Opiate abuse is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion, and infectious diseases like hepatitis and HIV.  Suboxone (buprenorphine/naloxone) is indicated for the treatment of opioid dependence and should be used as part of a complete treatment plan that includes counseling and psychosocial support.  Maintenance treatment with Suboxone for opioid addiction consists of three phases: (1) induction, (2) stabilization and (3) maintenance.

Initial Consultation

At our first appointment, I will do a thorough intial psychiatric evaluation.  You should not expect to receive Suboxone at this initial visit.  If this evaluation reveals that you are a good candidate for Suboxone then you will be scheduled for an appointment within five days during which you will receive your first dose of Suboxone (induction).  After the initial evaluation, you will be instructed to obtain laboratory testing.  This must be completed prior to receiving your first dose Suboxone.  

Induction

Patients who are dependent on short-acting opioids should abstain from using 12-24 hours before taking their first dose of Suboxone.  You should arrive for your induction appointment in mild-to-moderate withdrawal, not severe withdrawal.  Prior to your first dose, we will assess your withdrawal symptoms using COWS (Clinical Opiate Withdrawal Scale) to guide the induction process.  The target daily dose minimizes both withdrawal, addictive urges and medication side effects.  

Stabilization

The stabilization phase begins when a patient has no withdrawal symptoms, experiences minimal or no side effects, and no longer has uncontrollable urges for opioid agonists.  Dosage adjustments may be necessary during early stabilization. 

Maintenance

The longest period that a patient is on Suboxone is the maintenance phase.  This period may be indefinite.  During the maintenance phase, attention must be focused on the psychosocial and family issues that have been identified during the course of treatment as contributing to a patient’s addiction.