Escitalopram is associated with reductions in pain severity and pain interference in opioid dependent patients with depressive symptoms

Summary: Use of escitalopram 10mg daily compared to placebo resulted in decreased pain severity and interference in a sample of opioid-dependent patients with depressive symptoms.Abstract: Pain is common among opioid-dependent patients, yet pharmacologic strategies are limited. The aim of this study was to explore whether escitalopram, a selective serotonin reuptake inhibitor, was associated with reductions in pain. The study used longitudinal data from a randomized, controlled trial that evaluated the effects of escitalopram on treatment retention in patients with depressive symptoms who were initiating buprenorphine/naloxone for treatment of opioid dependence. Participants were randomized to receive escitalopram 10mg or placebo daily. Changes in pain severity, pain interference, and depr…

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Suboxone Detox Instead of Methadone Treatment ?

Suboxone Detox

Suboxone Detox

Suboxone Detox Instead of Methadone Detox

Detoxing from a narcotics involves slowly reducing the quantity of a drug to avoid severe or dangerous withdrawal. People usually seek detox for : Alcohol, benzodiazepines (Xanax, Valium, Klonopin), and opioid drugs.  Physical dependence is when an individual experiences withdrawal symptoms when abruptly discontinuing a medication. Symptoms may include tremors, insomnia, anxiety, high blood pressure, seizures, and even death. When a person has taken a narcotic for a long enough period, suddenly stopping the narcotic will lead to withdrawal because of their physical dependence.  Symptoms specific to opioid withdrawal: severe cravings, goosebumps, runny nose, diarrhea, stomach cramps, and sweating.  The reason for a slow narcotic detox is to help limit these problems and  avoid relapse.


Methadone, Suboxone (buprenorphine/Naloxone) are two medications used for detox from opioid drugs. They are used if the patient has not been able to taper the drug they are taking on their own or with the supervision of their physician. One is usually switched from the current medication(Oxycontin, Vicodin, or heroin) to Methadone or Suboxone (buprenorphine) and then the dose of the drug is slowly reduced.

Who should consider Suboxone detox or Methadone Treatment Detox?

  1. If you are unable to stop using heroin in any form.
  2. If you have become addicted to pain killer medications.
  3. If you are having dangerous side effects from opioid pain medications.
  4. If you are injecting or ‘shooting up” narcotics in any form.
  5. If you are snorting opioids in any form.

Previously, it was thought  that people addicted to heroin were the main people needing detoxification. However, more recently, we have seen a lot of younger and older patients seeking treatment because of being addicted to their  pain medications. Remember, Everyone will eventually get physically dependent to opiods if they are taken long enough and at a high enough dose. However, not everyone becomes an opioid addict. The people who are physically dependent but not involved in addictive behaviors (stealing, planning use, using despite health or social consequences)  do quiet well once they are detoxed from opioids.

Suboxone Detox: Another Choice than Methadone Treatment

Suboxone detox is that it can be accomplished from your doctor’s office. Previously, one had the choice of having a opioid detox in the hospital or going to a methadone treatment center for detox. A Suboxone detox is generally more convenient the patient than methadone and can take less time. Many people prefer going to their own physician rather than a methadone clinic. If the patient and doctor decide to do a slow detox with suboxone, there are less office visits (methadone treatment requires almost daily visits) . Suboxone (buprenorphine/naloxone) detox is considered a good for many, but not all opioid addicted individuals who don’t want to go to methadone treatment.

Opioid Detox: How Fast To Reduce

How fast the Methadone or the Suboxone is tapered depends on the what is best for each patient. The detox can be as short as a week to longer than half a year.

The more stable a patient is in their personal, work, and social life, the faster the reduction can be done. Has the patient relapsed many times in the past during or after detoxification? How long have they been using opioids? Are they on other drugs of abuse? Do they have another psychiatric illnesses like depression? How much legal problems dothey have? Theses things need to be weighed by the patient and discussed with their physician before undergoing methadone treatment detox or Suboxone detox.

