Transitions is a clinic for opioid substance use disorders and low cost opiate replacement therapy,using buprenorphine.
Our philosophy:
“Opioid dependence/addiction is a brain disorder, stupid.”
The scientific research is clear: Opioid dependence is not merely a moral failing or character defect. It is a complex brain disorder, resulting from a complex set of interactions among: 1) genetic factors, 2) life experiences, 3) social and cultural influences 4) other disorders such as bipolar, depression, and personality disorders and, 5) personal needs and desires. Prolonged abstinence from all opioids is an extraordinarily difficult thing for an opioid-dependent or –addicted person to achieve. People who think otherwise are either ill-informed or unwilling to believe the scientific evidence. Opioid dependence defies simple explanations and simple solutions. Opioid use should not be a criminal offense. Both the medical (buprenorphine) and the psycho-social (counseling) models of treatment for opioid dependence have been shown to be effective, and the combination of the two is the best treatment.
We believe that the current emphasis on punishment (jail or prison) for use of opioids is misguided and probably makes the problem worse rather than better.
“Time out, detox, or destination: all three are legitimate reasons for taking buprenorphine.”
We recognize that some opioid-dependent people just want a break from the chaos and destructiveness of their opioid drug use, some want a long-term solution to their dependence that does not necessarily involve complete, permanent abstinence, and some want to permanently discontinue their use of opioids. In keeping with harm reduction philosophy, all of these are viable alternatives to every day problematic opioid use. We are interested in supporting people in their desire for any of these solutions. However, because each physician is allowed to carry only 100 patients on buprenorphine at a time we have difficulty treating a person for short periods of time. We emphasize maintenance and slow detox in our clinic. We train other physicians in buprenorphine treatment strategies.
We believe that buprenorphine treatment should be easy to get from a person’s primary care provider as part of routine medical care for opioid-dependent people. To this end we encourage doctors-in-training to visit us and learn about prescribing buprenorphine. We ask our patients to welcome these visitors – who knows, one of them may be your primary care provider in the future! Patients are, of course, free to ask that the visitors not be present during their monthly interview.
Pain and opioid dependence
People on buprenorphine get pain, too. Some people started the opioid in the first place to treat severe pain. Usually pain that occurs while taking buprenorphine can be controlled with acetaminophen (Tylenol) or ibuprofen (Motrin). If it can’t, we will advise you about going off buprenorphine and returning to it after the severe, acute pain is over (such as a surgery). For a person in chronic pain who is taking high doses of prescribed opioids buprenorphine can sometimes treat both the pain and the opioid dependence. Buprenorphine usually brings the pain intensity down about 2 points on the 10-point pain scale as opposed to no treatment, and keeps it there. Many people find that this is enough to control their pain, and they don’t have the wide swings in pain intensity that are common on shorter-acting opioids such as Norco and OxyContin. This is because, when taking shorter-acting opioids for prolonged periods much of the pain that a person experiences between doses is actually withdrawal pain. Patients do not experience frequent withdrawal pain if they are taking buprenorphine as prescribed.
Our model:
We combine medical (buprenorphine prescribing) and psychosocial interventions (counseling, motivational interviewing) to assist opioid-dependent people fulfill their desire of controlling their opioid use. This is a standard model for the treatment of opioid dependence and addiction. It has a 40-50% long-term success rate (as measured by >1 year of abstinence from pills or heroin) compared to about 10-20% after each round of standard “detox” or residential treatment.
“First, get rid of the craving, so you can think straight.”
We believe in eliminating opioid withdrawal and craving as a first step toward a person’s understanding of his or her relationship to opioids and to the day-to-day conduct of their lives. It is difficult to think clearly or make reasonable decisions when a person is trapped in the never-ending cycle of withdrawal and relief, finding the money for their drug, and obtaining the needed/desired opioid. It is an all-consuming cycle. To “detox” is almost unthinkable in this situation. For most opioid-dependent people “detox” has failed over and over again. A break from the cycle is accomplished using buprenorphine (sometimes referred to as “Suboxone” or “subs”, which is just one brand of buprenorphine). It controls withdrawal and craving for as long as a person takes it.
We provide induction services and a prescription for the buprenorphine on the first visit. Once withdrawal and craving are controlled the patient/client can consider his/her plans for the future.
Then, counselling and psychosocial support.
Once craving is controlled we use counseling and educational techniques that have been shown to be effective in assisting people to gain control over their opioid dependence/addiction. These techniques include motivational interviewing and psychosocial support strategies.
Then, get on with your life.
When craving and withdrawal are controlled you can get on with your life with minimal interference from us. Learn to think and plan your life again, free from the cycles of withdrawal and relief you are used to. We believe that the best motivation for remaining on buprenorphine or “detoxing” very slowly is returning to work and family, not spending a lot of time in group counseling sessions, though we recognize the value of counseling and urge our clients to make use of it. Both individual and group counseling (AA, NA, etc.) can help you stay abstinent from problematic drug use. Our goal is to assist our patients to return to work, to caring for their families, and to experiencing their minds and pursuing their aspirations again, free of the craving and altered consciousness that opioids inflict on them, to the extent to which each person is capable. We recognize that this also involves essentially giving up the pleasure they have derived from taking opioids in the past.
“Detoxing”
We believe that a very slow “detox”, over 6-12 months or longer, is likely to be more successful than rapid detox (a few weeks) because it allows slow adjustment of the brain and body to the decreasing amounts of opioid, and because it allows the opioid-dependent person additional time in which to change thinking and re-integrate himself or herself back into family, job, and society.
Long-term maintenance therapy
Most of our clients opt for long-term maintenance therapy (years) until such time as they feel secure enough to begin a very slow detox regimen. We support long-term maintenance as an approach to living with opioid dependence.
“We strive to provide the best, least expensive, buprenorphine induction, maintenance and detox services that we can, to opioid-dependent people in the Sacramento region who want to change the way they relate to opioids such as Norco, Vicodin, Oxys, heroin, and methadone, whether obtained legally or illegally.”
Our responsibilities to our clients/patients:
1) We offer respectful buprenorphine-based treatment for opioid dependence that includes the prescribing and monitoring of buprenorphine, and counseling support for our clients. We will provide “induction services” (making the transition from your current opioid to buprenorphine) on your first visit to the clinic, if necessary.
2) We will refer patients for psychiatric or medical consultation as indicated. We will support slow “detox” regimens or long-term maintenance with buprenorphine according to patient desires.
3) We will assist our patients with obtaining prior authorization for their buprenorphine from their insurance company and provide other services when we can. This takes a lot of staff time, and is not always successful.
4) If they do not have insurance we will assist our patients in getting insurance, and, until they can get insurance, we will prescribe the least expensive form of buprenorphine, even though this is discouraged by government agencies. We do not believe that the benefits of buprenorphine therapy should be denied to people who don’t have insurance and cannot afford the more expensive buprenorphine products ($200 for generic, plain buprenorphine vs.$600-$900 a month for combination buprenorphine/naloxone). We believe it would be unethical medical practice to withhold buprenorphine based on ability to pay for it.
5) We must abide by rules set down by the U.S. Drug Enforcement Agency, even if we do not agree that they are necessary or appropriate in a particular client.
6) We must abide by HIPPA regulations regarding the privacy of your information and records.
7) Rarely, we find it necessary to ask a patient/client to leave the Clinic permanently because we cannot tolerate his or her behavior. We do this with reluctance and sadness and only as a last resort. We will prescribe a detox regimen and provide a list of other buprenorphine doctors in the area and handle emergencies for one month after dismissal from the Clinic.
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