Addiction FAQs

General

Will my insurance pay for physician visits and the medication?
Nearly all insurance plans cover treatment for substance use disorders and the medications prescribed. Please verify what mental health (aka behavioral health) benefits are included in your insurance plan and whether your plan covers substance use disorders. Even if Dr. Chicks is not “in your plan” you may be given special permission to see Dr. Chicks in specific situations. These situations may include the following:

No other MAT (Medical-Assisted Treatment) programs are available to treat your condition
The waiting list is too long
MAT programs are available in your area, but they are too fa

In these cases, please contact For Your Health for assistance with getting permission.

Does using MAT increase my success at achieving sobriety and recovery?
Absolutely. Even after long rehabilitation programs, sobriety is temporary for the vast majority of patients, with only 6.6% of patient's successfully completing treatment. (Weiss RD et al. Arch Gen Psychiatry. 2011;68(12):1238-1246) Additionally, these types of programs are extremely expensive.

Isn’t the use of medications like Methadone and Suboxone simply replacing one addiction with another?
No. The briefest explanation is – opiates are used to get high; Methadone and Suboxone are used precisely because they discourage users from wanting to get high.

Read on if you want to know even more.

Methadone and Suboxone are prescribed or administered under monitored, controlled conditions and are safe and effective for treating opioid addiction when used as directed. Compared to heroin and other abused opioids, they act slower, producing stable levels of the drug in the brain. When used correctly (e.g. not combined with alcohol and other opiates), Suboxone is very rarely associated with overdose or death when used correctly. Methadone is also very as long as it's used as directed and not combined with other drugs.

Maintenance treatments help to stabilize individuals, allowing treatment of their medical, psychological, and other problems and avoid street crime, violence and incarceration. The result is individuals can contribute effectively as members of families and of society.

In contrast, abusing pain pills or heroin can cause overdose and death. In addition to death from overdose, other very serious and deadly health consequences include: infection of the AIDS virus and/or Hepatitis C virus and infection of in the muscles around the veins. Some of the less life threatening complications related to injecting drugs range from infection, scarring of the veins, to abscesses of the skin. Lung disease from smoking drugs comes from the smoke itself and contaminants used to “cut” the drugs, for example-baby powder or drugs used to treat malaria. Snorting can cause the nasal septum to collapse, disfiguring the nose and making breathing difficult.

I’m pregnant. Can I still take Suboxone, methadone or Vivitrol?
YES. In fact, medical studies indicate treatment of pregnant women with Suboxone or Methadone is HEALTHIER for their babies; MAT with Suboxone reduces the dose of medication required to treat withdrawal symptoms in the baby (neonatal withdrawal syndrome (NWS)) and decrease the number of days the baby is hospitalized length of hospital stay by nearly 60%. Methadone is considered the “gold standard” for MAT in pregnancy. Because it has been around much, much longer than Suboxone more information is available about it’s safety. There is even less information available about Vivitrol. But all 3 medications are classified in the same risk group for pregnancy - Category “C”. Whether or not to use any medication during pregnancy is based on determining the “risk to benefit” ratio. The determination is based upon if risk to the fetus and the mother is greater or lessor than the benefit to the fetus and the mother. When deciding whether or not to continue MAT during pregnancy your treating physicians (OB and MAT prescriber) opinions should be sought, but ultimately the decision will be yours.

Suboxone

Why are Suboxone treatment programs so hard to find?
In short, Suboxone is the most tightly regulated medication in the country. In 2000, the Drug Abuse Treatment Act (DATA 2000) approved treatment with Suboxone in the setting of a physician’s office, but also imposed restrictions on the number of patients a physician can treat simultaneously. Specific education related to it’s use and management and Risk Evaluation and Mitigation Strategies (REM) is required. Additionally, to prescribe Suboxone (and related medications) approval by the Substance Abuse and Mental Health Services Administration (SAMHSA) and an additional Drug Enforcement Agency (DEA) identification number is required. There are numerous other reasons, chief among them- of 800,000+ licensed physicians in the United States only 2% are properly certified. And many certified physicians do not provide addiction treatment services. Suboxone and Vivitrol can be used in OTPs too.

How are Suboxone and Methadone different? How are they the same?
Methadone is a opiate which stimulates the opioid receptors in the brain 100%. Suboxone is an opiate too, but it only partially stimulates the opiate receptors. Neither Methadone nor Suboxone treatment require a complete detoxification from other opiates before the first dose.

What is the average dose of Suboxone?
First, it is important to understand the correct dose of Suboxone for YOU is the dose that eliminates cravings for opiates and withdrawal symptoms. Doses ranging from 8 to 16 mgs (sometimes 24 mg) are adequate for most people.

What if all I want is to be detoxed off of opiates using Suboxone?
If that is what you want to do, I’ll help you do it. Later on you may decide to continue on MAT, and that’s okay.

