Seven Things That Every Person Taking Suboxone Needs
Suboxone (buprenorphine) is a lifesaving medication when taken appropriately. However, it is not a cure for addiction and should always be used as a component of a holistic treatment plan under the care of a licensed professional.
In this post, Dr McGeachy explains the seven things that every person taking Suboxone needs (this list applies equally to people taking Subutex or methadone, as well).
Miralax
This one is pretty obvious. Buprenorphine is a live saving drug, but like any drug it has side effects. Chief among them, constipation. Opioids in general slow down the movement of digested food through your bowels. This allows the colon more time to suck the moisture out of stool and this hard stool is harder to pass. Untreated constipation can lead to the development of a number of painful conditions, such as diverticulitis, hemorrhoids, and anal fissures.
Miralax helps counteract this side effect by increasing the amount of water retained in stool. This leads to softer stools which pass easier and faster. All it typically takes is one scoop per day; you dissolve the powder in water or some other liquid and drink it down.
Of course, it is also important to eat plenty of dietary fiber, keep hydrated with clear fluids, and get regular exercise, but Miralax can help tremendously in preventing hard, painful stools. It's easy, cheap, over-the-counter, and basically free from side effects, which is why I often recommend it to my patients. Of course, speak with your physician before starting any course of treatment. If Miralax is not enough, you may need to be screened for other causes of constipation, such as colon cancer, so it's important to consult with a doctor.
2. Naloxone
Every person who uses opioids, even pharmaceutical opioids, can benefit from Naloxone, also known as Narcan. It is the antidote to opioid overdose and when used correctly, can save a life.
Narcan is typically distributed as a nasal spray, but Auto-injectors are also available by prescription. The FDA recently approved an over-the-counter version of Naloxone nasal spray and previous to this many states had laws allowing people to buy Nalaxone without a prescription. If you don't want to pay out of pocket, you can ask your doctor for a prescription or seek out a Harm Reduction program which distributes free Narcan.
Naloxone nasal spray is easy to use, safe to give, and as I already mentioned, life-saving in the event of an opioid overdose. It's important to keep it on hand for emergencies and rehearse how to use it so you are prepared should the occasion arise. Tell your friends and family about the Narcan, where you keep it, and how to use it so they are prepared as well.
Even if you are certain that you aren't going to overdose, you might just be called on to use it in the event that a friend or family member overdoses on opioids. It's a scary world right now and naloxone can help provide a little safety.
3. A Good Friend
Unlike some other items on this list, this one's a not an object, but rather a person. Addiction is a disorder that involves social isolation and withdrawal to some degree. I personally believe that every person recovering from substance use disorder needs at least one close friend or family member who can provide them with support.
Social support has many benefits for the person in recovery. Your support person can help you with keeping medical appointments, keep you accountable to your goals, safeguard your medications if you can't trust yourself to take it according to directions, keep an eye on you during medical withdrawal, and provide material support like driving you to appointments or cooking for you when you're feeling too sick or tired to do so yourself.
More importantly, this support person provides a sympathetic ear and a shoulder to cry on. This person should be someone you trust and you should feel comfortable being 100% honest with them. There are some things you may be hesitant to tell a medical professional, but comfortable talking about with the person or people who provide you social support.
The ultimate goal of recovery from addiction is the patient's reintegration into their community. These support people provide a safe space for you to practice the skills and behaviors that you need to rejoin the wider community.
Ideally, each person in recovery would have at least one social support who has their own experience with recovery from addiction, but this is not a requirement. Anyone who you trust and who cares about you can be a social support.
4. A Trusted Professional
Every person on Suboxone benefits from having a trusted medical professional. It could be the doctor who prescribes you buprenorphine, but it could also be a counselor, psychologist, or social worker you trust.
Having a medical professional in your ring helps you navigate the healthcare system. It's easy to get lost even when you aren't battling addiction.
