Buprenorphine
Treatment

AppleGate Recovery specializes in outpatient medication-assisted treatment (MAT) for opioid addiction. Individualized, comprehensive treatment plans include buprenorphine and Suboxone® alongside counseling and recovery services. We help patients identify what individual recovery looks like and more importantly, how to get there.

Advantages of Buprenorphine

  • Approved by the FDA for clinical use in 2002, buprenorphine has been proven to be effective in the treatment of opioid addiction.
  • The first opioid treatment medication approved for this use, buprenorphine can be prescribed by a medical provider and filled at any pharmacy offering flexibility and freedom from daily program visits.
  • A long acting medication, a once daily dose prevents cravings and withdrawals for 24 hours or more. As patients stabilize, physicians may reduce the dosing to every other day.
  • Overdose on buprenorphine is unlikely if patients take the medication as prescribed, following all safety precautions and drug interaction warnings.
  • Buprenorphine compounds with naloxone act as effective deterrents to misuse.

SUBOXONE® and SUBUTEX® are registered trademarks of Indivior UK Limited.
ZUBSOLV is a licensed trademark of Orexo US, Inc.
BUNAVAIL® is a registered trademark of BioDelivery Sciences International, Inc.

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Individualized Treatment Plans

Each patient will work with their medical provider and counseling staff to develop a treatment plan that addresses their unique needs. Those plans include:

  • Medication-assisted treatment with buprenorphine and buprenorphine compounds including Suboxone®, Bunavail® & Zubsolv®
  • Ongoing medical and clinical assessment
  • Individual counseling
  • Group counseling
  • Case management
  • Life skills training
  • Referral to community resources
  • Smoking Cessation Assistance*
  • Lab services – including Hepatitis C and HIV testing (Select Locations)
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Treatment During Pregnancy

Pregnancy is an exciting and challenging time for any mother, but those in recovery may require a higher level of care and support. AppleGate understands the importance of our role in the lives of our pregnant patients, and works to wrap support around them during and after the pregnancy. This support includes:

  • Active communication with the obstetrical physician and team
  • More frequent visits as the pregnancy progresses for the same monthly fee
  • Assistance with tobacco cessation
  • Ongoing medication assessment and adjustment as needed to support changes during pregnancy
  • Discussion of the benefits of and concerns about breastfeeding for both mother and baby
  • Guidance on minimizing Neonatal Abstinence Syndrome as much as possible
  • Engagement in recovery during the critical post-partum period

How Buprenorphine
Treatment Works

Buprenorphine and buprenorphine compounds reduce the effects of opioid withdrawal and ease the cravings experienced due to those effects. They do this by attaching to the same receptors in the brain that other opioids do, eliminating the physical withdrawals so that patients can focus on their recovery.

Buprenorphine is a partial agonist which activates the opioid receptors in the brain, but to a much lesser extent than full agonists. It has a “ceiling effect”. This means that as you continue to take more of the medication, the effects do not continue to increase. Unlike commonly misused opioids, buprenorphine has the ability to control withdrawal symptoms without being used to “get high”. Additionally, it blocks other opioids from attaching to the receptors in the brain.

Compound medications including Suboxone®, Bunavail® and Zubsolv® combine buprenorphine with naloxone. Naloxone causes no opioid effect and has no negative reaction when taken under the tongue as prescribed. However, if misused or injected it will cause immediate withdrawal symptoms. This deterrent helps to reduce misuse and diversion.

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Medication Dose

An important part of your treatment is working with an experienced medical provider to determine the medication and dosing that is right for you. A proper dose in buprenorphine treatment varies for each person. While the medications have been shown to be more effective at lower doses, most providers typically begin relatively aggressively. The ceiling effect of the medication makes this approach safe, and supports the goal of eliminating withdrawal symptoms, helping patients stabilize more quickly.

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Phases of Treatment

From the Substance Abuse and Mental Health Services Administration, buprenorphine treatment happens in three phases:

phase-induction

1. The Induction Phase is the medically monitored startup of buprenorphine treatment performed in a qualified physician’s office or certified OTP using approved buprenorphine products. The medication is administered when a person with an opioid dependency has abstained from using opioids for 12 to 24 hours and is in the early stages of opioid withdrawal. It is important to note that buprenorphine can bring on acute withdrawal for patients who are not in the early stages of withdrawal and who have other opioids in their bloodstream.

phase-stabilization

2. The Stabilization Phase begins after a patient has discontinued or greatly reduced their misuse of the problem drug, no longer has cravings, and experiences few, if any, side effects. The buprenorphine dose may need to be adjusted during this phase. Because of the long-acting agent of buprenorphine, once patients have been stabilized, they can sometimes switch to alternate-day dosing instead of dosing every day.

phase-maintenance

3. The Maintenance Phase occurs when a patient is doing well on a steady dose of buprenorphine. The length of time of the maintenance phase is tailored to each patient and could be indefinite. Once an individual is stabilized, an alternative approach would be to go into a medically supervised withdrawal, which makes the transition from a physically dependent state smoother. People then can engage in further rehabilitation—with or without MAT—to prevent a possible relapse.

There Is Hope

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