapy sessions instead of the group session if you prefer more confidential settings.
We also offering on-going, drop-in, process groups providing group support and counseling for all opioid dependence patients. You are welcome to attend the process groups during the same time period you are attending your mandatory psycho-education groups, or as follow-up group support after completing your mandatory psycho-education groups. Since the needs of the individual group members will likely vary from session to session in drop-in groups, the format of this process group is flexible and oriented to meet the needs of the particular individuals in attendance.
 
Treatment Charges
 
In our Center we are no longer able to maintain in network status with any insurance companies.  Patients with out-of-network benefits are qualified as a self-pay. The self-pay patients or patients with out-of-network benefits will be required to pay the full fee prior to each service provided. Patients should contact their insurance companies to determine their out-of-network benefits. We will provide information to help patients submit for out-of-network reimbursement on their own from their insurance company.
 
  • Opioid Dependence Evaluation(Substance abuse Evaluation):                            $400.00

  •  Combination of  Med. Management  & Opioid Dep. Medication                   Treatment with mandatory Urine Toxicology Screen:                                     $250.00

  • Combination of Opioid Dep. Medication Treatment with Individual   Opioid Dep. Therapy and mandatory Urine Toxicology Screen:                                         $250.00

  • Individual Opioid Dependence Therapy (30 min):                                                $150.00

  •  Opioid Dependence Medication Treatment with mandatory     
                    Urine Toxicology Screen:                                                                                                 $135.00

  • Opioid Dependence Group Therapy (45-60 min mandatory monthly):             $50.00  (per session)      

  • Urine Toxicology Screen (opioid dependence patients):                                            $50.00

  • Missed / Late Cancel Follow-up Med. Management/Opioid Dep. App.:     $85.00

  • Missed / Late Cancel Follow-up Group Therapy/ Opioid Dep. Groups:     $50.00