In-person addiction treatment in St. Louis, built by a pain and addiction physician

Addiction is not a moral failure. It is a brain disease with an economic and social engine underneath it. Addictionology Center, on Woodson Rd in St. Louis next to Lambert International Airport, treats it that way: confidential, individualized, evidence-based, and without judgment.

The medical work happens face to face. You are examined in the clinic. Your medication is started and reviewed in the clinic. Your drug screen is collected in the clinic. Withdrawal is managed at home.

The physician is Dr. Gurpreet Singh Padda, MD, MBA, MHP, an interventional pain physician and diplomate in addiction medicine (full background). That pairing is why this clinic exists. Most addiction programs cannot treat the pain that started the addiction. This one can.

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What does Addictionology Center treat?

Three programs, all delivered at the Woodson Rd clinic:

• Opioid addiction. Buprenorphine/naloxone (Suboxone), prescribed in person, with comfort medications for withdrawal.
• Alcohol addiction. Supervised medical detox first, because stopping alcohol cold can be dangerous. Then medication assistance and behavioral support.
• Drug addiction. Stimulants, polysubstance use and the conditions underneath them, from detox through therapy, counseling and aftercare.

Alongside them: dual diagnosis care, outpatient treatment, substance abuse medication management with ongoing monitoring, and behavioral services, including sessions delivered by teleconference over an encrypted platform. The therapy menu is individual, group, behavioral, solution-focused, trauma EMDR, CBT, DBT, motivational interviewing and family therapy. Aftercare includes counseling, support groups and relapse prevention planning.

The clinic calls itself the most affordable long-term care solution for opioid dependence on the market.

Why is addiction a disease and not a character flaw?

Society once answered addiction with prison, asylums and prayer. Those methods failed because they aimed at the wrong organ.

Follow the chemistry. An opioid taken daily occupies the receptors your own endorphins should fill. The brain adapts and turns its own production down. Now the drug is not a high. It is the floor. Without it you feel sick. What began as an outside drug has become an inside demand, and those changes outlast the last dose by months.

Then follow the life around it. The clinic's position is blunt: the real issue is often boredom and loneliness, and opioids are a short-term cure for both. A person who has lost work, family and purpose lives in a cage, economic, psychological or social, and the drug delivers an immediate reward far larger than the immediate risk. That is the hedonic treadmill with the exits welded shut.

Treat the receptor and ignore the cage, and the patient relapses. Treat the cage and ignore the receptor, and the patient withdraws. The program treats both.

The clinic cites treatment results of 40% to 70% of patients treated for drug abuse remaining drug-free, and about one-third of those treated for alcohol problems having no further symptoms a year later.

How is opioid addiction treated here?

With buprenorphine/naloxone, prescribed in person, on a plan built on your history.

Buprenorphine is a partial opioid. It grips the receptor tightly enough to stop withdrawal and cravings, but it does not produce the high of oxycodone, heroin or fentanyl. It has a ceiling: past a certain dose, no more opioid effect, which is why its overdose risk used alone is low. Naloxone is added to discourage misuse.

Suboxone is the only medication the clinic uses for opioid dependence. Methadone works, but it requires frequent visits to a federally licensed program, and that does not fit an office-based model. Already on methadone? The clinic transitions you to Suboxone once your dose is 40 mg or less. Switching from a higher dose is dangerous, so it waits.

Is Suboxone trading one drug for another?

No. That framing costs lives. Medication stabilizes the reward and stress systems so the rest of recovery becomes possible. Patients maintained on buprenorphine die at substantially lower rates, and risk climbs again when medication stops. The clinic cites research showing 75% of patients on medication still in recovery at one year, while more than 50% relapse within a month of stopping buprenorphine.

So the clinic treats it like blood pressure medication: often long term. If you insist on coming off, the providers build the safest possible plan. They will not push a taper on a timeline that raises your overdose risk.

What happens at the first visit?

A history. A physical examination. An honest account of what you use and how much.