I’ve heard Suboxone is the hardest medication to get off of, is that true?
NO. The ease with which an individual can be tapered off Suboxone is highly variable. Tapering off Suboxone may be easy for a given person; but the same person can have significant problems tolerating dose reductions of Methadone. Some people have problems discontinuing the “weak” opiates – like hydrocodone (Vicodin). Others don’t experience much difficulty coming off any of the opiates. This is exactly why standard protocols, i.e. “cookie cutter protocols” don’t work most of the time. You are an individual and should be treated as an individual, with a treatment plan specifically tailored for you.

Methadone

Why is Methadone only used in Methadone clinics?
Methadone was the first drug used for treatment of opiate dependence. Federal law restricts it’s use (for opiate addiction) to opiate treatment programs (OTPs). MAT in OTPs are highly regulated and structued, requiring daily attendance (for the 1st 90 days, at least), and onsite individual and group therapy. When these regulations were first developed (early 1970’s) it was felt this would increase the likelihood of success.

I’ve tried Methadone and it didn’t work. Will Suboxone or Vivitrol work?
There are no guarantees, no single medication (or program), will help everyone. BUT, for everyone there is a medication (or program), which will work.

Vivitrol

What is Vivitrol? How is it different from Suboxone and Methadone?
Vivitrol (generic name naltrexone) is completely unlike Suboxone and Methadone; it is not an opiate at all. It is a complete, 100% blocker of opiate activity in the brain. It is the same medication as Narcan (the opiate overdose rescue drug) but is an intramuscular injection given every 28-30 days. Vivitrol will control withdrawal symptoms, and reduce or eliminate control cravings. There must be an extended period of time between last use of an opiate and the first dose of Vivitrol, but Vivitrol does not require tapering the dose down to discontinue treatment. Any licensed health care provider can prescribe Vivitrol.

Vivitrol is also used to treatment of alcohol dependence.

Sobriety and Recovery

What is the difference between sobriety and recovery?
Being sober means not using drugs; recovery means living your life to it’s fullest potential.

What else should I do to increase my success at achieving sobriety and recovery?
Studies definitely indicate MAT combined with professional substance abuse counseling with is better than either alone.

Will I be REQUIRED to go to substance abuse counseling (SAC)?
NO. You are an individual and you are treated as an individual at For Your Health. Multiple factors influence whether or not SAC will be recommended for you. These factors include whether or not you have had your SAC previously, if your SAC effective, and what your progress has been like in the For Your Health treatment program.

What are 12-step groups (aka mutual-help)?
These are groups of individuals who have addiction disorders who meet to support each other in their quest for sobriety and recovery. There are 2 categories of mutual-help groups- faith based vs. secular (non-faith based). The most widely known faith based mutual-help groups are the “12-step” groups, e.g. Narcotics Anonymous. SMART Recovery is a secular mutual-help group. Meetings can be face-to-face or online for any of the mutual-help groups. (See the links page?)

How long will I need to be on medication?
The length of YOUR treatment is based on what YOU want/need. Your stage of recovery is typically given the most importance when considering discontinuing MAT. As your physician it is my responsibility to make recommendations based upon YOUR progress AND my professional experience. The better I know you as an individual; the better my advice to you will be. I will be forthright with, you if you feel differently about whether or not your goal is reasonable. Even if I disagree with your decisions regarding medication management I will support you as much as possible to ensure your success.

It is MY duty as your physician to inform you of the advantages and disadvantages of each treatment option. Plainly stated, very short-term use ( up to 28 days) of MAT is not treatment at all- it’s detoxification. There is no evidence detoxing has any long term benefit at all. MAT used for 2, 3, 4 or so months is not treatment either- it’s just a longer detox. That said, there are people who have been successful under these circumstances. They truly are “exceptions to the rule”. The effectiveness of SAC they participated in while on treatment will contribute to success.

When the length of treatment (whether months or years) after a patient has become sober is based upon the patient’s past experiences with sobriety and relapse, the current stability of their economic and social situations, and any underlying mental health condition (depression, anxiety, etc.) has been adequately treated - the likelihood of maintaining sobriety and recovery after discontinuing MAT is much higher. See FAQ #____

Will my dose be the same until I’m ready to taper?
NO. As treatment continues, progressive dose reductions are made gradually, as tolerated. Reemergence of cravings and/or withdrawal symptoms suggest the dose changes may need to be more gradual. The reason to make interval dose reductions is because when you are ready to completely taper off MAT the amount of time necessary is shorter. Simply because your dose is closer to zero (0?) mg. Keep in mind when selecting a medication for MAT, a huge advantage to Vivitrol does not require a taper, because discontinuing it does not cause withdrawal symptoms.

Can I stay on Suboxone, Methadone or Vivitrol for the rest of my life?
YES. There is no harm in lifelong maintenance MAT. For some people it is the best option for maintaining sobriety or recovery. But if you think you will need lifetime treatment when you start, it’s not carved in stone. Later on you may decide it is not necessary. See FAQ # ____