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Buprenorphine Treatment for Opiate Addiction and Pain

Carolina Behavioral Care (CBC) offers a full array of clinical services around buprenorphine treatment for opiate addiction. With the high level of concern nationally over opiate addiction, we thought it worthwhile to address the landscape of treatment options. As a result over the last five years, we have developed buprenorphine treatment under the leadership of Robert Fleury, M.D. For both detoxification from opiates as well as abstinence-focused maintenance, buprenorphine (Suboxone, Subutex, Zubsolv, Bunavail brand names) has become an excellent option. This drug has also emerged as a treatment for chronic pain, especially for those patients who have difficulty controlling their use of opiates. We have many patients, who have come to us because of difficulty with opiate use, report a reduction in pain symptoms comparable to opiates.  

Buprenorphine works to treat opiate addiction and chronic pain through its effect on the same brain receptor where opiates work. It is technically an opiate partial agonist and has its effect by binding to the opiate brain receptors. Both craving and chronic pain are controlled through the interaction at these receptors. Buprenorphine is not addicting like opiates because tolerance does not develop. However, withdrawal will occur if stopped without medical supervision. The goal of buprenorphine is to control craving so the patient has no desire to take opiates. Because of the genetics of addiction, some patients may take buprenorphine for the long term. But the goal clinically is always to regulate the patient’s cravings on the least amount of the drug possible. Over time, patients work towards reducing buprenorphine use, and many patients stop it completely with good stability of abstinence.  

CBC offers medically assisted treatment (MAT) at our Durham, Hillsborough and Pinehurst, N.C., locations. A distinct advantage of buprenorphine over other forms of opiate addiction treatment is that it can be prescribed at a physician’s office. At the time of this post, CBC has eight certified buprenorphine prescribers.  

Clinical Procedures for Safe Buprenorphine Treatment in Durham, N.C., and the Triangle area

For patients requesting help with their addiction, there are several stages of care to address. Initially, a complete substance abuse assessment is performed with one of our prescribers.  This includes a psychiatric assessment as well to identify any co-morbid psychiatric issues such as depression or anxiety. Additionally, a basic medical evaluation is performed. CBC has in-house lab services to assess potential metabolic or infectious disease problems. We also perform urine drug testing to identify any substance which might affect recovery. If the patient requires detoxification from opiates or any other drug of abuse, the CBC staff will develop a tailored detoxification regimen for the patient. This is greatly facilitated through our in-house pharmacy. All dosing requirements are developed  in collaboration with the CBC pharmacist. Patients need to be off all opiates for at least 24 hours before beginning buprenorphine. Those patients who have been actively using opiates have to be in active withdrawal for the safe administration of buprenorphine.

The next phase of treatment is called induction. In this phase, buprenorphine is started while in the office, and if detoxification has been managed correctly, withdrawal symptoms will usually subside within a few hours. The CBC staff will monitor the patient’s vital signs during induction to be sure there are no significant side effects before returning home. Routinely the patient’s medication level is adjusted over the course of the first month with the goal of achieving control of opiate craving. Additionally the patient will receive a substance abuse counseling assessment with treatment focused on changes in the patient’s psychosocial life to support recovery. Involvement in AA or NA is recommended.  

Maintenance treatment is achieved through the ongoing relationship with the prescriber. Monthly visits with the prescriber are required to monitor craving and to make adjustments of the buprenorphine as needed. Since CBC prescribers also have psychiatric credentials, they can address any co-morbid psychiatric problems that exist. The role of the substance abuse counselor is also important during each phase of treatment to set realistic recovery goals and address healthy changes in lifestyle.  

Buprenorphine comes in several preparations. Most patients take a form that includes naltrexone. These brands include Suboxone, Zubsolv, and Bunavail. Naltrexone is a medicine which also reduces cravings. It has been added to buprenorphine to specifically block possible euphoric symptoms if a patient were to abuse the drug by taking it intravenously. Buprenorphine alone (Subutex) is recommended during pregnancy, and the staff at CBC has extensive experience working with women during pregnancy.  

In-House Buprenorphine Treatment in Durham and Hillsborough

The CBC in-house pharmacy is particularly helpful when a patient starts buprenorphine treatment. Most insurance companies have a preferred form of the medication, and the CBC pharmacist will complete all precertification requirements so the patient can start treatment immediately. Our pharmacists also monitor dosing of all medications and ensures that refills are available so that the patient will always have their medications.  This is especially important with buprenorphine treatment because withdrawal will occur if doses are missed. This collaboration between the prescriber and the pharmacist is critical to the success of the treatment. CBC has full-time pharmacy staff at all three sites.

CBC welcomes requests for treatment directly from patients as well as from the medical community at large. To schedule an appointment or make a referral, contact our Call Center at (844) 534-7208 Monday through Friday from 8 a.m. to 5 p.m.

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Dr. Fleury received his medical training at Wake Forest University Medical School and then entered residency training in family medicine at the Eastern Maine Medical Center. He completed his training in psychiatry at Dartmouth Medical School. He received certification in psychiatry and neurology in 1983. He was awarded the honor of Fellow in the American Psychiatric Association in 1992.

  • Pinehurst office

    289 Olmsted Blvd Pinehurst, NC 28374

    910-295-6007

  • Hillsborough office

    209 Millstone Drive Hillsborough, NC 27278

    919-245-5400

  • Durham office

    4102 Ben Franklin Blvd Durham, NC 27704

    919-972-7700

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Dr. David Cowherd, MD, FACC - Pinehurst Medical Clinic

Carolina Behavioral Care has been my number one choice for my psychiatric referrals for the past 20 years. Their level of professionalism is unsurpassed and I have never been disappointed.

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