- Are you or someone you care about struggling with heroin, morphine or any type of prescription painkiller overuse, abuse or addiction?
- Would you like to wake up to a beautiful day every morning full of opportunity?
- Are you tired of living under the chains of your past?
Know that you can close the door on those things that happened before but somehow still affect you. Treatment is available and recovery is possible.You have made the first step to a brighter tomorrow.
Dr. Battle is board certified in Family, Sleep and Addiction Medicine. She is also the creator of Reboot Repair Rebirth, a model that aids those who are suffering to truly forgive themselves so they are capable of self-love.
Dr. Battle offers a buphrenorphine/naloxone maintenance program to support recovery from opioid addictions at Carolina Performance. Her practice is designed for highly motivated patients who are willing to be honest and are ready for change with the goal of coming off maintenance long term. She establishes a connection with patients while also creating a non-judgmental environment that focuses on your individual needs. Her style is candid, compassionate, and interactive. She believes the role of the physician is to guide.
If you are seeking to learn more, please send us a text in the secure Klara message portal in the bottom right corner of your screen. Intakes are available in the Klara portal upon request. Upon completion of an intake, the doctor will either offer an apppointment if your addiction management is appropriate for her virtual practice or she will make recommendations for in person practices.
A Whole New Take On Personal Care
Imagine a doctor that really cares about you. Dr. Battle works closely with your treatment plan through her virtual integrative practice. There are no week-long waiting times or sitting for hours in a waiting room. You will get first-rate service with a doctor who takes the time to get to know you. Learn more and experience an evolved level of care.
What Is Personalized Care?
Someone who will invest in your health, life, and longevity. This is what is known as personalized care. Allow me to introduce you to an elevated level of care.
1. Medication Assistant Treatment (ie Buphrenorphine/Naloxone with Therapy Partner Mind Healthy)
2. Sleep Testing/Evaluation (Learn More at restwellpllc.com)
I take time with my patients and understand your needs. You and I will cooperate with each other so that you may live a longer and happier life.
I offer same-day appointments, extended visits, and additional care such as nutrition and fitness.
Focused medical help: I take care of a smaller number of patients to give you the attention and detail you deserve.
Treating the source: My focus is geared towards the prevention of illness and wellness, with specialties in sleep and integrative medication assistant treatment.
What To Expect From Your First
Save yourself time Before your visit
Before your visit, you will have to fill out your information on our online screen form or request a screening form through Patient Portal/ Klara .
Dr. Battle will review your screen and determine if your treatment is a good fit for a virtual practice. If deemed appropriate she will provide you next steps to request an intake packet through the patient portal/Klara. If deemed to need in person care, her team will link and refer you to an in-person practice.
Once identified as appropriate, completing the Intake packet ahead of time will allow me to spend more time with you. During your virtual visit, there is no rush. You and I will discuss the best routes to accomplish your addiction and or sleep goals. Let’s work together to make a plan fit for your health.
Get to Know your MAT Doctor
What makes Dr Battle Different
I believe that the relationship between patient and physician is a two-way road with open communication. My goal is to maximize your ‘health by taking a complete look at your lifestyle. Using proper education, good information, and planning, you and I can work together to form a complete picture of your life.
Why should I pay extra to see a physician over my insurance?
Over the years, the new normal has become minimal time with the doctor, loss of preventative medicine, and the loss of overall quality of care. There are many programs coming out to help improve this system. I have seen improved outcomes with more time and personalized care and some insurance companies are just not willing to pay for that extra time or personalized care.
Many physicians see 4 to 6 patients an hour, focusing on as many patients as efficiently and swiftly as possible. That is not what I do here. I take the time to get to know you, take time to work through your problems, educate you, and take care of you. You no longer have to wait 10 to 20 days for an appointment or be stuck in the office because the doctor can be up to 4 hours behind.
This is medical care that saves you time and money in the long run, the kind that cares about your needs.
United Healthcare, AETNA, Cigna, Med Cost, Multi Plan, Humana, BlueCross BlueShield, Medicaid and Medicare is accepted. Some Plans may lower your cost.
Call (919) 230-2569 for questions or to start your personalized care today!
