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, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Oregon, Pennsylvania, Texas, Vermont, Virginia, Washington, Wisconsin, and Wyoming.
We’re continually expanding to new areas. Check back with us about availability in your area.
You’ll speak with an enrollment coordinator who will answer your questions about our program and what we offer, and we’ll also ask you questions to try to ensure that our program will be a helpful fit for your care.
We’ll also walk you through some required forms including consent to treatment, review of program policies and practices, payment, and directives for how we handle your medical records.
We’ll work with you to set an initial appointment which will be same-day if at all possible. We’ll then provide guidance for you to download the required app for the video visit with your provider, and your provider will contact you through the app at your appointment time.
If you’ve been misusing opioids, you might need professional help. But it can feel awkward or even frightening to talk to your doctor about Suboxone or another medication for opioid use disorder (OUD).
Almost 85% of Americans say they trust their doctors. But even so, some patients fear starting this discussion with their health care professional.
The first thing to know is that disclosing your drug use to your physician is completely confidential. There are laws in place that prevent your doctor from disclosing your personal substance use history to law enforcement.
Even if there weren’t legal protections, doctors aren’t policemen: their job is not to punish you. Their job is to keep you as healthy and safe as possible, and most of them are happy when you disclose your concerns about your substance use as it gives them an opportunity to help you.
Know that you can always trust your doctor with information about your drug use. Starting the conversation could be lifesaving, and help you get the treatment you need.
Here's what you need to know about starting these conversations with your doctor.
First, know that your doctor is not legally allowed to talk to others about your drug use, including making a report to law enforcement. Anything you say to your doctor is confidential and protected under a law called HIPAA 
You're not required to talk about where you obtain your drugs, and your doctor isn't likely to ask.
Your doctor may ask about the following:
Your doctor may ask you questions like, what substances do you use habitually? What substances do you use intermittently? Have you tried a drug once and never used it again? Is there a substance that you are using regularly? This helps them to understand what drugs you might be dependent on and what medications and therapies would be the most helpful for treatment.
How much of each substance do you take? Do you have symptoms (like nausea, shaking, or a headache) if you don't take your drug? Do you need more to get the results once delivered with a small dose? This helps your doctor understand if you have a tolerance of a physical dependence on the drug, which can help guide him or her in what types and doses of treatments can be offered to you.
Your doctor may ask about this because different delivery methods of drugs pose different risks to your health. For example, individuals who use injection drugs are at risk for different infections than those who merely snort or smoke. Your doctor may ask if you swallow pills, snor/crush pills, or if you inject drugs. If so, they may ask if you share needles with others, which increases your risk of infections.
Have you tried to quit using drugs before? What methods did you use? How did you feel when you tried to quit? What made you relapse? This can help your doctor understand right away what treatments have or have not worked for you in the past so that you can decide together what treatments - either pharmacological or behavioral - are the right ones for you.
Many primary care or family medicine doctors treat patients with Substance use disorders. Therefore, if you have a primary care doctor that you know and see regularly, talking to him/her is a good place to start. However, some primary care doctors do not treat a lot of patients with addiction, and may refer you to another specialist doctor. Oftentimes, these doctors are psychiatrists or physicians who have done additional training as addiction medicine specialists.
In some states, doctors must get a special license to prescribe Suboxone (although this is changing and becoming less common in many states in order to facilitate more easy administration of this medication.  In other states, Nurse Practitioners (NPs) can also prescribe Suboxone.
If you have a doctor you know and trust, ask them if they prescribe Suboxone, or if they can refer you to a provider that does.
You can also use an online tool like this one to find a buprenorphine doctor near you.
Suboxone treatment programs can last for months, years, or indefinitely for some patients who need life-long treatment  It's important to work with someone you trust, as you'll be connected for a long time.
Don’t let fear or intimidation prevent you from talking to your doctor openly and honestly about Suboxone: they are there to help. Ask your doctor about Suboxone, or reach out to us here at Bicycle health for more information.
