Archive for the ‘Miscellaneous’ Category
Opiate Outpatient Detox
Suboxone and Outpatient Detox
Suboxone is a medication used for the treatment of opiate dependence. Suboxone (buprenorphine/naloxone) is typically taken once a day and stops withdrawal and cravings. With the patient’s mind now clear of obsessive thinking about using, one can then focus on the recovery process which includes group therapy, individual therapy and 12 step meetings.
We now understand that the opiate receptor in the brain has been damaged by long term use of short acting opiates. This is why tolerance develops and withdrawal occurs if the drug is suddenly stopped. Suboxone actually allows the opiate receptor to heal while it is being taken. There is recent new evidence that indicates that the opiate receptor takes about 100 days to heal and that it will actually heal while the Suboxone is being used.
A common treatment model I use in my practice is to put the opiate addicted patient on a stable dose of Suboxone for about three (3) months, while they are engaging in a recovery process and developing a relapse prevention plan. After about 100 days on Suboxone, with the opiate receptor now healed, tapers off the Suboxone are typically tolerated very well. Typically the taper takes a few weeks. I like to follow Suboxone treatment with monthly injections of Vivitrol which would block the effect of any opiate if the patient were to have a slip or a relapse (see Vivitrol page).
Get opiate outpatient detox treatment answers at our Frequently Asked Questions.
- How Counseling & Medication Work Together
If your first thought is that you can go it alone, consider this: opioid cravings can occur months and even years after your last use.
Contact Dr. Seikel’s office to get treatment for you or your loved one.
View patient intake forms and arrive to your appointment prepared.
Medication Assisted Treatment
There are many pathways to addiction recovery. One of those pathways is Medication Assisted Recovery – the use of medication, as prescribed and overseen by a physician, to support recovery from a substance use disorder. We know that people who suffer from the disease of addiction need each other to recover. Some view the use of a medication to abstain from a drug as “just substituting one drug for another.” However, decades of research and treatment experience show that it is not.
What is Medication Assisted Recovery?
The phrase “Medication Assisted Recovery” is a practical, accurate, and non-stigmatizing way to describe a pathway to recovery made possible by physician-prescribed and monitored medication, along with other recovery supports, e.g., counseling and peer support. Although no medications cure dependence on drugs or alcohol, some do play a significant and lifesaving role in helping people begin and sustain recover.
Many treatment programs and primary care physicians use medications as an important tool in the treatment of addiction, for purposes such as:
- To detoxify a person or prevent withdrawal
- To reduce the frequency and intensity of cravings
- To block the experience of feeling “high” (intoxication)
- To provide a shield against impulsive use
- To treat or control symptoms of a medial or mental disorder, that if left untreated could lead to relapse
Co-occurring Disorders
Many people with substance use disorders also have problems such as depression, anxiety, or post-traumatic stress disorder. Treating co-occurring (substance use and mental health) disorders together increases the chances of long-term recovery. Mental health care often and appropriately includes the use of medications, such as antidepressants.
Alcohol Dependence
Excessive long-term use of alcohol can actually disrupt the balance of the brain’s chemistry. It is believed that this change is linked to alcohol dependence. Alcoholism is not based on poor morals or a character flaw, but on how alcohol interacts with certain physical and mental conditions, functions, and processes within the human body.
About Antabuse
Antabuse (disulfiram) is a medication that causes a bad reaction if people drink alcohol while taking it. Because people know the medication will make them very ill if they drink alcohol, it helps them not to drink.
The reaction is flushing, nausea, vomiting, and anxiety. Even small quantities of alcohol, such as from food sauces and cough medications, may induce some of these symptoms.
Used alone, without proper motivation and without supportive therapy, Antabuse is not a cure for alcoholism, and it is unlikely that it will have more than a brief effect on the drinking pattern of the chronic alcoholic unless the patient is receiving comprehensive care.
How it works
Antabuse is nontoxic, but it alters the metabolism of alcohol in the body by increasing the concentration of acetaldehyde. Acetaldehyde is the first break-down product of alcohol, as it is metabolized by the body. This increased concentration makes it impossible for one who is taking Antabuse to drink without experiencing severe discomfort.
About Campral
Campral (acamprosate calcium) is a medication that helps people stay alcohol-free in combination with counseling or support groups, once they have stopped drinking. Campral helps reduce the emotional discomfort and physical distress (e.g., sweating anxiety, sleep disturbances) associated with staying alcohol-free.
About Vivitrol and Revea
Naltrexone (ReVia or Vivitrol) is a medication that reduces the craving for alcohol, and also reduces the pleasurable effects of alcohol. This can help keep people who drink a small amount of alcohol from drinking more of it.
Programs also sometimes use naltrexone to treat heroin or other opioid dependence because it blocks the drug’s effect. It is important for people who use opiates to go through Detox first, so they are opiate free before starting to take naltrexone.
Opioid Dependence
Typically, the changes that cause opioid dependence will not correct themselves right away, even though the opioid use has stopped. In fact, these changes can trigger cravings months and even years after a patient has stopped using opioids. Consequently, overcoming opioid dependence is not simply a matter of eliminating narcotic drugs from the body.
Buprenorphine (Suboxone) helps suppress withdrawal from prescription pain medications, heroin or similar opioids. It helps decrease cravings for and also reduces the effects of other opioids.
