By now almost every opiate addict has heard of suboxone, the amazing medication for opiate dependence that has taken the using world by storm. I will admit to mixed feelings about suboxone based on what I have seen and heard while treating well over 100 patients over the past two years. I also acknowledge that my opinions are likely influenced by my own experiences as an addict in traditional recovery. While suboxone has opened a new frontier of treatment for opiate addiction, it also threatens to split the recovering and treatment communities along opposing battle lines. Such and outcome would be a huge missed opportunity to improve the lives of opiate addicts.
For clarification, the active ingredient in Suboxone is buprenorphine, a partial agonist at the mu opiate receptor. Suboxone contains naloxone to prevent intravenous use; another form of the medication, Subutex, consists of buprenorphine without naloxone. In this article I will use the name 'Suboxone' because of the common reference to the drug, but in all cases I am referring to the use and actions of buprenorphine in either form. The unique effects of buprenorphine can be attributed to the drug's unique molecular properties. First, the partial agonist effect at the receptor level results in a 'ceiling effect' to dosing after about 4 mg, so that increased dosing does not result in increased opiate effect beyond that dose. Second, the high binding affinity and partial agonist effect cause the elimination of drug cravings, dispelling the destructive obsession with use that destroys the personality of the user. Third, the high protein binding and long half-life of buprenorphine allows once per day dosing, allowing the addict to break the conditioned pattern of withdrawal (stimulus)-use (response)- relief (reward) which is the backbone of addictive behavior. Fourth, the partial agonist effect and long half life cause rapid tolerance to the drug, allowing the patient to feel 'normal' within a few days of starting treatment. Finally, the withdrawal from buprenorphine provides a disincentive to stop taking the drug, and so the drug is always there to assure the person that any attempt to get high would be futile, dispelling any lingering thoughts about using an opiate.
Different treatment approaches.
At the present time there are significant differences between the treatment approaches of those who use suboxone versus those who use a non-medicated 12-step-based approach. People who stay sober with the help of AA, NA, or CA, as well as those who treat by this approach tend to look down on patients taking suboxone as having an 'inferior' form of recovery, or no recovery at all. This leaves suboxone patients to go to Narcotics Anonymous and hide their use of suboxone. On one hand, good boundaries include the right to keeping one's private medical information so one's self. But on the other hand, a general recovery principle is that 'secrets keep us sick', and hiding the use of suboxone is a bit at odds with the idea of 'rigorous honesty'. People new to recovery also struggle with low self esteem before they learn to overcome the shame society places on 'drug addicts'; they are not in a good position to deal with even more shame coming from other addicts themselves! An ideal program will combine the benefits of 12-step programs with the benefits of the use of suboxone. The time for such an approach is at hand, as it is likely that more and more medications will be brought forward for treatment of addiction now that suboxone has proved profitable. If we already had excellent treatments for opiate addiction there would be less need for the two treatment approaches to learn to live with each other. But the sad fact is that opiate addiction remains stubbornly difficult to treat by traditional methods. Success rates for long-term sobriety are lower for opiates than for other substances. This may be because the 'high' from opiate use is different from the effects of other substances-users of cocaine, methamphetamine, and alcohol take the substances to feel up, loose, or energetic-ready to go out and take on the town. The 'high' of opiate use feels content and 'normal'- users feel at home, as if they are getting back a part of themselves that was always missing. The experience of using rapidly becomes a part of who the person IS, rather than something the patient DOES. The term 'denial' fits nobody better than the active opiate user, particularly when seen as the mnemonic: Don't Even Notice I Am Lying.
The challenges for practitioners lie at the juncture between traditional recovery and the use of medication, in finding ways to bring the recovering community together to use all available tools in the struggle against active opiate addiction.
See Part Two: Drug obsession and character defects.
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» left by Bob B. from South Jersey (25 days 5 hours ago.)
Interesting article. I have used Suboxone for quite some time under the care of a Dr. and I have to say that the withdrawal that I am experiencing from just 2mg a day of Suboxone is worse than the Oxycontin withdrawal I had in the first place. I don't know anybody who has successfully come off of the "Subs" at all and I know many!!!! I am on day 14 without that poison and I have only made it this far with the help of N/A... I will tell anybody reading this; DON'T TAKE SUBOXONE YOU'RE ONLY PROLONGING THE INEVITABLE! And get into a REAL program before you ruin your life any further!
» left by ray from new jersey, atantic city (14 days 5 hours ago.)
i too have been on suboxone for a year and am on day seven of my detox from suboxone....the w/d is horrible and i would rather go back in time and just tough out the four days or so of vicodin w/d than to have been putting this poison in my body for the last year....it numbs you it keeps you tranquilized and kills your emotions......you look forward to your dosing just like any other drug and it just as addictive and twice as potent as vicodin......maybe for heroin or oxycontin users it may be a good idea but for someone addicted to percs or vics or any other low concentration opiate they should turn and run when dr. miracle offers you suboxone
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