The exam is not a formality. A starting dose is a guess until a physician has looked at you, and the conditions that ride along with long-term use, in the liver, the heart, from infection or untreated psychiatric illness, are found by examining, not asking.

Where appropriate, medication starts that day and is usually called in to your pharmacy. No sedation is used, so you drive yourself. You do not need to be in withdrawal for this visit, and you do not need a referral.

Appointments are usually available within days rather than weeks, and the clinic takes same-day requests. That speed matters. A wait in opioid use disorder is not neutral. It is more days of exposure to a supply now laced with fentanyl.

Why is detox done at home?

The medical visit is in person. Withdrawal is managed at home, in a familiar place, with your provider reachable.

Timing is everything. Buprenorphine binds harder than other opioids and shoves them off the receptor. Take it too early and you trigger precipitated withdrawal, sudden and severe. So you wait for mild to moderate withdrawal, scored on a withdrawal scale, before the first dose. The clinic's rough guide: 12 to 24 hours for short-acting opioids like heroin, oxycodone, Percocet, Vicodin or Dilaudid, about 36 hours for intermediate-acting ones like fentanyl, OxyContin or MS Contin, and 48 to 72 hours for methadone.

Prepare like this:

• Fill your buprenorphine and comfort medications before withdrawal starts.
• Set up at home with a bathroom close by.
• Take a day or two off. Many working patients start on a weekend.
• Ask a supportive friend or relative to check on you.
• Do not start withdrawal before talking to your provider, and do not taper your dose beforehand. It rarely helps and it hurts.

Comfort medications hit specific symptoms: clonidine for anxiety, sweating and aches; hydroxyzine for anxiety and sleep; tizanidine or baclofen for spasm; ondansetron for nausea; loperamide for diarrhea; naproxen for muscle pain. Once buprenorphine starts, the symptoms fall away.

In the first days you meet your provider again to adjust the dose, typically starting around 12 mg and moving to 16 mg on day two by the provider's guidance, and you complete early drug screens. If you become dehydrated from vomiting, call during business hours or go to urgent care or an emergency room after hours. Overdose or thoughts of self-harm: call 911.

What does ongoing treatment look like?

The opening weeks carry the most visits, because induction and dose adjustment both need a physician in the room. Once you are stable, you are seen weekly until your screens are consistent, then at least monthly. Screening runs at least monthly at the start, collected at the clinic. Clinical support specialists fix pharmacy and payment snags before they become relapses.

The phone has one job. Patients destabilize between visits, and a clinic that cannot reach them is not safe. So phone contact is kept for urgent support. The phone monitors. It never prescribes.

What are the program's rules?

Structure is treatment. Every patient must agree to the program's policies and be genuinely interested in sobriety.

• Random screenings. When the office calls, you come in within 24 hours with all your medication to be counted. No exceptions. Missing one disqualifies you.
• Supervised samples may be required. Consistent negatives mean less frequent testing. Positives mean more.

You are discharged for lying at intake or during treatment, continuing illegal drug use, cheating or failing a screen, a medication count that does not add up, selling or sharing your medication, getting pain medication from another physician, or stopping your medication without your monitoring physician.

Why do pain and addiction belong in one clinic?

Because pain is where most of it starts. The clinic's data: more than 30% of Americans have acute or chronic pain, and more than 57% of patients with opiate addiction started opiates because of chronic pain.

The history explains the flood. Opioid prescribing rose in the early 1990s, powered by financial incentives aligned with human hedonic behavior. Pain relief became a customer-satisfaction metric. Capitation pushed complex pain onto primary care without the tools to treat it any other way. Then came OxyContin in 1996, marketed as a 12-hour drug that lasted 8. The endorphin system shut down under the load, patients escalated, and the pills leaked into the street. When the crackdown came, the dependent moved to heroin, then to fentanyl.

Those same crackdowns hurt pain refugees who had been stable on their prescriptions, cutting them off and leaving them in misery.

