The BUPRENORPHINE Program involves administering an appropriate, adequate dose of a long acting, synthetic opioid called buprenorphine. Buprenorphine acts to stabilize the brain in opioid addicted individuals.  Once an adequate dosage level has been achieved, the patient can expect to experience very little, if any, “craving”, “withdrawal” for at least 24 hours, or other discomfort associated with abstinence from illicit opioid use. “Adequate” dosage is defined as the dose level that relieves withdrawal symptoms and drug craving without producing sedation.  At a sufficient dose, Buprenorphine also acts as a blockade for euphoria if opioids, such as heroin, are taken.  The dose may be adjusted up or down to achieve this state.  Being a safer medication than methadone during the induction phase, a stabilization dose can be reached in a generally short period of time.

The stabilization process generally takes from 1-3 weeks. During and after the stabilization process, the patient will work with the counseling and medical staff to eliminate all illicit drug use.  Buprenorphine is designed as a long-term treatment that includes individual and group counseling centering on assisting the patient in overall lifestyle changes to achieve and maintain recovery.  Buprenorphine is available in tablets or film strips.

In summary, buprenorphine accomplishes 3 main goals for the patient:

1. Removes withdrawal symptoms

2. Reduces drug cravings

3. Blocks incoming opioids, so incoming opioids will not be felt

Other benefits include:

· Reduced clinic visits compared to methadone treatment

· Reduced rate of relapse

· Reduced involvement in illegal activities

· Reduced hospitalizations/emergency room visits for opioid related problems, such as abscess treatment, cellulitis, overdose, etc.

· Reduced risk of contracting HIV and/or Hepatitis C and other communicable diseases

· Improved outcomes for pregnant/parenting women and their newborns or children

· Development of a strong support system for long-term recovery

· Increased ability to gain and maintain employment and/or engagement in school activities

· Improved family relationships

· Overall improved health and sense of well-being

The Buprenorphine Program includes, but is not limited, to the following services:

1. A detailed history and physical exam

2. Urine drug screen testing and analysis (random and at least monthly)

3. HIV and Hepatitis C testing

4. Syphilis testing

5. TB testing and screening

6. Individual and group counseling services provided on-site by a certified or registered AOD counselor

7. Liver Function Tests as needed

8. Narcan/naloxone

9. Limited medical services (abscess treatment, etc.)

10. Referrals for transportation, mental health, medical, and other appropriate referral services

11. Discharge planning

The METHADONE Maintenance Program involves administering an appropriate, adequate dose of a long acting, synthetic opioid called methadone. Methadone acts to stabilize the brain in opioid dependent individuals.  Once an adequate dosage level has been achieved, the patient can expect to experience very little, if any, “craving”, “withdrawal” for at least 24 hours, or other discomfort associated with abstinence from illicit opioid use. “Adequate” dosage is defined as the dose level that relieves withdrawal symptoms and drug craving without producing sedation.  At a sufficient dose, Methadone also acts as a blockade for euphoria if opioids, such as heroin or fentanyl, are taken.  The dose may be adjusted up or down to achieve this state.

The stabilization process generally takes from 2 weeks to 3 months. During and after the stabilization process, the patient will work with the counseling and medical staff to eliminate all illicit drug use.  Methadone is designed as a long-term treatment that includes individual and group counseling centering on assisting the patient in overall lifestyle changes to achieve and maintain recovery.

In summary, methadone accomplishes 3 main goals for the patient:

1. Removes withdrawal symptoms

2. Reduces drug cravings

3. Blocks incoming opioids, so incoming opioids will not be felt

Other benefits include:

· Reduced rate of relapse

· Reduced involvement in illegal activities

· Reduced hospitalizations/emergency room visits for opioid related problems, such as abscess treatment, cellulitis, overdose, etc.

