Opioid Use Disorder Treatment
We were among the first private practices in the Bay Area to adopt buprenorphine treatment for opioid use disorder, and we remain experts in its use for both addiction recovery and chronic pain management.
Medication-Assisted Treatment
Board-Certified Addiction Medicine
Understanding Opioid Use Disorder
Opioid use disorder (OUD) can develop from prescription pain medication, heroin, or synthetic opioids like fentanyl. The common thread is the same: physical dependence combined with psychological compulsion that makes stopping extraordinarily difficult without medical support.
Medication-assisted treatment (MAT) is now the gold standard, not a crutch, but a lifesaving intervention that normalizes brain chemistry and allows patients to rebuild their lives. We've seen this work for hundreds of patients.
Whether you developed dependence from chronic pain treatment or recreational use, our approach is the same: expert medical care, psychotherapy, and structured accountability.
Brain Changes
Chronic opioid use alters reward pathways: this is physiology, not weakness.
Physical Dependence
Withdrawal symptoms make quitting difficult without medical support.
MAT Works
Medication treatment for opioid use disorder is associated with roughly half the risk of death, and with substantially better outcomes.
Recovery is Possible
With proper treatment, many patients maintain long-term recovery.
Source: Sordo et al., BMJ, 2017
Buprenorphine Treatment
Dr. Abramson was among the first physicians in the Bay Area to obtain the DEA X-waiver to prescribe buprenorphine when it became available in 2002. We have over two decades of experience with this medication.
Buprenorphine (available as Suboxone, Subutex, Sublocade, Brixadi, and generic formulations) is a partial opioid agonist that:
- Relieves withdrawal symptoms and cravings
- Blocks the effects of other opioids (preventing relapse from being "rewarding")
- Has a "ceiling effect" that makes overdose far less likely
- Can be prescribed in an outpatient setting (no methadone clinic required)
For Opioid Use Disorder
The primary indication. We typically begin with daily sublingual dosing and adjust based on response. Many patients eventually transition to extended-release injectable formulations (Sublocade) for convenience and to eliminate diversion concerns.
For Chronic Pain
Buprenorphine is also an effective analgesic with a better safety profile than full agonist opioids. For patients with chronic pain who have developed tolerance or dependence on other opioids, buprenorphine can provide pain control while stabilizing their opioid use.
Dual Diagnosis
Many patients have both chronic pain and opioid use disorder, a situation poorly served by traditional pain clinics or addiction programs alone. Our integrated approach addresses both simultaneously.
Other Options
Buprenorphine isn't the only option. We individualize treatment based on each patient's situation.
Methadone
Methadone is effective and well-evidenced, and some people with high opioid tolerance do better on it than on buprenorphine. It is available only through federally licensed opioid treatment programs, so we cannot provide it here. When it is the right choice, we say so and refer.
Sublocade & Brixadi
Long-acting injectable buprenorphine formulations that provide steady-state levels for weeks to a month: Sublocade is dosed monthly, Brixadi weekly or monthly. Ideal for stable patients who want to eliminate daily dosing or for those requiring verified medication compliance.
Adjunctive Medications
We use clonidine, gabapentin, and other medications to manage withdrawal symptoms, anxiety, and sleep disruption that often accompany early recovery.
How Treatment Works
1
Initial Assessment
Comprehensive evaluation of substance use history, medical conditions, psychiatric comorbidities, and social situation. We'll discuss goals and develop a treatment plan.
2
Induction
Starting buprenorphine has traditionally meant waiting until withdrawal begins. Newer approaches using transdermal or long-acting injectable formulations often allow us to start without putting you through that. We monitor closely through the first days either way, to keep you comfortable and get the dose right.
3
Stabilization
Once on a stable dose, we see you regularly to monitor progress, adjust medications, and integrate psychotherapy. Drug testing provides accountability and early warning of issues.
4
Maintenance & Transition
Long-term treatment with gradual extension of visit intervals. Some patients taper off medication; others continue indefinitely. We support whatever path works for you.
Fentanyl Changes Everything
The contamination of the drug supply with fentanyl means that opioid use is more dangerous than ever. What might have been manageable use of prescription pills or heroin now carries extreme overdose risk. If you or someone you care about is using opioids obtained outside of medical supervision, please reach out. We can help.
Your Treatment Team
Paul Abramson, MD
Medical Director & Founder
Dr. Abramson comes from a multi-generational lineage of physicians.
Kelly Yi, PhD
Psychotherapist
Dr. Kelly Yi completed his doctoral training from the clinical psychology program at Sofia University in Palo Alto, CA.
Orion Harris, LMFT
Psychotherapist
Orion Harris completed his masters degree in Counseling Psychology at California Institute of Integral Studies.
This Is Treatable
Recovery from opioid use disorder is possible. Contact us for a confidential consultation. What you tell us stays private, and nobody here will judge you for asking. We'll assess your situation and discuss treatment options.