You have read about buprenorphine twice this week, both times late, both times alone. One thought gets there faster than the information does: saying this out loud will cost you something.
A job. Custody. The way your sister looks at you at Thanksgiving.
An appointment about buprenorphine for opioid use disorder is an ordinary outpatient visit in Fort Worth. Someone takes a history. You talk.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline).
SAMHSA National Helpline: 1-800-662-HELP (4357) – free, confidential, 24/7, in English and Spanish, for treatment referral and information.
If someone may be overdosing, call 911. Naloxone reverses opioid overdose and is available without a prescription in Texas.
Stopping alcohol or benzodiazepines suddenly can be dangerous. Talk with a clinician before you stop, and go to an emergency room if you develop shaking, confusion, or seizures.
What does “partial agonist” actually mean?
The FDA lists three medications approved for opioid use disorder: buprenorphine, methadone, and naltrexone. This one is buprenorphine, which Dr. Ghelber is certified to provide.
SAMHSA describes it in a sentence usually quoted at half length. Buprenorphine “is an opioid partial agonist” that “produces effects such as euphoria or respiratory depression at low to moderate doses,” though “these effects are weaker than full opioid agonists.” Taken as prescribed by someone already opioid tolerant, it usually reads as quieter rather than high. Those same effects, SAMHSA adds, mean it “can be misused, particularly by people who do not have an opioid dependency.”
You will not find a starting dose or first-day schedule here, and be wary of one online. Buprenorphine binds tightly at the receptors other opioids use, so taking it too soon after a full agonist can bring on withdrawal rather than relieve it. That is precipitated withdrawal, and the American Society of Addiction Medicine (ASAM) recommends waiting for objective signs of withdrawal before starting.
Is buprenorphine just replacing one addiction with another?
This is the sentence that keeps people out of treatment. NIDA answers it: taken as prescribed, these medications “prevent drug cravings and withdrawal symptoms without causing the intense feelings of pleasure (or ‘high’) that other opioid drugs produce.”
Now the honest half. NIDA says they “do produce dependence,” that stopping abruptly brings milder withdrawal than other opioids, and that both can be misused if injected, though most who misuse it are controlling withdrawal, not chasing a high.
Dependence is a body that has adapted. NIDA describes addiction as compulsive drug seeking and use that continues despite harmful consequences. Not the same thing.
NIDA is direct: treatment with methadone, buprenorphine, or naltrexone “is standard of care for opioid use disorder.” ASAM frames it as maintenance medication plus psychosocial treatment, and adds that declining counseling should not delay the medication.
What happens at an outpatient office visit?
Buprenorphine was the first medication for opioid use disorder that could be prescribed in physician offices, SAMHSA notes. A first visit is an evaluation: what you use and how, what else is in the mix, then sleep, mood, trauma, pain.
SAMHSA’s 2024 National Survey on Drug Use and Health counted roughly 21.2 million U.S. adults with both a mental illness and a substance use disorder. Depression and PTSD often sit alongside substance use. One caution: some low mood and sleeplessness in early stabilization comes from the substance itself and eases as things settle, and some was there first. Telling those apart takes weeks.
Alcohol and sedatives get their own warning: mixing large amounts of other medications with buprenorphine, SAMHSA says, “can lead to overdose or death.” That is about combinations and monitoring, not eligibility. ASAM states that the use of benzodiazepines and other sedative-hypnotics “should not be a reason to withhold or suspend treatment.” So say what you actually take: it is a safety question, not a character question. ASAM adds that an active alcohol or sedative use disorder may need more intensive care than an office provides.
SAMHSA also says buprenorphine “should be prescribed as part of a comprehensive treatment plan that includes counseling and other services.” Counseling is not among the services this practice lists.
Dr. Ghelber’s provider page states it verbatim: “I am also a certified provider of buprenorphine treatment for opioid addiction.” She treats addiction inside a general adult outpatient office in southwest Fort Worth, not a separate program. Rates for this self-pay practice are on our price list.
What about my job, or a custody case?
Substance use disorder treatment records carry protections beyond ordinary medical privacy; SAMHSA describes 42 CFR part 2 as protecting the confidentiality of those records. What that means for a particular job or custody matter is not something a psychiatric office can tell you. Ask, before you book anywhere, how records are handled there.
Does buprenorphine for opioid use disorder lower the risk of overdose?
NIDA states that people treated with methadone or buprenorphine “are less likely to die or to have an overdose than those who do not receive treatment.”
