We offer Medication for Addiction Treatment (MAT) with Suboxone (buprenorphine/naloxone) to help patients stop their opioid use.
Combined with our empathetic care model, this transformative treatment boasts 95% of patients reporting no withdrawal symptoms at 7 days. It can change your life.
We never share any health information without your explicit consent. Your care is 100% confidential, and we take this very seriously.
With your consent, our team will design and coordinate a treatment plan that is ideal for you. And you can access this plan easily through our app.
Bicycle Health is currently available in Arizona, California, Colorado, Connecticut, Delaware, Florida, Illinois, Iowa, Maine, Maryland, Michigan, Montana, Nebraska, New Mexico, North Carolina, North Dakota, Oregon, Pennsylvania, Texas, Vermont, Virginia, Washington, Wisconsin, and Wyoming.
We’ll be available in Massachusetts soon. And we’re continually expanding to new areas. Check back with us about availability in your area.
Medications (along with behavioral therapy) are an important part of treating opioid addiction and helping patients stay in recovery. Compared to being on medications for opioid addiction treatment, patients NOT on medications are more than 3 times likely to die from an opioid overdose. The three scientifically-proven medications to treat opioid addiction include: buprenorphine/naloxone (Suboxone), methadone, and vivitrol. Each work slightly differently and the choice to be one versus another really comes down to patient preference.
Buprenorphine/naloxone (Suboxone) is convenient in that it can be prescribed in an outpatient setting and does not require daily trips to methadone clinics; though, some people need that level of accountability. Unlike methadone, Suboxone has very few medication interactions, and has a ceiling effect (taking more and more does NOT result in an overdose or getting “high”) so it is very difficult for patients to overdose on it. It is considered to be a very safe medication. Vivitrol is a third effective option provided as a monthly injection that is available in the outpatient setting too.
When taken appropriately, all these medications should help patients avoid feeling cravings or withdrawals from opioids, block other opioids (like heroin or fentanyl or oxycodone), and help patients feel normal so they can get back to a meaningful and fulfilling life.
The decision of which medication to choose is ultimately an individual one. Since Suboxone is very safe and convenient with almost no contraindications, many people prefer this option.
Bottom line: Patients with opioid addiction who are motivated to be in recovery and desire treatment with Suboxone are considered good candidates.
In most instances, yes, particularly in the pandemic, telehealth visits are covered by most major insurances. If there is any doubt, the best way to find out is to call your health plan directly and inquire directly about telehealth visits to ensure that they are covered. However, most insurances do cover telehealth visits just like they would cover a regular office visit.
Suboxone can be taken any time of day as long as you stick to your schedule and take it at the same time each day as determined by your treatment provider.
The exact time may depend on how long it has been since you last took a full opioid agonist and where you are in treatment or recovery.
When deciding on the best time to take your first dose of Suboxone, you will need to look at when your last dose of a full opioid agonist was. Taking a full dose of Suboxone while a full opioid agonist is still active in your system can precipitate withdrawal symptoms and make you sicker. Therefore, you ideally should be feeling some withdrawal symptoms before you take your first dose of Suboxone.
Generally, opioids stay in your body for varying amounts of time:
It is important to already be feeling withdrawal symptoms when starting your first dose of Suboxone. This means that all other opioids are entirely out of the body and Suboxone will not therefore cause “precipitated withdrawal”.
The time of day you choose to take your first dose of Suboxone depends on how severely you are feeling withdrawal symptoms and when your last dose of a full agonist opioid was. If your last dose of heroin was at night, for example, you will likely want to start Suboxone the following morning about 12 hours after your last use of a full opioid agonist.
How much and when you take Suboxone after the initial dose will again depend on how you are feeling. Suboxone should make you feel better and minimize withdrawal symptoms.
It will take about 20 to 45 minutes for Suboxone to take effect. If Suboxone makes you feel worse, contact your provider right away as this could be precipitated withdrawal.
