Information For Family, Friends And Caregivers

It is common for people to think of substance dependence as a weakness in character, instead of a medical condition that needs treatment. It is very important to make it clear that you are not judging, and that you do not think less of this person because he or she is dependent.

By the time a person becomes dependent, taking drugs every day and needing medical treatment, it can be considered to be a "brain disease." The changes that have occurred in that person's brain activity actually drive him or her to use drugs. Willpower and judgment are greatly diminished.

It is important to be reassuring that you do not blame him or her for being dependent any more than you would blame that person for having any other long-term condition, such as diabetes or high cholesterol.

Also, many people are not aware that they can be treated for opioid dependence in a doctor's office. They may think treatment will require them to visit a clinic every day, or enter a residential treatment facility. Reassuring them that they can receive treatment privately and conveniently can help.

Lastly, offering to support this person through his or her treatment is important. It helps to reinforce that your concern is genuine and that you are sincere about understanding the challenges the other person may face.

To learn more about your role in treatment, read Families' Frequently Asked Questions. We receive many calls from Parents, Friends or our "Significant Others" concerning their loved ones and asking  us for information about the medication and telling us how helpless they feel, wanting to know how they can help them. 

We will always be here for you any hour of the day or night to answer any questions you may have. We are here to assist you in locating available treatment and above all to give support. We realize for some of you it is your first time dealing with a dilemma, such as addiction. You may have many questions to ask and we defintely understand how frightening it can be for you. We want you to know besides the information we provide here for you - we are just a phone call away.

  Frequently Asked Questions-Family

1. What is an opioid?

Opioids and opiates are synthetic and natural drugs that are related to drugs found in opium; many, such as heroin, are addictive narcotics. Many prescription pain medications are opioids, such as codeine, Vicodin®* (hydrocodone bitartrate and acetaminophen), Demerol®† (meperidine hydrochloride, USP), Dilaudid®* (hydromorphone), morphine, OxyContin®‡ (oxycodone hydrochloride controlled-release), and Percodan®§ (oxycodone and aspirin tablets, USP). Methadone and buprenorphine are also opioids.

A small amount of naloxone is in SUBOXONE. Naloxone is added to discourage misuse of SUBOXONE. If SUBOXONE were to be crushed and injected, the naloxone would cause the person to go into withdrawal.

2.  Why are opioids used to treat opioid dependence?  

Many family members wonder why doctors use buprenorphine to treat opioid dependence, since it is in the same family as heroin. Some of them ask, "Isn’t this substituting one addiction for another?" But the two medications used to treat opioid dependence—methadone and buprenorphine—are not "just substitution." Many medical studies since 1965 show that maintenance treatment helps keep patients healthier, keeps them from getting into legal troubles, and reduces the risk of getting diseases and infections that are transferred when needles are shared.

3What is the right dose of SUBOXONE?

Dependence is a developed need to have the opioid receptors in the brain occupied by an opioid. Finding just the right amount of SUBOXONE to fill the receptors at the right rate is an important part of the induction process.

Every opioid can have stimulating or sedating effects, especially in the first weeks of treatment. The right dose of SUBOXONE is the one that allows the patient to feel and act normally. It can sometimes take a few weeks to find the right dose. During the first few weeks, the dose may be too high, or too low, which can lead to sickness, daytime sleepiness, or trouble sleeping at night. The patient may ask that family members help keep track of the timing of these symptoms, and write them down. Then the doctor can use all these clues to adjust the amount and time of day for buprenorphine doses.

Once the right dose is found, it is important to take it on time in a regular way, so the patient’s body can maintain consistent medication levels to avoid experiencing withdrawal symptoms.

4. How can the family support good treatment?

Even though maintenance treatment for opioid dependence works  very well, it is not a cure.  This means that the patient will continue to need the stable dose of Suboxone, with regular monitoring by the doctor. This is similar to other chronic diseases, such as diabetes or asthma. These illnesses can be treated, but there is no permanent cure, so patients often stay on the same medication for a long time. The best way to help and support the patient is to encourage regular medical care, encourage the patient not to skip or forget to take the medication and most importantly, encourage the patient to partake  in regular counseling sessions or support groups.        

-Regular Medical Care
Most patients will be required to see the physician for ongoing SUBOXONE® treatment every two to four weeks, once they are stable. If they miss an appointment, they may not be able to refill the medication on time, and may even go into withdrawal.

