Who this is for
- Opioid dependence, whether it began with prescription pain pills after an injury or surgery, or with heroin or fentanyl.
- Alcohol dependence, where drinking has become daily, stopping brings on shakes or sweats, and cutting down on your own has not held.
- Fear of withdrawal. For a lot of people the thing standing between them and stopping is the memory of how bad withdrawal felt last time. Medication changes that.
- Staying sober. Some patients have already stopped and want medical support to keep from going back, including monthly Vivitrol.
Office-based care is for people who are medically stable. If you are in acute withdrawal with seizures, hallucinations, severe confusion or unstable vital signs, go to the emergency room; that level of withdrawal needs hospital supervision, and we can take over your care once you are stable.
What office-based care means
You keep living at home and going to work. Treatment happens in a private medical office, the same clinic where our pain and neurology patients are seen, so nobody in the waiting room knows why you are there. There is no group setting and no overnight stay. Visits are with Dr. Rudy Escarria, MD, who trained in internal medicine and geriatrics at New York Medical College and spent years at the VA in West Palm Beach before leading detox and medication-assisted treatment here.
The first visit
Plan on about an hour. The visit includes:
- A medical and substance use history: what you use, how much, how often, and what has happened when you tried to stop.
- A physical exam, vital signs and a withdrawal assessment.
- Blood work (liver and kidney function, blood count, and hepatitis and HIV screening with your consent) and a urine drug screen.
- A written treatment agreement covering how medication is prescribed, how monitoring works and what we expect from each other.
- A naloxone (Narcan) kit or prescription for anyone with opioid dependence.
- An induction plan. For buprenorphine, that means instructions on when to take the first dose so it starts in mild withdrawal, either at home with phone support or in the office. For alcohol, it means a withdrawal plan matched to your risk level.
The rhythm of treatment
Early on you are seen often, because that is when doses need adjusting. The usual schedule is weekly for the first month, every two weeks in month two, and monthly from month three once you are stable. Each visit includes a check-in on cravings, sleep and mood, a urine screen at intervals, a review of the state prescription database, and a prescription for the next period. Counseling runs alongside.
Medication-assisted treatment with buprenorphine
Suboxone, Zubsolv and Brixadi all contain buprenorphine, which eases withdrawal and craving without producing a high. It is the backbone of opioid treatment here. Read about medication-assisted treatment.
Vivitrol
A monthly injection of extended-release naltrexone that blocks opioids and reduces alcohol craving. No daily pill and not a controlled substance, but you must be opioid-free for 7 to 14 days before the first dose. Read about Vivitrol.
Alcohol treatment
Assessment of withdrawal risk, medication to ease withdrawal when it is safe to manage in the office, and naltrexone or Vivitrol to reduce craving in the months that follow. Read about alcohol treatment.
Counseling
Medication works better with counseling than without it. We coordinate individual counseling in the clinic, with partner counselors and by telehealth. Read about counseling.
Does insurance cover it? Visits are covered by Medicare, Aetna, Blue Cross Blue Shield and Cigna as office visits, the same as any specialist appointment. Medication coverage varies by plan. Generic buprenorphine-naloxone is usually covered without prior authorization. Brand-name products and Brixadi often need prior authorization, and Vivitrol always does. Our front desk checks your pharmacy benefit before the first visit and submits any authorization needed. Self-pay is available. Read more about insurance and self-pay.
Confidentiality
Your substance use treatment records are protected by federal confidentiality rules (42 CFR Part 2) in addition to HIPAA. We do not release them to your employer, your family or anyone else without your written consent, except in the narrow situations the law requires, such as a medical emergency.
Do I have to stop using before the first visit?
No. For buprenorphine, you actually need to be in early withdrawal when you take the first dose, and we tell you exactly how to time it after the assessment. For Vivitrol, a 7 to 14 day opioid-free period is required before the first injection, and we plan that with you.
Will anyone find out I am being treated?
Not from us. Your records are protected by 42 CFR Part 2 and HIPAA, and you are seen in a general medical clinic alongside pain and neurology patients.
Is this the same as going away to a program?
No. This is office-based, outpatient care led by a physician. You live at home, keep working and come in for scheduled visits. It is not the right setting for someone in severe withdrawal, who needs hospital supervision first.
Which clinic offers detox and addiction medicine?
Both. Dr. Escarria sees patients at Davie for Broward County and at Boynton Beach for Palm Beach County. The front desk will tell you which days he is at each clinic when you call.
Does Medicare cover treatment?
Yes. Office visits are covered under Medicare Part B, and buprenorphine and oral naltrexone are covered under most Part D plans. Vivitrol is covered but requires prior authorization, which we submit for you.