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Suboxone

Why treat opiate dependence ?. Increased health risks in opiate addiction Related to injection, risky behaviors45,000 New Mexicans need drug addiction treatmentNew Mexico has highest rate of drug related deaths in nation Twice national rateOften combination of drugs, not a single large dosePai

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Suboxone

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    1. Suboxone Office-based Opioid Replacement Therapy

    2. Why treat opiate dependence ? Increased health risks in opiate addiction Related to injection, risky behaviors 45,000 New Mexicans need drug addiction treatment New Mexico has highest rate of drug related deaths in nation Twice national rate Often combination of drugs, not a single large dose Pain pill addiction highest in southern NM Half are age 25 or under Heroin use high in Hispanic population Many introduced by family Opiate dependent persons can remain in community Return to work, responsibilities quickly Lack of resources for inpatient treatment

    3. Portrait of an Opiate Addict on Suboxone Age: in 30’s First use in teens Prescribed pain pills Family history of addictions Multiple attempts to quit No drug related legal problems Married with children Working

    4. Methadone Introduced in 1960’s Limited to methadone clinics Close monitoring Less than 25% receive treatment Stigma Limited access Availability of clinics Daily visits Cash only Addictive Harsh withdrawals

    5. Bupenorphine Approved for opiate replacement in 2000 Partial agonist at mu receptor, antagonist at kappa receptor Two sublingual forms for replacement therapy Suboxone: Buprenorphine combined with naloxone 2mg\0.5 mg or 8mg\2 mg Subutex: buprenorphine 2 mg and 8 mg Has analgesic properties

    6. Buprenorphine advantages Will displace and block other opioids Low abuse potential Naloxone combination Less withdrawal symptoms Greater safety Ceiling effect (low potential for respiratory depression) Prescribed from physicians office on waiver license Requires 8 hour training Medicaid and insurance will pay for it

    7. How Suboxone Works Therapy initiated when patient in withdrawal Suppresses withdrawal symptoms Decreases craving Has very limited euphoria Long duration of action

    8. Maintenance therapy Induction Inpatient, in office, or at home Stabilization First week, determines dose Maintenance 6 to 12 months Many wean earlier Discontinuation

    9. Detoxification Withdrawal form short acting opiates or methadone Goal is transition from dependence to freedom from opiates with minimum withdrawal symptoms

    10. Precautions Need stable living situation Need support system Recommend self-help group or counseling Avoid benzos, alcohol Avoid pregnancy Use Subutex Limit to one pharmacy

    11. Current status at DOH Two prescribers First patient late July 2007 Screened 35 to date Referred by others in program Found us on Suboxone.com website Transferred from other Suboxone prescribers Currently 23 on Suboxone or Subutex 2 Have weaned off drug Some lost to follow-up or moved away 2 referred to Methadone treatment Trained and Supervised by Project ECHO Weekly teleconference Available by phone for consultation

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