Suboxone Detox Treatment Doctor

Stephen Gilman, M.D. - Addiction Psychiatrist in New York



Opiate Addiction Detox

This website focuses on the use of buprenorphine (Suboxone, Subutex) for opiate addiction detox and maintenance treatment. However, in order for you to make an informed decision about treatment for your addiction, it's important to know about some other options available to you.

Below are some of the other acceptable ways to detox and treat opiate dependency. I'll outline what I believe from my experience to be the Pro's and Con's of these other approaches. In consultation with your adddiction treatment provider you can then have an informed discussion and choose what is right for your unique situation.

Attempt To Wean Off The Opiate

This method can work in cases where you're dependent on relatively small amounts of the drug and can tolerate experiencing some withdrawal symptoms. In some cases, I have had patients who were able to do this with support from me during treatment sessions. However, it takes a high degree of motivation and the willingness to tolerate the withdrawal symptoms for an extended period of time.

In general I do not recommend this approach. As you come down on the opiate amount, you will not only experience withdrawal symptoms, but cravings (the strong, overwhelming desire to use again) which can cause you to simply resume use at your previous level.

Advantage is that this could be done in a private office based setting.

Detox Using Clonidine And Other Medications To Ease Withdrawal Symptoms

Like above, this can be effective if you are dependent on relatively low amounts of an opiate and are willing to still tolerate some withdrawal symptoms. Clonidine is a medication that can blunt withdrawal symptoms, yet it is not nearly as comfortable or effective as buprenorphine. Other medications are used to help decrease anxiety, help with sleep, decrease muscle cramps, decrease nausea, vomiting and diarrhea. However, these other meds are only somewhat effective - you'll still be quite uncomfortable as you detox.

And if you are heavily dependent, then you will likely not be able to complete the detox - it will be too intolerable.

Furthermore, this medication does nothing to help decrease cravings for the opiate, so you could still be at risk to relapse right after the detox period.

Advantage is that this too could be done in a private office based setting.

Methadone Detox

Methadone is a long acting opiate, so it is suited to detox most people from the drug they are abusing.

However, there are some Con's to this approach. It must be done as an inpatient in either a hospital or a detox or rehabilitation center. It can take anywhere from a few days to a week or so (if you are dependent on long acting opiates such as Oxycontin). This can be costly and will keep you away from work and family while receiving treatment.

Methadone can't be used in the U.S. in an outpatient, office based setting for opiate addiction detox. It's not legal.

There are some significant advantages, however, to using methadone - so don't completely discount it. If you are heavily addicted to opiates, then buprenorphine may not be "strong enough" for you and methadone may be your best choice. Also, when used on an ongoing basis, methadone is powerful at decreasing cravings and the risk of relapse to addiction. But this comes with a price because you would need to enroll in a methadone maintenance clinic, pick up your methadone daily or every few days at the clinic. This is a concern for people who want to maintain the utmost in privacy and discretion.

The decision to use methadone is a big one, and I strongly recommend you discuss this option thoroughly with an addiction psychiatrist or other addiction treatment trained physician to make sure it is right for your situation.

Ultra Rapid Opiate Detox

This is a procedure where you are put under anesthesia and given a high dose of an opiate receptor blocker, such as naloxone. This throws you into massive, full blown withdrawal. You are under anesthesia for the procedure so you don't feel the symptoms.

Then, when you wake up in a few hours, you are usually given some naltrexone (as a pill or injection/implant) which will block your opiate receptors so you can't get high.

But there are significant risks to this procedure.

First, there is the anesthesia risk. Deaths have been reported with this procedure.

Second, the naltrexone used will block the ability to get high, but it is not that effective in decreasing cravings. So there have been cases of people getting the ultra rapid detox, taking the naltrexone and still using some opiates. The problem is that after the rapid detox, you are actually more sensitive to opiates. And this is where people end up accidentally overdosing and dying!

Third, there tends not to be the best ongoing follow-up treatment set in place. Remember, the docs doing this procedure are usually anesthesiologists and are most focused on the detox itself - most have no interest, desire or training in doing ongoing substance abuse treatment and therapy.

I often get calls from people who have had the procedure done, wondering what to do next - fearing that a full relapse is right around the corner.

I have never sent a patient of mine to have this procedure done - its too risky.

Buprenorphine Office Based, Private, Discreet Detox and Maintenance

This option is an overall winner for most. You can do it in a doctor's office, and it helps both with the detox portion (getting you off the opiate you're abusing) and helping with ongoing craving control.

The main snag that most people have is that it can be difficult to find a clinician if you are outside of major metropolitan areas. And even in larger cities, there can be wait-lists. This is becasue by U.S. law a Suboxone doctor can only have 30 active patients on buprenorphine at any given time. Recently, up to 100 patients is allowed if the physician has been actively treating with this medication for over a year.

This limit has caused issues with some docs only willing to do detox and not accept patients for maintenance buprenorphine treatment.

I work a bit differently. Any patient I accept into treatment always has the option of staying on the medication for maintenance treatment (when indicated). I only open up a new suboxone patient slot in my practice if I can offer both detox and the option of longer term treatment.

But note, I can have a wait-list at times, so if you are serious and interested - don't wait and call my office.

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108 1/2 East 37th St. - btw Park and Lexington Avenues

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