Typically, your first dose of Suboxone will be in the morning. Most providers recommend starting with a 2 mg dose the first time. If you are still feeling withdrawal symptoms one to three hours after your first dose, you can take a second 2 mg or even 4 mg dose in the afternoon. You can repeat with a third or even fourth dose when needed, again with one to three hours in between doses and only if you are still feeling difficult withdrawal symptoms. Most providers would advise that you should not exceed 8 to 12 mg of Suboxone the first day. However each patient is very different which is why it is essential to be in close communication with your doctor for the first couple of days of starting Suboxone. Some providers even suggest that patients take their first few doses in the office (called “in office initiation”) so that their doctor can be close by to offer reassurance, provide suggestions and monitor symptoms.
Generally, you will only need one dose per day not to exceed 16 mg. However every patient is different and dosing schedule is largely determined individually between each patient and provider.
You can continue to take Suboxone as long as needed to keep drug cravings and withdrawal side effects from returning. Many people remain on Suboxone indefinitely.
Buprenorphine, the active ingredient in buprenorphine/naloxone (Suboxone), is not part of the standard drug screen, so it should not show up on a standard test. For Suboxone to show up on a urine drug screen, someone would have to specifically order “buprenorphine” in addition to the standard drug test.
If you are concerned about your employer checking for Suboxone and using the test results in negative ways against you, Bicycle Health providers will provide an official letter explaining you have a prescription for buprenorphine/naloxone (Suboxone) without breaking patient confidentiality. This helps reinforce the legal protections you have from employment discrimination. You are not permitted under the law to be fired or penalized for being on Suboxone, so long as it is prescribed by a doctor.
Until recently, Suboxone could only be prescribed by a doctor who had completed a “waiver training.” However, the government has long been receiving a lot of pressure to make Suboxone more readily available for those that need treatment, which means expanding access to the number of providers that can prescribe Suboxone without additional licensing or training.
In January of 2021, the Department of Health and Human Services eliminated the waiver for Suboxone, meaning that all prescribers that currently prescribe controlled Substances can now prescribe Suboxone as well. However, certain providers may or may not feel comfortable doing so if they are new to Suboxone prescribing.
Cutting is not an "on-label" practice that is approved by the FDA but is very commonly recommended by prescribers due to the need to customize doses to patient needs.
When it comes to cutting buprenorphine/naloxone (Suboxone), the Suboxone film can be cut into small pieces. The medication is probably not completely evenly distributed throughout the film or tablet, so it is okay if you are not super-precise when you cut it. And if you end up taking a little bit “more” on one day and a little “less” on another, that’s okay as the levels in the blood will average out over a few days.
Yes, people can safely and effectively switch from methadone to buprenorphine/naloxone (Suboxone). However, this switch will need to be planned carefully in coordination between the methadone clinic (opioid treatment program) and the provider prescribing buprenorphine/naloxone (Suboxone). Generally, a person taking methadone will need to gradually taper their methadone dose to 30 mg/day or less. Once they get down to this lower dose of methadone: After taking their last dose of methadone, they will need to wait a period of 48 to 72 hours and experience withdrawal symptoms. Then, their Suboxone provider can start their buprenorphine/naloxone (Suboxone) in an observed setting.
These opioid withdrawal symptoms can be managed with “comfort” medications-- medications that help with nausea/vomiting, diarrhea, body aches, and agitation/anxiety. Tapering off methadone too quickly can cause opioid withdrawal symptoms and transitioning to Suboxone too early can cause even more pronounced withdrawal symptoms.
It is also important to recognize that when patients transition from methadone to Suboxone, they often go from more frequent visits and accountability (with daily trips to a methadone clinic) to less support. So, when making this transition, patients should think about what additional support they may need to ensure they do well in recovery (individual therapist, group support, 12 step meetings, reaching out to supportive friends and family).
In summary, the transition from methadone to buprenorphine/naloxone (Suboxone) can be done safely and effectively. It just needs to be well planned and coordinated between all the patients’ providers and with the patient.
