During the 12-week treatment, patients are inducted on buprenorphine and stabilized.

After the 12-week treatment there are three options available:

• Option 1: Detox from buprenorphine by decreasing the dose of buprenorphine by 2mg a week.
• Option 2: A slow detox from buprenorphine, decreasing the dose of buprenorphine by 2mg every month.
• Option 3: For those who need to be maintained long-term on buprenorphine. These patients are ordinarily seen once a month by Dr. Chacko.

In appropriate cases, a treatment program different from the above-described protocol can be devised. The cost of such an individualized program will depend on the length and intensity of the treatment program.

Sometimes patients who are heavily addicted to opioids will require inpatient detox before starting the outpatient treatment. In these cases, Dr. Chacko will refer the patient to an inpatient detox program (the cost of which will be borne by the patient) for a period of two to seven days before initiating the 12-week outpatient treatment with Doctor. Chacko.

Treatment for opioid addiction utilizes buprenorphine (Suboxone/Subutex), as well as other appropriate medications and counseling.

Buprenorphine (Suboxone, Subutex) treatment is appropriate for patients addicted to opioids, including narcotic pain medications, street Methadone and heroin.

The patient has to be in a state of mild to moderate withdrawal in order to initiate Buprenorphine induction.

Researchers have long known that the human brain rewards behaviors conducive to survival (e.g. eating, procreation) by stimulating dopamine activity to create a reinforcing, pleasurable sensation. Substances (such as opioids) with a high potential for abuse also increase dopamine activity, which reinforces the drug-taking behavior and, in effect, tricks the brain into believing opioids are essential for survival.

Opioid Dependence is often described as a “brain disease” because prolonged exposure has been shown to cause:

• Pervasive changes in cognitive and drug-rewarding circuits.
• Significant alterations at the neurochemical, molecular and cellular levels.
• Changes to brain structure and function that persist long after drug use has ceased.

Buprenorphine, also known as Suboxone and Subutex, is a partial opioid agonist with a high affinity for the mu-opioid receptor and lower intrinsic activity than full opioid agonists. These properties may enable buprenorphine to:

• Suppress patients’ opioid withdrawal symptoms and decrease opioid cravings.
• Cause limited euphoria compared to full agonists, but produce sufficient positive effect to aid in treatment compliance.
• Cause less physical dependence than full agonists.
• At adequate doses, buprenorphine blocks the effects of any subsequently administered opioids by keeping them from binding to the mu receptors.
• Pose less risk for fatal respiratory depression compared to full agonists because of the “ceiling effect” characteristic of partial opioid agonists like buprenorphine.

Buprenorphine (Suboxone) has potent analgesic properties. Therefore, sometimes patients who are on narcotic pain medications, who tend to abuse them, can be safely switched over to Suboxone and maintained on it.

Patients visiting a physician’s office for Suboxone treatment are indistinguishable from those being seen for any other reason, reducing the patients’ fear of being stigmatized.

Because Suboxone is a prescription medication dispensed for take-home use, it can eliminate the need for daily visits to a clinic, giving patients the freedom to go on business trips, visit family and friends out of state, or go on vacation.

Dr. Chacko is qualified to treat patients with buprenorphine (Suboxone, Subutex) by virtue of the fact that he holds a subspecialty board certification in addiction psychiatry from the American Board of Medical Specialties. In addition he has completed a training program specifically for the management of opioid-dependent patients.

• WebMD; Buprenorphine SL Information
• WebMD; Suboxone SL Information
• Suboxone Online, Treatment Programs (http://www.suboxone.com)
• American Psychiatric Association (http://psych.org/)
• American Academy of Addiction Psychiatry (http://aaap.org/)
• American Society of Addiction Medicine (http://asam.org/)