How Guardian IOP Utilizes Suboxone Maintenance
Q & A With Dr. Tamer Wassef

For the past 15 years, Dr. Tamer Wassef, Guardian Intensive Outpatient’s chief psychiatrist in New Jersey, has been utilizing Suboxone Maintenance to help individuals overcome opioid addiction. Suboxone is an opioid partial agonist that binds to the brain’s opioid receptors to both curb intense cravings and block the brain’s receptors from receiving other opioid drugs. This means an individual is unable to get high from other opioids, such as heroin, fentanyl or prescription pain medications, while also experiencing far less cravings to use opioids. Suboxone also contains an active ingredient, naloxone, which inhibits an individual’s ability to experience an overdose. Even if an individual does relapse while on Suboxone, they will likely not die.

Suboxone has been shown to greatly improve an individual’s odds of staying sober in early recovery. According to Dr. Wassef and his knowledge of current academic research, the use of medication assisted treatment like Suboxone reduces an individual’s chance of relapse within their first year of sobriety from about 80 percent (with no medication), to about 15 percent with medication.

Suboxone Maintenance refers to the use of Suboxone for several months while an individual is learning how to be sober. The client is slowly weaned off Suboxone as they grow stronger in their recovery and learn the tools and coping mechanisms necessary for long-term sobriety.

Finding a Better Way to Utilize Suboxone

While Dr. Wasseff says he has always believed in the effectiveness of medication assisted treatment, about two years ago he had a change of heart in regards to how medication should be utilized. He came to believe that Suboxone should not be used as a standalone treatment option, rather it should only be used in conjunction with a professional addiction treatment program like the one offered at Guardian IOP.

Dr. Wasseff recently answered some questions about Suboxone maintenance, medication assisted treatment and his decision to only pair medication with a comprehensive program of recovery.

Q & A with Dr. Wassef

How long have you been utilizing medication assisted treatment and why do you believe it is effective?

I have been using medication assisted treatment for the past 15 years. Addiction — especially to heroin and opioids — is a chronic disease, so relapse is very common. If a patient goes to detox and then just does psychotherapy and AA meetings, the chance of relapse within one year is 80 percent. The number goes down to 15 percent if they are on medication assisted treatment. So there’s a huge difference.

This is evidence-based. It’s been proven by a lot of research and studies. So it is a no-brainer. Many of the addiction treatment organizations, most of the big hospitals and facilities, even ones that didn’t used to believe in medication in the past, came around after they started to see the numbers.

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Why did you decide to stop prescribing Suboxone as a standalone treatment option and require individuals to participate in a treatment program?

I used to prescribe Suboxone without a treatment program but I stopped. The main reason is because I felt that by giving patients the drug without having a program to teach them new skills was kind of like re-enforcing their drug use behavior. Eventually those patients started to do tricks and experiment and get high. So I stopped. I decided that medication has to be given only when the patient is in a program.

It’s like when you have a life jacket. You have the life jacket on while you learn how to swim. But, if you are not learning how to swim or learning any new skills, then once I remove the life jacket you will sink. That’s exactly the same with Suboxone. Suboxone is a tool but it needs to be used by experienced addiction professionals in a program. Suboxone buys us time. It buys us time so that we can teach our patients new skills and help them change their lifestyles.

One of the common criticisms of Suboxone Maintenance is that you are exchanging one addiction for another. You just change drugs. This is very accurate if you are not in a program and you are not continuously tapering the dose down, working on yourself and learning new coping skills.

Can you describe the difference between Suboxone and Vivitrol?

Suboxone is a partial agonist so this is for people who are really, really struggling with opioid cravings. It fills some of the opioid receptors but doesn’t get a person high. It’s kind of like you have a key and you put it in the door but it doesn’t turn all the way. Suboxone blocks the opioid receptors, but without getting someone high. It helps a lot with cravings. Clients are not as vulnerable when they are in a situation when they could use. It gives them a little more control. It’s like when you go to the supermarket and you’re really hungry, versus when you had a snack or a smoothie before. I explain it to my patients this way. It gives them an edge over the craving.