A 2017 systematic review and meta-analysis in The BMJ identified 19 eligible cohorts, including 15,831 people treated with buprenorphine. All-cause mortality was 4.3 per 1,000 person-years in treatment and 9.5 out of it; overdose mortality was 1.4 in and 4.6 out. Read those carefully: the all-cause figure rests on three cohorts, the overdose figure on one, most data came from Australia, and the rates are unadjusted.
The review also found the weeks right after leaving treatment carried a particularly increased risk of death, which is why ASAM asks that anyone discontinuing be counseled about overdose risk first, and why a prescriber wants that conversation before you are at the door rather than after. Planned, it is a slow taper with monitoring.
What this practice does not provide
What is not here, and where it lives:
| Not offered here | Where that lives |
| Methadone for opioid use disorder | Certified opioid treatment programs only |
| Supervised withdrawal, rehab, PHP, IOP | Addiction facilities and hospitals |
| 24/7 or crisis substance use services | 988 and 911 |
| Drug testing, court, DOT/SAP evaluations, legal letters | Not provided |
On methadone, SAMHSA is unambiguous: it “can only be dispensed through a SAMHSA certified opioid treatment program.” Needing it is not a failure.
Ketamine is not a treatment for opioid use disorder. It holds no FDA approval for any substance use disorder, the DEA lists it in Schedule III of the Controlled Substances Act, and it has a long history as a drug of misuse. Where it is used here it is for depression, off-label and considered investigational by the FDA, with substance use history assessed beforehand.
Buprenorphine here treats a diagnosed condition, a different use from opioids prescribed for pain. We do not prescribe opioid medications for pain under any circumstances. Where chronic pain is part of your life, we treat the depression and other conditions that travel with it.
If alcohol or benzodiazepines are also in the picture
Stopping either one suddenly can be life-threatening. Some people need medically supervised withdrawal, which this office does not provide. Talk with a clinician before you stop anything, and go to an emergency room if shaking, confusion, or seizures start.
How do you get naloxone in Texas?
One clarification, because the names collide. Buprenorphine is often dispensed as a combination product containing naloxone, added, SAMHSA says, to reduce diversion and misuse. That is not the take-home nasal spray.
Naloxone is, in the FDA’s words, “a lifesaving emergency treatment that reverses opioid overdose.” The FDA approved the first over-the-counter version in March 2023. The Texas Targeted Opioid Response says it is sold “without a prescription in many Texas pharmacies, convenience stores, grocery stores, gas stations and online,” and points Texans to free naloxone at NaloxoneTexas.com.
Two limits. SAMHSA says it reverses opioid overdose even when opioids were combined with sedatives or stimulants, but not a benzodiazepine or stimulant overdose alone, and the effect is temporary, so get help immediately. It only works if someone is there to use it.
Naloxone in a kitchen drawer is not a prediction about you. It is the logic of a smoke detector.
Frequently asked questions
Is buprenorphine just replacing one addiction with another?
No. NIDA states that taken as prescribed, these medications “prevent drug cravings and withdrawal symptoms without causing the intense feelings of pleasure (or ‘high’) that other opioid drugs produce,” which “makes methadone and buprenorphine less addictive.” NIDA is equally clear that they do produce dependence, which is not addiction.
Do I have to be in withdrawal before I can start buprenorphine?
Timing is why this is planned rather than improvised. ASAM’s National Practice Guideline recommends that buprenorphine not be started in someone opioid dependent until there are objective signs of withdrawal, to reduce the risk of precipitated withdrawal. What that means for you depends on what you have taken, and when.
How long do people stay on buprenorphine for opioid use disorder?
There is no set answer. SAMHSA says the length is tailored to each patient and can in some cases be indefinite. ASAM states there is no recommended time limit, that tapering is generally accomplished over several months with close monitoring, and that people should stay in treatment afterward.
Do you offer detox, rehab, methadone, or an addiction program?
No. This is a general adult outpatient psychiatry practice. There is no medically supervised withdrawal, residential care, partial hospitalization, intensive outpatient service, drug testing, methadone, or 24/7 substance use coverage here. Dr. Ghelber treats addiction within general adult psychiatric care and is certified to provide buprenorphine.
