• How to Avoid the Methadone Trap

    How to Avoid the Methadone Trap

    A patient in my office for addiction treatment once stated:
    When I started at the Methadone clinic; another patient told me, ‘Say good bye to the next 5 years of your life’. That was 5 years ago!”.

    This quote provides insight into a problem with addiction treatment centers. Many people are aware that Methadone treatment involves daily visits to clinics. I have had many patients complain about clinics not responding to their desire to taper and or having their dosage rapidly increased. The longer a patient stays “in treatment” the more profitable it is for the clinic.

    Note the following quote from the American Society of Addiction Medicine:

    ‘…Equally as important, recommended dosages of methadone and Buprenorphine when used to treat addiction involving opioids differ from recommended dosages for pain treatment. The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use notes that, while a relatively low dose of methadone (e.g., <30 mg per day) can lessen acute withdrawal, it is often not effective in suppressing craving and blocking the effects of other opioids.viii Most patients fare better if their initial 30–40 mg per day dose is gradually raised to a maintenance level of 60–120 mg per day. Indeed, multiple randomized trials have found that patients have better outcomes, including retention in treatment, with higher doses (80–100 mg per day) than lower doses.

    Regarding Buprenorphine, the ASAM Guideline recommends that Buprenorphine doses after induction and titration should be, on average, at least 8 mg per day. However, if patients are continuing to use opioids, consideration should be given to increasing the dose by 4–8 mg. The US Food and Drug Administration (FDA) approves dosing to a limit of 24 mg per day. There is some evidence regarding the relative efficacy of higher doses.

    Converting these recommended dosages to morphine milligram equivalents (MME) (also known as morphine equivalent units (MEU)) reveals that they exceed the CDC recommendations regarding MME for chronic pain. The recommended 60-120 mg of methadone per day becomes 600 –1,440 MMEix; the recommended range of 8-16mg Buprenorphine becomes 80-160 MME.”

    MME or Milligram Morphine Equivalent is a conversion factor used to convert between opiate medications. Above it is noted that the MME for Methadone is 5 to 10 times greater for Methadone to obtain the same desired effect! Using the lowest dose of medication has the less potential for harm to a patient in the long run. During my experience in treating opiate addiction several questions have come up:

    1. 1) Why would a patient choose to make daily visits to a Methadone clinic when they can have weekly or monthly visit for Buprenorphine?

    2. 2) Buprenorphine is recommended to be started when a patient is at 30-60 MME of an opiate. So, doesn’t the rapid induction and increasing of Methadone dosage to a high MME (above 60 MME as described above) prevent or deter conversion to Buprenorphine?

    3. 3) Does the goal of keeping a patient “in treatment” lead to a conflict of interest?

    4. 4) How does one determine if their clinic is keeping them on a high dose of Methadone to prevent the patient from leaving the clinic?

    5. 5) Does a counselor at a Methadone clinic serve a patient or maintain the patient “in treatment” for the clinics monetary gain?

    6. 6) Why don’t Methadone clinics report to the prescription monitoring data base? Doesn’t this create risk of patients diverting the opiates while they are in treatment?

The above questions are difficult to answer with certainty. However, one can certainly see that there is a potential for a conflict of interest between the patient’s health and the clinics profits.

In my Marietta addiction center, we offer Buprenoprhine (Suboxone, Subutex and Sublocade) as a Methadone alternative. These medications offer the flexibility of weekly to monthly dosing. We refer our patients out to outside counselors to avoid conflict of interest.The Buprenoprhine dosage used has a lower MME than patients commonly using Methadone therapy.

Many new patients presenting to our Suboxone treatment center ask about how long they will need to be in treatment. My standard answer:
It will be more than six months but I am not going to extend in out for 6 years. Having said that, there are people who need to be on therapy for extended periods. The goal is to use the least amount of medication necessary as all medicines have the potential to damage internal organs with long term use.

In addition to addiction treatment with Suboxone, our office also is able to use the NADA acupuncture protocol for addiction. As a licensed pain management clinic we treat pain primarily with acupuncture and physiotherapy. Our goal is to have patients “pain free without pillsTM. This includes having patient free from the pain of addiction. With our pain management patients, we ALWAYS use the smallest dose of opiates possible to treat pain. We introduce all of our patients to acupuncture with one FREE treatment. Why the FREE acupuncture treatment? To demonstrate to patients that there are other means to treat pain other than pills. Remember our goal: “Pain Free Without PillsTM.

Whether you need addition treatment or treatment for chronic pain with responsible opiate prescribing we are here for you. Call us today or make an appointment on line: Click Here

  • Low THC and CBD OIL: What’s all the hype about??

    Low THC And CBD OIL

    From Opioid Treatment Centers to Pain Management Doctors there are many patients asking questions about Low THC oil and CBD oil. The first question is: What’s the difference between CBD oil and Low THC oil? CBD and THC are both Cannabinoids. THC is the more psychoactive (high producing) compound. There are many Cannabinoids each having different attributes.