Most patients who have become dependent on opioids will need formal counseling at some point in their care. The patient may have regular appointments with an individual counselor, or for group therapy. These appointments are key parts of treatment, and work together with the SUBOXONE to improve success. Sometimes family members may be asked to join in family therapy sessions to provide additional support to the patient and information to the health care provider.

-Support Groups
Most patients use some kind of support group to maintain their healthy lifestyle. It sometimes takes several visits to different groups to find a comfortable environment. In the first year of recovery from opioid dependence, some patients go to meetings every day, or several times per week. These meetings work with SUBOXONE to improve the likelihood of a patient’s treatment success. Family members may have their own meetings, such as Al-Anon, or Adult Children of Alcoholics (ACA), to support them in adjusting to life with a patient who has become dependent on opioids.

-Taking The Medication
SUBOXONE is an unusual medication because it is best absorbed into the bloodstream when taken “sublingually” meaning the patient must hold the tablet under his or her tongue while the medicine dissolves (swallowing SUBOXONE actually reduces its effectiveness). Please be aware that this process takes about 5-10 minutes. While the medication is dissolving, the patient should not speak. It is very important that the family support the patient by understanding that s/he will be “out of commission” for those 5-10 minutes intervals surrounding regular daily dosing times.

One way to support new SUBOXONE patients is by helping them to make a habit of taking their dose at the same time every day. Tying dosing to a routine, everyday activity (eg, getting dressed in the morning) is often one of the best ways to do this, because then the activity itself begins to serve as a reminder.

-Storing The Medication
If SUBOXONE is lost or misplaced, the patient may skip doses or become ill, so it is very important to find a good place to keep the medication safely at home-away from children or pets, and always in the same location, so it can easily be found. The doctor may give the patient a few "backup" pills, in a separate bottle, in case an appointment has to be rescheduled, or there is an emergency of some kind.

It is best if the location of the SUBOXONE  is not next to the vitamins, or the aspirins, or other over-the-counter medications, to avoid confusion.  If a family member or visitor takes SUBOXONE by mistake, a physician should be contacted immediately.

5.  What does SUBOXONE treatment mean to the family? 

It is hard for any family when a member finds out s/he has a chronic medical condition.  This is true for opioid dependence as well.  When chronic conditions go untreated, they often have severe complications which could lead to permanent disability or even  deathFortunately, SUBOXONE maintenance can be a successful treatment, especially if it is integrated with counseling and support for life changes.

Chronic disease means the disease is there every day, and must be treated every day.  This takes time and attention away from other things, and family members may resent the effort and time and money that it takes for SUBOXONE treatment and counseling. It might help to compare opioid dependence to other chronic diseases, like diabetes or high blood pressure.  After all, it takes time to make appointments to go to the doctor for blood pressure checks, and it may annoy the family if the food has to be low in cholesterol, or unsalted.  But most families can adjust to these changes, when they consider that it may prevent a heart attack or a stroke for their loved one.

It is common for people to think of substance dependence as a weakness in character, instead of a disease.  Perhaps the first few times the person used drugs it was poor judgement. However, by the time the patient became dependent, taking drugs every day, and needing medical treatment , it can be considered to be a "brain disease" rather than a problem with willpower.

Family support can be very helpful to patients on SUBOXONE treatment. It helps if the family members understand how dependence is a chronic disease that requires ongoing care. It also helps if the family gets to know a little about how treatment with SUBOXONE works, and how it should be stored at home to keep it safe. Family life might have to change to allow time and effort for the patient to become healthy again. Sometimes family members themselves can benefit from therapy.

You are not alone. We are here around the clock.  If you need us to assist you in any way with your loved ones, then please give us a call. We can be reached at 770-527-9119. We understand the stigma and discrimination attached to "Addiction," and we realize Confidentiality is important. If you just need to talk then we are here to listen and we will uphold your confidence. If you can't afford to call us, we understand and have made arrangements.  

If you will address an e-mail to us at the address given and include your name, phone number and the best time to reach you, then we will call you at our expense. We realize all of you may not have the money to call but your need is just as great, therefore, we have made help available to all at any hour.  

mail to: 

 Reference:  (1) Information For Family,Friends and CareGivers                   

Written and Edited:  Deborah Shrira    Dated:  8 September 2007