First Appointment

Newport Integrated Behavioral Healthcare, Incorporated
4540 Glenwood Road  Decatur,GA 30032
Phone (404)-289-8223

Q. What do I expect during my office visit to the physician for buprenorphine treatment?  

A. The treatment of buprenorphine is divided into the different stages below.

1.  Intake

Your first visit is generally the longest, and may last anywhere from one to three hours.

When preparing for your first office visit, there are a couple of logistical issues you may want to consider.

*You may not want to return to work after your visit-this is very normal, so just plan accordingly.

* Because SUBOXONE can cause drowsiness and slow reaction times, particularly during the first few weeks of treatment, driving yourself home after the first visit is generally not recommended, so you may want to make arrangements for a ride home.

It is very important to arrive for your first visit already experiencing mild to moderate opiate withdrawal symptoms. If you are in withdrawal, SUBOXONE will help lessen the symptoms. However, if you are not in withdrawal, SUBOXONE will "override" the opiates already in your system, which will cause severe withdrawal symptoms.

The following guidelines are provided to ensure that you are in withdrawal for the visit. (If this concerns you, ask to speak with an employee over the telephone prior to the visit. The physician may be able to prescribe medication to reduce the discomfort of withdrawal.)

* No methadone or long-acting painkillers for at least 24 hours. 
* No heroin or short-acting painkillers for at least 10 hours.

Bring    ALL    medication    bottles   with   you   to   your   first appointment.

You will need to arrive about thirty minutes early to fill out all the paperwork. All the forms must be completed before the physician can see you.  In addition, you will need to pay all fees prior to treatment.

Before you begin treatment, the doctor or nurse will ask you questions about your medical health history, your mental health history, and your substance use history, including your current opioid use.  There are no wrong answers to these questions-the goal is to be sure that your doctor has accurate information so she or he can create a treatment plan that meets your needs. All the information you give will be held strictly confidential (for more on this, see Patients' Right to Privacy).   

During this visit, you and your doctor will go over the pros and cons of Suboxone treatment (if you haven't already).  Your treatment expectations as well as your doctor's expectations of you will be discussed. You will most likely be asked to provide a urine sample so the doctor's office can confirm any use of opioids and possibly other drugs. You may also need to have your blood drawn; blood analysis is important for detecting any health conditions (such as anemia or hepatitis) that might interfere with your Suboxone treatment if not addressed.

2. Induction  

You are expected to have ceased taking your current street drug or prescribed opiate medication and arrive in the physician's office experiencing withdrawal symptoms. This point cannot be emphasized enough!  If you take Suboxone before you are in withdrawal, the medication will make you feel worse because it can cause withdrawal symptoms.

Your doctor or nurse will assess your withdrawal symptoms and give you your first dose in the office. Patients may begin to feel some relief within twenty minutes, although the full effects take about an hour. You will then be monitored for a couple of hours by your physician. Depending on the extent to which the first Suboxone dose suppressed your symptoms,  an additional dose of medication may be given to you to reduce withdrawal symptoms.

When you ready to leave the office after the first induction visit:

*Your  doctor  will   make  arrangements  for  you  to have    Suboxone  to  take   home.    Typically,  your  doctor  will   give  you  a  prescription   for  the   amount  of  Suboxone   that  you  will  need  until  your  next appointment, along  with any special instructions related to your care. 

*Your  doctor   may   also   prescribe  other  medications to   help control withdrawal symptoms. 

During induction, daily appointments are not uncommon. This allows your doctor to adjust for your withdrawal symptoms and cravings. Induction can last anywhere from 2 to 7 days. Urine drug screening at every visit is also fairly standard during induction. Patients whose SUBOXONE dose may be too low often use other drugs to try to suppress the withdrawal symptoms and cravings; doctors look for this when evaluating whether a patient is at the right dose.

Intake and induction may both occur at the first visit, depending on your needs and your doctor's procedures.  

Checklist For Your First Visit

*Arrive experiencing mild to moderate opiate withdrawal symptoms.
* Bring completed forms that were mailed to you and/or arrive early to fill out all the paperwork.  
*Bring ALL medication bottles or make a list of the current medications you are taking (including any over-the-counter or herbal medications).   
*Fees due at time of visit (cash or credit card). 

3. Stabilization

During stabilization, your SUBOXONE dose is "fine tuned" about once a week, as needed. The goal is to find a dose where your withdrawal symptoms and cravings are suppressed, and you experience minimal to no side effects. You and your doctor will discuss your treatment options going forward, specifically, maintenance versus medically supervised withdrawal.

4.  Maintenance

Once your dose is stabilized, the maintenance phase of treatment begins. During maintenance, your treatment compliance and progress will continue to be monitored.

Participation in some form of behavioral counseling is strongly recommended to maximize the likelihood of your treatment success. You and your doctor will discuss counseling options that meet your needs.

Your doctor may request urine samples from time to time. Some doctors find urine testing a helpful part of treatment because by verifying the absence of opioids in your system they can evaluate the effectiveness of your SUBOXONE dose. Talk with your doctor if you have questions about the role of urine testing in treatment.

During your ongoing maintenance treatment, your doctor will want to know if you experience any cravings. If you do, your dose may need to be adjusted.

Appointments are usually scheduled on a weekly basis, however, if treatment progress is good and goals are met, monthly visits may eventually be considered sufficient. The maintenance phase can last anywhere from weeks to years—depending on what you, your doctor, and, possibly, your therapist or counselor determine is best for your individual needs.

5. Medically Supervised Withdrawal

Length of therapy is up to your doctor, you, and sometimes your therapist or counselor. In this phase of medically supervised withdrawal, your doctor will slowly taper your SUBOXONE dose, taking care to see that you experience minimal withdrawal symptoms or cravings. Your dose can always be changed if you experience uncomfortable symptoms or cravings at the reduced dose. 

Let's Kick The Habit?

It is important to note that there is no pre-set length of time that someome should be in treatment.  You should not stop taking SUBOXONE until you have discussed it and put together an action plan with your doctor and counselor.  

References:  (1)

Written and Compiled: Deborah Shrira        Dated:  31 August 2007