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.

Doctors currently require a special license (called a Suboxone “waiver”) to prescribe buprenorphine/naloxone (Suboxone) (although this may change over time). Therefore, not all doctors can prescribe Suboxone. If you have a primary care doctor or a psychiatrist, ask them if they prescribe Suboxone, and if not, if they can help refer you to someone who does. Many hospital systems have a special department for addiction services where you can be connected to a doctor with experience prescribing Suboxone. Don’t be afraid to ask your doctor about Suboxone - doctors are used to working with patients with substance use disorders. Even if your doctor does not personally prescribe Suboxone, they should still be able to help you find a doctor who does. It is part of our job to connect you to care!

Buprenorphine/naloxone (Suboxone) is a long-acting, partial opioid agonist used to treat opioid use disorder. 

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.

• Medicare and Medicaid typically DO cover Suboxone. Depending on the state, Medicaid coverage may or may not require a prior authorization request before a doctor can prescribe it.
• If you do NOT have any insurance coverage, the cost can vary based on the prescribed dose. A one-month supply of brand-name Suboxone could cost between $166-$570 while the generic version buprenorphine-naloxone could cost between $60-$200. 

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).

To learn more about Bicycle Health’s pricing and get your own custom price estimate, click here.

Addiction to a substance is a disabling chronic condition that has two components:

• Physical dependence on the substance; and
• Negative impact of uncontrolled substance use on one’s life.
  

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.

Buprenorphine alone (without naloxone) is approved by the U.S. Food & Drug Administration (FDA) for pain management. Buprenorphine/naloxone (Suboxone) is not approved for treatment of pain.

Buprenorphine/naloxone (Suboxone) should be taken when the body has already started to feel withdrawal symptoms. When taken at the appropriate time,  Buprenorphine/naloxone (Suboxone) should make you feel BETTER (not worse!). 

When you should take Buprenorphine/naloxone (Suboxone) depends on your level of tolerance (how much your body has become “used” to having opioids) and the specific substance and dose you have been taking. 

In general, patients should wait the following number of hours after taking their last opioid before starting their buprenorphine/naloxone (Suboxone) induction:

• 12-24 hours after their last dose of short-acting opioids (heroin, hydrocodone/Vicodin, oxycodone-immediate release/Percocet, hydromorphone/Dilaudid);
• 24 hours after their last dose of intermediate-acting opioids (oxycodone-sustained release--Oxycontin or morphine-sustained release--MS Contin);
• 36 hours after their last dose of methadone
• 48-72 hours after their last dose of long-acting opioids (Note: since fentanyl’s metabolite, norfentanyl, lasts a long time in the body, it is recommended that patients experience significant withdrawal symptoms before starting Buprenorphine/naloxone (Suboxone))

A good rule of thumb to make sure you experience the appropriate amount of withdrawal before starting Buprenorphine/naloxone (Suboxone) is to make sure you have AT LEAST 3 symptoms of withdrawal AND you feel pretty uncomfortable:

• Twitching, tremors, or shaking
• Enlarged pupils
• Bad chills or sweating
• Heavy yawning
• Joint and bone aches
• Runny nose, tears in your eyes
• Goose flesh (or goose bumps)
• Cramps, nausea, vomiting or diarrhea m Anxious or irritable

A final good rule of thumb is to wait until you feel pretty uncomfortable in your withdrawal and THEN wait an additional 1-hour (set an alarm clock!) before taking Buprenorphine/naloxone (Suboxone).

At Bicycle Health, we provide patients with a home-induction handout that will walk you through your withdrawal symptoms so you take Buprenorphine/naloxone (Suboxone) at the appropriate time. We also provide clinical support specialists who are available 24/7 by phone to answer questions and provide support during patients’ home induction.

Many people struggling with addiction to opioids put off getting treatment because they worry that their family, friends or boss might find out they are enrolled in a Suboxone treatment program. Rest assured! When a patient is enrolled in a treatment program, their information is kept confidential. 

During the COVID-19 era, the Health and Human Services (HHS) issued a “Notification of Enforcement Discretion,” waiving enforcement of Health Insurance Portability and Accountability Act (HIPAA) regulations, thus allowing providers to treat patients outside of the office in new venues such as with telehealth appointments. 

This new venue of delivering care, which makes it easier to access buprenorphine/naloxone (Suboxone), must comply with federal laws and regulations that keep patients’ information confidential. A Suboxone program 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) unless:

• The patient consents in writing
• The disclosure is allowed by a court order, or
• The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or practice/program evaluation.‍

At Bicycle Health, we protect the privacy of our patients’ health information in accordance with federal and state law. In particular, we protect the privacy and security of your substance use disorder in accordance with 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 (Health Information Portability Act) 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: https://www.bicyclehealth.com/legal/npp

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.