Patients who have been taking opioids, like oxycodone (percocet), hydrocodone (Vicodin), hydromorphone (Dilaudid), methadone, heroin, fentanyl, on a daily basis can become dependent on these substances, meaning that if they do not take them daily, they will experience awful withdrawal symptoms, like nausea/vomiting, diarrhea, body aches, agitation/anxiety. Many people become addicted and the opioids start to take control of their life. They have cravings, think about opiates all the time, and are unable to fulfill their daily responsibilities like going to work or taking care of friends and family. It becomes an “all consuming disease”.
Buprenorphine/naloxone (Suboxone) works by stabilizing the brain. By binding to the opiate receptors in the brain, Buprenorphine/naloxone (Suboxone) prevents withdrawal symptoms, staves off cravings, and also blocks these receptors so other opioids (like heroin or fentanyl) cannot bind, preventing overdoses and saving lives. As a partial agonist (meaning it only partially stimulates the opioid receptor), Burpneorphine/naloxone (Suboxone) rarely causes patients to feel “high.” Rather, patients taking buprenorphine/naloxone (Suboxone) should feel NORMAL, able to go about their day and live their life to its fullest. For these reasons, Buprnorphine/naloxone (Suboxone) is considered very safe, and it is considered evidence-based treatment for opioid addiction.
Buprenorphine/naloxone (Suboxone) is most effective when used in conjunction with counseling and psychosocial support.
Buprenorphine/naloxone (Suboxone) treatment duration exceeds 1-6 months. Addiction is a chronic condition, and because of that, we recommend long-term use of buprenorphine/naloxone (Suboxone). Research shows that patients who stay on buprenorphine long-term are more likely to be opioid-free.
Conversely, studies demonstrate that within one month of stopping buprenorphine treatment, more than 50% of patients relapse to illicit opioid use. Our program at Bicycle Health is a long-term, continuous program that supports patients over months-to-years. One-month or otherwise short-term Suboxone treatment is not something we do or support.
The cost of buprenorphine/naloxone (Suboxone) varies widely and is usually insurance-dependent. The best way to find cost is to contact your insurance company.
Generally speaking, though:
Many private insurance companies DO cover Suboxone, as long as a physician deems it is medically necessary. Some insurance companies require a prior authorization request in which the provider must submit a form to get it approved before prescribing it. Some insurance companies also dictate the formulation (generic formulation: buprenorphine-naloxone versus brand-name) and whether they will cover films/strips versus tablets/pills. They also might specify a maximum daily dose and length of treatment. Patients will also likely be charged a copay based on their plan.
You can also get discounted buprenorphine/naloxone (Suboxone) using pharmacy coupons or cash prizes. If you go to the GoodRx website (goodrx.com), you can enter in your zip code and find coupons and discounts at your pharmacy of choice. (On average, if you use GoodRx coupons/discounts, you can slash the typical price of generic Suboxone film from $395 to $118).
Addiction to a substance is a disabling chronic condition that has two components:
Patients are physically dependent on taking buprenorphine/naloxone (Suboxone) daily in order to feel normal and healthy—similar to patients with high blood pressure, diabetes, heart disease, or depression who take daily medications to feel healthy. Buprenorphine/naloxone (Suboxone), when taken as prescribed by a medical provider, treats addiction and does not cause the negative impacts of uncontrolled substance use on one’s life, goals, and daily functioning. Buprenorphine/naloxone treatment is NOT replacing one addiction with another.
The U.S. Food and Drug Administration (FDA) does not currently give approval for Suboxone purely as a pain medication (with the exception of the Butrans patch, which is FDA approved for chronic pain).
However, many other countries do use Buprenorphine as a pain medication because it does have analgesic properties in the same way that other opioids do. In the US, many doctors use Suboxone as an off-label treatment for chronic pain, particularly in patients who have previously been on opioids and do not want to continue to use opioids long term due to the risks of addiction and dependence.
If you're using Suboxone to address an opioid use disorder (OUD), your prescription could help with pain too. Some people start using opioids in the first place to address a chronic pain condition. Suboxone can be a wonderful alternative to treat pain off-label, particularly if a person is recovering from an OUD.
The FDA currently has not approved buprenorphine as a pain medication alone, with the exception of Butrans which is a subdermal patch form of Buprenorphine that is in fact FDA approved to treat chronic pain.
