What are the treatments?
Currently, the best evidence supports treatment with an opioid agonist like methadone or buprenorphine (also called suboxone, sublocade (a once a month injection) or probuphine (a set of implants that slow release medication over 6 months), along with counselling. For people who do not do well with either of these options, slow release oral morphine treatment is also available.
Injectable opioid agonist therapy is only available in specialized centres, such as Toronto or Ottawa.
Detoxification can also be done, but has a high risk of relapse, and people are at risk of overdose after detox, because they may use the same amount of opioid they did before they detoxed, but your body loses tolerance quickly to opiates (within a couple of days).
Opioid Agonist Therapy
In this type of treatment, the patient is prescribed a substitution medication such as methadone or buprenorphine (also called suboxone, sublocade or probuphine), so that they can reduce the harm of opiate use to their bodies and lives. This usually means that they get to stop having to buy illegal opiates, which can help them get their life back, whether that is through returning to work or school, or just by being part of their family again.
Some people are concerned that this treatment means they are trading "one addiction for another". Although all opiates make you physically dependent on them, having a steady dose of opiate in your body instead of the rapid ups and downs of using short acting opiates helps keep a person level. Also, because you no longer need to look for opiates, or try to find the money for them, or hide what you are doing, or try to cover up recovering from their effects, you really can go back to leading a completely normal life. Really, it is similar to having diabetes. Some people with diabetes need to be on medication. This is not an issue of willpower - they need the medicine to continue to live their lives.
How do I know what treatment is best for me?
This depends on a lot of things - including how each medication makes you feel, as well as how you pay for your medication, and what other health issues you have.
Buprenorphine is available as a daily sublingual (under the tongue) tablet, a once a month injection (for people on 8 mg of buprenorphine tablets or more) and as a 6 month implant called probuphine (for people on less than 8 mg of buprenorphine tablets). Dr. Holowaty is trained in placing the Probuphine implants and providing the abdominal injections. Feedback on both have been very positive.
What if I also have pain?
Both methadone and buprenorphine are very good pain medications. Some people worry about the naloxone component in Suboxone (the trade name for buprenorphine/naloxone in Canada). Naloxone is NOT absorbed to a significant degree by mouth. It was added to prevent people from injecting it. If you inject naloxone, it produces a rapid withdrawal effect. But you do not need to worry about that if you are taking the medication as prescribed, under your tongue.
How do I get started?
Please call us anytime or drop in on Mondays or Thursdays to set up an intake visit. We are often able to offer same day appointments (which can be by phone, video or in person). To minimize the amount of time you spend in the waiting room, we use secure messaging portals that allow you to fill in a lot of information before you even arrive.
If you are not in the area, but a different part of Ontario, please go to the Drug and Alcohol Helpline (1-800-565-8603) to connect with programs and services in your area.