Suboxone: Detox or Maintenance?

opiate addiction treatment

Opiate addiction

Suboxone: Detox or Maintenance? First, here is a description of Suboxone/Buprenorphine from sources such as USDA:

Buprenorphine

Prescription drug
Consult a doctor if you have a medical concern.

Treats moderate to severe chronic pain. This medicine is a narcotic analgesic.

So, Suboxone treats chronic pain, and it’s also used to treat Opioid addiction. Suboxone is a good detox for opioid addiction because it doesn’t create the euphoric effect, but it stops the craving for opioids like oxycodone or heroin. Used as a short-term detox medicine, Suboxone is highly effective. Whether or not Suboxone is a good maintenance drug for the long term treatment of opioid addiction, well, here there is controversy.

There’s some indication that Suboxone is good long term maintenance for opiate addicts who have been addicted for a long time with very heavy use. It’s better to take Suboxone because a person can function on Suboxone, whereas the heroin addict loses the ability to function normally. The reason Suboxone would be used for long term treatment maintenance is because a severe opiate addict has done a lot of damage to their brain, and it’s almost impossible for the serious opiate addict to stay clean without a lot of help. Counseling and Suboxone maintenance show more success than previous treatment modalities for serious opiate addiction.

The problem is that Suboxone is addictive — it’s basically an opiate drug, although it acts differently on the brain than an opiate like heroin. It’s also not like Methadone. Methadone can make a person “high”, but Suboxone doesn’t have that euphoric effect after a couple of days, and Suboxone contains another drug, Naloxone, that neutralizes the effects of opiates like heroin, so if the person on Suboxone maintenance used heroin, the heroin would have no effect.

So, the controversy continues. Some healthcare professionals believe that opiate addiction shouldn’t ne treated with an opiate drug, but they have to show better results with other methods before their protestations have merit. If Suboxone is managed by a physician with understanding of addiction, and if the opiate addict is receiving addiction counseling and treatment, and if the Suboxone use is limited to an end date, and if the Suboxone is gradually reduced to meet the end date, then an opiate addict, who before had a slim chance at recovery, now has a much greater chance of becoming drug free and a changed person.

Understanding Suboxone

opiate addiction

Suboxone treatment

There’s a lot of controversy surrounding the use of Suboxone for the treatment of Opiate addiction. There are still health care professionals who should know better who claim that Suboxone is no better than ordinary opiate addiction. This type of misrepresentation of a drug that is helping opiate addicts recover at a high rate is not easy to understand. This is from Psychcentral:

In 2002, the FDA approved the use of the unique opioid buprenorphine (Subutex, Suboxone) for the treatment of opioid addiction in the U.S. Buprenorphine has numerous advantages over methadone and naltrexone. As a medication-assisted treatment, it suppresses withdrawal symptoms and cravings for opioids, does not cause euphoria in the opioid-dependent patient, and it blocks the effects of the other (problem) opioids for at least 24 hours. Success rates, as measured by retention in treatment and one-year sobriety, have been reported as high as 40 to 60 percent in some studies. Treatment does not require participation in a highly-regulated federal program such as a methadone clinic. Since buprenorphine does not cause euphoria in patients with opioid addiction, its abuse potential is substantially lower than methadone.

Suboxone is a great tool for the treatment of opiate addiction, and there’s some evidence that Suboxone is a good tool for the treatment of other drug addictions. Suboxone doesn’t cause euphoria after the first few dosages, so there’s no incentive for the person taking Suboxone to take more than prescribed. Plus, if the opiate addiction treatment plan is developed correctly, there will be an end-date at which the person weans off Suboxone and becomes drug-free. Counseling and addiction education will also be involved, because no drug that helps with withdrawal is a magic pill that cures addiction.  Anyone who’s demonizing Suboxone, though, doesn’t understand the drug and its success — they certainly don’t understand the history of opiate addiction treatment. In the past, opiate addiction treatment has been ineffective, but, now, with Suboxone, the success rate in recovery is impressive. Suboxone fills the opiate receptors in the brain and, basically, tells the brain that it doesn’t need opiates, so the physical craving is eliminated, but without the euphoria that drives the addict to take more and more and eventually incapacitates the addict. On Suboxone, a person can go about their normal life with no impairment of judgment — they aren’t high in an unreal world.

Even if a person who’s prescribed Suboxone finds a way to misuse it, the regulation of Suboxone is such that the person would quickly be cut-off by doctors and pharmacies. I suppose there’s a way to misuse all drugs, but Suboxone is not a drug that a drug addict would choose to use on a regular basis unless they want to get off heroin or Oxycontin or some other opiate. It doesn’t make sense that Suboxone is seen as a drug no different than your ordinary pain-killers. I encourage all health professionals who think Suboxone is dangerous to study the findings, talk to some recovering opiate addicts who’ve taken Suboxone and learn something about this recovery tool. I understand the caution when a new drug is introduced and hailed as a panacea, but Suboxone has a proven track record. Understanding Suboxone means understanding that it’s simply a tool to help addicts become drug-free — how can that be bad?