Lotus Addiction and Recovery Center
- 814 Elm St Suite #204, Manchester, NH 03101
WHAT IS HEROIN USE DISORDER
Heroin Addiction Is One of the Hardest Things a Person Can Face. Treatment Works.
The supply is more dangerous than it has ever been. The stigma is heavier than it should be. And the path out is real – confidential, evidence-based telehealth treatment available anywhere in New Hampshire.
Heroin does not ease you in. It works fast, it works powerfully, and it changes the brain in ways that make stopping feel physically and psychologically devastating.
When heroin enters the body it binds to opioid receptors and floods the brain with dopamine at a level that nothing natural can replicate. Over time the brain stops producing its own dopamine at normal levels and starts depending on the drug just to feel baseline. What started as relief – or escape, or curiosity, or pain management – becomes a physical need the body genuinely cannot function without.
This is not weakness. This is neuroscience.
The people who struggle most to stop are often the ones who are fighting hardest. They just do not have the right tools yet. Medication Assisted Treatment exists because willpower alone was never going to be enough – not against something that has rewired the brain’s most fundamental reward system.
If you are using heroin and you want a way out, there is one. It is medically supported, clinically proven, and available to you right now.
A NOTE ON FENTANYL
This is something I feel strongly about being direct on.
The heroin supply in the United States has been largely taken over by fentanyl – a synthetic opioid that is 50 to 100 times more potent than morphine. Most people using what they believe is heroin are actually using fentanyl, or a mixture of both, often without knowing it.
Fentanyl has a much narrower margin between a dose that gets someone high and a dose that stops their breathing. That is why overdose deaths from opioids have surged so dramatically in recent years. It is not that people are using more carelessly. It is that the substance they are using is genuinely more lethal.
What this means for you:
Every use now carries a level of risk that did not exist even a few years ago. That is not meant to shame you. It is meant to be honest with you about the stakes – and about the urgency of getting into treatment.
If you do not have Narcan (naloxone) available to you right now, please get it. It is available without a prescription at most pharmacies in New Hampshire and it can reverse an opioid overdose. It is not a substitute for treatment but it can keep you alive long enough to get there.
And then please reach out. The sooner we can get you started on a treatment plan, the sooner you are out of that daily risk.
HOW SHIVANI TREATS HEROIN USE DISORDER
Heroin use disorder has several highly effective FDA-approved medication options – and I prescribe all of them. Here is a quick breakdown of each.
Suboxone (Buprenorphine/Naloxone) – Daily film or tablet Reduces cravings and prevents withdrawal without producing a high. Decades of clinical evidence behind it.
Zubsolv (Buprenorphine/Naloxone) – Daily sublingual tablet Same as Suboxone but mint flavored, dissolves in five minutes, and available in lower doses to support tapering.
Sublocade (Buprenorphine) – Once-monthly injection No daily medication to remember. A 60-day half life that supports gradual tapering for patients who want that option.
Brixadi (Buprenorphine) – Weekly or monthly injection The most flexible injectable option – multiple dose levels, multiple administration sites, and your choice of weekly or monthly schedule.
Vivitrol (Naltrexone) – Once-monthly injection Blocks opioid receptors entirely so heroin produces no effect. Also treats alcohol use disorder. Requires a period of abstinence before starting – we plan that together.
Not sure which is right for you? You do not need to arrive with a preference. That is what the first appointment is for.
WHY TELEHEALTH MAKES A DIFFERENCE
Of all the substances people seek treatment for, heroin carries perhaps the heaviest stigma. The way it is portrayed in media and culture has created a picture that does not reflect the reality of most people who are struggling with it – and that picture makes asking for help feel terrifying.
Telehealth does not eliminate stigma from the world. But it removes it from the doorway to treatment.
When your appointment is in your own home, on your own schedule, with nobody else in the room – the barrier that stigma creates largely disappears. There is no parking lot to walk through, no reception desk, no waiting room. Just a private conversation with a provider who is not going to judge you.
For people using heroin specifically, this matters enormously. I have worked with patients who spent months wanting help before they could bring themselves to ask for it – not because they did not want recovery, but because they were terrified of how they would be treated.
You will not be treated that way here.
Beyond privacy, telehealth also means care is available anywhere in New Hampshire. Rural communities in particular have historically had the least access to addiction treatment.
That should not be the case and with telehealth it does not have to be.
Frequently Asked Questions
Is heroin withdrawal dangerous?
Opioid withdrawal is intensely uncomfortable but is generally not life-threatening in otherwise healthy adults – unlike alcohol withdrawal, which can cause seizures. That said, the severity of heroin withdrawal should not be underestimated. It is one of the primary reasons people return to using after trying to stop. Medication makes withdrawal significantly more manageable and dramatically improves the chances of staying in treatment. You do not have to go through it without help.
What if I am actually using fentanyl, not heroin?
The same medications apply. Fentanyl is an opioid and MAT works for fentanyl use disorder the same way it works for heroin. One clinical note – patients coming off fentanyl sometimes need to wait a bit longer before starting buprenorphine-based medications to avoid precipitated withdrawal. We plan for this carefully in your treatment.
Do I need to be in active withdrawal to start Suboxone?
For buprenorphine-based medications like Suboxone, Zubsolv, Sublocade, and Brixadi, yes – you generally need to be in at least mild withdrawal before your first dose to avoid precipitated withdrawal. We will walk through exactly what that means and how to time it so the process is as comfortable as possible.
What if I have overdosed before?
Then getting into treatment is urgent and I am glad you are here. A previous overdose is a strong indicator of the risk level you are living with right now and it makes starting MAT even more important. Please do not let shame about your history be a reason to delay. It will not change how I treat you.
Will anyone find out I am in treatment?
No. Your treatment is protected under federal confidentiality law – specifically 42 CFR Part 2, which provides stronger protections than standard HIPAA for substance use disorder treatment records. What happens in our appointments stays there completely.
What if I have tried MAT before and it did not work?
Something about that experience was not the right fit. The medication, the dose, the support, the timing – any of those factors can make the difference between something that holds and something that does not. I would want to understand exactly what happened and think through what might be different. A previous attempt is not a verdict.
Is this covered by insurance?
Coverage varies by plan. I recommend contacting your insurance provider to ask specifically about telehealth MAT for opioid use disorder. I am happy to provide any documentation needed to support prior authorization requests.
Treatment Is Available Right Now.
Not next month. Not after you have tried one more time on your own. Right now.
I know that reaching out feels like a bigger step than it should. I know that shame and fear and exhaustion make it hard to pick up the phone or send a message. I know that a lot of people who needed help did not get it in time – not because they did not want it, but because the door felt too heavy to push open.
This door is not heavy. You send a message, we find a time, and we start. That is all the first step requires.
Whatever has happened before. Whatever you are carrying right now. You can walk through this door exactly as you are.