Expert: Hector Manuel Rodriguez - 10/9/2009

Question
I am a 27yr old female, work full-time and come from a middle-class family. I suffer from obessive compulsive disorder and depression. I met an ex-boyfriend a few months ago, who introduced me to heroin. I was mentally in a bad place at the time and have become addicted. I currently use a bag a day, which only helps me function normally. I desperatly want to stop taking heroin and have tried to detox myself a number of times by going cold turkey and havn't took any other drugs to help me detox, ie methodone, and have been unsuccsefull. I can't seem to get past a few days. The sweats and depression become too much and I end up using again. I saw my doctor, who has put me on the waiting list to see the local addiction team, however, this is a lengthy process and i have been told the resources are extremely limited and can take months to be seen. My doctor mentioned Suboxin. Could you please give me more information about this. Such as;
1.  What dosage of suboxin is used for people using a bag a day?
2.  How long is the treatment?
3.  Would i feel many of the withdrawal symptons?
4.  Are there any side-effects?
5.  After the withdrawl period of herion is over, do you still need to take suboxin?
The ironic thing is i don't smoke, drink or take any other drugs. I know i'm to blame for what i've done and take full responsibilty. I just desperatly want to stop. I'm finding it hard keeping my job and dealing with this at the same time. Its not the life I want to live. I have been searching the internet for hours and was so glad to come across your site, one thats simple and to the point and free. Thank you for taking the time to read this and answer my questions. I'm most greatful.

Answer
Hello Rebecca.

Here is a copy of our manual in regards of Suboxin= Suboxone= Buprenorphine.

1. Induction from short-acting opioids (eg, morphine, oxycodone, hydrocodone, heroin)
Instruct patients on how to take a sublingual tablet and provide patient information about induction.

Administer a patient's first dose (4 mg) of SUBOXONE or SUBUTEX sublingual tablets after moderate opioid withdrawal symptoms have developed. Consider the use of an opioid withdrawal scale for patient assessment (eg, Clinical Opiate Withdrawal Scale [COWS]). Remind the patient that opioid withdrawal symptoms are usually alleviated in 20 to 40 minutes following the first dose of buprenorphine.

If possible, observe the patient for 1 to 2 hours. Dispense or prescribe a second dose of 4 mg of SUBOXONE or SUBUTEX if no precipitated withdrawal is observed. The usual first-day dose is 8 mg. Clinicians have reported prescribing a third dose (2-4 mg) to be taken later in the evening if needed for withdrawal symptoms.

Assess the patient's response to the first day's dosing. If opioid withdrawal symptoms were fully suppressed and the patient is feeling no withdrawal between doses, then keep the dose at the first day's total dose; otherwise increase the dose by 2 or 4 mg on day 2.

Assess the patient's response to the second day's dosing. If opioid withdrawal symptoms are fully suppressed and the patient is feeling no withdrawal between doses, then keep the dose at the second day's dose; otherwise increase the dose by 2 or 4 mg SUBOXONE on day 3.

After 3 days, once the patient is stable, or after a target dose of 16 mg SUBOXONE or greater is achieved, continue at that dose for 3 to 7 days until steady-state levels are achieved before increasing the dose further.

There is no specific dose based on the amount of  drug you consumed.
They will start you off with 2-4 mg up to 8mg/day.

Posible side effects are:

an allergic reaction (difficulty breathing; closing of the throat, swelling of the lips, tongue, or face; or hives);

slow breathing;

dizziness or confusion; or liver problems such as yellowing of the skin or eyes, dark colored urine, light colored stools (bowel movements), decreased appetite for several days or longer, nausea, or lower stomach pain.

Other less serious side effects may be more likely to occur. Continue to take buprenorphine and naloxone and talk to your doctor if you experience

headache;

pain;

problems sleeping;

nausea;

sweating;

stomach pain; or

constipation.

To be honest, all I hear is good about this drug to overcome the heroin addiction.

Thanks for counting on AllExperts for clearing  your questions.