The Suboxone Controversy

November 1, 2017 - Detox & Withdrawal - 1 Comments

Suboxone, a mix of buprenorphine and naloxone, is used to treat heroin and other opioid addiction by suppressing opioid absorption in the brain. This typically results in reduced cravings and withdrawal symptoms, as well as the user either not getting high when they do abuse, and sometimes in them getting physically sick when they do.

It’s a proven way to treat addiction, and is frequently used in clinics to help users through withdrawal. But, it’s also a subject of strong controversy, largely because addicts who start using stay on it for a long time, and may become addicted. Others compare it to drugs like Methadone, where treatment typically goes on for years, leading many to believe that it’s just replacing one drug with another.

What is Suboxone?

Suboxone is a mix of two opioid withdrawal treatment drugs, buprenorphine and naloxone.

Buprenorphine – First approved for medical use in 1981, buprenorphine has seen slow uptake in the medical community. The drug is a partial agonist opioid receptor modulator, meaning that it reduces the effects of opioids in the brain. Here, it is similar to methadone, an agonist opioid receptor modulator, but because it’s a partial agonist, it carries less of a risk of causing respiratory depression or shutdown should the user abuse opioids while on the drug. Buprenorphine largely reduces cravings while reducing the effect of the drug.

Naloxone – Naloxone is a silent agonist for opioid receptors, and it typically blocks the effect of opioids in the brain by preventing them from binding to opioid receptors. When given alone, it is frequently used to stop the symptoms of an overdose, and is frequently made available to the public for this purpose. If taken by someone who is currently using, it can force them into withdrawal symptoms.

Suboxone – Suboxone is a 4:1 combination of Buprenorphine and Naloxone, which together work to reduce cravings, suppress withdrawal symptoms, and help users to function without taking opioids. Naloxone also helps to reduce the chances of users abusing opioids while taking Suboxone, because naloxone can cause users to be physically ill if they slip up. This combination also deters abuse, because, if injected to get high, the naloxone causes immediate withdrawal symptoms.

Buprenorphine is an Opioid, Right?

A large part of the controversy surrounding Suboxone and Buprenorphine is the simple fact that Buprenorphine is an opioid. It is used medically for pain relief, and it can be abused. This is especially true for users who are not tolerant of other opioids. Injecting buprenorphine will also create a similar, but milder effect, to morphine or heroin. In tablet form, most users experience no high at all, but may experience some sedation. In the case of Suboxone, the risk of abuse via injection is negated simply because users will go into withdrawal rather than experiencing a high.

Is It Addictive?

Another large part of the controversy surrounding Suboxone is dependence. Over time, users become chemically dependent on the drug, although not typically ‘addicted’. This means that they will experience withdrawal symptoms when ceasing to take the drug, but will not experience any of the other DSM IV or DSM V symptoms of addiction. However, this is extremely normal for most medication. The body quickly adjusts to most substances, and will therefore go through withdrawal when the substance is taken away. For example, coffee and soda drinkers experience withdrawal symptoms and cravings when they quit.

Is It Safe?

Suboxone has a similar, but milder, side effect profile to most other opioids. Many users experience mild headaches, mild dizziness, numbness, tingling, drowsiness, insomnia, stomach pain or constipation, redness or pain in the mouth, and trouble concentrating. These side effects are similar to but milder than the side effects of methadone and buprenorphine.

When taken alongside opioids such as heroin or OxyContin, Suboxone has a low risk of causing potentially fatal respiratory depression. This risk is lower than buprenorphine and methadone. However, a person suffering respiratory depression after abusing an opioid while on Suboxone should be taken to a hospital for emergency medical care.

While not 100% safe, Suboxone is safer than its alternatives and significantly safer than using opioids.

The Controversy

Many people believe that if you’re taking Medically Assisted Treatment (MAT), you’re not really clean, you’re just taking another form of drug. For example, many 12-step communities refuse to admit Suboxone patients, because they’re still addicts. Non-Suboxone users argue that the brain might not heal and return to normal while using a drug like Suboxone. Others suggest that with Buprenorphine’s potential for abuse, many will just go back to using after their medically assisted treatment is over.

And, in the cases where Suboxone treatment is left indefinitely, many users do simply remain addicted to a different kind of drug.

Why Use Suboxone?

Suboxone and buprenorphine have been shown to work, and over the long-term. Even ‘hardcore’ heroin addicts recover quickly and can return to their lives, without cravings, with the help of Suboxone. With over 4 million people in the United States addicted to an opioid, a drug that can help is important. While Suboxone does have side effects, and it does carry a low risk of causing overdose-like respiratory depression in users who abuse opioids while taking it, it is safer than alternatives like methadone and safer than buprenorphine on its own, and unlikely to be abused. More importantly, while it is ‘just swapping one drug out for another’, Suboxone greatly reduces the risk of death, enables a person to return to a normal lifestyle, to reduce cravings and return behavior to normal, and reduces the risk of accidents, contracting a blood-borne disease, and committing crime in search of drugs. For example, addicts on Suboxone have a decreased exposure to HIV and Hepatitis. At the same time, they are more likely to be able to hold jobs, function normally, and focus and engage with their treatment or therapy.

So, there are a lot of benefits to using opioid agonists, even if prescribed for long-term use.

However, most doctors and treatment facilities are not using or prescribing Suboxone for long-term use. Instead, most use it to reduce symptoms and cravings during detox, and then to help with cravings throughout treatment. Users are expected to attend extensive therapy and counseling, to recognize problematic behaviors that lead them to drug use, and to learn to correct them. Many treatment centers also strongly focus on learning stress management through treatment like mindfulness, and work to repair family relationships so that the recovering addict can go home into a healthy environment, with no drugs.

An Ancillary to Treatment

Suboxone can aid in treatment a great deal. With some studies showing that patients given Suboxone are more likely to stay in treatment, and for longer – it has clear benefits for most users. However, it isn’t treatment. Many detractors fear that Suboxone will be used instead of treatment, enabling users to go home and remain addicts, but this very often is not the case. Suboxone is valuable as an ancillary to treatment, in addition to therapy, not replacing it.

Because drug use is often based on complex and multifaceted environmental factors, many treatment centers take a multifaceted approach, which tackles not just the physical addiction, but the mental and emotional problems behind it. With this in mind, medication like Suboxone can be extremely valuable, because it allows the user to learn how to cope and live without drugs, without forcing them to struggle with cravings at the same time.

This can enable many to remain in treatment, offer motivation, and ensure that they can focus on therapy and learn from it. After treatment is over, Suboxone should be tapered down until the user is able to function normally without it, without their addiction and without any medication.

While Suboxone is controversial, it is proving to be extremely valuable in the treatment of opioid addiction. With the potential to reduce death and disease, to help recovering addicts to stay in treatment, and to increase and improve the quality of treatment, it has a lot of potential in helping people to get their lives back. But, it shouldn’t be a permanent solution. Recovering addicts still need treatment and therapy alongside the medication so that they can get better on their own.

If you or someone you love is struggling with drug addiction or alcoholism, or you just have questions, please contact Lighthouse Treatment Center today. We are happy to provide a no-cost, no-obligation consultation with one of our experienced treatment advisors. Help is available today.