Read it For Yourself
Dr. Battle is by far the best doc in the triangle. She has such a compassionate heart and truly loves her patients. In a profession that has become full of power and greed, this doctor's true mission is to help others. Her own experiences and her faith has transformed her into a remarkable light for others. She is not only my doctor but has become a central part of my support system and a good friend. You will NOT find another doctor like her!! Hands down the best physician in NCJenn I.
Hands down the best doctor I have ever had the pleasure of meeting I would recommend her to anybody looking for a drug rehabilitation doctor she never treats you like a drug addict like most places these days my husband has been seeing her for almost a year and I'm going to be seeing her soon I'm tired of being treated like a junkie at the Carter clinic after being clean for the last 3 yearsCecil F.
Dr Battle is an excellent physician and has outstanding ability to communicate and connect with her patients. This is a rare ability among doctors. Many know their medicine but few can communicate well with their patients. And that is a huge part of effective diagnosis and proper healthcare.Kelvin C.
Award-Winning Physician, Abuse to Abundance Authority, #1 Best Selling Author and Consultant.
Turn your pain from addiction and abuse into the promise of abundance!
What is an Opiate?
Opiates, also known as narcotics, are powerful drugs derived from the poppy plant used frequently to relieve pain. They include:
Opium, Morphine, Codeine
Synthetic Opiates “Opioids”
Oxycodone, Vicodin, Percocet, Demerol, Heroin, OxyContin, Hydrocodone, Darvon, Percodan, Dilaudid, Methadone, Suboxone
Researchers report that physical addiction occurs after repeated use of an opiate alters the reward pathways in the brain. It is a real illness that causes physical damage to the brain, much like hypertension or diabetes damages the body. As a result, it is classified as a chronic disease and requires comprehensive medical treatment to address, not just willpower.
Opiate addiction is a brain disease that affects the lives of an estimated 4 million people creating compulsive, addictive behavior that destroys lives, careers, finances, health and families. Sadly, the guilt and stigma of this condition prevents many patients and family members from seeking medical treatment before it’s too late.
Our program is designed to educate you and your family members about this disease and to help you set your guilt, frustration and desperation aside, so you can embrace treatment. Our program offers medication assistance combined with counseling and support, offering you the highest possible chance of recovery. In fact, over 80% of our patients remain free of their previous addiction for more than 6 months – a truly remarkable achievement!
Who does Opiate Addiction affect?
There are many paths to addiction, ranging from individuals seeking relief from chronic pain, recovering from major surgery, to recreational drug users – all of whom gradually fell into reliance on an opiate. This diverse group of people encompasses all demographic and economic classes. Our patients include:
- Sales People
- Stay-at-home Moms
- Truck drivers
- Family Members
We approach each patient, not as an addict, but as an individual with a complex medical condition in need of respect, compassion, support and guidance.
What is the solution?
Our program provides:
- Medication-assisted treatment with Suboxone
- Counseling & support
- Medically supervised taper and withdrawal
- Post Suboxone support with Naltrexone
- We get amazing results!
What is Buprenorphine?
Buprenorphine is a prescription pharmaceutical, which attaches to the same reward centers in the brain as the abused opiate would occupy. By attaching to these sites, called Opioid receptors, buprenorphine completely eliminates withdrawal symptoms.
In 2002, the FDA approved Buprenorphine for the treatment of Opioid addiction for its favorable safety profile and the following benefits:
- Causes no euphoria
- Suppresses withdrawal symptoms, including cravings
- Blocks other opiates from the brain
- Lowers the risk of overdose and misuse of abused opiate
- Minimal side effects
1. Opioid receptor is empty. As someone becomes tolerant to opioids, they become less sensitive and require more opioids to produce the same effect. Whenever there is an insufficient amount of opioid receptors activated, the patient feels discomfort. This happens in withdrawal.
2. Opioid receptor filled with a full-agonist. The strong opioid effect of heroin and painkillers can cause euphoria and stop the withdrawal for a period of time (4-24 hours). The brain begins to crave opioids, sometimes to the point of an uncontrollable compulsion (addiction), and the cycle repeats and escalates.
3. Opioid replaced and blocked by buprenorphine. Buprenorphine competes with the full agonist opioids for the receptor. Since the buprenorphine has a higher affinity (stronger binding ability) it expels existing opioids and blocks others from attaching. As a partial agonist, the buprenorphine has a limited opioid effect, enough to stop withdrawal but not enough to cause intense euphoria.