    Here is a short list summarized from a list available on www.georgiacannabis.org :

    THC- Psychoactive and pain relieving effects
    CBD- Has many medical benefits attributed to it and nonpyschoactive
    CBN-Non psychoactive with a sedative effect
    THCA– Anti-inflammatory and neuroprotective effects
    THCV– Believed to be an appetite suppressant helpful with metabolic disorders including diabetes.
    CBG-Shows promise in treating glaucoma, inflammatory bowel disease and MRSA infections

    There are a large number of Cannaboids each having different properties. There are a number of people who have had benefits of using Low THC oil. The state of Georgia has recognized this and allows for patients with certain conditions to be certified by a registered physician and be issued  a “Low THC oil card”. This card allows people to possess Low THC oil for certain medical conditions without fear of criminal prosecution or what I call a “don’t go to jail card”. It should be emphasized that this card is only valid for Low THC Oil and NOT marijuana in a leaf form obtained illegally or from other states.

    Conditions that patients may be registered for include:

    -Cancer
    -ALS (Amyotrophic Lateral Sclerosis)
    -Seizure Disorder
    -Crohn’s disease
    -Mitochondrial disease
    -Parkinson’s  disease
    -Sickle Cell Disease
    -Tourette’s Syndrome
    -Autism
    -EpidermolysisBullosa
    -Alzheimer’s
    -AIDS
    -Peripheral Neuropathy
    -Patients in hospice care
    -Post Traumatic Stress Disorder (PTSD)
    -Intractable Pain

    In a recent Special NEWSWEEK Edition title: The Ultimate CBD Handbook. There were a number of quotes from people who have used CBD oil to treat a number of conditions.

    “Some people report results at 5mg and others need more like 250-1000mg. There are studies where the dosage was in the 6,000mg range with no ill effects, so we still have much to learn about how much is necessary to use. It has a long half-life, so repeated daily dosing will have a cumulative benefit.”

    – Katie Stearn

    “It was incredibly effective at dealing with everything I previously used Ibuprofen, coffee,Adderall or alcohol to deal with..”

    – Brad Bogus

    “ After about a month of ingesting a 10 mg dose of CBD tincture under my tongue twice a day, I gradually felt a sense of calm and relaxation. From there, I slowly weaned down off of my anxiety prescriptions.”

    – Randi Sether

    Laws are changing and vary from state to state. In Georgia, there are state residency requirements and stipulations about the relationship between the physicians and patient after a card is issued. For more information visit: http://www.dph.georgia.gov.

    CBD oil registration is just another addition to our modalities to get you” pain free without pills” Please feel free to  call our office at 678-247-2115 for more information. Don’t forget our first acupuncture and injury visit is FREE and we provide addiction treatment and recovery services in addition to treating pain and injuries.

  • Why Suboxone and not Methadone?

    We prescribe Buprenorphine (Suboxone) for addiction treatment. Unlike Methadone, Suboxone doesn’t require the daily dosing of medication at a Suboxone Treatment Doctor office. Consequently, patients have more time for work family and other normal life activities.

    Methadone also has a higher overdose rate and side effect profile. We feel Suboxone (Buprenorphine) is a better choice for patients needing treatment for opiate addiction. Quite simply, why spend the time visiting a clinic daily for Methadone when you can visit our office on a weekly or monthly basis? If you need help getting started with treatment or you want to switch from Methadone to a Buprenorphine product,

    Our team at Acupuncture and Injury (Dr. Granger) has numerous practice areas. With more than 15 years of experience at our side, we have the specialized skills, knowledge, and resources to diagnose your issues and help you start on the road to recovery. Our Suboxone Treatment Center is conveniently located in Marietta, offers competitive and affordable pricing, and has relationships with other medical and legal providers that we can refer you to, if necessary. Call our office today. 678-247-2115

  • Getting Started with Addiction Treatment

    Addiction Treatment And Recovery Services

    In Marietta GA and the Greater Atlanta area, substance abuse is a major problem. Many people struggling with opioid treatment centers aren’t sure how to go about getting help. If this describes you, you should know that there is drug addiction help available to you, but you need to take the first step to contact a clinic that offers this type of treatment. Addiction Treatment And Recovery Services

    Patient Education

    Before your appointment at the clinic, you should become informed about the nature of opiate addiction treatment. One common treatment method is the use of a class of medications known as opioid partial agonists . These are opioid medications that latch onto the same receptors in the brain as do opioid drugs. However, opioid partial agonists do not produce a feeling of euphoria. Instead, they work by blocking the unpleasant effects of drug withdrawal.

    Initial Therapy

    If this will be your first time receiving this type of addiction treatment and recovery services, then you should plan for a lengthy first appointment. The doctor will likely ask you to take a urine test to check for the presence of drugs. Then, you’ll be advised of the basics of the treatment program and how to use the medication. Your doctor will determine an appropriate dosage for you, but this dosage may need to be adjusted later.

    Dosage Administration

    This type of medication is available in different forms. One of the most common is a sublingual film, which is placed under the tongue and allowed to fully dissolve. Drink some water before placing the film under your tongue. When doing so, hold the film between your fingers by its outside edges and place the film close to the base of the tongue. Do not chew or swallow the film; allow it to fully dissolve.

    Ongoing Maintenance

    It’s likely that you’ll return to the clinic for follow-up appointments on a weekly basis until you’re in an established routine. After that, your follow-up appointments may become less frequent. Your urine may be randomly tested from time to time. If you experience any problems with the medication, such as side effects or decreased effectiveness, you should inform your doctor. This type of addiction treatment allows patients to work through other addiction therapies without suffering the ill effects of withdrawal.