This professional can also provide counseling or therapy to teach you the skills needed to sustain your recovery in the real world outside the clinic or treatment center.
Many people taking Suboxone also have chronic or acute medical conditions related to their previous substance use and would benefit from having a medical doctor for screening, diagnosis, and treatment of these conditions.
For these reasons and more, a trusted medical professional is a real asset to the person in recovery.
5. A Reliable Pharmacy
Taking Suboxone is simple, right? You get a prescription from your doctor and the pharmacy fills it?
If only it was this simple. It's not uncommon for patients to be told that the pharmacy is out of stock of their prescribed medication and they need to come back later. If you try calling around, pharmacies will refuse to disclose over the phone whether they have Suboxone in stock or not. If you travel to multiple pharmacies to fill your prescription, you might be flagged as a drug seeker.
It's all terribly unjust and arbitrary. The reason that it can be difficult to obtain Suboxone from a pharmacy is that the DEA has set arbitrary limits on the quantity of controlled substances each pharmacy can order. Each individual pharmacy has a limited supply that they must allot to their patients.
Established patients at a pharmacy typically have little issue with their refills. However, patients newly started on Suboxone may have trouble finding a pharmacy to fill their prescription because most of the supply is already allotted to existing patients. Pharmacies also dislike transferring controlled substance prescriptions to other pharmacies, as the DEA regulates this closely.
The take away is that patients taking Suboxone should establish with a single pharmacy for all their prescription refills. Since you're going to lock yourself into a long-term relationship with that pharmacy, it pays to chose one which treats you right and has a history of stable business operations. If you need to travel, it is better to schedule your trip around your refill schedule or obtain a vacation fill at your pharmacy of choice, rather than attempting to fill at an out-of-state pharmacy. If you are moving, identify a local pharmacy ahead of time and ask for a transfer of your prescription well in advance.
The doctor who prescribes your Suboxone is a good resource when it comes to identifying reliable pharmacies. They work with pharmacies on a daily basis and know which ones treat their patients well compared to the pharmacies which fail to meet their obligations. As a bonus, a pharmacy that works with your doctor on a regular basis is less likely to delay your prescription; a pharmacy which does not know your doctor well may feel it necessary to call their clinic in order to perform their due diligence and this will lead to delays.
You can also ask other people taking Suboxone which pharmacies they use to fill their prescriptions, as they have first hand experience of the atmosphere of the pharmacy and how the pharmacy staff treat patients.
6. A Journal
A journal is an excellent tool for self-discovery. Recovery from addiction requires addressing both the outward social issues but also the inner maladaptive emotions and thoughts which drive addictive behaviors.
Journaling is a process in which a person records the events of their day and their emotional reaction to these events. Recording even a brief journal entry each day causes a person to examine their thoughts and might help a person recognize patterns of behavior that they were previously unaware of.
People can also use a journal to record their craving symptoms and identify triggers. The person makes a brief journal entry each time they feel compelled to use their substance of choice. This accomplishes two things:
First, it helps the individual recognize their triggers and avoid them.
Second, perhaps more importantly, it serves to interrupt the automatic thoughts which drive a person to use their substance of choice when they feel a craving. The act of getting up, opening the journal, and then putting pen to paper changes your environment and this changes your brain's thought pattern.
I recommend a paper journal, rather than an electronic one. There is power is handwriting and the deliberate action of putting pen to paper can be more meaningful than typing on a keyboard. It also produces a tangible product by which you can use to measure your progress in recovery. Paper is also the most secure method of storing data in today's world, provided you safeguard the physical journal.
However, if a person has trouble writing in a paper journal, then it is acceptable to keep an electronic log on your phone or computer. Another option is a voice recorder, if you struggle with handwriting or typing. Regular journaling is more important than the form that journal takes.
If you do keep a journal, be sure to bring it with you to your physician appointments. That way you can reference any thoughts or observations you have made.
