Medically Supervised Withdrawal with Medication Assisted Treatment

What is Medically Supervised Withdrawal with Medication Assisted Treatment?

As opposed to Accelerated Opiate Detoxification, Medically Supervised Withdrawal is a longer form of treatment typically using a medication that is in the same class as the drug being abused is given until withdrawal symptoms are alleviated. The medication is then given in doses that are gradually tapered down. This allows for a more humane form of detox.

Buprenorphine/Nalxone (Suboxone, Bunavail, etc) is an excellent medication for the outpatient Medically Supervised detoxification from narcotic painkillers such as Oxycodone and Percocet. It is considered to be very safe, with a low risk of overdose. Bup/Nal medications are also unique in that in order to start the medication, the patient has to be somewhere between early to moderate withdrawal. If the medication is started too early, it will cause precipitated withdrawal, which is more severe than regular withdrawal.

DR LOCKETZ INTERVIEWED BY KSTP ANCHOR KEVIN DORAN ABOUT MAT WITH SUBOXONE

GOALS FOR Medically Supervised Withdrawal with Medication Assisted Treatment (MAT)

  • Prevent or decrease the chance of medical complications of withdrawal.
  • Provide as much respect, comfort, and anonymity as possible for the addicted patient.
  • Prepare the patient to do recovery work in order to maintain abstinence from illicit drugs.

WHAT DOES OUR PROGRAM CONSIST OF?

Buprenorphine is an FDA approved medication for special office based treatment of opiate and opioid addictions. Typically it is combined with Naloxone in formulations commercially available such as Suboxone or BunAvail. In order to use this medication a practitioner must obtain some additional certification from the DEA and what is called an XDEA license. So this medication can effectively treat a Heroin or Oxycodone addiction for example. It can treat all other prescription and non-prescription pain killers addictions as well.

Once established in our program maintenance can continue and the medication is taken at home every day in place of the opiate or opioid being abused. Rather than a daily dose at a clinic you will receive a prescription which can be e-prescribed monthly like any other medication. We first need to establish you with the clinic for a period of time and then we even offer TeleMedicine options to stable patients!

DR LOCKETZ INTERVIEWED BY KSTP ANCHOR KEVIN DORAN ABOUT MAT WITH SUBOXONE

To continue Buprenorphine is considered to be very safe, with a low risk of overdose. Buprenorphine is also unique in that in order to start the medication, the patient has to be somewhere between early to moderate withdrawal. If the medication is started too early, it will cause precipitated withdrawal, which is more severe than regular withdrawal. Dr. Locketz uses a number of medications to make patients more comfortable overnight before they start Buprenorphine the next day if needed. Clonidine is a blood pressure medication that treats symptoms such as sweats, chills, and shakes. He also uses the class of medications called benzodiazepines, such as Klonopin, Valium, and Ativan. These alleviate anxiety and insomnia, which are usually a big part of the withdrawal syndrome. Hyoscyamine is also a great medication prescription medication for abdominal cramping and diarrhea. Phenergan is another medication that tends to work very well for nausea and vomiting.

HOW MANY TIMES A MONTH DO THEY NEED TO FOLLOW UP WITH US IN CLINIC ?

Once a patient is induced on MAT and is stable we see them monthly. We require laboratory monitoring of compliance with our program for which we need a random urine sample from time to time.

Some patients choose to not go on Buprenorphine maintenance. Their goal is to do a medical detoxification off of the overused opioid or opiate and remain opioid or opiate free. A number of physicians believe that this second option is not advisable. They believe that all patients should go on Buprenorphine/Naloxone maintenance for an extended period of time until they are far clear from the situation that led to overuse/dependance/addiction.

Dr. Locketz does not agree that all patients require extended periods of maintenance. Instead, he chooses to customize the medication assisted treatment plan to each individual patient.

IS COUNSELING REQUIRED?

Psychotherapy using motivational interviewing and cognitive behavioral therapy (CBT) for substance abuse is common. Therapy is strongly encouraged but not required. There are home bibliotherapy workbooks. These have been shown to be very effective in the treatment of opioid, opiate, benzodiazepine, and alcohol addictions. Motivational interviewing is a non-confrontational style of addiction psychotherapy where the patient is guided to find their own internal motivation for change. CBT is based on social learning theory. which states that drug and alcohol use are learned behaviors. Because drug and alcohol use are learned behaviors, they can therefore be “unlearned”. CBT for alcohol and drug addictions is also based on the findings that inaccurate or biased thoughts and beliefs, coupled with poor coping skills, lead to drug and alcohol abuse. CBT teaches changes in thinking about, and reactions to, relapse provoking situations. It requires practice and time to effectively use the principles of CBT. In CBT, a lapse or relapse is not used as a punishment. Instead, they are used as a learning tool towards your ultimate goal of abstinence or moderate alcohol use.

Dr. Locketz also facilitates referral and entry into various forms of recovery treatment such as SMART Recovery® and Intensive Outpatient Treatment (IOP) at local addiction treatment centers. He offers non-12 step help with alcohol and drug addiction treatment. When inpatient drug and alcohol addiction treatment is warranted, Dr. Locketz will facilitate entry into an inpatient facility.

WHAT ARE THE DISTANCE REQUIREMENTS WHETHER OR NOT PEOPLE ARE ELIGIBLE FOR TELEMEDICINE?

Our goal is to help the patient through a recovery path. To that end most patients have internet access and can leverage Telemedicine in their recovery. We are expanding our services rapidly and now have better access in the Duluth, Rochester, St. Cloud, and Moorhead areas.

HOW LONG ARE THEY ON THE MAINTENANCE FOR SUBOXONE?

This will vary from patient to patient. We require a six month commitment for most patients.

PREVIOUS MEDICAL RECORDS REQUIRED?

We prefer to have the medical records the day of the first visit. We will await patiently their arrival after this visit if they are not available.