The bottom line
Buprenorphine has an unglamorous job. SAMHSA describes it as diminishing withdrawal symptoms and cravings, with effects weaker than a full opioid agonist’s, which for many people makes an ordinary week easier to hold together. Response varies, and medication is one part of a plan rather than all of it. The claim that it swaps one addiction for another is a misconception NIDA addresses by name; dependence is expected, and it is not addiction. What this office offers is narrow: an outpatient psychiatrist certified to provide buprenorphine. Asking a question is not the same as deciding anything.
Talk with us
If you are in Fort Worth or the surrounding North Texas area and what you have read here sounds familiar, we would be glad to talk it through with you. The Institute for Advanced Psychiatry is an outpatient practice at 6800 Harris Parkway, Suite 100, treating adults 18 and older. You can request an appointment or call 817-659-7344.
If you are in crisis or thinking about harming yourself, please do not wait for an appointment. Call or text 988 to reach the Suicide & Crisis Lifeline, available 24/7, or go to your nearest emergency room.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline).
SAMHSA National Helpline: 1-800-662-HELP (4357) – free, confidential, 24/7, in English and Spanish, for treatment referral and information.
If someone may be overdosing, call 911. Naloxone reverses opioid overdose and is available without a prescription in Texas.
Stopping alcohol or benzodiazepines suddenly can be dangerous. Talk with a clinician before you stop, and go to an emergency room if you develop shaking, confusion, or seizures.
Sources
- National Institute on Drug Abuse. “Medications for Opioid Use Disorder.” 2025. https://nida.nih.gov/research-topics/medications-opioid-use-disorder
- National Institute on Drug Abuse. “Treatment.” 2025. https://nida.nih.gov/research-topics/treatment
- Substance Abuse and Mental Health Services Administration. “Buprenorphine.” Accessed 2026. https://www.samhsa.gov/substance-use/treatment/options/buprenorphine
- Substance Abuse and Mental Health Services Administration. “Methadone.” Accessed 2026. https://www.samhsa.gov/substance-use/treatment/options/methadone
- Substance Abuse and Mental Health Services Administration. “Co-Occurring Disorders and Other Health Conditions.” Accessed 2026. https://www.samhsa.gov/substance-use/treatment/co-occurring-disorders
- Substance Abuse and Mental Health Services Administration. “Opioid Overdose Reversal Medications (OORM).” Accessed 2026. https://www.samhsa.gov/substance-use/treatment/overdose-prevention/opioid-overdose-reversal
- Substance Abuse and Mental Health Services Administration. “Statutes, Regulations, and Guidelines” (42 CFR Part 2). Accessed 2026. https://www.samhsa.gov/substance-use/treatment/statutes-regulations-guidelines
- Substance Abuse and Mental Health Services Administration. “SAMHSA’s National Helpline.” Accessed 2026. https://www.samhsa.gov/find-help/helplines/national-helpline
- Kampman K, et al. “The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update.” Journal of Addiction Medicine. 2020;14(2S Suppl 1):1-91. https://www.asam.org/quality-care/clinical-guidelines/national-practice-guideline
- Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, Ferri M, Pastor-Barriuso R. “Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies.” The BMJ. 2017;357:j1550. https://pmc.ncbi.nlm.nih.gov/articles/PMC5421454/
- U.S. Food and Drug Administration. “Information about Medications for Opioid Use Disorder (MOUD).” 2024. https://www.fda.gov/drugs/food-and-drug-administration-overdose-prevention-framework/information-about-medications-opioid-use-disorder-moud
- U.S. Food and Drug Administration. “Information about Naloxone and Nalmefene.” 2024. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-about-naloxone-and-nalmefene
- U.S. Drug Enforcement Administration, Diversion Control Division. “Ketamine (Drug & Chemical Evaluation Section fact sheet).” March 2025. https://www.deadiversion.usdoj.gov/drug_chem_info/ketamine.pdf
- Texas Targeted Opioid Response (Texas Health and Human Services Commission). “Resources.” Accessed 2026. https://txopioidresponse.org/resources
- National Institute on Drug Abuse. “Drug Misuse and Addiction.” 2020. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
- Institute for Advanced Psychiatry. “Diana Ghelber, MD.” Accessed 2026. https://www.psychiatryfortworth.com/providers/diana-ghelber-md/
Medical disclaimer
This article is for general education and is not medical advice, a diagnosis, or a treatment recommendation for any individual. Reading it does not create a physician-patient relationship. Treatment decisions, including whether any medication or procedure is appropriate for you, should be made with a qualified clinician who knows your history. Do not start, stop, or change a psychiatric medication without talking to your prescriber. If you are experiencing a medical or mental health emergency, call 911 or 988.