Process for Opioid Medication Treatment

Intake Appointment

The initial appointment is a comprehensive evaluation of your substance abuse, psychiatric, and medical history. We will discuss the medication assisted treatment process and expectations for treatment.

Induction Appointment

When starting Suboxone, you have to go through an induction process. It requires that you abstain from all opioids for 12-24 hours as you need to be in moderate withdrawal. If you have opioids in your system and take Suboxone you will most likely experience what is called precipitated withdrawal as these medications displace opioids from its receptor, causing withdrawal that comes on fast and is much more intense.

You will generally be prescribed clonidine to lessen the physical effects of withdrawal at your initial appointment. After your initial intake appointment, you will obtain the medication from a pharmacy and bring it back to the office following day. You will take your first dose of Suboxone in the clinic and be observed. This is ensure the dose is not too high nor too low for you. Your withdrawal symptoms should start resolving within 10 to 20 minutes and you should feel almost normal in 45-60 minutes.

Induction is not required for patients already taking Suboxone and transferring from another provider.

Follow Up Appointments

We will need to follow up one week after initiation of Suboxone treatment to ensure the dose is correct for you. After this we will adjust the number of appointments according to how you are progressing.

Prescription Coverage By Insurance

Coverage of Suboxone by insurance companies varies. Some prescription plans cover it without any additional paperwork. Many require preauthorization which may take a few days to be approved vs. rejected (the majority are approved). The pharmacy will fax the office a notice of rejection and I will start the authorization process to try to get it covered. That said, if it is covered, then only a certain brand may be covered. There could be a limitation on quantity allowed per month and how long the medication will be covered. While awaiting insurance coverage, you can pay cash for Suboxone to not delay treatment. Suboxone is $7.00-8.00 per strip in cash.

Partial Prescriptions

Most pharmacies will allow you to get a partial prescription. You can purchase a few tablets or films at a time to defray costs. Ask the pharmacy about their policy and, if they will not fill partial prescriptions, use another pharmacy who does.

Discount coupons

There are medication discount websites which allow you to download a coupon. This
might save you a little bit of money per script, which adds up over time. However, you
cannot use these coupons and insurance at the same time.

You don’t get over an addiction by stopping using. You recover by creating a new life where it is easier to not use. If you don’t create a new life, then all the factors that brought you to your addiction will catch up with you again.

Other Medication Options:

Naltrexone:

Naltrexone is a full opioid blocker that blocks the effect of opioids. It will not prevent withdrawal symptoms. This medication is suitable for someone who has not used opioids for at least 7 days and is very motivated to remain sober.

It is available as:
Naltrexone tablet: Cash price is $1 to $3 per 50 mg tablet. Only one tablet per day is needed.

Naltrexone injection: Vivitrol administered once a month. Cash price is $900 to $1100 per injection. Many insurance companies will cover this medication if you have failed Naltrexone in pill form.

Naltrexone cannot be abused, you cannot get high on it, and it is not a controlled substance.

If you have opioids in your system and take Naltrexone you may experience what is called precipitated withdrawal as these medications displace opioids from its receptor causing a withdrawal that comes on quickly and is much more intense.