Letter From the Doctor 2016


January 2016 UPDATE

Dr. Gresser is currently accepting a limited number of new patients.  If you require immediate care, please contact our Medical Assistant, Moe Elgamal at 443-900-9995 or visit our Preferred Providers page for all medical and emergency calls.

Consider this day as the first day of your new life when you don’t have to beg, borrow, steal or sell your most prized possessions to just NOT feel “sick”.  For every $100/ day that you spent on drugs, you could have saved $36,500/year. And if you are a smoker of one pack of cigarettes at $7 a pack, cessation of smoking would save you $2500 per year. You were in financial difficulty no matter how you look at it. Here is a simple solution even without a job. Make us a part of your “family”. When you are able to get a job, it will satisfy a part of your wellness plan. If you want and are able to go to school, that to becomes a part of the plan. Just don’t quit and you will get out of the “funk’ you are in. Stay with us.

After you have been evaluated, you will begin buprenorphine(commonly known as suboxone) or methadone and within an hour you will be experiencing the beginning of the relief that you have expected. But it will take time over the next several weeks or months to reach a maximum effect. It will not be like turning off a light bulb.

first day

The slow clickety-clack up the roller coaster of life will get you to the top. Now you are at the bottom of the roller coaster. There is no way to go except up. You will have the best support team in the world to hold both of your hands until you are able to stand on your own. Unfortunately, you have damaged your brain opioid receptors from the continued use of opioids and this produces a chronic disease that requires medical therapy on a regular basis, possibly for life. It is like taking insulin for diabetes or blood pressure pills for hypertension. You take medications daily and continuously to control the underlying disease. With the chronic disease of addiction, you take methadone or suboxone and once you have reached the optimal dose that controls your cravings and withdrawal symptoms, you feel normal again. Do you remember when that was?

Suboxone is effective for milder addiction but there is a maximum dose that is safely permitted. When it is not effective at these higher doses, then methadone is the next step which works when taken as directed.

Assuming the brain opioid receptors are permanently damaged from longstanding drug abuse, the mind and body have a difficult time to adjust without the stabilizing effect of methadone or buprenorphine (Suboxone) which takes time. Because we do not generally do brain biopsies on live people, the large body of scientific evidence supports the theory that the methadone maintenance treatment program is the best treatment even though it can be lifelong. Additional studies have shown a greater than 80% relapse rate after tapering methadone, even slowly. However, successful tapering without cravings or withdrawal symptoms requires a 1-2 mg per week taper, once the body and mind is stabilized. This can take up to one to two years. Tapering before stabilization or too rapid tapering is always a failure. Both you and the doctor can determine when you are ready to attempt this under medical supervision. Most patients choose not to taper and are satisfied when feeling well and normal again. There are no major side effects even long term. When you have concerns or questions feel free to talk to me to alleviate any fears.

The object of methadone maintenance or suboxone therapy is to stop the cravings and withdrawal symptoms. Methadone therapy requires a slower increase than suboxone because of the long acting nature of methadone. Withdrawal symptoms will decrease gradually one day at a time. It is not like turning off a light bulb. So, be patient and allow your mind and body to adjust over a 3-4 day time period for every dose increase. If you start to get sleepy the dose should not be increased and may have to be decreased. Your body will tell you and in turn tell us so we can make that adjustment daily.

Those with chronic pain that is not from withdrawal will be improved with methadone but not always with suboxone which is not indicated for chronic pain management. If it does it is an added blessing. Chronic pain issues are best left to specialists in this area where it requires a comprehensive approach.

I recommend the following over the counter medications if you are not allergic, sensitive or have had previous side effects from them. They will help you get over the troubling withdrawal symptoms that are associated with opiate withdrawal until the methadone or suboxone reaches its most effective level for YOU. I have found that two extra strength Tylenol(acetaminophen) plus two ibuprofen (like Advil or Motrin) can be used for muscle or joint aches or pains if you do not have underlying kidney, liver or stomach disease. Note that methadone is a strong pain killer and combinations are additive. For nausea, Dramamine once a day is a good choice but may make you sleepy. If you use it, do not drive until you are alert. For diarrhea, Imodium every four hours can be used.

Each day you will get better. Counseling and support, which is a major part of your wellness strategy, is always here to assist in your non-medical issues. This should be coordinated with a primary care provider for routine medical matters and/or a psychiatrist who can play a significant role in your recovery. I am more than willing to assist in your comprehensive care and work with whomever you choose to become a part of your team to provide the best possible plan for your well-being. It is essential on your road to recovery.

Author: Staff

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