However, the majority of medications in the US are used by doctors “off label”, aka for indications other than strictly what the FDA has approved them for. For example, Hydroxyzine is approved as an antihistamine drug to treat allergies, but because of its sedating properties, it is often used “off label” as a drug to treat anxiety and poor sleep. In this same way, Suboxone can be safely and effectively used “off label” to treat chronic pain, particularly when the alternative is subjecting an individual to chronic opioid use which may prolong or put them at risk of developing an OUD.
Researchers say buprenorphine is a safe and effective pain medication. In one overview study of 25 trials, researchers found 14 proving buprenorphine's efficacy. And in another study, researchers found no evidence of respiratory depression (a hallmark of overdose) in people using this medication for pain control.
So yes, there is good evidence that Suboxone can be used as a medication for pain, particularly in patients who already have an opioid use disorder but also potentially in patients who are opioid naive and in whom doctors want to prevent resorting to long term opioid therapy.
Some doctors may use Suboxone for pain relief, although it's not common. Many more clinicians are starting to use Suboxone as a pain medication as we become more familiar with it over time.
Several roadblocks keep doctors from using this medication to ease discomfort.
Although many medications are used off label, because of the stigma around opioid use disorder and the barriers to this treatment, some doctors have been more hesitant to use Suboxone “off label” to treat chronic pain in their patients with or without concurrent OUD.
Doctors must go through significant training and registration processes to prescribe buprenorphine, a process called obtaining an X-waiver. This creates additional barriers to prescribing this medication.
When a doctor writes a prescription for Suboxone, the doctor must offer a diagnosis code. Doctors who use any code other than OUD can be rejected by insurance companies.
Suboxone isn't the only medication that can ease discomfort. Other choices are available, and most doctors prefer to start with non-opioid medications for pain control due to their better safety profiles and lower likelihood of dependency.
Sometimes patients with OUD on Suboxone have chronic pain, or like anyone else have an acute episode of pain after an accident or after requiring surgery. Patients on Suboxone or with a history of OUD may be even more sensitive to pain than their counterparts. In this case, they may require alterations in their dose or even the addition of other pain medications temporarily. If you are a patient on Suboxone and anticipate having a worsening of your pain (an upcoming surgery, for example), talk to your doctor well ahead of time to help plan for how you will manage your pain while on Suboxone. There are a number of options available.
Suboxone is a Medication for Addiction Treatment (MAT). It is important to take it as prescribed, which includes beginning treatment at a specific time after you have ceased taking other opioid drugs. When you enter a drug rehabilitation program, you will work with a physician who will oversee the process of quitting an opioid like heroin, Vicodin, or OxyContin and beginning MAT with Suboxone.
Before you begin taking Suboxone, your body must fully metabolize out the last dose of other opioids. This will lead to withdrawal symptoms temporarily, before taking your first dose of Suboxone. When you start taking Suboxone and how much you take daily depends on which opioids you were using prior, how long you used them, and at what doses.
Before you begin Suboxone, you must ensure that all other opioids are out of the body. This means that you may experience withdrawal symptoms. In fact, having mild withdrawal symptoms is a good sign that there are no further opioids in your body and it is therefore the perfect time to start Suboxone.
Your physician might measure the severity of your withdrawal symptoms using a scale like the Clinical Opiate Withdrawal Scale (COWS). To be considered in withdrawal, you will probably experience:
A COWS score of 11 to 12, which is generally mild to moderate opioid withdrawal symptoms, indicates that you can begin taking Suboxone. Other clinicians might be less systematic and simply ask you to wait 12-14 hours after your last dose of an opioid prior to starting Suboxone.
If you begin Suboxone treatment at home, you should wait one hour after the onset of withdrawal symptoms and then take your first dose of Suboxone. You should feel relief within 30 minutes.
If you do not experience significant relief from withdrawal symptoms, you may need a larger dose. Your physician can guide you through the process of increasing your dose.
When you begin opioid addiction treatment with Suboxone, your physician will guide you on exactly when to start taking this medication. This is based on several individual factors.