Can you safely take Adderall with Suboxone? The answer: It depends.
Both Adderall and Suboxone are prescription medications your doctor uses to treat illness. Use them as directed, and ensure your doctorknows you are taking both medications, and the risk is small.
Misuse either medication, or refuse to disclose your use with the doctor treating you, and your risks go up.
Mixing drugs isn’t always safe. Effects may be stronger or more unpredictable when two substances enter your body. And in 2019, almosthalf of all drug overdose deaths involved multiple drugs.
Let’s dig into what both Adderall and Suboxone do, and then we’ll discuss their interactions.
Generic drugs dextroamphetamine and amphetamine are combined in the brand-name medication Adderall. Doctors use this medication to treat attention deficit hyperactivity disorder (ADHD).
People with ADHD can experience severe symptoms that impede their quality of life. Those symptoms include:
Amphetamine-based medications like Adderall may soothe electrical activity within your brain, leading to a sense of focus and control. When your ADHD symptoms abate, you may find it easier to succeed at home, at work, and in your relationships.
Adderall and other amphetamine medications have high abuse potential. If you use the drug recreationally (rather than to treat ADHD), or if you buy the drug from a dealer and not a doctor, you are abusing the drug. Doctors often prescribe the drug sparingly due to this issue.
The prescription medication Suboxone contains two generic drugs: Buprenorphine and Naloxone. Doctors use Suboxone to help people who have opioid use disorder.
For people with a substance use disorder, Suboxone can help to soothe cravings, ease symptoms, and make sobriety easier to attain and maintain. When taken as directed, it is impossible to abuse.
Studies have not found a direct link between Suboxone/Adderall mixing and overdose deaths. The two medications work on different pathways, so they do not augment one another.
For someone with a substance use disorder and ADHD, it can be wise to use both medications as a doctor directs. When your ADHD impulsivity is addressed, you might be less likely to revert to drug use.
You can run the risk of an Adderall overdose, however. Symptoms include hyperactivity, a racing heart, and tremors.
If you are ever tempted to take Adderall or Suboxone differently or in excess of what your doctor recommends, contact your doctor and seek other sources of help.
In the U.S., TSA regulations permit you to bring your medications (in pill or solid form) through airport security as long as they are screened. It is recommended that buprenorphine/naloxone (Suboxone) and other medications be clearly labeled to facilitate the screening process and that they include your name on the prescription bottle. Check with state laws regarding prescription medication labels. You are responsible for displaying, handling, and repacking the medications when screening is required.
International regulations vary, as each country has its own guidelines about which medicines are legal. The Centers for Disease Control (CDC) warns that medicines that are commonly prescribed or available over the counter in the United States could be considered unlicensed or controlled substances in other countries. Therefore, you should check with the foreign embassy of the country you will be visiting or passing through to make sure your medicines are permitted in that country. See this FDA video for more information.
No, you should not take Suboxone to treat depression. Although there is some evidence that suggests low-dose buprenorphine may help treatment-resistant depression, it is not an FDA-approved indication and requires more robust research.
Depression, also known as major depressive disorder (MDD), is a common mental health condition that affects how a person may think or act. It is the leading cause of disability for people aged 15 to 44 in the United States and affects more than 16 million adults annually.
People who experience depression often express feelings of sadness or a loss of interest in activities they previously enjoyed.
Common symptoms of depression:
The above list is not all-inclusive. Also, some people who have depression do not experience every symptom listed above or may have others not listed here.
Therefore, if you are experiencing any of the above symptoms, reach out to your doctor and schedule an appointment to be evaluated as soon as possible.
Sometimes other physical conditions can cause similar symptoms. It is important to have a thorough evaluation to rule out any other underlying conditions.
If you are thinking about suicide or have concerns about a friend or loved one, The National Suicide Prevention Lifeline (800-273-8255) is a free, confidential service available 24/7 for anyone in need.