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Choosing Change


The Choosing Change clinic provides effective treatment for people who want to stop using opioids such as heroin, prescription painkillers like oxycodone, and similar drugs.

Choosing Change patients use a medicine, buprenorphine (Suboxone) that reduces craving and withdrawal symptoms.

Patients also receive group therapy and support from a medical team that includes doctors, registered nurses, mental health counselors and community health workers.


Buprenorphine
Recovery Support
How to Join
Schedule
Providers
Patient Advisory Committee
Frequently Asked Questions
Resources

  • Buprenorphine

    Buprenorphine, also called Suboxone, is the prescription medicine most often prescribed as part of Choosing Change.

    Even though it is an opiate, like heroin or oxycodone, buprenorphine does not make the user feel high. Most people who take it say it makes them feel "normal."

    Buprenorphine helps patients reduce or stop their use of other opiates because it reduces their craving for those drugs.

    It also decreases withdrawal symptoms. That is important, because patients should stop using other opiates when they begin treatment with buprenorphine.

    The amount of time a patient uses buprenorphine depends on their need.


  • Recovery Support

    Choosing Change supports patients through regular group medical visits at clinics in all parts of Contra Costa County.

    Patients also meet one on one with medical providers, mental health counselors and nurses for support, counseling and connections to other recovery services.

    This program respects the privacy of its patients and does not share their personal information, as required by federal law.


  • How to Join

    Choosing Change is an option for patients who have been diagnosed with Opiate Use Disorder (OUD) and want to stop using.

    Call the Behavioral Health Access Line at 1-800-846-1652 or talk to your doctor to see if you qualify.

    Choosing change is available to patients who have Medi-Cal, Contra Costa Health Plan, or Medicare that includes a Part D plan.

    If you have different insurance, talk to your health provider about your treatment options.


  • Schedule

    Appointments and group therapy are regularly available at:

    • Antioch Health Center
    • Concord Health Center
    • George & Cynthia Miller Wellness Center (Martinez)
    • Pittsburg Health Center
    • West County Health Center (San Pablo)

    Enrolled patients can check our schedule to find convenient meeting times and locations. Note that groups are scheduled appointments and walk-ins may not be accommodated.


  • Providers

    Choosing Change utilizes a harm reduction approach and uses buprenorphine/naloxone (Suboxone) as the primary medication.

    Choosing Change staff are available to answer questions from providers about treatment, eligibility, referrals and other aspects of the program.

    Providers in the Contra Costa Health Services system of care can in-basket the Choosing Change Pool on ccLink.

    To refer a patient to Choosing Change, call the Behavioral Health Access Line at 1-800-846-1652 or place a referral through ccLink.

    Choosing Change is offered through Contra Costa Public Health in collaboration with Contra Costa Behavioral Health Services and Contra Costa Regional Medical Center & Health Centers.


  • Patient Advisory Committee

    Enrolled patients can help us improve the Choosing Change program through our Patient Advisory Committee.

    This group of volunteers meets every other month with program staff to talk about how to improve the patient experience.

    If you are an enrolled Choosing Change patient and would like to learn more about the committee, please let the Choosing Change staff know at group or contact Program Manager Phoebe Oliveira at Phoebe.Oliveira@cchealth.org.


  • Frequently Asked Questions

    Is buprenorphine treatment just trading one addiction for another?

    No. With successful buprenorphine treatment, the compulsive behavior, the loss of control of drug use, the constant cravings, and all other hallmarks of addiction vanish. When all signs and symptoms of the disease of addiction vanish, we call that remission, not switching addictions.

    Why is counseling an important tool in the treatment process?

    Addiction is a learned behavior that physically changes the brain as well. Medication alone can reduce cravings and withdrawal, but recovering from an addictive disorder requires a reconditioning of the brain.

    Through counseling and other behavioral modification, it is possible to undo some of the changes that occurred while addicted. Therapy will recondition the brain closer to pre-addiction status. This will better prepare the patient for a time when they may no longer require medication.