4. Over time (24-72 hours), buprenorphine dissipates.
However, it still creates a limited opioid effect (enough to prevent withdrawal) and continues to block other opioids from attaching to the opioid receptors.
Source: The National Alliance of Advocates of Buprenorphine Treatment – www.NAABT.org
Prescription drugs that contain Buprenorphine
Several drugs contain the active ingredient Buprenorphine, including Suboxone, Zubsolv, Bunavail, and others are expected in the future. Suboxone is the one most frequently prescribed by physicians, has the longest track record, and provides the most availability at pharmacies.
Understanding more about Suboxone
While Suboxone (Buprenorphine) is a medically approved and useful option for opioid dependency, it is important that you educate yourself as much as possible about this pharmaceutical before making a treatment decision.
Side effects can include:
- Withdrawal symptoms if stopped suddenly
You can read more about Suboxone at www.Suboxone.com. Suboxone is not a cure for dependence, just as insulin is not a cure for diabetes, but is a tool to be used for treatment.
How long should treatment last?
Opioid addiction is a result of brain changes that result from chronic opioid use. Each patient’s struggle for recovery is unique, but entails overcoming the effects of these changes. Adapting to new coping mechanisms and reversing these brain changes take time. 18 to 24 months is a reasonable expectation for a treatment timeframe.
Our office-based treatment program includes…
- Full Medical Evaluation
- Course of treatment prescribing Suboxone
- Regular office visits
- Urine testing
- Requirement that patient attends individual or group therapy
- Medically supervised taper and withdrawal plan
- Post Suboxone treatment with Naltrexone
Methadone or Buprenorphine?
For an individual looking for help with opioid addiction, there are a number of treatment options. The most widely recognized treatment in the past was Methadone maintenance. For over 60 years, clinics have been dispensing methadone to those affected by opioid addiction. Methadone is a longer and more gradually acting opioid that helps to reduce withdrawal symptoms and cravings which drive so many users back to heroin and other opioids like pain medications.
Although methadone is supposed to be a bridge to recovery from addiction, many users lapse back to heroin use with methadone. Accordingly, users often remain on methadone for years, sometimes even indefinitely. Sometimes called “trading one drug for another” the majority of methadone adversaries claim that methadone is just the “legal form of misuse.” Methadone is also a dangerous drug if misused.
In 2002, a different medication was introduced to the market designed to address a new approach for treating those suffering from opioid addiction called Buprenorphine. Suboxone® is a trade name for a drug made up of 4 parts of an opioid called Buprenorphine and one part opioid antagonist, Naloxone. While Buprenorphine has a very strong affinity for its receptors, it only activates it partially. In theory, this means it will take up all the receptors if a person decides to use it simultaneously with a full activator like heroin, but it won’t have as powerful of an effect and it may induce painful withdrawal.
The addiction of Naloxone, an antagonist which attaches to receptors and prevents them from being activated, is intended to deter people from injecting or misusing Suboxone. When the formulation is crushed and injected, the Naloxone in Suboxone is designed to block many of the receptors, essentially causing a user to suffer a very unpleasant to an even severe withdrawal as well as a waste of money due to blocking the euphoria effects.
Suboxone can be taken in pill form or film form – both are meant to be absorbed under the tongue.
Additionally, under the Drug Treatment Act 2000 specially licensed doctors can prescribe buprenorphine from their offices, instead of clinics. Once a stable dose is achieved and a patient has shown to be compliant to the program, your physician can slowly reduce your office visits from weekly to one visit per month. “Having the convenience of a monthly prescription of medication, patients don’t have to deal with the inconvenience and stigma of making daily visits to a clinic.
Many users also report feeling more confident, almost like their “old selves” with Suboxone. Since Suboxone is only a partial agonist, it causes a milder “high” and is not as prone to abuse or overdose.
NOTE: Your treatment plan is at the sole discretion of your physician and will be highly determined by your compliance to the program. Being responsible to attend counseling is part of the program and we highly recommend and require coupling counseling with your medication-assisted treatment (MAT) to heighten the chances of your success.
What are the pros and cons of treatment with Methadone?
