Your provider at Ophelia Medical Group, P.C. ("Ophelia"), will be prescribing you buprenorphine (Suboxone, Zubsolv, Bunavail or generic formulations) to treat opioid use disorder (OUD). The goal of this treatment is to reduce or prevent symptoms of withdrawal from opioids, improve how you feel, and to decrease cravings that might prompt returning to opioid use. By signing this form you are agreeing that your treatment goal/s include reducing or eliminating opioid use.
Buprenorphine is an FDA approved medication (typically prescribed as the combination product buprenorphine/naloxone except for pregnant women) for treatment of people with OUD by qualified medical providers. Buprenorphine can be used for detoxification or for maintenance therapy. Maintenance therapy can continue as long as medically necessary and is the gold standard treatment.
Buprenorphine itself is an opioid, but it is not as strong an opiate as heroin or morphine. Buprenorphine treatment will result in physical dependence however withdrawal is generally less intense than with heroin or methadone. If buprenorphine is suddenly discontinued, some patients have no withdrawal symptoms; others have symptoms such as insomnia, anxiety, muscle aches, stomach cramps, or diarrhea lasting several days. To minimize the possibility of opioid withdrawal, buprenorphine should be discontinued gradually, usually over several weeks or months under close supervision with your Ophelia team.
The form of buprenorphine you might be taking (Suboxone, Zubsolv) is a combination of buprenorphine with a short-acting opioid blocker (naloxone). If the Suboxone tablet were dissolved and injected it may cause withdrawal.
Buprenorphine tablets or film must be held under the tongue until they dissolve completely. It is suggested to not eat or drink before taking buprenorphine. Buprenorphine is absorbed over 5-20 minutes into the tissue under the tongue. Some people prefer to only use one film or tablet at a time to enhance absorption. Buprenorphine will not be absorbed from the stomach if it is swallowed and there will be no effects from it. Do NOT swallow buprenorphine like a pill.
Treatment with buprenorphine has certain risks associated with it, including, but not limited to: sleepiness or drowsiness, constipation, sweating, nausea, itching, vomiting, dizziness, allergic reaction, slowing of breathing rate, slowing of reflexes, or reaction time. While taking buprenorphine you will probably develop a tolerance to analgesic effects of other opioid medications resulting in their lower effectiveness in controlling pain. It is also possible that buprenorphine will not provide complete relief of craving and withdrawal. Sometimes this indicates the need for a dose increase.
If you are physically dependent on opioids, you should be in mild to moderate withdrawal when you take the first dose of buprenorphine. If you are not in withdrawal, buprenorphine can cause (precipitate) severe opioid withdrawal which may require hospitalization. Some patients find that it takes several days before they can tolerate their first dose of buprenorphine without precipitating withdrawal. This may be especially true among users who have been exposed to fentanyl and other synthetic opioids. After you become stabilized on buprenorphine, it is expected that other opioids will have less effect. Attempts to override buprenorphine by taking higher and higher doses of opioids could result in overdose or death. You should not take any other medication without discussing it with your Ophelia team first. Combining buprenorphine with alcohol or some other medications may also be hazardous. The combination of buprenorphine with medication such as benzodiazepines (Valium, Xanax, Ativan) may increase the risk of overdose.
Some hospitals that have specialized drug abuse treatment units can provide detoxification and residential treatment for drug abuse and may use naltrexone injections (Vivitrol) to help prevent relapse. Naltrexone is a medication that blocks the effects of opioids and reduces craving but has no opioid effects of its own. Other forms of opioid maintenance therapy include methadone maintenance. You should discuss risks and benefits of all treatment options with your Ophelia provider.
To schedule an appointment, you should contact your clinician directly using the contact information provided during your first visit, or contact Ophelia at (215) 585-2144 or firstname.lastname@example.org. In case of an emergency, call 911, or go to the nearest emergency room.
I have read this form or have had it read to me. I have had a chance to have all of my questions regarding this treatment answered to my satisfaction. By agreeing to this Consent for Treatment voluntarily, I give my consent for the treatment of opioid use disorder with buprenorphine.