7. A Meal Plan
Good nutrition is so important for health, especially for people recovering from substance use disorder. Such people are often deficient in both macro- and micro-nutrients.
Macro-nutrients are carbohydrates, protein, fat, and fiber. Carbs provide energy and are necessary for powering all the cells of your body. Proteins make up the machinery of these cells and are vital to life. Fats are both a source of energy, but also necessary for the formation of cell membranes, hormones, and the myelin sheaths which insulate your nerve cells. Unlike the first three, the body does not directly use fiber but it is necessary for regular bowel movements and therefore it is critical that patients taking Suboxone eat sufficient fiber to prevent constipation.
There is much debate about the ideal ratio of macro -nutrients in the human diet. There is probably no single perfect diet for every person. However, as long as you stick to unprocessed foods and eat a varied diet, you're doing better than 90% of people.
Micro-nutrients are the vitamin and minerals that the body cannot make itself and therefore needs to obtain from food. Vitamins are only made by living things, like plants and animals, whereas minerals are inorganic compounds which originate from the earth itself.
Entire books have been written about vitamins and minerals. For now, suffice to say that a varied diet, consisting mostly of whole foods is the best method to ensure adequate micro-nutrients intake. For most people, a vitamin supplement is not necessary to obtain these nutrients and the vitamins and minerals from food are better absorbed anyways. Sometimes, a vitamin or mineral supplement is necessary, but talk with your doctor before starting any supplement products.
The best way to ensure that you eat a healthy diet is meal planning. Life for a person recovering from substance use disorder is stressful enough, without the hassle of thinking about and preparing food everyday.
A meal plan removes a great deal of stress from daily life and helps keep you from resorting to junk food or takeout when you are hungry. It can also help you avoid snacking on sugary treats, which is a common vice of people in recovery. One symptoms of sub-acute opioid withdrawal is sugar cravings, because eating sugar triggers the same reward pathways in your brain that opioids and alcohol do.
If you're stumped as to what to prepare, there are countless blogs online which offer ideas for meal prep and shopping lists. If you don't want to do it yourself, you can subscribe to a meal prep service, such as Hello Fresh or a local meal prep company. Some meal prep companies will even ship you prepared meals that you only need to reheat before eating, if you hate cooking. For those who hate meal preparation, a meal replacement such as Soylent or Huel can be an option, though most people cannot stand the monotomy of drinking the same beige goo every single day.
Regardless of your decision, pick a meal plan and stick with it. The health benefits and time savings will pay dividends in your recovery. Even better would be to share a meal plan with other people and eat communally; this helps spread the work out among multiple people and counteracts the isolation that can lead to relapse into substance use.
Conclusion
There you go, the seven things that every person taking Suboxone needs. Are there any things that you think belong on this list? What has your experience with Suboxone treatment been like? Share your thoughts in the comments below. I promise to read and respond to each, as long as the comment is not a question about an individual medical situation.
Finally, if you or someone you love, are suffering from problematic drug or alcohol use and are seeking treatment, contact the clinic in order to schedule a discovery call to discuss treatment options.
If you or someone you love is suffering from problematic drug or alcohol addiction use and is seeking treatment, contact the clinic by calling or clicking the “Get Started” button in order to schedule a discovery call and initial evaluation, both of which are free.
We are here to help.
North Tampa Executive Health Clinic is directed by Dr. Jack McGeachy. He provides confidential and comfortable addiction treatments and therapy for opioid and alcohol use disorder. Rather than a rehab or detox, meaning that each patient is cared for one-on-one by a medical doctor, in contrast to other treatment programs. Heed Help? Book your in office appointment in the Tampa office or via video conferencing today.
Helping patients with addictions in Tampa Florida, Temple Terrace, Brandon, Bloomingdale, Carrollwood, Thonotosassa, Town N Country, Lutz, Wesley Chapel, Land O Lakes, St. Pete, Clearwater, Oldsmar, Westchase, Palm Harbor, Tarpon Springs and surrounding areas.