- More than 60 years of experience in treatment of opioid addiction
- Daily visits give more structure to patients who need it
- Cost is usually less and may be calculated on a sliding scale based on income
- Chances to interact with people affected by addiction in group counseling
- It is an opioid so it is able to stop the withdrawal symptoms
- It last for at least 24 hours
- There are no legal limits to how many patients a methadone clinic can treat
- Without a ceiling effect, doses can be increased as the patient becomes tolerant
- Good choice for patients in need for chronic pain management
- Highly addictive causing strong dependence to the drug and severe withdrawals if stopped
- It is possible to use illicit opioids while on methadone
- Methadone treatment follows a strict protocol which makes some patients feel they have no control over their own treatment
- Shows up in urine testing for employment
- Daily visits to the methadone clinic may be difficult for some patients who have jobs and when traveling distances is an issue
- Daily visits make overnight travel difficult for both business and pleasure
- Some people find it difficult to overcome self-esteem issues in a clinical environment
- Poor option of clients seeking to come off or taper off the drug
- Not all states allow methadone treatment for opioid addiction
- Methadone is by far the #1 drug that, if misused, leads to overdose (see diagram above)
What are the pros and cons of treatment with Buprenorphine/Suboxone?
- Newer, safe, and effective medicine for opioid addiction
- Possible to gradually taper and wean off of the Suboxone
- Long acting, allowing for every other day dosing during the taper period
- May be continued in case of pregnancy
- Monthly visits for compliant patients affording much better lifestyle during treatment
- Well tolerated even at high doses with a low likelihood of overdose
- Not usually a part of employment drug screening tests
- Prevents illicit drug usage during treatment by eliminating euphoria
- Associated with less stigma of drug abuse than Methadone
- Less potential for dependence to and withdrawal from the medicine
- Covered by most insurances carriers
- Great choice to transition from Methadone
- Can be more expensive for out of pocket paying patients
- Unpleasant taste sometimes reported
- May potentially be abused and diverted
- It is an opioid agonist, so dependence can develop during the course of therapy and withdrawals occur if treatment is abruptly stopped
- Typical, albeit mild, opioid side effect profile
- Most strictly regulated drug by DEA, hence requiring treatment by specialized physicians only
Addiction Services Below (for sleep services check out Restwellpllc.com)
A healthy body requires constant maintenance and clean fuel in the tank to perform at its best. By refraining from exposing your body to harmful chemicals, establishing a healthy regimen of nutrition, and tending to your body’s needs, you can reach optimal health.
- Opioid Addiction Treatment
- Addiction Recovery Counseling
- Substance Abuse Treatment
- Vivitrol (Naltrexone) Injections
- Nicotine Use Disorder
Opioid Addiction Treatment
Located in Raleigh, Dr. Battle and staff utilize the latest pharmaceutical approach combined with therapeutic counseling for successful opioid addiction treatment.
How prevalent is an opioid addiction?
Addiction to opioids, a class of drugs derived from the poppy plant, is a major epidemic in this country, affecting all types of people from students to white-collar professionals to stay-at-home moms. Nearly 2 million adolescents and adults have an abuse disorder involving opioid prescription pain relief medications while nearly 600,000 have an abuse disorder involving the illegal opioid, heroin.
Addiction Recovery Counseling
Located in Raleigh, Dr Battle provides counseling services through her integrative partnership with Mind Healthy.
Addiction Recovery Counseling can be different for every person who enters a recovery program. While medications like Suboxone and Vivitrol are an important part of becoming drug-free, these medications do not work on their own. The patient must, first and foremost, be fully committed to the recovery process. Being fully committed means agreeing to a counseling program in addition to the medication.
Substance Abuse Treatment
Dr. Battle provides a comprehensive substance abuse treatment program from her practice, located in Raleigh.
What is the patient intake process?
Substance abuse treatment is a multi-part process that can be customized according to the needs of each patient. The first part of this process is the patient screening. This can be done through the online screening form or through the Klara portal. Dr. Battle will review the screen and deem rather your treatment is appropriate for virtual practice. If appropriate the next step is to complete an intake packet which is required to confirm an appointment. If your treatment is not appropriate for a virtual practice, then Dr. Battle’s team will link and refer you to in person care. During your virtual appointment you will receive a secure text through the Klara patient portal to start the visit. If you are new to Suboxone, you will want to be in mild withdrawal in order to start the medication. Since the practice is virtual, this process will be a home induction where you will be monitored using the Clinical Opioid Withdrawal Scale.