· Reduced risk of contracting HIV and/or Hepatitis C and other communicable diseases

· Improved outcomes for pregnant/parenting women and their newborns or children

· Development of a strong support system for long-term recovery

· Increased ability to gain and maintain employment and/or engagement in school activities

· Improved family relationships

· Overall improved health and sense of well-being

The Methadone Maintenance Program includes, but is not limited, to the following services:

1. A detailed history and physical exam

2. Urine drug screen testing and analysis (random and at least monthly)

3. HIV and Hepatitis C testing

4. Syphilis testing

5. TB testing and screening

6. Individual and group counseling services provided on-site by a certified or registered AOD counselor

7. Narcan/naloxone

8. Limited medical services (abscess treatment, etc.)

9. Referrals for transportation, mental health, medical, and other appropriate referral services

10. Discharge planning

SUBLOCADE is the first once-monthly extended-release injection form of buprenorphine, which provides sustained level of the medication throughout the month.  Continuous release of the medication avoids the daily ups and downs, while it blocks the rewarding effects of opioids.  Patients must be dosed-stabilized for at least 7 days on at least 8 mg of Buprenorphine, with cravings and withdrawal symptoms controlled at current dose, and without evidence of other opioid use.  The sublocade medication is never dispensed or given to the patient; all injections are done on site by trained medical staff.  Injections are administered once every 28 days on this program.  No intakes will be initiated on Sublocade unless they are a direct transfer from another program and/or meet dose, stability, and length of treatment requirement.

In summary, sublocade accomplishes 4 main goals for the patient:

1. Removes withdrawal symptoms

2. Reduces drug cravings

3. Blocks incoming opioids, so incoming opioids will not be felt

4. Medication adherence (i.e. do not need to remember to take buprenorphine pills/film strips daily)

Other benefits include:

· Reduced clinic visits

· More consistent coverage of the opioid receptors leading to increased clinical outcomes

· Reduced rate of relapse

· Reduced involvement in illegal activities

· Reduced hospitalizations/emergency room visits for opioid related problems, such as abscess treatment, cellulitis, overdose, etc.

· Reduced risk of contracting HIV and/or Hepatitis C and other communicable diseases

· Improved outcomes for pregnant/parenting women and their newborns or children

· Development of a strong support system for long-term recovery

· Increased ability to gain and maintain employment and/or engagement in school activities

· Improved family relationships

· Overall improved health and sense of well-being

The Sublocade Program includes, but is not limited, to the following services:

1. A detailed history and physical exam

2. Urine drug screen testing and analysis (random and at least monthly)

3. HIV and Hepatitis C testing

4. Syphilis testing

5. TB testing and screening

6. Individual and group counseling services provided on-site by a certified or registered AOD counselor

7. Liver Function Tests as needed

8. Narcan/naloxone

9. Limited medical services (abscess treatment, etc.)

10. Referrals for transportation, mental health, medical, and other appropriate referral services

11. Discharge planning

Vivitrol is an injectable dose of extended release (i.e. long acting) naltrexone, which blocks incoming opioids.  Vivitrol is administered once every four weeks to patients on this program.  You must be off all opioids for at least ten (10) days prior to initiating Vivitrol.  You must be off methadone or buprenorphine for at least fourteen (14) days prior to initiating Vivitrol.  This medication does NOT remove withdrawal symptoms.

In summary, Vivitrol accomplishes 3 main goals for the patient:

1. May reduce drug cravings

2. Reduces Alcohol cravings

3. Blocks incoming opioids, so incoming opioids will not be felt

4. Medication adherence (i.e. do not need to remember to take naltrexone pills daily)

Other benefits include:

· Reduced rate of relapse

· Reduced involvement in illegal activities

· Reduced hospitalizations/emergency room visits for opioid related problems, such as abscess treatment, cellulitis, overdose, etc.

· Reduced risk of contracting HIV and/or Hepatitis C and other communicable diseases

· Development of a strong support system for long-term recovery

· Increased ability to gain and maintain employment and/or engagement in school activities

· Improved family relationships

The Vivitrol Program includes, but is not limited, to the following services:

1. A detailed history and physical exam

2. Urine drug screen testing and analysis (random and at least monthly)

3. HIV and Hepatitis C testing

4. Syphilis testing

5. TB testing and screening

6. Individual and group counseling services provided on-site by a certified or registered AOD counselor

7. Liver Function Tests as needed

8. Narcan/naloxone

9. Limited medical services (abscess treatment, etc.)

10. Referrals for transportation, mental health, medical, and other appropriate referral services

11. Discharge planning

· Program utilizing methadone or buprenorphine over a 6 month period.  

· A stabilization dose is achieved in the first few weeks of treatment.  Patients remain on the stabilization dose for approximately 3 months and gradually taper off the medication over the final 3 months.

· Individual and Group counseling

· Access to on-site groups

· Referral services

· Narcan/naloxone

· Limited medical services

· Discharge planning