    It is important to find a counselor with a modern, evidence-based philosophy of addiction treatment, who is skilled in treating patients who employ medications in their treatment.

    What life changes can I expect from therapy?

    Attention to eliminating things in life that cause stress or depression will help minimize the chance of relapse. Disassociating with friends who are in active addiction can be difficult but very necessary. An experienced counselor/therapist will be able to teach other techniques that will further help undo some of the brain changes and conditioned learning that occurred while becoming and once addicted.

    Counseling/therapy helps the patient rebuild relationships, repair finances, get a job, assume family responsibilities, decrease stress, anxiety and depression, and helps the patient make other meaningful changes in their lives that will allow them to achieve and maintain addiction remission.

    Can someone switch from methadone to buprenorphine?

    It is best to SLOWLY reduce your therapeutic dose of methadone to 30 mg a day or less for at least a week, before discontinuing it completely for at least 36 hours before starting buprenorphine. You MUST be in mild to moderate withdrawal before you take your first dose of buprenorphine. If you are doing well in methadone treatment it may not be advisable to change treatments at all unless you and your doctor determine it is in your best interest.

    What if I need pain medication for surgery, or acute pain?

    You will still be able to be treated for pain with elective dental or surgical procedures. Your doctors should speak with each other about the plan. Choosing Change will provide a letter to your doctor with the recommended plan for continuing buprenorphine maintenance

    Does buprenorphine show up in an employer drug screening?

    Buprenorphine isn't commonly included on standard drug screen panels. Buprenorphine will NOT cause a positive result on tests for other opiates.

    How do I know if I'm taking the right dose?

    Choosing Change nurses will call you to follow up and monitor your progress. It's important to let your healthcare provider know about any withdrawal symptoms or cravings you experience, so we can work together to determine whether you may benefit from a change in your dose or from additional counseling services.

    What happens if someone takes buprenorphine at the same time as another opioid?

    It depends on which was taken first. If someone who is taking buprenorphine as prescribed takes another opioid, then, at the right dose, the buprenorphine may help block the effect of the other opioid.

    If someone who is actively using other opioids takes buprenorphine, it may cause sudden and severe withdrawal.

    What if I've relapsed?

    Get in touch with your healthcare provider right away. Your counselor may also be able to help. Relapse does not have to mean treatment failure. The chronic nature of opioid dependence means that relapsing to drug use may occur. The most important thing is to seek treatment.

    When should I stop treatment?

    The length of treatment can vary from patient to patient. The decision to discontinue therapy should be made as part of a comprehensive treatment plan. If you and your treatment team agree that the time is right, your healthcare provider has the option either to lower your dose over time, or to abruptly discontinue buprenorphine under medical supervision.

    What happens if I take buprenorphine too early?

    If someone takes buprenorphine before the other opioids have left their body, they may experience a rapid onset of uncomfortable withdrawal symptoms. To avoid this "precipitated withdrawal," carefully follow the instructions discussed with you during your intake and visit with Choosing Change staff.

    How long does Suboxone stay in your system?

    Suboxone is comprised of buprenorphine and naloxone. Buprenorphine takes more than 24 hours to leave the body once it is used consistently. Naloxone stays in the system for 30 to 60 minutes.

    What is Narcan or naloxone?

    Narcan, also known as naloxone, is a lifesaving medication used to treat emergency opioid overdoses. It is administered when a patient is showing signs of opioid overdose. Narcan reverses the toxic effects of opioids. It is not harmful to give to someone if you suspect they are overdosing, but it later turns out they were not. If this medication is administered, call 911 immediately, as Narcan only remains in a person's system for 30 to 60 minutes.

    This medication comes in two forms, injectable and nasal spray. It can be obtained at a pharmacy from a pharmacist, needle exchanges and as a prescription from your health care provider.


  • Resources