Vivitrol (Naltrexone) Injections
Once the practice is back to in person visits, patients can receive Vivitrol (Naltrexone) injections if their treatment plan requires it. If you are requesting Vivitrol while the practice is virtual, Dr Battle’s team can link you to an in person provider.
What is Vivitrol?
Vivitrol is sometimes also known by the name naltrexone, as that is its active ingredient. Vivitrol is an injectable medication that falls into the group of medications called opioid antagonists. This medication acts as a blocker. It impacts the opioid receptors in the brain, blocking the feelings of pleasure that come from taking opioids. It is also used in alcohol treatment programs.
We believe in promoting a healthy lifestyle free of harmful chemicals and substances. In today’s modern society, we are easily exposed to so many different pollutants, and this exposure makes living a healthy lifestyle especially tricky.
Obtain new patient forms in Klara.
If you have any questions regarding your first visit, please don’t hesitate to call us at 9192302569.
Who is a candidate for Suboxone treatment?
- People who abuse opiates and have not been able to quit on their own
- People who are otherwise healthy and are able to participate in an office-based program
- People who have the financial resources to afford treatment and medication
- People who are appropriate for outpatient treatment and do not require detox from other addictive drugs (i.e. alcohol, Xanax, Valium, Klonopin)
- People who have received previous treatment for their addiction, but continue to have cravings
- People who are honest about their addiction, serious about their recovery, and understand that this program is their best chance of success
This appointment takes about 1 hour during which the patient will be evaluated.
Not all patients will be admitted into this program. Dr. Battle will assess whether or not the program will meet the needs of the individual patient and determine the patient’s ability to meet the program requirement through a screening process first. Honesty and commitment are critical!
Not all patients will be admitted into this program. Dr. Battle will assess whether or not the program will meet the needs of the individual patient and determine the patient’s ability to meet the program requirements. Honesty and commitment are critical!
If accepted into our program, the next steps are to…
- Complete the program intake paperwork.
- Schedule appointment
- Pay the program concierge membership fee
Should I expect once I’m accepted?
Step 1: Home Induction if new to Suboxone
Step 2: Stabilization
Step 3: Maintenance
Step 4: Medically Supervised Taper/Withdrawal
- Your decision to take the first step is your biggest investment.You can start today by scheduling your into our program. Please contact us.
- Get connected to support therapy and begin learning how to manage your triggers.
- Use the Here to Help Program® to strengthen your recovery.
- Fulfill your responsibilities to the program and to yourself(See Intake.
I understand that not all patients are accepted into this program. I understand Dr. Battle will determine my eligibility for acceptance based on 2 factors:
- Will this program meet my particular recovery needs?
- How likely am I to meet my responsibilities to this program?
I understand that there are alternatives to buprenorphine treatment for opioid addiction including:
- Medical withdrawal and drug-free treatment
- Naltrexone treatment
- Methadone treatment
I understand that medication alone is not sufficient treatment for my disease and I agree to participate in the recommended patient education and relapse prevention program, to assist me in my treatment.
I understand that receiving regular counseling is an important part of this program and that I am required to attend individual or group sessions at least 2 times per month.
I understand Dr. Battle reserves the right to contact the Prescription Monitoring Program to ensure your compliance with this treatment program.
I understand that I will be urine/saliva drug-screened on every visit and that Dr. Battle reserves the right to perform additional testing if she deems necessary.
I understand that Dr. Brattle reserves the right to discharge me from the program if I have a positive drug screening (Benzodiazepines, Opiates, Cocaine, or Amphetamine/Methamphetamine, Marijuana) or if I violate any part of this agreement.
I understand that I must be in a state of mild to moderate withdrawal before being admitted into this program.
I understand during Phase I of the program (first 6 months), new patients are seen every 1-2 weeks and stable transfer patients engaged in therapy are seen every 2 weeks then monthly.
I understand during Phase II of treatment (after 6 months), Dr. Battle will determine the frequency of my office visits based on my treatment plan. I understand that MOST patients are seen once every 4 weeks, provided there is no relapse history; however this is entirely at the discretion of Dr. Battle.
