The Case for Suboxone

       Lisa D. Williams, MS, CAC, CCS      3/1/11

I am writing in response to the anti-Suboxone article by Steven R Scanlan, MD printed in the January/February 2011 issue of the 12 Step Gazette.  I am disturbed by a number of Dr. Scanlan's claims.  He referenced only a single study conducted on the effects of the medication on rats. (1)

He states "Patients often say they feel great on Suboxone and since they are not getting high they want to continue on it. I tell them, 'You are not dealing with your feelings because you are still not feeling-you are still numb. You need to start experiencing emotions to understand what you were trying to self-medicate in the first place. It's time to live life on life's terms." (2)I believe Dr. Scanlan is missing the big picture.  Suboxone patients are alive, not shooting heroin and have the opportunity to engage in recovery and the treatment process. In addition, he does not offer any advice for the difficulties specific to opiate addiction that often necessitate Suboxone treatment.

Chronic drug abuse causes biological changes to the brain and central nervous system that continue to affect emotions and behavior long after acute withdrawal (detox) has ended. (3) Usually acute detox from opiates lasts for 4-10 days and for methadone 14-21 days.  Having survived the obvious "dope-sickness," it would appear that the addict is well on his way to recovery.  If he stays clean and goes to meetings he should get better.  Oftentimes he doesn’t get better.  He may be overcome with urges to use and relapses.  Even if he stays clean and tries to do the next right thing, he does not feel better, sometimes for months, maybe years.

People who are addicted to heroin, Oxycontin, Percocet or other narcotics often suffer from an unrelenting Protracted Withdrawal Syndrome (PWS) that includes impulsive behavior, extreme mood swings, unexplained pain, poor concentration, insomnia, uncontrollable drug cravings, irritability and an inability to experience pleasure.  These symptoms do not necessarily diminish over time in a logical way.  Many addicts are not able to tolerate these symptoms for long.  They remain in the grip of their addiction and do not have a way out.

Fortunately there are medications to aid recovery, for those who have been unable to stay clean.  Suboxone is a combination of Buphrenorphine (a synthetic opiate) and Naloxone (an opiate blocker).  This formulation acts to stabilize brain biochemistry, relieving most PWS symptoms without the euphoria of other opiates.  The Naloxone blocks the high of other opiates or if Suboxone is used intravenously.  Suboxone does produce a mild sense of well being that enables the addict to function.  Suboxone is now being studied for its antidepressant effects thought to be a result of blocking of certain opiate receptors in the brain.

We have a responsibility to at least be open-minded to medication assistance, even if it feels uncomfortable. 

There is a general misunderstanding that use of Suboxone is just trading one drug addiction for another.  It is a myth that Suboxone patients are not clean.  Use of Suboxone does not result in powerlessness or life unmanageability.  It is a stabilizing influence.  At what point should an addict consider Suboxone treatment?  Should he or she need to go to ten or twenty rehabs or get arrested fifteen times?  Unfortunately we in the recovery and treatment communities can be very judgmental and slow to accept change, especially when an approach such as Suboxone is outside our own experience

Not long ago, everyone detoxed cold turkey, any without medications, except when withdrawal was life-threatening.  Fortunately practices have begun to change.  In 2011, detoxes routinely treat withdrawal with a variety of medications and do not rely on extreme suffering of withdrawal to "teach a lesson" about addiction.  Each addict’s particular disease has symptoms and issues unique to the drugs of abuse and personal histories.  It is vital to the addict in crisis that we meet them where they are, not where we wish they could be.

In order to be effective, Suboxone must be prescribed by a physician, based on an individual assessment and diagnosis.  Follow up and participation in counseling are vital.  Studies have proven the effectiveness, success and safety of Suboxone. (4)  Relapses of Suboxone patients most often happen because of failure to take Suboxone as prescribed or premature termination of medication.  Use of other drugs, particularly benzos (benzodiazepines, such as Xanax or Klonopin) is problematic.  Suboxone patients also face the same relapse issues as all people in recovery, such as a failure to work the steps, untreated mental illness, medical problems, unresolved grief and trauma issues.

In our experience at Harmony House, the majority of men who are stabilized on Suboxone are successful at maintaining recovery.  Many of these individuals previously relapsed repeatedly.  They report decreased cravings and are able to function in society.  If they do relapse, rarely do they return to heroin use, but tend to use alcohol, cocaine or benzos.  The severity of these relapses has been less, the life damage less and there is an easier return to abstinence if use of Suboxone is maintained.

Suboxone can be problematic.  It can be abused and misused.   Suboxone may be sold on the street to get high, but more often, addicts attempt self-medication to function and temporarily prevent dope-sickness.  Suboxone is not a great high because it contains an opiate blocker.  For most addicts who want to get high, heroin is cheaper and easily accessible.  The expense of doctor visits and medication also contribute to selling of Suboxone.

In short, we must move forward and embrace medication supports for those who need them.  Looking back will only return us to the days when sponsors flushed antidepressants and rehabs advised against psychiatric evaluations—and people died needlessly.  At the very least, I hope we can begin to give up the idea that we know all there is to know about how someone else should stay clean.

1 Bryant RM, Olley JE, Tyers MB. Antinociceptive actions of morphine and buprenorphine given intrathecally in the conscious rat. Br J Pharmacol 1983 April; 78:659-63

2 Scanlan, SR.  Suboxone: concerns behind the miracle.  Addiction Professional 2010 November-December;8(6):28-29

3 Center for Substance Abuse Treatment. (2010). Protracted Withdrawal. Substance Abuse Treatment Advisory, Volume 9 Issue1      

4 Gunderson, EW, Gordon, AJ Data demonstrate buprenorphine's effectiveness. Addiction Professional 2011 January-February;9(1):30-31

**Medication supported treatment utilizing any prescription medication should be done only as prescribed and monitored by a licensed physician.  Nothing contained in this website should be considered medical advice.  Please consult your physician.

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