Suboxone Detox: What Happens

The amount of narcotic withdrawal symptoms that people experience during Suboxone detox varies from patient to patient. Usually, the higher the dose one is starting from and the quicker one reduces the medications, the more withdrawal symptoms that will be experienced.

Despite using Suboxone or Methadone for detox, most people will experience opioid withdrawal symptoms. During opioid withdrawal, my experience is patients have the most problems with the sleeplessness, abdominal pain, diarrhea, and cravings. The National Pain Foundation has a nice summary regarding the symptoms and ways to help.

There are a number of drugs that can be used to help with the withdrawal symptoms that happen during detox. They can be very helpful in getting rest while going through detox in addition to reducing the diarrhea. Using methadone or Suboxone alone during the detox with a slow taper will help reduce the cravings and cramping.

Suboxone Detox: Where Can I find One?

Most psychiatric hospitals can provide a suboxone detox. This can be done in the hospital, or by attending a partial hospitalization program. In an outpatient setting, you need to find a doctor who will prescribe suboxone. There are several Suboxone (buprenorphine) physician directories available that will help you find a center or doctor in your area.

Suboxone Detox Summary:

Methadone and Suboxone are drugs that are used for detoxification in those people wanting to get off their opioid medications or illicit narcotic drug use. The opiod withdrawal symptoms can be reduced with a number of medications. Suboxone doctors and Methadone treatment clinics are available and can be found  treatment center directories online.

Find Methadone Treatment or a Doctor in Your Area That Can Start You on Suboxone:

If you need help and are looking for a physician who prescribes Suboxone, click Suboxone Doctor Directory. If you think you may need more intensive treatment such a methadone detox, other opioid detox, or getting started on buprenorphine inpatient, click here for our state opioid treatment center registry. Dr. Senyszyn is a Maui psychiatrist.

CADTH Rapid Response Report: Clinical evidence for Suboxone® (buprenorphine/naloxone) for short-term detoxification

Source: Canadian Agency for Drugs and Technologies in Health (CADTH)
Area: News
This Rapid Response Report from the Canadian Agency for Drugs and Technologies in Health (CADTH) discusses the available evidence regarding the comparative clinical efficacy and safety of short term (<4 weeks) use of Suboxone® (buprenorphine/naloxone) compared with other opioid detoxification agents such as buprenorphine alone, methadone, and clonidine, and placebo.
 
The results of their limited literature search are described and summarised in the report (see link below); the main conclusions drawn were as follows:
 
. The evidence comparing the clinical effectiveness of short term Suboxone® detoxification with other alternative medications in the treatment of patients with opioid…

CADTH Rapid Response Report: Clinical evidence for Suboxone® (buprenorphine/naloxone) for short-term detoxification

Source: Canadian Agency for Drugs and Technologies in Health (CADTH)
Area: News
This Rapid Response Report from the Canadian Agency for Drugs and Technologies in Health (CADTH) discusses the available evidence regarding the comparative clinical efficacy and safety of short term (<4 weeks) use of Suboxone® (buprenorphine/naloxone) compared with other opioid detoxification agents such as buprenorphine alone, methadone, and clonidine, and placebo.
 
The results of their limited literature search are described and summarised in the report (see link below); the main conclusions drawn were as follows:
 
. The evidence comparing the clinical effectiveness of short term Suboxone® detoxification with other alternative medications in the treatment of patients with opioid…

CADTH Rapid Response Report: Clinical evidence for Suboxone® (buprenorphine/naloxone) for short-term detoxification

Source: Canadian Agency for Drugs and Technologies in Health (CADTH)
Area: News
This Rapid Response Report from the Canadian Agency for Drugs and Technologies in Health (CADTH) discusses the available evidence regarding the comparative clinical efficacy and safety of short term (<4 weeks) use of Suboxone® (buprenorphine/naloxone) compared with other opioid detoxification agents such as buprenorphine alone, methadone, and clonidine, and placebo.
 
The results of their limited literature search are described and summarised in the report (see link below); the main conclusions drawn were as follows:
 
. The evidence comparing the clinical effectiveness of short term Suboxone® detoxification with other alternative medications in the treatment of patients with opioid…