The use of Suboxone is becoming one of the most common ways to treat an opioid addiction. With its ability to help lessen the effects of opioid withdrawal and a “high” that is far less intense than other addiction treatment options, this drug is being used more and more each day.
While the benefits might seem too good to be true, the fact is that Suboxone, when used improperly, can cause a host of problems on its own. What’s more, long-term Suboxone treatment plans can lead to the development of tolerance, dependence, and eventually addiction.
Conversely, when Suboxone is used in tandem with other treatment methods and is only utilized on a short-term basis, it can be quite effective and safe at treating opioid addiction.
In order to better understand the superiority of short-term Suboxone use, it’s best to know a little bit about the drug itself.
All drug facts come from the Mayo Clinic and MedlinePlus as well as the Substance Abuse and Mental Health Services Administration’s (SAMHSA) information on buprenorphine and naloxone.
What is Suboxone and How Does It Work?
Suboxone is a brand name of a specific drug and is not an actual chemical itself. Instead, it’s composed of two separate drugs called naloxone and buprenorphine and is used primarily in the treatment of opioid addiction.
Both naloxone and buprenorphine play crucial roles in the treatment of opioid withdrawal symptoms which can be quite excruciating. Naloxone, for instance, is most commonly used independently to reverse opioid overdose. This is because it is an opioid antagonist. As such, it can bind to opioid receptors and block the transmission of opioids throughout the brain (hence the antagonist).
In an overdose situation, then, naloxone can stop the opioid receptors from bringing in more opioid agonists (chemicals that stimulate such receptors) and help return the body to increased functioning, especially with regards to respiration.
Buprenorphine works a bit differently. This chemical is classified as a synthetic partial opioid agonist. In contrast to naloxone then, buprenorphine attaches to and stimulates the opioid receptors but only partially. The result is an ability to dampen the withdrawal symptoms from opioids without causing the same euphoria and sedation as full opioid agonists. When combined with naloxone, the effects are even further decreased, thereby limiting the potential for abuse.
How to Take Suboxone
Suboxone can be taken in one of several ways. Patients undergoing addiction treatment can use a sublingual tablet that is placed under the tongue and then allowed to dissolve completely. It also comes in the form of a buccal or sublingual film that is placed inside the cheek or under the tongue respectively. These films then deliver small doses of buprenorphine and naloxone as they dissolve over a 10-minute timespan.
The pill form of Suboxone is more common in treatment plans that prefer short-term use of Suboxone while the films are typically used in long-term treatments.
The dosage for Suboxone will be determined by your physician and should be adhered to at all times. Taking Suboxone outside of the recommended dosages could result in the development of tolerance, dependence, and addiction.
Why Was Suboxone Developed?
Suboxone is first and foremost a treatment option for decreasing the severity of opioid withdrawal symptoms. As a combination of both an opioid antagonist and a partial opioid agonist, Suboxone is an effective way of helping patients overcome some of the initial stages of withdrawal which are often the worst. Such symptoms include:
- Painful muscle aches
- Incessant yawning, sweating, and runny nose
- Severe cramping
The symptoms of opioid withdrawal have been described as extremely uncomfortable and sometimes excruciating. This severity is, in fact, one of the main reasons that many opioid addicts return to using within the first stages of detox. The National Institute on Drug Abuse, for instance, reports that 40 to 60% of the people treated for substance abuse will relapse.
Suboxone has also been shown to be more effective at keeping up retention numbers at opioid treatment centers than some other medications. Retention when using clonidine, for instance, dropped from around 45% on day 3-4 to around 25% on day 13-14. With buprenorphine-based treatment however, rates of retention went from around 70% to almost 80% in the same time span according to the National Institute on Drug Abuse.
With results like these, it’s no wonder some treatment centers swear by this drug and think it might be one of the best ways to treat opioid addiction.
The Opioid Epidemic
Another reason for the meteoric rise of Suboxone treatment is the growing opioid epidemic in the United States. Of all the drugs on the market today, opioids are responsible for more addictions and overdoses than any other substance. In fact, over 60% all overdose deaths can be attributed to opioids according to the Center for Disease Control.
And these numbers are on the rise. Recent estimates from NIDA put worldwide opioid abusers at around 26.4 million to 36 million. Beyond that, 467,000 Americans are suspected to have a heroin use disorder and a shocking 2.1 million people are estimated to have a prescription opioid pain reliever use disorder.
How did the problem get so bad? Part of it has to do with improper prescription guidelines. In a survey conducted by the U.S. National Safety Council, about 75% of physicians that participated reported that they would prescribe opioids in a situation that only called for over-the-counter pain relievers. What’s more, 70% said they would prescribe narcotic painkillers for conditions like back pain even though this isn’t considered to be the proper course of treatment according to the safety council.
