We Talk About Advice on How to Dose.
Protocol for Dosing
If you miss a dose or doses, depending on the circumstances and number of days involved, you will require to be RESTARTED on your medications. You will need to see the doctor for an assessment and your dispensing script will likely need to be rewritten to get you BACK onto your usual dose SAFELY. There are complex rules the doctor follows to restart you dosing on the programme.
Generally, patients are allowed to miss dosing for 1-2 doses, before being required to see a doctor for rescripting, to allow the pharmacist continue to dispense.
If you wait too long and miss too many doses, it is more likely that the doctor needs to do a restart at a low dose and build up the dose again in full. The sooner you come back, the more likely that the doctor can restart you on the same dose.
The main issue is that patients may lose tolerance while off their medications. So to be safe, medications need to be started low and increased as quickly as possible as can be done safely.
Patients who need to get earlier doses than scripted are asked to:
Do not dose on the day you wish to get your early dose.
We will give you // script you- a dose on the day. This means that we have a WITNESSED dose rather than a take away dose on the earlier pick up day. The program demands more witnessed doses and supervision for safety reasons. We call this "Swap" dosing.
For Suboxone/ Subutex: HOW TO TAKE YOUR DOSE
Place in the mouth.
Dissolve in the mouth.
Spread around the mouth as much as possible. If the medication contacts a larger surface area, more will be absorbed. Most doctors and pharmacists tell you to put it under your tongue simply because this is the quickest and easiest instruction top get the message across.
Hold in the mouth as long as possible: 15-30 minutes is usual.
When you swallow the medication it will be absorbed from the intestine and then taken through the liver. The liver burns (metabolises_ the medication faster than it can be absorbed. There is essentially no absorption of the medicine into the system if swallowed. Absorbing the medicine from the mouth lining bypasses the liver and allows the medicine to get into the main (systemic) circulation, where it actually lasts a long time from a single dose.
Methadone
This medicine is closely supervised with less take-aways than Subutex and Suboxone. Taking doses NOT AS INSTRUCTED can be dangerous. Of the people who overdose, this medication is much more likely to be involved than buprenorphine in Subutex / Suboxone.
The rules for the ORT program are designed to allow safety under as many circumstances as possible - but - to try to give patients as normal a life as possible.
Suboxone
Do not inject this medication. If you have a high Opioid tolerance, it can trigger an instant and perhaps even dangerous withdrawal. This is because this medicine contains and opioid antagonist. Taken the usual way (in the mouth ~~ under the tongue, as we say), little of this second medication enters the bloodstream. It also helps reduce symptoms such as the severe constipation that plagues people on the program, using methadone or Subutex.
Buvidal and Sublocade
These are new injectable long acting buprenorphine medications just becoming available. You need to be very stable on pills or films before we do any injections. we can do this over a week. They can be injected weekly or monthly.
See Buvidal Patient Booklet.pdf
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Contact Details
Dr Andrew Pluta
UMC North Lakes Doctors
26 Torres Crescent, North Lakes
P: 3482 3123
umcnorthlakes@unitedmedical.net.au
The Science of Addiction Medicine www.DDDocs.com.au
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