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Medications

What medications do you prescribe?

Ideal Option providers may prescribe a variety of medications, including Suboxone® or Subutex® (buprenorphine), Vivitrol® (naltrexone), disulfiram, acamprosate, gabapentin, carbamazepine, pregabalin, and many others. We do not prescribe methadone.

Everyone responds to medication differently but most patients experience little to no side effects. Side effects also differ depending on the medication you are prescribed and your provider and/or pharmacist will discuss them with you.

Reported side effects for the main medications we prescribe can include the following.

Suboxone® or Subutex® (buprenorphine): Dizziness, nausea/vomiting, constipation, headache, fast heartbeat, increased sweating, and/or insomnia.

Vivitrol® (naltrexone): Nausea, headache, dizziness, anxiety, irritability, tiredness, and/or loss of appetite.

No. You do not have to be in withdrawal for your first appointment, but you do need to be off opioids for a certain number of hours before starting buprenorphine. If you take buprenorphine too soon after your last dose of opioids, withdrawals can actually be precipitated/caused. Your provider will speak with you about these time frames.  However, some typical time frames are as follows: 

  • Suboxone®/buprenorphine can be started 24-48 hours after your last opioid use as long as that opioid is not methadone. Transitioning from methadone to buprenorphine requires a longer duration of time before starting buprenorphine.   
  • Vivitrol® cannot be administered until you’ve been off all opioids for at least 7 to 14 days, depending on the opioid used.
  • You do not need to be in alcohol withdrawal for Vivitrol® to be effective.

The transition from methadone to Suboxone® is dependent on your current methadone dose and the length of time you've been using methadone. Ideal Option is very experienced with helping patients with this transition. Each patient’s transition will be appropriately individualized based on that patient’s situation. 

Vivitrol® is an antagonist or blocking medication. Antagonists create a barrier that blocks opioid molecules from attaching to opioid receptors. Antagonists attach to opioid receptors, but do not cause the release of dopamine. They are non-addictive and do not lead to physical dependence.

Suboxone® contains buprenorphine and naloxone. Buprenorphine attaches to the same receptors as other opioids but only partially activates those receptors. This eliminates withdrawals and cravings, which helps people feel normal. Naloxone is an antagonist / opioid blocking medication that causes withdrawals if someone tries to inject or snort the Suboxone®.

If or when you decide to taper off of medication, we will work with you to safely and slowly taper down your medication. Many patients need to stay on medication like Suboxone® indefinitely.

We work very hard to make sure you don’t run out of medication before your next appointment but you must be seen in order to get your prescription. We do not fill prescriptions early, and we are unable to replace lost or stolen prescriptions.

Patients receive a refill for their prescription medication at each visit unless there is a safety issue or diversion (selling or giving away the medication). For the first couple of weeks, visits are scheduled every few days, then visits are weekly, bi-weekly, and eventually, once every 3-4 weeks. Changes to the frequency of visits may be made at any time by our providers depending on the patient's recovery.

For the majority of our patients who are Medicaid members, the medication is fully covered. For Medicare and commerically insured patients, the co-pay varies depending on the plan you are enrolled in. 

Barring any insurance or other issues beyond our control, prescriptions are typically available for pick up at your pharmacy the same day or within 24 hours of your appointment.

How long you stay on medication-assisted treatment is dependent on your unique situation and history of drug use. While some of our patients can taper off their medication and maintain a stable long-term recovery, others find they need to stay on medication indefinitely. Addiction is a chronic disease of the brain that is treatable, but unfortunately, not curable. Just as many people with diabetes will need insulin for the rest of their lives, many people with substance use disorder will need medication for the rest of their lives as well.

Buprenorphine binds to and partially activates opioid receptors. This partial activation means it is less likely to cause dangerous side effects and/or the euphoria that are often caused by opioids that fully activate opioid receptors. This means that buprenorphine is safer and less likely to cause euphoria than opioids that fully activate the receptors. However, buprenorphine does activate these receptors enough to remove withdrawals and cravings, which helps people feel normal. Methadone binds to and fully activates opioid receptors. This full activation means it is more dangerous and more likely to cause euphoria than buprenorphine. However, there are many patients who are still good candidates for methadone, such as extremely heavy opioid users. It is important to also understand that buprenorphine is typically a prescribed medication that is picked up at a pharmacy whereas methadone must be dispensed from a clinic if it is used for the treatment of opioid use disorder.  

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