Detox and Addiction care Medical House Calls

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By Dr. Raymond Zakhari

While it may seem obvious in order to stop an addiction one has to stop using the addictive substance.  Quitting a narcotics addiction, in particular, can be very uncomfortable, and the discomfort during the initial detoxification process often leads people to abandon their efforts.  A medically supervised detox may alleviate some of the suffering associated with narcotics detox.  There are several medications on the market that can be used to minimize your symptoms of withdrawal as you go through this process. 

For the longest time methadone has been the primary prescription medication of choice when switching from a narcotics or illicit substance addiction.  Methadone came with a burden of having to go to a specific location each day over the course of many years.  In this respect, the individual’s entire life began to revolve around addiction treatment.  For many years now a medication called buprenorphine has been on the market as a way to maintain sobriety and facilitate detox and withdrawal from narcotics. Buprenorphine comes in a variety of formulations including in combination with naloxone. When buprenorphine is combined with naloxone it is sold under the brand name Suboxone. 

When you have identified a treatment provider and therapist he will discuss the timing of beginning Suboxone treatment.  In order to reduce the effects of withdrawal, Suboxone must be used with support.  It is best to wait 18-24 hours after using a short-acting narcotic before beginning Suboxone.  If you’re on a long-acting narcotic its best to wait 48-72 hours before beginning Suboxone. 

When the time comes to begin using Suboxone film you should be in a state of mild to moderate withdrawal.  You should begin by having a full glass of water to make sure your mouth is sufficiently moistened. Then placed the film under your tongue or in the between your cheeks and teeth and let it slowly dissolve. This film should not be chewed, torn, swallowed, injected, or taken in any other way other than slowly dissolving in the mouth.  You should not eat or drink anything until the film is completely dissolved. Typically you will take a film every 2 hours until you are stable. 

While using Suboxone maintenance and detox it is important to begin to engage yourself in other life activities so that you can set yourself up for success. If you are well motivated to do the right thing there is a very good chance you can successfully overcome your narcotic addiction with the proper help and support.  During your use of Suboxone, it is important to avoid all other medications unless specifically advised by your healthcare provider who is managing your narcotics withdrawal.  Once you have reached a steady state of Suboxone medication usually after 90 days to 6 months you may consider a very slow taper (2mg/ month).  It is not uncommon for some people to just remain in the steady state and not taper.

If you withdraw from narcotics or Suboxone too quickly you will notice increasing signs and symptoms of a narcotic withdrawal which can include:  Insomnia, stomach cramps, diarrhea, hot and cold flashes, restless leg syndrome, nightmares, depression, aggression, fear, and anxiety.  There are other supportive medications that can be prescribed to reduce the symptoms and improve your comfort.  Withdrawal symptoms may come and go for as long as 5 or 6 days before they go away for good. 

Suboxone therapy can be done in a doctor’s office, the medication-assisted treatment center, or in the privacy of your own home should you require discretion.  Many people have successfully kicked their narcotics addiction with the use of Suboxone and supportive therapy.


Dr. Raymond Zakhari is a triple board certified (Adult- Adolescent, Family Practice, Psychiatric Mental Health) Nurse Practitioner (NP). He provides Concierge Medical House Call services in Manhattan and outer boroughs.

General #MedicalHouseCalls #PsychiatricHouseCalls (Therapy & Medication Management) #SkilledNursing House Calls Dr. Raymond Zakhari, NP does not take any insurance as he is out of network; provides concierge-style medical and psychiatric House call services. (If you have out of network benefits you may be reimbursed, check your plan for details).