I agree to keep and be on time to, all my scheduled appointments.
I understand that I must get approval by Dr. Battle to miss or reschedule an appointment and that I MUST call 24 hours prior to my appointment
If I fail to show up for a scheduled appointment or fail to give 24 hours’ notice, I will be charged a $125 late/no show fee which will be due immediately.
If I fail to show up for a scheduled appointment, I will be given one opportunity to reschedule for the next office day. I understand that if I fail to show up for this appointment , I may be discharged from the program. I further understand that I may have to repeat the Patient Intake process and will have to pay additional fees to be readmitted to the program (if space is available and not greater than 6 months).
I agree to conduct myself in a courteous manner while in the physician’s office.
I agree to leave all backpacks and large purses in my car.
I agree not to arrive intoxicated or under the influence of drugs. If I do, the staff will not see me and I will not be given any medication until my next scheduled appointment.
I agree not to deal, steal, or conduct any other illegal or disruptive activities in or in the vicinity of the doctor’s office.
I understand that NO MEDICATION is kept on site including Suboxone, Subutex, or any other Narcotic.
I agree that my prescription can only be given to me at my regular office visits. Any missed office visits will result in my not being able to get medication until the next scheduled visit.
I agree that the medication I receive is my responsibility and that I will keep it in a safe, secure place. I agree that lost medication will not be replaced regardless of the reason.
I agree to take my prescribed medication as Dr. Battle has instructed and not to alter my medication schedule without first consulting the doctor.
I agree not to sell, share or give any of my medication to another person. I understand that such mishandling of my medication is a serious violation of this agreement and would result in my treatment being terminated without recourse for appeal or reimbursement.
I agree not to obtain medications from any physicians, pharmacists, or other sources without informing my treatment physician. I understand that mixing buprenorphine with other medications, especially benzodiazepines, such as Valium, (diazepam), Xanax (alprazolam), Librium (chlordiazepoxide), Ativan (lorazepam), Klonopin, and/or other drugs of abuse including alcohol can be dangerous. I also understand that a number of deaths have been reported in persons mixing buprenorphine with benzodiazepines.
I understand that I may be discharged immediately if I test positive for any Benzodiazepine.
I understand that the use of buprenorphine/naloxone (Suboxone) by someone who is addicted to opioids could cause them to experience severe withdrawal.
What drugs are opioids?
Painkillers such as morphine, methadone, hydrocodone, and oxycodone. Sold under brand names such as OxyContin®, Percocet®, Vicodin®, Tylox®, Demerol®, Fentanyl®, among others. Heroin is also an opiate and is illegal.
What drugs are NOT treated with Suboxone®, buprenorphine?
Drugs that are opioids such as cocaine, methamphetamines, ecstasy, LSD, ketamine, steroids among others.
What is addiction?
For you to fully understand you must be aware of the difference between tolerance, physical dependence, and addiction. When a person takes opioids for an extended period of time they become less sensitive to it and require more to achieve the same effect. Receptors in the brain become less sensitive. This means they need more and more opioid to achieve the same effect. This is called tolerance. When the body can no longer make enough natural opioids to satisfy the less sensitive receptors, the body becomes dependent on the external source. This is physical dependence. Physical dependence is physiological state of adaptation to a substance, the absence of which produces symptoms and signs of withdrawal. Physical dependence is the result of physical changes in the brain. It is not a matter of willpower rather it is actual physiology.
Addiction, in general, is defined as a behavioral syndrome characterized by the repeated compulsive seeking or use of a substance despite adverse social, psychological and physical consequences. Opiate addiction is included in this category but is also marked by a physical alteration of receptors in the brain. As these changes occur with repeated opioid use, the individual is less sensitive to its effects and requires an increasing amount to achieve the same desired effect. Addiction is a disorder which requires treatment while physical dependence is not. In summary, addiction is uncontrollable compulsive behavior caused by alterations of parts of the brain from repeated exposure to high euphoric responses.
What is withdrawal?
Withdrawal syndrome consists of a predictable group of signs and symptoms resulting from the abrupt removal of, or a rapid decrease in the regular dosage of, a psychoactive substance. The syndrome is often characterized by over activity of the physiological functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug. In other words, the opposite of what the drug did. If the drug suppressed depression then the person would be depressed while in withdrawal. If the substance suppressed pain then the person will experience pain while in withdrawal.
