Choosing a treatment pathway can be challenging for people who are dependent on opioids. buprenorphine/naloxone (Suboxone) is one of several options available for opioid use disorder treatment. How should you decide if Bicycle Health’s treatment program is right for you?
Why choose Suboxone?
Buprenorphine/naloxone (Suboxone) is a proven treatment for opioid use disorder that has helped many people bring their addiction under control and return to the life they want to lead. Suboxone is a type of “medication assisted treatment” (MAT) or “medication for opioid use disorder” (MOUD) that alleviates the biochemical effects that occur when a person stops opioids. Physical stabilization with medications like buprenorphine/naloxone (Suboxone) helps create the space to address underlying issues that contribute to opioid addiction, including mood disorders (anxiety/depression), chronic pain, PTSD, etc.
Bicycle Health’s Suboxone program can be helpful in the following cases:
Opioid dependence: To be treated at Bicycle Health, you must have a dependence on opioids, which can include pain pills (oxycodone, hydrocodone, tramadol, etc), heroin, fentanyl, kratom, or other forms of opioids including Suboxone from street sources. Bicycle Health uses standard criteria to determine if a person has a dependence versus similar issues that can confuse a diagnosis, such as poorly controlled chronic pain.
People develop opioid dependence for many reasons, including chronic pain, recreational overuse, and psychiatric issues. Regardless of how someone started on opioids, the effects of long-term opioid use are consistent, including tolerance (the need to use more opioids to get the same effect) and withdrawal (feeling ill when opioids are suddenly stopped). Suboxone can effectively treat opioid addiction regardless of the reason that someone started opioids.
Chronic pain with opioid dependence: The main ingredient in Suboxone (buprenorphine) was invented to control pain, and many patients with chronic pain benefit from Suboxone treatment. Suboxone may be helpful for various kinds of pain such as neuropathic (nerve) pain, increased pain utilizing opioids (“opioid-induced hyperalgesia), or somatic pain from old injuries.
Opioid dependence during pregnancy: It is critical that pregnant women have access to care for opioid dependence due to high relapse rates during pregnancy and opioids’ potential harm to the baby. Suboxone is most likely safe during pregnancy, but a different medication called Subutex is often used in pregnant women because its safety profile is better understood.
While Suboxone treatment is effective for many people with opioid use disorder, not everyone is an ideal candidate for this kind of treatment with Bicycle Health. The following are reasons that our program might not be right for you:
- Lack of an opioid use disorder (OUD) diagnosis: To receive Suboxone services at Bicycle Health, you must have an addiction to opioids - not just a chronic pain issue for which you take opioids. If you are unsure if you meet the criteria for addiction, please contact Bicycle Health to discuss with our staff. If you do not meet the criteria for addiction, a pain clinic or primary care provider might be able to help with transition to buprenorphine/naloxone (Suboxone) for pain.
- Prior unsuccessful attempts at Suboxone treatment despite adequate support: Previous participation in Suboxone programs does not exclude an individual from treatment with Bicycle Health, especially if the treatment was working but interrupted by incarceration, a provider leaving a practice, COVID19, or other barriers. Restarting Suboxone with a telemedicine provider can help overcome some of those barriers and increase the chance of success. However, if an individual has not been able to achieve sobriety via Suboxone programs with good support and follow up, Suboxone may not be the right medical choice. In those cases, methadone (a long-acting substitute opioid) or Vivitrol (an injectable opioid blocker) may be better options; unfortunately, these medications must be given in person so cannot be obtained through Bicycle Health.
- Severe chronic pain unresponsive to Suboxone: Many patients become dependent on opioids after an illness or injury they received opioids for. Buprenorphine (the main ingredient in Suboxone) was invented first as a pain medication, and many people with chronic pain find that their symptoms improve with buprenorphine. However, buprenorphine/naloxone (Suboxone) is not strong enough for all pain conditions; in that case, methadone might be a better treatment. Sometimes the only way to know for sure is to trial Suboxone under medical guidance to see if it is strong enough to treat both opioid addiction and chronic pain.
- Untreated severe mental illness: Every patient deserves the best care for overlapping issues of addiction and mental health. Patients with mood disorders (anxiety/depression), trauma or post-traumatic stress disorder (PTSD), attention deficit disorder (ADD), and similar psychiatric issues may do very well with Bicycle Health’s services. Because Bicycle Health does not offer complex psychiatric services, individuals with more severe or untreated psychiatric disorders (such as hallucinations or mania) may benefit more from an integrated program that can provide diagnosis and medications for addiction and other issues at the same time. If you are unsure where you fall on this spectrum, please contact Bicycle Health to speak with our staff.
- Desiring Suboxone for short-term tapers or detoxification: Short buprenorphine/naloxone (Suboxone) tapers used to detox from opioids are usually ineffective, and most people who attempt rapid tapers return to opioids quickly. These short tapers are dangerous because people lose their “tolerance” to opioids when they taper off; when they return to a former dose of opioids, overdose is common. The optimal length of treatment varies from person to person, but short tapers benefit very few. If you are unsure about the optimal length of treatment for you, please talk to our staff about this process.
- True allergy to Suboxone: True allergies include hives, swelling in the throat/lips/eyes, and anaphylaxis; anyone who has experienced this with Suboxone should avoid taking it again unless they are under close medical supervision.
- Like any medication, Suboxone has side effects; the most common side effects are headache and nausea. Many people who have tried Suboxone from street sources have had the unpleasant experience of severe “precipitated withdrawal” when Suboxone is taken too soon after an opioid. All of these can be managed with close medical supervision and do not exclude individuals from Suboxone treatment.
Even after you start treatment for opioid use disorder, you have the right to decide if this program is the right choice for you.
Reasons why you may want to consider options outside of Bicycle Health’s services include:
- Intolerance to Suboxone, including allergic reactions (rare) and nausea/headaches (common but usually tolerable if medications are started carefully).
- Inadequate response to Suboxone for opioid dependence, including continued cravings and withdrawal symptoms despite Suboxone.
- Inadequate pain control for those patients who have both an opioid addiction and an underlying pain issue.
If you experience any of these challenges after starting Suboxone, please bring them up with your medical provider so that you can look for solutions together.
If you think that Bicycle Health’s Suboxone treatment program for opioid addiction is right for you, please call us at (844) 943-2514 or schedule an appointment here to learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment.
For more information on buprenorphine/naloxone (Suboxone), opioid dependence, and our telehealth treatment model, please visit our FAQ.
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