FREQUENTLY ASKED QUESTIONS

What insurances are accepted?

We accept all major insurances, including Medicaid and Medicare. Copays are due at the time of service. If you do not have insurance, please call our office to discuss available payment options.

Am I eligible for Medicaid if I have a job?

Yes. Opioid Use Disorder is a diagnosis for which patients require “health sustaining medication” This qualifies patients on MAT for Medicaid. If your income is above the Medicaid income limits, you must apply for “modified” Medicaid. It is known as MAWD online (Medicaid for Workers with Disabilities). You can apply by following the online instructions after searching for PA MAWD. There is a very small monthly premium for MAWD. Patients on MAWD enjoy the usual benefits of Medicaid.

What is Suboxone?

Suboxone is the brand name for the combination product of buprenorphine and naloxone, used in the treatment of Opioid Use Disorder. Suboxone is not used for Alcohol Abuse Disorder (Vivitrol injection may be used for both). Buprenorphine is the active ingredient in Suboxone, Zubsolv, and Sublocade. Buprenorphine acts as a “place holder” in the brain for the opioid requirement experienced by individuals who are physically dependent on opioids. While occupying opioid receptors in the brain, buprenorphine eliminates cravings and withdrawal symptoms, thereby decreasing or eliminating drug-seeking behavior. This is how Suboxone is instrumental in helping those suffering from Opioid Use Disorder to recover. The naloxone in Suboxone is not absorbed well orally and is present to help prevent diversion by injection.

What are the forms of Suboxone?

Suboxone, the combination product, is available as a sublingual film or sublingual tablet. The mono-product (buprenorphine only) is available as a subcutaneous abdominal injection. A second mono-product, Subutex, has been formerly used during pregnancy, but is not a recommended medication at Trilogy now that it has been established that Suboxone may be taken safely during pregnancy. Note: patients claiming an “allergy” to the naloxone in Suboxone will be referred for Sublocade treatment primarily. Individual cases will be provider discretion.

If I take Suboxone, am I just trading one addiction for another?

No! Addiction involves drug-seeking behavior and other dysfunctional behaviors that severely affect an individual’s health and safety, quality of life, and interpersonal relationships. Suboxone stops addiction. It does this by eliminating cravings and withdrawal symptoms. Suboxone does not cause euphoria or a “high” and is a relatively safe medication with minor side effects. Please ask your provider for details on exactly how Suboxone works.

 

How do I take Suboxone….can I just swallow it?

Suboxone is not absorbed well orally and therefore must be absorbed directly into the vein under your tongue. This is called SL, or “sublingual administration” which means “under the tongue”. If Suboxone film OR tablet is swallowed, it will not be absorbed into the bloodstream and therefore will not be effective. Proper administration is very important for Suboxone to relieve cravings and stop withdrawal symptoms. Your Trilogy provider will discuss this with you.

Can I get brand name Suboxone?

It is unlikely that your insurance will cover the brand medication without evidence of serious adverse effects, especially since several generic forms are now available. When patients dislike the films, often changing to the tablet form is helpful. Another option is injectable Sublocade.

What does it mean to get “dopesick”?

The term “dopesick” is street terminology for the phenomenon of precipitated withdrawal. Precipitated withdrawal occurs when a buprenorphine product such as Suboxone is taken after an individual has also taken another opioid, whether prescription or illicit. The buprenorphine in Suboxone will rapidly displace the other opioid; when this occurs, the individual will experience a very severe and sometimes life-threatening form of withdrawal. This is why it is important for our patients to have transparency regarding what drugs or medications that they have taken, and when, before Suboxone treatment is begun. This is also why your provider must see your toxicology screen results prior to initiating Suboxone.

What is Sublocade?

Sublocade is an injectable form of buprenorphine, the active ingredient in Suboxone. Sublocade offers patients the opportunity to receive a monthly, slow-release medication. It eliminates the need for daily self-dosing of Suboxone. Sublocade is injected into the subcutaneous tissue of the abdomen. It is covered by insurance.

