Opioids once referred to synthetic opiates, such as Oxycontin. Opiates referred to drugs derived from opium, such as heroin. Now, most people in the medical field use the term opioids to refer to all opiate-like drugs, natural, synthetic or semi-synthetic. So, when I write opioids, I’m referring to all opiate-like drugs. Suboxone is an opioid, but it’s a different kind of opioid, and it’s a misunderstood opioid. There might be more misinformation disseminated about Suboxone than any other known drug at this point. I’m not familiar with all controversial drugs, so maybe I’ll limit the misinformation regarding Suboxone to within the field of addiction treatment.
Some in the treatment field have a financial incentive to oppose Suboxone, such as in-patient detox facilities, because now opioid addicts are detoxed on an out-patient basis with Suboxone from a doctor’s office. I’m not saying that the detox facilitity personnel consciously oppose Suboxone for purely financial reasons, but the resistance to Suboxone is better understood from this perspective. Otherwise, the resistance makes no sense at all.
For anyone unfamiliar with Suboxone, go here. When it’s said that Suboxone has a significantly lower euphoric effect, it’s an understatement. Ask an opioid addict who’s taking Suboxone if the euphoric effect of Suboxone is anything like heroin or Oxycontin — they’ll laugh. Any “euphoric” effect from Suboxone, after the first few days, is mostly the feeling of relief an addict experiences when they’re no long craving opioids. Suboxone is a partial agonist, which means it doesn’t produce the full opioid effect, but it blocks the receptors so that withdrawal is stopped. Recovering addicts using Suboxone can perform all their daily actions without impairment. Some people are a little tired on Suboxone, but once their dosage is adjusted properly, they are able to work, drive, and do anything else a non-addict would do. Some people, of course, react differently, but that’s true of practically all medicines.
The point is that Suboxone is a great tool when used to stop opioid withdrawal so that an opioid addict can get into treatment and make the necessary changes to recover and live a drug free. The controversy comes in when some in the treatment field say you shouldn’t treat drug addiction with an addictive drug. First of all there’s a difference between reliance/physical dependence on a drug and addiction. Treatment of chronic pain can cause a person to become reliant or physically dependent on pain killers, but most do not become addicted with the mental obsession and crazed need to continue the drug despite negative consequences. Addiction is associated with compulsion to use a drug, obsession with the drug and the continued use of a drug despite negative consequences. I don’t know of anyone who takes Suboxone for a mood altering effect, or who would continue taking the drug if they were locked up for taking it, or if they lost their family from taking it, or if they were fired from their job for taking it.
Yes, Suboxone can be abused, but, because of the Naloxone, Suboxone is not an easy drug to abuse, nor is it a drug that can be abused long term because of the ceiling effect. If you have to go through a lot of trouble to get a minimal effect, it’s not usually worth it to an addict. Just because a certain treatment can be abused, though, doesn’t mean that the treatment shouldn’t be used — it just needs monitoring by a competent, knowledgeable physician.
The reason most people take Suboxone long term is because it’s doing no harm and their lives are so much better — they simply don’t want to fix what’s not broken. At NewDay our Medical Director recommends that an opioid addict take Suboxone long enough to get into recovery, then taper off and become drug free. Let’s call it Planned Abstinence. We know a lot more today about the science of addiction, how brain chemistry changes. It’s malpractice to force an addict to suffer withdrawals, and probably relapse, when there’s medicine to relieve withdrawals long enough for the person to get into treatment and plan their path to a drug free recovery. Do doctors and counselors need to a better job helping recovering addicts manage their recovery to a drug-free state? Certainly, but that’s something we can all work on. In the meantime, let’s not allow old ideas to block progress in addiction treatment. And let’s not subconsciously treat recovering addicts who use Suboxone like they aren’t in recovery — they are in recovery.