Here the pain gets treated without opioids. The clinic runs a pain management program for people in recovery, people who have finished treatment, people entering it, and anyone who wants a conservative approach. For pain in the neck, mid-back or low back, the knees, hips or elbows, and cluster headache or chronic migraine, it offers interventional procedures for immediate and sustained relief without opioids. The work targets root causes instead of masking them. You will not find an opioid-centered practice here. See interventional pain management and non-opioid pain treatment.

Across Dr. Padda's pain practice, arriving patients average more than 90 MME a day after two and a half or more years in pain. Under interventional treatment, 21% are fully weaned within 90 days and 34% within one year. Across the established population, fewer than 1% remain above 90 MME. These are practice-reported figures from our own population, not trial outcomes, and individual results vary. The full picture is in opioid stewardship and opioid tapering.

Does metabolic health matter in recovery?

Yes. Fewer than 12.2% of Americans were metabolically healthy in the 2009 to 2016 survey, and fewer than 7% on the tighter criteria applied after 2021. Overweight and metabolic syndrome exceed half the population.

The mechanism: processed food heavy in industrial seed oils and high-fructose corn syrup drives metabolic inflammation. Metabolic inflammation becomes neuroinflammation. Neuroinflammation leans on the same reward circuits that drive addictive behavior.

So diet and exercise are part of the program, offered when you are ready: nutritional counseling, fitness counseling, workout plans, functional analysis and corrective exercise.

What medications beyond Suboxone does the clinic describe?

• Naltrexone extended-release injection (Vivitrol). Monthly, with counseling, to keep people who have stopped drinking or using opioids from going back. It blocks euphoria, cuts cravings, and has no withdrawal.
• Librium (chlordiazepoxide). Boosts the brain's calming GABA signal to control symptoms of alcohol and drug withdrawal.
• Baclofen. Typically used for cocaine addiction, where it has shown early efficacy alongside counseling.

How does paying for treatment work?

A monthly fee, not a per-visit charge, because opioid dependence is treated continuously. It covers all prescription refill visits, care between visits and care navigation. It does not cover lab tests, medications or support groups.

• Insurance: not accepted for the clinic's fees. Use your card for medications and labs, and the clinic provides a superbill for out-of-network reimbursement.
• Financing: available over and beyond the treatment period, without credit checks, plus third-party lenders that specialize in addiction care.
• Cancellations: free up to 72 hours before an appointment. No refunds for a month in which you spoke with or saw your provider. Restarting after cancelling carries a $500 induction first-month fee.

How do I start?

Call an enrollment coordinator. If the clinic can meet your needs, your first visit is booked. Or complete the online enrollment form, which asks what a first call would and lets you pick phone or email for follow-up. Messages left after hours are returned the next business day.

Addictionology Center, 4477 Woodson Rd, Suite 101, St. Louis, MO 63134, next to the airport, parking at the door. Call (314) 463-0100 or text (314) 886-5902. Monday through Friday, 8:00 AM to 5:00 PM. It sits within the network on the pain and metabolic medicine hub.

Frequently asked questions

Will I leave the first visit with a prescription?

Usually. Your provider decides, and prescriptions are typically called in to your pharmacy the same day. Refills come at follow-ups.

Does the clinic prescribe for other conditions?

Case by case, for problems tied to your treatment, such as nausea from Suboxone. For everything else, you are asked to see a primary care provider, and the clinic helps arrange one if you have none.

Will Suboxone show up on a drug test?

Only on a test specifically for buprenorphine. It is not on the standard screen, and a prescribed patient has legal protection from employment discrimination.

Can Suboxone get me high?

Very rarely, and not in people with active opioid use disorder who are used to full opioids. Euphoria is possible mainly in someone with no opioids in their system.

Is treatment confidential?

Yes. Your records are protected under HIPAA and the federal rules for substance use disorder records, and nothing is shared without your explicit consent.

How long does treatment take?

It is not a quick fix. It depends on how long and how much you used and how you respond. Suboxone curbs cravings without fog, so you function while it works.