Withdrawal from opioids can be severe and excruciating. Withdrawal generally begins between 4 to 72 hours after the last dose of opioid use (depending on dose and opioid). The symptoms are both physical and emotional to include; goose bumps, watery eyes, runny nose, yawning, loss of appetite, tremors, panic, chills or profuse sweating, nausea, vomiting, muscle cramps, insomnia, stomach cramps, diarrhea, shaking, depression, irritability, jitters and increased sensitivity to pain.
Why do I need to be in withdrawal to start Suboxone®/buprenorphine?
It is important to be in a state of mild to moderate withdrawal when you begin your induction to buprenorphine. If you have a high level of another opioid in your system, buprenorphine will compete with it and knock the opioids off the receptor sites in your brain, creating instant withdrawal. If you are already in mild to moderate withdrawal buprenorphine will make you feel better, not worse, and this will help determine the minimal dose necessary.
How long do I need to wait since I last used before I can start Suboxone®/buprenorphine?
In general, you will need to wait until you are feeling the initial sensations of withdrawal before you can safely take your first induction dosage of buprenorphine. The waiting times vary depending on the drug of abuse. A rough estimate includes:
- Heroin – 12 – 24 hours
- Percocet®, or Oxycodone® – 12 – 24 hours
- Crushed painkillers – 12 – 24 hours
- Methadone (less than 30 mg) – 36 + hours
Since Suboxone®/buprenorphine are opiates, isn’t it just trading one addiction for another?
No, with successful buprenorphine treatment, the compulsive behavior, the loss of control of drug use, the constant craving, and all the other hallmarks of addiction vanish. Since buprenorphine does not have the full effects of an opiate, there is no euphoric high which requires increasing doses to achieve. In fact, the opposite occurs as the patient is weaned off buprenorphine systematically. This slow weaning process allows the brain time to heal and for the patient to address, through counseling, the factors that originally triggered the drug use to begin.
Addiction is a brain disease that affects behavior. This addictive behavior can be devastating to the patient and the loved ones. It’s not the need to take a medication that is the problem, but rather it is the compulsive addictive behavior to keep taking it despite the harm you are doing to yourself or your loved ones that need to stop. Whether or not the person takes a medication to help achieve this shouldn’t matter to anyone. If buprenorphine helps stop the damaging addictive behavior then that is successful treatment and not switching one addiction for another.
Can someone switch from Methadone to Buprenorphine?
Yes. It is best to SLOWLY reduce your therapeutic dose of Methadone to 30 mg a day or less for at least a week, before discontinuing it completely for at least 36 hours before starting Buprenorphine. You MUST be in mild to moderate withdrawal before you take your first dose of Buprenorphine. If you are doing well in Methadone treatment it may not be advisable to change treatments at all unless you and your doctor determine it is in our best interest.
What if I miss a dose?
If you remember your dose hours later, take it upon remembering it. If you forget until it is close to the time of the next dose do not take a double dose. Not because you will take too much but rather you will just be wasting it, due to the ceiling effect. After being in treatment for a relatively short period of time, you will feel so normal it may be difficult to remember unless you implement taking your medication to a daily activity.
Common Buprenorphine side effects:
- Headaches – Common remedy for headaches is over-the-counter pain remedies such as Tylenol® or non-inflammatory steroids drugs i.e. ibuprofen with a glass of water. Water alone may be all that’s needed. Opioids can contribute to dehydration and one of the first signs of dehydration is a headache.
- Constipation – Many medications can cause constipation, especially opioids. First, try increasing your water along with high fiber. Stool softeners such as Colace® or Miralax® are options.
- Dry Mouth – Opioids induce dry mouth which can have expensive consequences. Preventative oral care along with over-the-counter products such as Biotene®, which has natural enzymes to help normalize mouth conditions, may help to save tooth enamel and prevent costly restoration or infection.
What is Naloxone?
Naloxone is a pharmaceutical ingredient used to treat opiate overdose. It is present in Suboxone® to prevent misuse through diversion.
Why is counseling/therapy an important tool in the treatment process?