What if I need a higher dose of Suboxone than I was given?

If you feel that your Suboxone dose is not right, it is important that you discuss this with your provider. There are many factors that can increase cravings or result in mild withdrawal symptoms. Factors such as inappropriate administration, incorrect dosing intervals, continued association with known triggers, and an increase in overall stress due to family or work issues may all contribute to a sense that the Suboxone is not working well. The standard dose of Suboxone is 16mg per day and there is no empiric evidence that higher doses are required or make a significant difference in the opioid-receptor occupation that the standard dose provides,

If I am currently taking Methadone can I change over to Suboxone?

Yes. Patients may convert to Suboxone after Methadone use. However, the Methadone clinic must reduce your daily dose to no higher than 30mg per day before this can be done safely. Your Trilogy provider cannot decrease the Methadone dose. Depending upon your Methadone dose, it may take several weeks for your dose to be decreased enough for you to be able to start Suboxone.

Is therapy required for me to receive MAT?

Therapy is well-documented as a helpful adjunct to MAT for recovery from Substance Use Disorder. At Trilogy, we highly recommend that our patients participate in either mental health therapy or drug-and-alcohol therapy. We hope to incorporate on-site therapy at our Trilogy offices in the future.

Can my ADHD be treated while I am taking Suboxone?

Yes. It is optimal to treat ADHD as part of a recovery program with Suboxone. However, if stimulant medication is going to be used it must be one of the long-acting preparations (e.g. Adderall XR instead of Adderall). You can not receive MAT at Trilogy if you are taking Adderall or Ritalin. Those patients presenting with prescriptions for these medications will be given time to have their medication changed to a long-acting stimulant.

Will Trilogy prescribe my other medications?

No. Trilogy providers will prescribe your MAT medication only. We can not assume the role of your PCP or psychiatrist. You must obtain other medications from these other providers.

Do I need Narcan and where can I get it?

Yes. Narcan, the “rescue medication” for opioid overdose, should be accessible to anyone participating in MAT for Opioid Use Disorder. There is an “open” prescription available at most pharmacies, through the state, for anyone requesting Narcan and for those receiving Suboxone prescriptions. Your Trilogy provider can also provide a Narcan script.

If I have Alcohol Abuse Disorder can I still get MAT for my Opioid Use Disorder with Suboxone?

Yes. However, if you struggle with Alcohol Use Disorder and currently consume excessive amounts of alcohol, it will be necessary for you to also participate in an alcohol recovery program including therapy. Consuming large amounts of alcohol while taking Suboxone poses a risk for respiratory depression and death, therefore we cannot provide Suboxone in these cases without active progress towards sobriety. Vivitrol injection, one of the MAT medications offered at Trilogy, is a recommended treatment for our OUD patients who also struggle with alcohol abuse. Ask your provider about how Vivitrol can help with alcohol abuse disorder.

How often will I have to come to clinic for my MAT?

New patients are seen every two weeks for at least two months to assure stability. Once a patient has shown good progress in their recovery, they may come to clinic on a monthly basis. Patients receiving Sublocade and Vivitrol injections attend monthly. Visit frequency is related to toxicology results. Occasionally, patients who are struggling with their sobriety will be asked to attend clinic weekly.

Can my Hepatitis C be treated at Trilogy?

Currently, Hepatitis C is not treated at Trilogy. If your screening bloodwork is positive, you will be referred to your PCP or a liver specialist for treatment.

What if I have surgery and am taking Suboxone?

If you have an upcoming surgery or dental procedure, your provider will discuss our recommendations on Suboxone use in the perioperative period. Trilogy providers do not provide pre-or-post surgery opioid medication.

Can I take Suboxone if I have dentures?

Yes. Many of our patients have dentures and can take their Suboxone films or tablets. Often, it is easier to take Suboxone if the dentures are removed but this is not necessarily required. Discuss any questions you may have with your Trilogy provider.