Medicines for Opioid Addiction

Disclaimer: this is very basic information, please see your doctor before starting any of these medicines and see the links below for further information.

Buprenorphine (Suboxone, Subutex, Bunavail, Zubsolv)

  • Stimulates the Mu-opioid receptor partially. This helps to prevent cravings and/or withdrawals.
  • Partially antagonize the Kappa-opioid receptor. This causes a mild euphoria.
  • Stays bound to the opioid receptors about 5-7 days with peak effect at 3 days.
  • Strongly attracted to the opioid receptor therefore will knock any other opioid out of the receptor leading to precipitated withdrawal symptoms.
  • Start buprenorphine 12 to 24 hours after last opioid taken (except for Methadone)
  • Wait about 5 days after last methadone dose of 20-25 mg before starting buprenorphine.

Naloxone (Vivitrol, Naltrexone)

  • Blocks the opioid receptors. (Enough opioids can theoretically override it).
  • Give a small test dose before starting.
  • Start after negative urine drug screen for opioids, suboxone or methadone.
  • Naltrexone starting dose is 50 mg per day orally.
    • Most common adverse effect is a headache or stomach ache, may decrease the dose to 25 mg if these persist after 1 week.
  • Vivitrol starting dose is 380 mg dissolved in a 4 cc vial and injected once a month in the gluteal region.

Meds are about 10% of recovery, they help the Physiological addiction, the rest of recovery is helping the Psychological addiction.

  • The psychological addiction takes daily work.
  • We recommend going to NA meetings for a start.
  • If you have PTSD, Depression, Anxiety, Bipolar disorder you should see Psychiatry.
  • If you have a history of trauma you should see a trauma informed counselor.
  • EMDR (Eye Movement Desensitization and Reprocessing)  is a type of therapy that has been shown to help single episode trauma.
  • Long term exposure trauma can be helped with ongoing counseling.

“My brother was turning blue, he was not moving, not even breathing. I put that bag on his mouth and started squeezing air into his lungs. I could see his chest move. He finally started waking up. I didn’t have to call 911 that time,” my patient recalled.

Continue reading “Addicts, Heroes Among Us”

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