Although insurance coverage seems to be growing, there may be problems with both private and Medicaid insurance reimbursement for prescriptions and physician services so you should check carefully in advance.

Two formulations were approved. The first, Subtex, has only buprenorphine and is used in the first few days a patient starts treatment. The second, Suboxone, contains buprenorphine and naloxone. Naloxone blocks the effects of opioids and is likely to cause intense withdrawal if misused intravenously. It’s used for people on maintenance drug therapy.

Subutex has been available for the treatment of opioid dependence in France since 1996. It has received marketing authorization in over 30 countries around the world, including most of Europe and is marketed in 25 countries.  As of October 2006 the European Commission has approved Suboxone for use in all 25 European Union countries, Iceland and Norway.  In the U.S. this medication can be obtained from any physician who has taken the required 8-hour training. Physicians who are already certified as addiction specialists are exempt from the training requirements.

Woody GE, et al. Extended vs. short-term buprenorphine-naloxone for treatment of opiod-addicted youth. JAMA. 2008; 300(17):2003-2011.

This clinical trial compared counseling and short-term detoxification with suboxone (2 weeks) with counseling and extended suboxone treatment (12 weeks) in 154 patients aged 15 to 21. The extended suboxone treatment led to better control of symptoms of opioid withdrawal, a reduction in drug use on long-term follow up, and better treatment rention. The medication was well tolerated and people remained alert and could function well during the day.

SAMHSA Buprenorphine Physician & Treatment Program Locator
A nationwide registry of physicians who have taken this training is available at buprenorphine.samhsa.gov/bwns_locator/index.html. You can choose Physician List Search at the bottom of the page to search by city, county, zip code or state or just click on the state you want on the map.

Suboxone Assisted Treatment (SuboxoneAssistedTreatment.org)
A comprehensive site on buprenorphine containing clinic locators, state and federal regulations, patient success stories, patient forums,and a staff on call coast to coast 24/7 to help anyone in need. Other information on opiates and addiction are covered as well.

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NALTREXONE can help lessen alcohol's positive effects. It blocks the parts of your brain that "feel" pleasure when you use alcohol and narcotics. When these areas of the brain are blocked, you feel less need to drink alcohol, and can stop drinking more easily.

Naltrexone has been shown to improve treatment outcomes in alcoholics when combined with psychosocial treatments such as Alcoholics Anonymous meetings, addiction counseling, family therapy, group therapy, and hospital or residential treatment, among others.

A recent study supported by the National Institutes of Health showed that patients who received naltrexone, specialized alcohol counseling, or both showed the best drinking outcomes after 16 weeks of outpatient treatment. All patients also received Medical Management, an intervention consisting of nine brief, structured outpatient sessions provided by a health care professional. This is the largest clinical trial ever conducted of pharmacological and behavioral treatments for alcohol dependence.

Anton RF, et al. ³Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence: The COMBINE Study: A Randomized Controlled Trial.² Journal of the American Medical Association. 295(17):pages 2003-2017, 2006

Naltrexone is also now available through long-acting injections. In a clinical study conducted at 24 sites, once-a-month Naltrexone injections combined with psychotherapy was found to significantly reduce heavy drinking in patients being treated for alcohol dependency. Results found a reduction in heavy drinking within the first month of treatment, and this response was maintained over the six-month treatment period. There were few side effects.

Garbutt, J, et al. "Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence: A Randomized Controlled Trial." JAMA. 293(13): 1617-1625, 2005.

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LAAM is a long acting form of methadone. Individuals treated with LAAM only need to take the medication every 2-3 days.

METHADONE is a long acting medicine that reduces opiate craving and blocks the effect of illegal opiates. It requires frequent visits to a network of clinics that can be found at www.atforum.com. Side effects include the need to keep taking the medication, cognitive slowing and depression. While logistically hard to take because of the need to go to specialized clinics, methadone continues to save thousands of lives.

Addiction Treatment Watchdog (atwatchdog.org)
This educational web site is geared to the needs of patients on medications for opiate addiction.  It has a Clinic Report database and submittal form for reporting on the quality of treatment at specific methadone clinics, a section on clinic complaints, a resource section which includes Methadone Advocacy Organizations, a Methadone Watchdog section which answers questions on methadone maintenance, a chat room and two message boards (one for those in recovery and one for friends and families seeking information on opiate addiction).

Medical Assisted Treatment (medicalassistedtreatment.org)
This national organization was founded by advocates for the medical treatment of addiction. It supports the idea of addiction as a medical illness rather than a social ill and acts as a mediator for patients to assure that quality treatment is available. Someone is available 24 hours a day for emergency calls at (770) 527-9119, (770) 428-8769 or office (770) 428-0871. Their web site provides a great deal of information on opiate drug treatment, patients' rights, methadone maintenance, legal issues, news, addiction science, an online forum, and over 30 online videos on various aspects of addiction. Click on Opiate Drug Treatment in the left hand menu to find information on methadone, buprenorphine, ibogaine and naltrexone.

DESIPRAMINE (Norpramin) is an antidepressant that may be useful in facilitating opiod abstinence in opiod maintained patients.

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