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People become addicted to opiates such as heroin or prescription pain medication because these drugs attach to receptors in the brain that stimulate pleasure. The body responds by reducing endorphins, natural hormones related to the same process. This reduction triggers the user to need more of the opiate, which over time creates both physical and psychological dependence on the drug. Suboxone is an “opioid receptor agonist-antagonist†that attaches to the same receptors in the brain that opiates do. It stimulates them enough to avert withdrawal symptoms, but not enough to produce the “high†that an opiate would produce. If the patient does use an opiate, there will be no effect because the receptors are already busy with Suboxone. This helps reduce cravings for the drug, making it easier for the patient to refrain from using. Suboxone treatment is unique because it can be used in the doctor’s office in a primary care setting. “Unfortunately there is a lot of stigma related to going to a clinic-based program, like Methadone, that requires daily on-site treatment,†says Dr. Robert-Schultheis. “Our program is office-based. The patient takes the medicine the first time in the doctor’s office, observed by their provider. After that, the daily dose can be self administered at home.†Once a patient begins taking the medication, they are screened weekly for illicit substance use via urine toxicology screens. If no evidence of other substances is found, they are reduced to bimonthly visits. After an extended period of abstinence and proven treatment program compliance, which includes therapeutic modalities such as group and individual psychotherapy, they are finally reduced to monthly maintenance visits. We encourage most patients to stay in the program for at least a year, often longer. “It takes a long time to recover from opiate addiction,†says Dr. Roberts-Schultheis. “Our patients usually have to find employment and stable housing. Most have to build a whole new social network away from a peer group that was supporting their destructive behavior as well as receive treatment and stabilize from any co-occurring mental health disorders. It is a very difficult process and we want to make sure they have the support they need.â€
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