The medications
- Suboxone is buprenorphine combined with naloxone, taken as a film that dissolves under the tongue or inside the cheek once a day. The naloxone is there to discourage injecting the medication; taken as directed it has no effect.
- Zubsolv is the same combination in a small tablet that dissolves under the tongue. It is equivalent, and the choice often comes down to what your plan covers.
- Brixadi is buprenorphine given as an injection under the skin in the clinic, either weekly or monthly. There is nothing to take home and no daily decision to make, which suits people who struggle with daily dosing.
How buprenorphine works
Buprenorphine is a partial opioid agonist. It attaches to the same receptors as oxycodone, heroin or fentanyl, tightly enough to stop withdrawal and craving, but it activates them only partway. That gives it a ceiling effect: past a certain dose, taking more does not produce more effect, which is why it is far safer than full opioids and why patients on a stable dose feel normal rather than high. It also lasts a long time in the body, so one dose a day holds you steady. Because it binds so tightly, it blocks other opioids from working while you are on it.
Starting: the induction
Timing matters. Buprenorphine has to be started when you are already in mild to moderate withdrawal, typically 12 to 24 hours after short-acting opioids and longer after methadone or fentanyl. Taken too early, while other opioids are still on the receptors, it can push them off and cause precipitated withdrawal, a sudden and unpleasant worsening of symptoms. Dr. Escarria explains exactly when to take the first dose, based on what you have been using.
Most patients do the induction at home with written instructions and a number to call, taking the first dose when the withdrawal signs we describe appear. Others prefer to come in and take the first dose in the office with a medical assistant checking on them. Either way, the first few days are about finding the dose that takes withdrawal away without making you drowsy.
Stabilization and maintenance
Once your dose is settled, cravings fade and life gets predictable again. That is when the real work starts: counseling, repairing sleep, rebuilding routines. We recommend staying on buprenorphine for at least 12 months, and often longer, because the evidence is clear that people who stop early relapse at high rates. Coming off is done with a slow taper, when you feel ready and your life is stable, never on a deadline.
Does insurance cover it? Office visits are covered by Medicare, Aetna, Blue Cross Blue Shield and Cigna. Generic buprenorphine-naloxone films and tablets are on nearly every formulary and usually do not need prior authorization. Brand-name Suboxone and Zubsolv often do, and Brixadi always does, because it is given in the clinic and ordered through a specialty pharmacy. Our front desk checks your pharmacy benefit at the first visit and submits any authorization required. Self-pay is available. Read more about insurance and self-pay.
What to expect
- Before the first visit, we verify coverage and ask you to bring ID, your medication list and an honest account of what you use. Do not stop opioids ahead of time unless we ask you to.
- At the first visit: assessment, labs, urine screen, treatment agreement, naloxone kit and your induction instructions.
- Induction at home or in the office, with a check-in within the week.
- Follow-up weekly for the first month, every two weeks in month two, then monthly.
Monitoring and safety
Every buprenorphine patient is monitored; it is how we know the treatment is working and keep you safe. We check the Florida prescription database before every prescription, run urine drug screens at intervals, and may ask you to bring your films or tablets in for a count. Prescriptions are written to last until your next visit, not longer.
Two combinations are dangerous. Buprenorphine with benzodiazepines (Xanax, Klonopin, Valium) or with heavy alcohol use can slow breathing badly, and both need to be discussed with the doctor before you start. Tell us about every medication you take, including sleep aids. You are given naloxone (Narcan) to keep at home, and we show you and a family member how to use it.
Since 2023, any DEA-registered physician can prescribe buprenorphine; the special waiver that used to limit access no longer exists.
Does Suboxone get you high?
Not when it is taken as prescribed by someone who is opioid-dependent. At a stable dose, patients describe feeling normal: no withdrawal, no craving, no high.
How long will I be on it?
At least 12 months is our recommendation, and many people stay on it longer. When you and Dr. Escarria agree the time is right, the dose is tapered slowly over weeks to months.
I have chronic pain. Can I still be treated here?
Yes. Buprenorphine itself relieves pain, and because our pain physicians and Dr. Escarria work in the same practice, your pain care and your dependence care are coordinated rather than split between two offices.
Which clinic offers medication-assisted treatment?
Both. Dr. Escarria sees patients at Davie for Broward County and at Boynton Beach for Palm Beach County. Brixadi injections are given in the clinic at either location.
Do I need a referral?
Usually not. Original Medicare and PPO plans do not require one. Some HMO plans do, and the front desk checks your plan before your first visit and tells you what is needed.