INSTRUCTIONS
You have found that you are unable to just stop using heroin, oxys, percs or other opiates.
We can TRY to make it tolerable, not fun or comfortable. This
is done with oral medications for the first twenty-four hours followed by three days of buprenorphine
maintenance therapy by injection and then oral sedatives and other medications for symptoms of withdrawal.
The way this is done involves taking buprenorphine daily for three days and then other oral medications
for three days. The buprenorphine is administered subcutaneously, that is to say just under the
skin - skin popping.
If you use the buprenorphine intravenously it may cause or worsen withdrawal symptoms.
It is important that you start the buprenorphine only after you are definitely in withdrawal.
Wait 24 hours after you stop using opiates.
For additional medication, you MUST return to the office. Other medications are available
but you must return to the office for another visit (no additional charge for this follow up visit).
DO NOT CALL FOR PRESCRIPTIONS.
DETOXIFICATION STEPS
- Stop using opiates (Heroin, Percs, Oxys, etc.)
- Wait at least 24 hours. You should be experiencing withdrawal at this time.
You can take the baclofen and the clonidine to get through the 24 hours. These pills can lessen the
severity of withdrawal.
- Baclofen for muscle discomfort and sleep.
- Clonidine for sweating, anxiety, and sleep.
- Diphenhydramine for sleep
- After at least 24 hours, inject buprenorphine just under the skin, (not IV). It should
make you feel better IF you waited the 24 hours since your last dose of opiates. Otherwise,
you may go into withdrawal and there is nothing to be done except the use of the medicines prescribed,
baclofen and clonidine, and wait for the discomfort to subside. Do not take more buprenorphine or
opiates until another 24 hours has elapsed.
- Repeat the dose every 24 hours. Inject the buprenorphine once a day (every 24 hours) for three days.
Inject the whole amount in the syringe. Do not divide the dose.
- 5. After the THREE buprenorphine injections are completed, you can use the baclofen and clonidine again.
They may also cause drowsiness and dry mouth.
- RETURN TO THE OFFICE for any problems that you have after the buprenorphine is finished.
There is no charge for this visit. You will receive additional medications depending on what
symptoms or problems that you are having. We have medications for:
- Diarrhea
- Belly pain and cramps
- Nausea
- Anxiety
- Difficulty sleeping
- Restless legs
- Craving
- On the 7th day clean, since you last used any opiates, take the naltrexone capsule.
It is to be taken at home at least four hours prior to coming into the office
for injection of a naltrexone pellet. Many patients take the capsule the night before the pellet is to be injected.
- The capsule will change the color of your urine to ORANGE. A urine sample will be checked before a pellet will be injected.
WARNING
You MUST be clean before you take naltrexone or you will get VERY sick.
The withdrawal is WORSE than any you have ever experienced.
It is recommended that you be clean for 7-10 days to prevent this from happening.
An injection of naloxone, a short acting type of naltrexone, will be administered to patients
prior to receiving a pellet. If you are clean 7-10 days or if you are taking naltrexone there will
be no effect from this injection. If NOT, in about 10 minutes you will start getting sick.
It will wear off in about an hour but we will not put in a pellet.
We require that you take a naltrexone capsule at home before coming in for a pellet.
© Lance Gooberman, M.D., J.D. 2-06