Beyond the tendency for physicians to overprescribe opioids in today’s healthcare landscape is the fact that opioids are incredibly addictive already. As such, even individuals that aren’t seeking out substances to abuse may unintentionally become addicted to these types of painkillers, even if they end up following their doctor’s orders to a T.
The Pitfalls of Long-Term Suboxone Use
With all the seemingly great benefits to taking this drug during opioid detox combined with the growing opioid epidemic, the question becomes, “What’s the problem with taking Suboxone?” The controversy surrounding the use of Suboxone exists for several reasons.
First, many physicians and treatment centers believe that using a technical opioid to treat addiction is irresponsible and ineffective. Part of their concern is due to the fact that Suboxone and more specifically buprenorphine can become a highly addictive drug since it’s actually an opioid. In essence, using Suboxone to treat addiction is trading one type of substance use disorder for another. Many clinicians argue that doing so does not help get to the root of addiction.
This is particularly true when it comes to long-term treatments using Suboxone. Chronic abusers of opiates are oftentimes put on such long-term treatment plans in order to mitigate the risk of relapse due to their drug use history. These treatment plans can last anywhere from a few months all the way up to several years.
While continued use of Suboxone may keep an individual from using again for much of and even all of this time, they are still physically dependent on an opioid. As such, they are not moving closer towards a drug-free lifestyle which, many argue, is the point of addiction treatment in the first place.
What’s more, a study from Johns Hopkins University showed that the average length of time patients took buprenorphine was just 55 days, after which may returned to using opioids. Without supplemental treatment methods, it seems that even a reduction in withdrawal symptoms isn’t enough to ensure abstinence from using again.
Long-Term Use Results in More Abuse
Another problem with using Suboxone as a core tenet of a long-term treatment plan is the increased risk of abusing the drug. For instance, a report released by SAMHSA showed that hospital visits involving buprenorphine increased from 3,161 in 2005 to an astounding 30,135 in 2010.
Drug manufacturers first included naloxone with buprenorphine treatments in order to serve as a deterrent for injecting the drug. Doing so will not only result in a diminished high, it will also immediately bring on withdrawal symptoms, also known as precipitated withdrawal. However, some users have found ways of isolating the beneficial effects of abusing Suboxone and circumventing this safeguard.
While many physicians prescribe Suboxone in order to transfer the patient’s addiction from a more harmful drug, the truth is many users are actually using Suboxone to maintain their prior addiction as well. As the National Pain Report points out, some addicts will simply use their drug of choice and then use Suboxone between highs in order to lessen the degree of withdrawal. As such, Suboxone is actually making their addiction more convenient.
Short-Term Suboxone Treatments
Rather than trading one addiction for another like with long-term Suboxone treatments, opioid addiction programs should rely on short-term administering of Suboxone under the guidance of a medical professional. Short-term use (around a month) can help patients deal with the initial effects of opioid withdrawal which are generally the most prevalent reason for using again in the first place.
Short-term Suboxone treatment should also be paired with tapering off of the drug rather than immediate cessation. Doing so can help to lessen the effects of withdrawal and make relapse far less likely. Tapering should only be done by a qualified medical professional.
Since Suboxone is being used for a short amount of time, it’s crucial to the success of the patient’s recovery that additional treatment methods are used at the same time. These types of treatments should focus primarily on what caused their substance abuse in the first place. Was it emotional stress? A hostile home life? Isolation and loneliness? Tackling the core issues that led to abuse can help to ensure that once the physical effects of addiction aren’t felt any longer, they won’t resort to using again due to unresolved issues in their lives.
What’s more, such supplementary therapies can help patients cope with additional life stress that might have driven them to use again otherwise. Some treatment centers focus on relaxation techniques like breathing exercises or mindful meditation. Others might instruct patients in recognizing and becoming better acquainted with their unconscious reactions to situations through cognitive behavioral therapy, giving them the knowledge they need to expect such reactions and choose not to act on them.
As an opioid seeking help for your addiction, it’s up to you to take the proper steps for finding the right kind of help for your situation.
Opioid addiction is one of the most destructive use disorders known today. The substance is highly addictive, widely available, and is incredibly dangerous and possibly fatal. It seems at first glance, then, that any method of curbing such addiction should be used with little to no hesitation.
While Suboxone can be an immensely helpful medication to take during the detox phases of opioid addiction treatment, the probability for abuse, likelihood of addiction, and the diversion from a drug-free life that come with long-term Suboxone treatments make it a poor rehabilitation option.
Instead, a combination of short-term Suboxone therapy for treating the initial opioid withdrawal symptoms and additional treatments such as talk therapy, counseling, stress management, and cognitive behavioral therapy is by far the better option for lifelong abstinence and permanent drug addiction relief.
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