By LYLE R. FRIED, CAP, ICADC, CHC In Addiction Recovery, Addiction Withdrawal, Opioid Addiction
Posted September 7, 2015
What is Suboxone?
Suboxone is classified as a semi-synthetic opioid and largely used to reduce the painful and difficult withdrawal symptoms associated with heroin and other opiate dependence. In a monitored, medical detox setting, Suboxone is often prescribed as a taper which brings an individual through heroin or opiate withdrawal in a much more comfortable way than “cold turkey.” Since fear of the painful withdrawal process is often what keeps an individual in active addiction, Suboxone definitely has a place in the recovery process.
Suboxone is just the brand name. The active ingredient in the drug is buprenorphine, which is also found in Subutex, Norspan, Zubslov, Butrans, and Buprenex. Although Suboxone can be a a welcome relief to individuals who desire to quit using drugs such as heroin, morphine, and prescription painkillers, much controversy surrounds the drug due to its use in lengthy (and even life-long) maintenance programs keeping patients using the drug far longer than medically necessary.
How Does Suboxone Work?
When introduced into the body, buprenorphine binds to opiate receptors in the brain just as an opiate would, releasing dopamine and essentially making the brain believe it has consumed an opiate, but without the euphoric effect. This chain of events can successfully suppress withdrawal symptoms, and is the reason why the drug is commonly used for individuals being medically detoxed from opiates.
That’s the simple, condensed version of how it works. Of course, every person is different and sometimes —if other opioids are still present in the user’s brain, for example— an individual may experience some degree of withdrawal symptoms before the buprenorphine begins to take effect.
So, What’s the Problem?
All of the above information sounds good, and it is. Suboxone, when used in a monitored medical detox situation (short term) is useful in the recovery process. But, as many individuals who have battled heroin and opiate addiction for any length of time are aware, Suboxone can have it’s dark side.
Suboxone is addictive – Although some say the euphoric effects pale in comparison to other drugs, it is still classified as an opiate, with a high potential for physical dependency if consumed on a regular basis for an extended period of time.
Because the opioid receptors of the brain are used to binding with a chemical that tells them when to release dopamine, withdrawal begins when this chemical is absent. This is true for any opiate.
Suboxone maintenance – Recently, a friend of mine relapsed on heroin. Due to a laundry list of complicated situations, he decided not to return to a treatment center. Here’s where a little bit of knowledge can be dangerous. Instead of treatment, he decided to seek out a doctor who would prescribe a Suboxone taper. Sounds like a pretty normal idea on the surface, right? Except, he came home from the doctor with a full month’s supply. “The doctor told me I was not capable of breaking free from addiction and decided to put me on Suboxone maintenance. He said I’d probably be on it for the rest of my life.”
Much like the methadone maintenance programs, Suboxone is becoming increasingly used by many doctors. The rationale behind this may be that it is safer to be taking prescribed Suboxone on a daily basis than it is to be out scoring harder drugs. But in reality, it is trading one bondage for another and the user is still dependent on a substance to make it through the day.
A New York Times investigation into Suboxone found that it’s manufacturer, Reckitt Benckiser, has employed aggressive tactics to locate physicians interested in rolling the painkiller market over into Suboxone-lifers. I know this might seem crazy to anyone in the recovery community, but much of the general medical population still believes that an individual with a history of painkiller abuse can never be drug-free.
Suboxone maintenance is a threat to recovery, as well as your physical health.
Long-term Suboxone “therapy” can cause thyroid dysfunction, shut down the endocrine system, lower testosterone levels, and cause premature menopause, infertility and osteoporosis.
Doesn’t it Sound Familiar?
It doesn’t take much brain power to recognize the similarities between Suboxone maintenance programs and the pain clinics that caused a national epidemic in recent years. “Suboxone clinics” are opening all over the country at an alarming rate, often charging patients a “cash-only” rate just to speak with a doctor who can potentially put them on a maintenance plan.
As a medical doctor, becoming certified to prescribe buprenorphine is remarkably easy. It requires completion of one eight hour online course. No background in addiction medicine is required to take the course. The amount of time in the course agenda dedicated to detoxing patients off of the drug is little to none. Combine the growing population (which is already vast) of opiate addicts to the easy money connected to Suboxone maintenance and you have quite a situation for physicians who may be opportunists.
Suboxone vs Subutex
Suboxone is a combination of buprenorphine, which is an opiate, and naloxone. Naloxone is added to prevent Suboxone from being used intravenously. The presence of naloxone would initiate immediate withdrawal if used intravenously. Subutex, on the other hand, is pure buprenorphine (and can be used intravenously) so has a much higher chance of abuse.
Harm reduction may sound good in theory, until you listen to what some of the individuals who were put on Suboxone maintenance actually say they went through (or are still going through).
Bottom line, Suboxone is, in fact, a mood and mind altering substance with physically addictive properties. When used properly, in a medical detox setting, it can be extremely useful. Left in the hands of an individual in active addiction to monitor and self-dispense….probably not a good idea.
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