What to expect with my first Dr visit?

[addicted123]

I went to see the Dr, but he wanted to put me on a med for alcoholism,called Naltrexone, and the Ativan. I asked about making an appointment to come back in after a couple weeks, and he said no appointment is necessary, "just show up when you're almost done with hour meds" it seems to unstructured and I need structure and stability right now with this. And putting me on a med for alcoholism doesn't seem right either. I found another Dr in my area that is specific for opioid addiction, and has something called a 'Suboxone Program' and actual scheduled weekly visits. I have not made my initial appointment yet, as it is $250 my first visit, then $150 every week after. I called my grandmother in NY who worked with addicts for 22 years, and she is willing to pay for my visits, as long as I pay her back once I start working. What should I expect with my first visit? All I know so far is that I need to be in withdrawal. Do I have to have opioids in my urine/blood tests when they test me though?

[NeverAgain127]

If you've made your choice then follow through with it.

I have no experience with Suboxone, but I do with addiction to opiates... you said you are craving 'structure.  Have you considered attending some N/A meetings?  

Feeling overwhelmed and like a boat without a rudder is very common.  In N/A you will absolutely be offered structure, and a plan to live your life.   You do NOT have to be drug-free to join N/A.  All that is required is the desire to stop, and you have that.

It is just a suggestion, but it might just be the ticket. You are so very young, and this disease of addiction is so incredibly powerful.  No one can do the detox but you...but the recovery process is SO MUCH easier if you do it with other addicts.    It is just people, sitting in a room, trying to help each other.  Just food for thought.

[pillguy]

Using SUBOXONE to detox, rather than replacement therapy addresses many of the concerns I expressed about SUBOXONE.  I've read many success stories using SUBOXONE in this manner.  I think if your combine this with some sort of therapy / aftercare you should be able to change your life.  Good luck with your journey.

[pillguy]

Here's a link to a site that defines the COWS SCALE for induction into SUBOXONE treatment.  I hope this helps

http://www.naabt.org/documents/cows_induction_flow_sheet.pdf

[addicted123]

I believe that I need meds to stop because I've tried everything else. Literally.

[addicted123]

But, my original question, what should I expect from my first visit? Do I have to have opioids in my system?

[addicted123]

I firmly believe**

[addicted123]

Thank you!! I did some research on both drugs. And infirmly believe Suboxone is the choice. I am aware that it is very hard to get off of and tapering or weaning off is the best plan. I am not an alcoholic, and with the naltrexone I have read that it throws you into horrible withdrawals and does not curb the craving for opioids. Where Suboxone does curb them. I would like to participate in the Suboxone program for 3 weeks, and have help with a tapering plan from someone if the Dr will not accept me only doing the Suboxone for 3 weeks. I am addicted to OxyContin, Percocet, Vicodin, Tramadol. I was taking anywhere between 10-16 pills daily of whatever I could get my hands on. Sometimes I would go 4-7 days without anything sometimes even two weeks if I did not have the money, but the cravings overcome me every single time. I'm 26. I've been an addict since I was 19. And I want this cycle broken. I can't live my life like this any longer and base every day around whether or not I have enough pills, or when I can get them next.

[pillguy]

Here's some info about Naltrexone from the Mayo Clinic website

"Naltrexone is used to help narcotic dependents who have stopped taking narcotics to stay drug-free. It is also used to help alcoholics stay alcohol-free. The medicine is not a cure for addiction. It is used as part of an overall program that may include counseling, attending support group meetings, and other treatment recommended by your doctor.

Naltrexone is not a narcotic. It works by blocking the effects of narcotics, especially the "high'' feeling that makes you want to use them. It also may block the "high'' feeling that may make you want to use alcohol. It will not produce any narcotic-like effects or cause mental or physical dependence. It will not prevent you from becoming impaired while drinking alcohol.

Naltrexone will cause withdrawal symptoms in people who are physically dependent on narcotics. Naltrexone treatment is started after you are no longer dependent on narcotics. The length of time this takes may depend on which narcotic you took, the amount you took, and how long you took it. Before you start taking this medicine, be sure to tell your doctor if you think you are still having withdrawal symptoms."

Naltrexone is kind of like an anti-narcotic.  It blocks the effects of opiates.  It does not treat or reduce the effects of opiate withdrawal.   The Doc prescribing this med should have explained how this med fits into an overall treatment program.  Have you already gone through withdrawals?  This is a prerequisite for taking this med.  The Ativan is a med in the benzodiazepine class.  It can help with withdrawals but is highly addictive and tolerance builds very quickly.

I'm not a doc and therefore can't tell you whether this is an appropriate treatment.  I can tell you the lack of information from this doc is very concerning.

Now, on to Suboxone.  Suboxone is a very powerful opiate replacement therapy.  This drug will essentially reduce or eliminate the effects of withdrawal from opiate dependence.  That's the good part.  The bad part is that the med is extremely powerful.  No one here could tell you whether it's a reasonable choice without knowing what opiates you've been using and how much.  Suboxone has a history of being one of the most difficult meds to stop using.  Difficult like a bad heroin addiction for some.  You must taper very slowly to have a decent shot at getting off this drug.  My taper off Suboxone took 6 months.  At $150 per week that would have cost me approx $3600 dollars in doctor's visits and that doesn't include the cost of the medication.  It's not uncommon for people to be on this drug for several years.  We would all like to think our doctor has our best interest at heart, but I've heard countless stories of patients feeling like the doctor was more interested in those weekly appointment payments than helping them get off the med.  my own doctor was no help.  He even told me, "I'm the pen", meaning it was my job to figure out how to get off the med, his job was to write the script.  As you probably understand now, using Suboxone is a complicated choice.  You need to know what you are getting into.

Now, after all that, this is not hopeless.  There are countless people posting here that have successfully tackled they opiate addiction.  Could you give us some more info about your drug of choice and your usage?  That would help us provide some specific recommendations for you.

[jifmoc]

What is your backround? Are you addicted to opiates and alcohol? For how long?

Why do you think you needs "meds" to stay clean?