Vivitrol, which is a monthly shot we provide in our office, works very differently. This one basically blocks the receptors for a month. It is not an opioid. It helps with the cravings for sure, but not to the same degree. It’s an opioid blocker so even if the patient had a weak moment and they relapsed they don’t get any reward from the relapse. They get the feeling of guilt and upset, they feel like they lost their money, and they didn’t get anything in return. They know that their receptors are blocked for a month, so there is no way to go back. You can’t reverse it. So then it gives them one month of sobriety.

We give them a second shot, and it gives them a second month of sobriety. So once we add up to six or seven months, hopefully the habit is less intense and they are able to be successful. They’ve had a chance to learn all the recovery behaviors.

It’s extremely, extremely helpful. And one big thing as well — because these two medications occupy part of the opioid receptor, even if a person relapses, they don’t die. This is a huge deal because at the end our target is for people to stay alive.

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What has it been like for you personally to be on the front lines of the opioid epidemic?

I see the devastation the most when patients feel like they are stronger than the drug and they say I can do it without the medication assisted treatment and they leave the office. Then I hear the following month that some of them have overdosed and died. This is why we recommend staying on medication assisted treatment for one year.

Why do you recommend one year of treatment?

One year is enough time for anyone to ditch a habit. Even if you drink a cup of coffee or you smoke it takes one year to be able to learn a new skill and new habits. People can’t rush the process and only trust themselves. We say to those patients — you are powerless in front of drugs. Don’t think you have the skill or the knowledge to beat them. The brain takes time to rewire its neural pathways.

When I say one year I mean a client should be in treatment moving from one level to the next through the year. They might be on Suboxone for 3 or 4 months, then when they are feeling stronger, I move them to Vivitrol, which is more challenging because it doesn’t have any opioids in it. It’s only a blocker. Then, when they get stronger, they can stop the Vivitrol, but stay in intensive outpatient and come 3 or 4 times a week for therapy. So that’s what I mean by one year. People who say oh I will just go and attend AA meetings — AA meetings are amazing — but it is not professional treatment. It is a peer support recovery, so that is often not enough.

Can you describe the process at Guardian IOP?

We meet with all the patients in their first week. We put together a treatment plan based on their readiness. Some patients don’t need medication at all. They are feeling confident. They are not experiencing cravings. They are in a better place. Some patients are having a lot of intense cravings with intense urges to use. Or sometimes they even are using. In this case we start to discuss the medication options between Vivitrol and Suboxone based on the patient’s need and what they are expecting. We start the process, and again the patient could navigate from one medication to the other during the process. They attend therapy 3-4 times a week and participate in our recovery program. They learn a lot of new skills. And they are medication free before they leave the program.

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About Dr. Wassef

Dr. Tamer Wassef is Guardian IOP’s chief psychiatrist at both the New Brunswick and Hoboken locations in New Jersey. He has roughly two decades of experience in the mental health and addiction treatment fields and has been affiliated with multiple hospitals in the New Jersey area, including CarePoint Health Bayonne Medical Center and CarePoint Health Hoboken University Medical Center. He received his medical degree from Cairo University School of Medicine.

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To learn more about Suboxone Maintenance, medication assisted treatment or Guardian’s intensive outpatient program, contact us any time. Our Treatment Advisors are available 24/7 to answer your questions and help you craft a strategic plan for sobriety. Opioid addiction is a progressive and potentially fatal condition. There is no better time than now to seek treatment and get on the road to recovery.

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Anna-Barrett

Reviewed for accuracy by: our Executive Director:

Anna earned her Masters of Social Work at Barry University in Miami, FL in 2017 and completed her internship in co-occurring disorders. Anna has a Bachelors of Art in Religious Studies from Naropa University and is a certified yoga and meditation instructor. Anna has received specialized training in somatic counseling with an emphasis on body-centered psychotherapy.