Suboxone- How it works
Buprenorphine is a narcotic that blocks other opioids from attaching to receptors in the brain. Buprenorphine is an opioid partial agonist. This means that, although buprenorphine is an opioid, and therefore can produce typical opioid agonist effects and side effects such as euphoria and respiratory depression, its maximum effects are less than those of full agonists like heroin and methadone. At low doses, buprenorphine produces enough agonist effect to enable opioid-dependent individuals to stop misusing opioids without experiencing withdrawal symptoms.
Read Dr. Seikel’s Medication Assisted Recovery and Medication Assisted Recovery for Alcohol
Get Medication Assisted Treatment answers at our Frequently Asked Questions.
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How Counseling & Medication Work Together
If your first thought is that you can go it alone, consider this: opioid cravings can occur months and even years after your last use.
Contact Dr. Seikel’s office to get treatment for you or your loved one.
View Medication assisted treatment intake forms and arrive to your appointment prepared.
Vivitrol Orlando
Vivitrol Treatment Orlando
Vivitrol is a medication used both for Alcohol Dependence and Opiate Dependence. Its’ use for Opiate Dependence was just recently approved by the FDA in October, 2010.
Vivitrol is a once a month injection of a drug call naltrexone. Naltrexone is an anti-craving drug which decreases the re-inforcing effect of using alcohol or drugs, or even thinking about using alcohol or drugs. A “thought of using” turns into a full blown craving because thinking about drinking or using feels good to our primitive brain, called the limbic system. Vivitrol blocks this re-inforcing effect, thus stopping a “thought” from turning into a “craving”. This can help the patient’s mind be able to focus on recovery, rather than fighting thoughts of using.
Read Dr. Seikel’s Vivitrol PowerPoint Presentation
Get Vivitrol treatment answers at our Frequently Asked Questions.
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How Counseling & Medication Work Together
If your first thought is that you can go it alone, consider this: opioid cravings can occur months and even years after your last use.
Contact Dr. Seikel’s office to get treatment for you or your loved one.
View New Patients Intake Forms and arrive to your appointment prepared.
To Pain Management Physicians,
I am providing comprehensive assessments for substance use disorders in patients who test positive for illicit substances while under care in a pain management practice. This assessment will be done in my downtown Orlando private practice.
My services include screening labs, laboratory confirmed urine and alcohol testing, hair testing when indicated, a comprehensive psychosocial assessment, and an in depth evaluation by me and my staff. I will contact the referring physician after the patient’s initial visit to discuss the assessment and follow up, if needed.
My goal is to not only identify patients that have substance use disorders, but to help them stabilize so that they can receive Pain Management services through their current pain physician, with concomitant substance use treatment. I do not provide pain management services, but am willing to work with the referring physician, so that these patients may be retained in their practice, if appropriate. Patients with substance use disorders have a disease which is responsive to treatment when given adequate structure and support. Patients with co-occurring chronic pain and substance use disorders deserve high level treatment for both.
I look forward to working with you to keep these patients in your practice, either because they do not have a substance use disorder, or because they are willing to comply with treatment recommendations that will allow their stabilization. All referrals require a doctor to doctor phone discussion prior to an appointment being made. Pain physicians may reach me on my cell phone at (407) 697-2911. Once approved, patients may then call the office to make an appointment at (407) 504-9536. Fees for the services vary, depending on the cost of hair testing.
Please feel free to call me to discuss these services further. I am very excited about collaborating in the care of your patients. As a physician with expertise in both addiction medicine and pain management, this is an area for which I feel passionately.
Sincerely,
Stacy Seikel, M.D.
Board Certified Addiction Medicine
Board Certified Anesthesiology
Suboxone Orlando
Suboxone and Outpatient Detox
Suboxone is a medication used for the treatment of opiate dependence. Suboxone (buprenorphine/naloxone) is typically taken once a day and stops withdrawal and cravings. With the patient’s mind now clear of obsessive thinking about using, one can then focus on the recovery process which includes group therapy, individual therapy and 12 step meetings.
We now understand that the opiate receptor in the brain has been damaged by long term use of short acting opiates. This is why tolerance develops and withdrawal occurs if the drug is suddenly stopped. Suboxone actually allows the opiate receptor to heal while it is being taken. There is recent new evidence that indicates that the opiate receptor takes about 100 days to heal and that it will actually heal while the Suboxone is being used.
A common treatment model I use in my practice is to put the opiate addicted patient on a stable dose of Suboxone for about three (3) months, while they are engaging in a recovery process and developing a relapse prevention plan. After about 100 days on Suboxone, with the opiate receptor now healed, tapers off the Suboxone are typically tolerated very well. Typically the taper takes a few weeks. I like to follow Suboxone treatment with monthly injections of Vivitrol which would block the effect of any opiate if the patient were to have a slip or a relapse (see Vivitrol page).
Dr Seikel’s PowerPoint on Suboxone.
Get Suboxone treatment answers at our Frequently Asked Questions.
- Buprenorphine Efficacy Shown In Office-Based Practices
Buprenorphine combined with naloxone (Suboxone) and buprenorphine alone (Subutex) are both safe and effective at reducing opiate use and craving when administered in an office-based setting. - Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth
The usual treatment for opioid-addicted youth is detoxification and counseling. Extended medication assisted therapy may be more helpful.
Contact Dr. Seikel’s office to get treatment for you or your loved one.
View Suboxone patient intake forms and arrive to your appointment prepared.