Physical connections create pathways in the brain that can be altered when we learn something new. These changes to the brain can even be documented with medical imagery. With complex learning activities, such as learning to play a musical instrument, these changes can be permanent. Addiction is a learned behavior that changes the brain as well. Through counseling and other behavioral modifications, the brain develops new neural pathways. Changing one’s environment, developing new hobbies and friends, and learning new coping mechanisms will alter the brain in this beneficial way, thereby undoing some of the detrimental changes that occurred while addicted. Therapy can help recondition the brain closer to its pre-addiction state… helping prepare the patient for a time when they no longer require medication.
Counseling/therapy helps the patient rebuild relationships, repair finances, get a job, assume responsibilities, decrease stress, anxiety and depression and helps the patient make other meaningful changes in their lives. This will allow you to achieve and maintain addiction remission.
How soon can I return to work?
It is recommended to take the first day of treatment off. You should be able to return to work the next day with greater attentiveness and clarity than before starting treatment. The transition from addiction to Buprenorphine is usually painless and most patients experience no adverse physical effects. In fact, most say that for the first time in years they feel normal again.
What if I need pain medication for surgery or acute pain?
You will be able to be treated for pain with elective dental or surgical procedure. It is imperative you inform all your physicians you are in a buprenorphine treatment program and give consent for them to contact your buprenorphine provider. Together they will develop the best pain management plan for you.
Does buprenorphine show up in an employer drug screening?
Buprenorphine has to be specifically tested for and still isn’t commonly included on standard drug screen panels. Buprenorphine will not cause a positive result on tests for other opiates.
Is my medical information confidential?
The confidentiality of alcohol and drug dependence patient records maintained by a program are protected by federal law and regulations. Generally, the program may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as being alcohol or drug dependent unless:
- The patient consents in writing;
- The disclosure is allowed by a court order, or
- The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or practice/program evaluation.
Are you having legal issues regarding alcohol or substance abuse?
Once thought of as a behavior of choice, substance abuse is now fully understood by the medical and legal community to be in fact, a chronic, even fatal, disease. As with any disease it must be medically treated and the most effective treatment option for addiction is a combination of a Medically-Assisted Treatment (MAT) Program which is combined with behavioral therapy.
Buprenorphine has to be specifically tested for and still isn’t commonly included on standard drug screen panels. Buprenorphine will not cause a positive result on tests for other opiates.
Proper Compliance Letters and Paperwork
Patients which follow our program, and are often mandated by the courts or by the recommendation of their counsel or lawyer, will be able to prove their compliance with personal letters completed by our physician. We provide this at no extra charge to the patient.
Our physician, as well as our staff, know what you are going through. Often times, successful treatment is the best option in lieu of incarceration.
Frankly speaking, our courts and jails are inundated with non-violent individuals with substance abuse charges. Jail is rarely the best answer. A specialized and medically proven treatment for addiction always is.
If you would like to know more please do not hesitate to contact us. Our courteous Administrator or Patient Advocate can help with any questions you have and most appointments can be made the same week. We look forward to helping you.
How can Dr. Battle help you and your legal issues?
First, your recovery is the most important objective period. Once you begin our program, you will start to see things in your life return to the way they used to be before your addiction.
Patients that are compliant with our program are required to have one-on-one counseling sessions with our physician each visit. They are required to attend weekly meetings and you will be required to provide urine drug screens on each visit while in our care.
Some of our patients include:
- Persons that are pre and post-trial for DUI, alcohol and drug related charges
- Patients fighting for visitation and custodial rights of their children
- Individuals that are awaiting the sentencing phase on court charges
- Employees and business professionals that are facing sanctions at the workplace
- Spouses that understand the value of a safe and substance free relationship and home
- Employers that value the importance of a co-worker affected by addiction
Medication is known as the “tool” which helps reduce or eliminate the cravings associated with drug and alcohol and also provides a safe mechanism to help with the painful withdrawal symptoms of coming off of using.
Why Behavioral Therapy?
Once a patient has started a MAT Program, this is where therapy such as counseling plays a pivotal role in understanding WHY you are addicted and how you can make the changes necessary to finally obtaining the long lasting recovery you deserve.
Did you know that strong evidence, over several decades, has proven that using ONLY traditional abstinence and faith based therapy has an over 95% relapse rate? Yes, the overwhelming majority of traditional programs including expensive in-patient rehabs have proven to be only short term solutions.