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Safely Managing Opiate Withdrawal Symptoms With Suboxone

Heroin addiction, as well as all opiate addictions, usually require medically monitored detox for the severe withdrawal symptoms the drugs produce. Heroin use causes a strong physical dependence and therefore withdrawal can result in serious complications when the use of the drug is stopped abruptly. Cold-turkey heroin detox and withdrawal symptoms can include seizures, heart irregularities, vomiting, insomnia and the sweats. Once the body has adapted to the presence of the drug, withdrawal symptoms may occur if heroin use is reduced or stopped. Withdrawal, in regular abusers, may occur as early as a few hours after the last administration. It may also produce drug craving, restlessness, muscle and bone pain, diarrhea, cold flashes, goose bumps, leg kicking movements and various other physical symptoms. Most heroin detox and withdrawal symptoms peak between 48 and 72 hours after the last dose. Sudden withdrawal from some synthetic opiates such as methadone can be fatal. Several different schools of thought exist as to the best method for opiate detox.

The formula

SuboxoneŽ, a sublingual tablet, comes in two dosage forms: 2 mg buprenorphine/0.5 mg naloxone and 8 mg buprenorphine/2 mg naloxone.


Because of its ceiling effect and poor bio availability, buprenorphine is safer in overdose than opioid full agonists. The maximal effects of buprenorphine appear to occur in the 16-32 mg dose range for sublingual tablets. Higher doses are unlikely to produce greater effects.

Opiate Treatment With SuboxoneŽ

This section provides a brief overview of the clinical use of buprenorphine (SuboxoneŽ) for heroin, methadone and other opiate treatment.

Ideal candidates for heroin treatment and other opiate addiction treatment with SuboxoneŽ are individuals who have been objectively diagnosed with an opiate addiction, are willing to follow safety precautions for treatment, can be expected to comply with the treatment, have no contraindications to buprenorphine therapy and who agree to buprenorphine treatment after a review of treatment options. There are four phases of SuboxoneŽ therapy: induction, stabilization, titration and treatment.


This phase is the medically monitored startup of buprenorphine therapy. Buprenorphine for induction therapy is administered when an opiate-dependent individual has abstained from using heroin or other opiates for 12-24 hours and is in the early stages of opiate withdrawal. If the patient is not in the early stages of withdrawal, i.e., if he or she has other opioids in the bloodstream, then the buprenorphine dose could cause acute withdrawal.

Induction is typically initiated as observed therapy in the physician's office and is carried out using SuboxoneŽ.


This phase begins when the patient has discontinued the use of his or her drug of abuse, no longer has cravings, and is experiencing few or no side effects. The buprenorphine dose may need to be adjusted during the stabilization phase. Because of the long half-life of buprenorphine it is sometimes possible to switch patients to alternate-day dosing once stabilization has been achieved.


The titration phase is reached when the patient is doing well on a steady dose of Suboxone. Once the patient shows no sign of opiate withdrawal, the patient is then titrated (stepped-down) from the buprenorphine therapy, until he or she is drug-free. This phase replaces what is otherwise known as "detox".


Effective treatment for heroin addiction, methadone or other opiate addiction requires comprehensive attention to all of an individual's medical and psychosocial co-morbidities. Pharmacological therapy alone rarely achieves long-term success. Thus SuboxoneŽ therapy should be combined with concurrent behavioral therapies and with the provision of needed addiction treatment services. This point is of such importance that physicians must attest to their capacity to refer patients for addiction treatment and counseling when they submit their Notification of Intent to begin prescribing SuboxoneŽ to SAMHSA (Substance Abuse and Mental Health Services Administration).

After the Suboxone treatment client is stabilized on the medication (usually 2-4 days after induction) he has the option of entering our affordable Orange Detox Rehab for men. The program is 30, 60 or 90-days in length and addresses the core elements of recovery-spiritual, emotional, physical, mental and social through a combination of individual counseling sessions, peer groups, process groups, relapse prevention groups, lectures, workshops and 12-step meetings.

Each resident participates in living skills (house chores, light yard-work, etc.) to promote a sense of personal responsibility and social accountability. The men also learn to rely on their support group, a tool that is absolutely a necessity to maintain long-term sobriety after he leaves treatment.

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