Psychopharmacology

 It is first worth noting that medication alone is not meant to be the sole treatment for substance use disorders. Like any chronic disease, psychosocial support, along with lifestyle modifications play an essential role.

 

Vivitrol:

Vivitrol is a non-addicting, once per month injectable medication approved by the FDA for the treatment of both opiate use disorder and alcohol use disorder. This medication helps with cravings and allows your brain to restore the natural connection between the thinking/rational part of your brain (frontal lobe) and the feeling/emotional part of the brain (limbic system). What this means is that you become less preoccupied with obtaining and using these substances and more able to enjoy appropriate activities. This is because the areas in your brain that reinforce the high from opiates/alcohol (pleasure/reward pathway) and irritability and withdrawal from opiates/alcohol (anti-reward pathway) are able to recalibrate. Patients often wonder if this means that they will lose the ability to take pleasure in other activities; however, Vivitrol does not interfere with other pleasurable activities. Again, Vivitrol is non-habit forming and is not mind-altering.

Dr. Beatty has extensive experience with Vivitrol and the injection is given in his office.


Buprenorphine:

Buprenorphine is available as an oral or transmucosal (under the tongue) medication that is FDA approved for the treatment of opiate use disorders. However, it is a synthetic opioid which means that it was formulated to produce some of the effects of opiates without the euphoria. What this means is that you can become physiologically dependent on it. For that reason, SandpiperMD typically utilizes this form of buprenorphine for detoxification rather than maintenance.

Detox: Buprenorphine partially activates the opiate receptors in the central nervous system (CNS) and helps prevent the withdrawal syndrome when used as prescribed. This is achieved by providing a more gradual taper (weaning) of the medication rather than an abrupt withdrawal.

Maintenance: In cases where detoxification from opioids is not initially feasible, consideration of maintenance doses of buprenorphine may be appropriate.

*Please do not contact the office for maintenance treatment with this form of buprenorphine.*


Probuphine:

This is the latest development approved by the FDA for the treatment of opiate use disorder (opiate dependence). Probuphine is a subdermal (under the skin) implant that delivers a constant low dose of the medication buprenorphine over a six-month time span. The relatively short office procedure is done while completely awake and a locally acting anesthesia (lidocaine) is used as the numbing medication. The soft implant is placed just below the skin in the upper-inner arm and generally goes unnoticed (4 small flexible rods about the size of a matchstick)

Candidates for this medication must already be stable on 8mg or less of oral buprenorphine (Suboxone). There are several factors in determining stability that must be evaluated and discussed in consideration for this procedure. Typically new patients to the practice will be in treatment with another physician and be actively engaged within a psychosocial support network.

Dr. Beatty is one of the first and one of the only psychiatrists in Philadelphia who is trained and certified as both a prescriber and inserter of Probuphine. If the Probuphine procedure is right for you, it can be completed in the exam room at SandpiperMD.

For more info on about Probuphine and it's uses, click here.

For a picture of Probuphine, click here.

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