Everyone responds to medication differently but most patients experience little to no side effects. Side effects also differ depending on the medication you are prescribed and your provider and/or pharmacist will discuss them with you.

Reported side effects for the main medications we prescribe can include the following.

Suboxone® or Subutex® (buprenorphine): Dizziness, nausea/vomiting, constipation, headache, fast heartbeat, increased sweating, and/or insomnia.

Vivitrol® (naltrexone): Nausea, headache, dizziness, anxiety, irritability, tiredness, and/or loss of appetite.

You do not have to be in withdrawal for your first appointment, but you do need to be off opioids for 24-36 hours before starting buprenorphine. If you take buprenorphine too soon after your last dose of opioids, intense withdrawal symptoms can be triggered (known as precipitated withdrawal). Your provider will speak with you about these time frames.  However, some typical time frames are as follows: 

• Suboxone®/buprenorphine can be started 24-36 hours after your last opioid use as long as that opioid is not methadone. Transitioning from methadone to buprenorphine requires a longer duration of time before starting buprenorphine.   
• Vivitrol® cannot be administered until you’ve been off all opioids for at least 7 to 14 days, depending on the opioid used.
• You do not need to be in alcohol withdrawal for Vivitrol® to be effective.
• If you cannot abstain from opioids for 24-36 hours, your provider will talk to you about our low dose and high dose initiation protocols.

Precipitated withdrawal is common when opioid users take a full dose of buprenorphine too soon after their last use of opioids. Buprenorphine binds tightly to the opioid receptors in the brain, kicking other opioids off. The sudden replacement of a highly potent "full agonist" opioid like fentanyl or heroin with a mild "partial agonist" opioid like buprenorphine leads to intense and severe withdrawal symptoms like vomiting, fever, muscle aches and diarrhea. For buprenorphine to be effective, the opioid receptors in the brain should be empty, which can take 24-36 hours. Ideal Option's low dose and high dose initiation protocols are designed to avoid precipitated withdrawal for patients who cannot abstain from opioids long enough to follow a conventional initiation dosing program. 

Yes, switching from methadone to buprenorphine (Suboxone) is similar to switching from other full agonist opioids like heroin or fentanyl. The transition is dependent on your current methadone dose and the length of time you've been using methadone. Ideal Option is very experienced with helping patients with this transition and will work with you to create a personalized dosing program. 

Brixadi is a brand name for a long-acting injectable form of buprenorphine used to treat opioid use disorder. Brixadi is given to those who have started treatment taking a sublingual form of buprenorphine like Suboxone. Brixadi injections are meant to control symptoms of withdrawal and minimize the risk of return-to-use of illicit or dangerous opioids like heroin or fentanyl. Brixadi is generally given weekly or monthly.

Vivitrol® is an antagonist or blocking medication. Antagonists create a barrier that blocks opioid molecules from attaching to opioid receptors. Antagonists attach to opioid receptors, but do not cause the release of dopamine. They are non-addictive and do not lead to physical dependence.

Suboxone® contains buprenorphine and naloxone. Buprenorphine attaches to the same receptors as other opioids but only partially activates those receptors. This eliminates withdrawals and cravings, which helps people feel normal. Naloxone is an antagonist / opioid blocking medication that causes withdrawals if someone tries to inject or snort the Suboxone®.

If or when you decide to taper off of medication, we will work with you to safely and slowly taper down your medication. Many patients need to stay on medication like Suboxone® indefinitely.

If you run out of medication when our clinic is open that day or the next day, you will be scheduled for a same or next day emergency visit, either in-person (preferred) or remotely using our virtual clinic. If you run out of medication when our clinics are not open that day or the next day, a request for a bridge prescription will be submitted to the prescribing provider. A nurse will contact you to inform you of the provider's decision as soon as possible.

Patients receive a refill for their prescription medication at each visit unless there is a safety issue or diversion (selling or giving away the medication). For the first couple of weeks, visits are scheduled every few days, then visits are weekly, bi-weekly, and eventually, once every 3-4 weeks. Changes to the frequency of visits may be made at any time by our providers depending on the patient's recovery.

For the majority of our patients who are Medicaid members, the medication is fully covered. For Medicare and commercially insured patients, the co-pay varies depending on the plan you are enrolled in. If you have non-standard Medicaid coverage, our insurance verification team will send you an explanation of your benefits including any out-of-pockets costs before your first appointment.

After your visit, our ePrescription team receives your prescription from the provider and prepares the prescription. As required by the Controlled Substances Act (CSA), the prescription is then sent back to the provider for signature before the prescription can be sent to your pharmacy to be filled. Barring any insurance or other issues beyond our control, prescriptions are typically available for pick up at your pharmacy within 4-8 hours of your appointment but in some cases may take up to 24 hours for processing. 

How long you stay on medication-assisted treatment is dependent on your unique situation and history of drug use. While some of our patients can taper off their medication and maintain a stable long-term recovery, others find they need to stay on medication indefinitely. Addiction is a chronic disease of the brain that is treatable, but unfortunately, not curable. Just as many people with diabetes will need insulin for the rest of their lives, many people with substance use disorder will need medication for the rest of their lives as well.

Buprenorphine binds to and partially activates opioid receptors. This partial activation means it is less likely to cause dangerous side effects and/or the euphoria that are often caused by opioids that fully activate opioid receptors. This means that buprenorphine is safer and less likely to cause euphoria than opioids that fully activate the receptors. However, buprenorphine does activate these receptors enough to remove withdrawals and cravings, which helps people feel normal. Methadone binds to and fully activates opioid receptors. This full activation means it is more dangerous and more likely to cause euphoria than buprenorphine. However, there are many patients who are still good candidates for methadone, such as extremely heavy opioid users. It is important to also understand that buprenorphine is typically a prescribed medication that is picked up at a pharmacy whereas methadone must be dispensed from a clinic if it is used for the treatment of opioid use disorder.