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Suboxone offers help for opiate addicted patients in primary care
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New drugs offer renewed hope for patients addicted to opiates, and primary care physicians in Indiana, like those across the nation, are beginning to discuss cases of successful treatment.
Buprenorphine is a partial opioid agonist that reduces illicit drug use with long-term therapy. The brand Subutex is buprenorphine alone; Suboxone is buprenorphine in combination with naloxone. The rationale for this drug usage is based on the fact that when the combination is taken intravenously it causes withdrawal. (Naloxone is an opioid antagonist that has poor absorption.)
The major advantage of Suboxone, compared with methadone, is that Suboxone may be obtained from appropriately trained physicians a month at a time, freeing the patient from daily methadone visits.
Suboxone may be used in a maintenance fashion, as with methadone, but some practitioners use Suboxone as a bridge from illicit opioid use and wean the patient to an anticipated drug-free state. Smaller studies demonstrate Suboxone’s efficacy in helping the patient achieve sobriety, but we still lack large prospective studies.
Ideally, patients treated in the office for opiate withdrawal should receive ongoing counseling, along with the prescription regimen involving Suboxone. Physicians should be familiar with local community chemical dependency resources, as well as mutual self-help groups like Alcoholics Anonymous.
Buprenorphine is the first drug in the U.S. that can be prescribed in the office for both opioid detoxification and/or maintenance. It can be used only by certified physicians who have registered with the Center for Substance Abuse Treatment.
As with methadone, patients who develop acute pain should be treated with appropriate pain medications, and short-acting opiates should be dosed in higher than usual doses.
The details of acute and chronic pain management in the patient using buprenorphine are beyond the scope of this article.
A.A. assists patients fighting alcohol dependency
Alcoholics Anonymous can help you with patients who are recovering from alcoholism. To find a meeting near you or for more information, go online or call (317) 632-7864.
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