Case for Suboxone
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
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
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
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
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.