In general, patients are counseled to wait a certain number of hours after taking their last opioid before starting their buprenorphine/naloxone (Suboxone) induction:
Once you begin online Suboxone treatment, you will likely follow these general steps:
It is important to wait until your last opioid dose completely metabolizes out of your body before beginning Suboxone treatment. This is because buprenorphine binds more strongly to opioid receptors in the brain than other opioids. It can therefore replace other opioids on the receptors in your brain too quickly and trigger withdrawal.
Precipitated withdrawal is the rapid onset of withdrawal symptoms that can occur by taking Suboxone too soon after taking other opioids. Symptoms of precipitated withdrawal include pain, nausea, anxiety, goosebumps, and physical and emotional discomfort.
Precipitated withdrawal occurs in about 9% of patients taking buprenorphine inductions, almost always because the individual is too impatient to relieve the withdrawal symptoms that occur when their body hasn’t had opioids, and they take their Suboxone too soon. Opioid withdrawal symptoms are not dangerous or life threatening, but they can be extremely unpleasant and uncomfortable. Therefore, be sure you communicate closely with your doctor and understand the instructions for starting Suboxone prior to initiating your first dose! If done appropriately, Suboxone can be a truly life saving medication for those with opioid use disorder.
Many people struggling with opioid use disorders (OUD) put off treatment because they worry that their family, friends, or boss might find out they are taking Suboxone. This shouldn’t be the reason you don’t receive the medication you need. Under the law, all your health information is private from friends, family and employers, including the fact that you are on treatment for OUD.
The Health Insurance Portability and Accountability Act (HIPAA) restricts access to protected health information, including your name, medical conditions, and prescriptions.
Per this act, a Suboxone provider cannot give out any information about a patient or their health (that the patient is enrolled in a Suboxone program, how the patient is doing, their diagnosis, any test results, their medical records, etc.).
A provider can't break the rules of confidentiality unless one of the following occurs:
This law exists so that doctors do not ever share your medical information, including the fact that you are on Suboxone, unless you give them permission to do so.
For example, it would be illegal for your boss to call your doctor and ask if you are on Suboxone, unless you give your doctor explicit permission to share this information. Physicians are very aware of the laws of HIPAA and are usually very careful about never revealing confidential health information.
HIPAA rules also apply to telehealth visits in the same way that they do to in-person visits. . Telehealth providers must comply with federal laws and regulations that keep patients’ information confidential. Connecting with a doctor virtually doesn’t mean that the provider can tell anyone about your prescription.
At Bicycle Health, we protect the privacy of our patients’ health information per federal and state law. In particular, we protect the privacy and security of your substance use disorder per 42 U.S.C. § 290dd–2 and 42 C.F.R. Part 2, the Confidentiality of Substance Use Disorder Patient Records (“Part 2”) in addition to HIPAA and applicable state law.
If you are interested in learning more about how Bicycle Health protects your health information, see this Notice of Privacy Practices (“Notice”) that outlines our legal duties and privacy practices.
Telehealth, or telemedicine, offers virtual healthcare through the use of digital devices, like telephones and computers. It is a safe, effective way for patients to meet with their medical providers and is often more accessible and convenient. Many services are available and effective via telehealth, including diagnosis and treatment of chronic disease, as well as behavioral health therapy.
At Bicycle Health, patients download a smartphone app to engage in video conferencing calls with their providers, and health coaches are available to help patients with setup prior to their first appointment with the medical provider, as well as any ongoing technology questions or concerns. Telehealth for addiction services allows patients to meet with their providers to check-in on their symptoms, medication management, social conditions, and more.
As telehealth becomes more popular as a safe, effective means of seeking medical care, patients and providers alike are responsible for telehealth privacy. Healthcare organizations must ensure their telehealth systems employ encrypted, password-protected videoconferencing, and this is something Bicycle Health takes seriously to best protect our patients’ privacy. Patients are also responsible for engaging in security best practices, like only using home WiFi (not public WiFi) and ensuring the security of their passwords.
Before the first video conferencing visit with your provider, patients at Bicycle Health will be educated on security best practices in order to ensure the highest level of privacy and security possible. You can read more about Bicycle Health’s Telehealth Informed Consent here.