There is a group of people that Suboxone is targeted. Attributes of these people are: employed (or have access to assets), functional, and have housing. Essentially, people that still have a semblance of responsibility and people that you wouldn't mind showing up at a doctor's office. The other attribute of course is dependence on an opiate. These include heroin, oxycontin, oxycodone, and hydrocodone just to mention a few.
Invariably I find that physicians utilize an office based "detox" protocol of months, rather than weeks when a client presents for the first time for detox. I'm sorry, but months does not denote detox, it denotes maintenance. The client becomes addicted and dependent on Suboxone and then has to detox from Suboxone (this, anecdotally reported, is not easy). Suboxone makers (www.suboxone.org) promote a detox protocol using Suboxone from five to ten days, not months.
Why do physicians use months rather than weeks? Convenience? Evidence Based Practice? Drug Rep Detailing? Why?
- This type of dosing can be more convenient, it is less intense and the dependent patient does not have discomfort (initially) therefore the patient does not continually contact the physician.
- The patient might have been tried multiple times on some type of detox and be a legitimate candidate for a maintenance program.
- The physician may believe that evidence supports this type of dosing. I would like to see the evidence that keeping patients on suboxone for months is better than detoxing them in 7-10 days. I don't believe there are any comparisons and I believe most arguements are based on theory, not actual evidence.
- Do Drug Reps actually tell office physicians that Suboxone can be used to detox the patient in the office setting in 7-10 days or are they pushing for suboxone to be used over months so they can have a better profit? This is important as there is a 'partnership' with SAMHSA and there is an expectation of a higher ethical practice when our government is actively supporting the product as well.
Of course I am going to make the arguement for a 7-10 day opiate home detox using Suboxone. Almost any addict or dependent person will tell you they would like this monkey off their back. A seven to ten day taper can be set up to comfortably detox the client. The client has to exhibit a responsible life style to support this. Ideally, the client has responsible people around them to monitor these seven to ten days. Additionally, the client can employ a nurse or health professional to assist in the monitoring over this time period. This can take the form of a daily check in or can extend to a live-in nurse (www.homedetox.biz) for this time period.
I have pesonally assisted a number of addicted or dependent opiate clients with detox in 7-10 days. Also, thousands of patients detox in an inpatient setting using essentially the same Suboxone protocols in about 6 days. The difference in the inpatient setting vs. the outpatient setting is supervision, therefore if you set up the supervision on an outpatient basis, you can mimic the inpatient protocol.
I do want to go on the record that I think Suboxone maintenance is a good idea for the right person. Suboxone maintenance should be reserved for the patient that has demonstrated he or she cannot sustain recovery after multiple attempts at a supervised detox.
Certainly there needs to be a comprehensive after care plan and yadda yadda yadda. Let's look at Yadda later.
