Frequently Asked Questions
- What is Suboxone?
- Why is Suboxone a Combination of two Medications?
- Is Suboxone switching from one to another Addiction?
- Is Addiction a real disease?
- How does Suboxone Treatment work?
- Is Suboxone Addictive?
- Wouldn’t just quitting be better than long drawn out treatment?
- Why is being Addiction-Free relevant, and being abstinent not?
- Is it harder to get off Suboxone than other Opioids?
- How long should I stay on Suboxone so I don’t get addicted to it?
- For how long should I stay in Suboxone treatment?
- Does Suboxone Show up in an Employer’s Drug Test?
- Is Suboxone just Harm Reduction?
- Why do some people consider Suboxone treatment controversial when it shouldn’t be?
- Is Suboxone the best Medical Treatment for Prescription Opioid Pain Pill, Heroin or Fentanyl Addictions?
- Why don’t people get Substance Abuse Treatment?
- What is Office Based Outpatient Opioid Rehab Program?
- Are there Treatments other than Suboxone?
- What is Sublocade?
What is Suboxone?
Suboxone is an opioid medication used to treat opioid addiction in the privacy of a physician’s office. It can be prescribed for take-home use for a month at a time. This, in addition to its pharmacological and safety profile, makes it an attractive treatment for opioid addiction.
At the correct dose, Suboxone suppresses cravings and withdrawal symptoms and blocks the effects of other opioids. To understand how it works you need to become familiar with these terms:
- Opioid Agonists are drugs that cause an opioid effect like heroin, Oxycodone, hydrocodone, and methadone.
- Opioid Antagonists are drugs that block and reverse the effects of agonist drugs. Narcan® is an antagonist and is used to reverse heroin overdoses.
- Partial Agonist Unlike full agonist opioids, Suboxone has a limit to its effects Suboxone can act as both an agonist and antagonist. It attaches to the opioid receptors but only activates them partially, enough to suppress withdrawal and cravings, but not enough to cause extreme euphoria in opioid-tolerant patients. When all available receptors are occupied with Suboxone, no additional opioid effect is produced by taking more.
This is called the ‘ceiling effect’. The antagonist property of the medication expels, replaces and blocks other opioids from the opioid receptor sites. Therefore, if the patient decides to misuse opioid drugs after taking Suboxone, the effects can be blocked, depending on dosage. Alternately, if taken too soon after other opioids, by an opioid-physically dependent patient, the Suboxone can precipitate withdrawal. The ceiling effect, blocking ability, and possibility of precipitating withdrawal, contribute to Suboxone having a favorable safety profile and helps lower the risk of overdose and misuse.
Why is Suboxone a Combination of two Medications?
Suboxone is actually a Combination of buprenorphine and another drug called naloxone. As noted, buprenorphine suppresses the debilitating symptoms of cravings and withdrawal associated with opioid addiction. Naloxone is a medication used to help prevent the abuse of Suboxone if it is injected intravenously.
If Suboxone is injected, the naloxone in it can help cause immediate withdrawal symptoms in opioid-physically dependent people. However, naloxone is poorly absorbed sublingually. Therefore, when taken as directed, very little naloxone enters the blood. Normally, patients are unaffected by the presence of it, and it is considered clinically insignificant. Suboxone itself can cause withdrawal in physically dependent people misusing full agonist opioids. Naloxone may only slightly attenuate the effects of Suboxone if misused by injection.
Is Suboxone Switching from One to Another Addiction?
Once stabilized on Suboxone, the loss of control of drug use, the constant cravings, the compulsive behavior and all of the other hallmarks of addiction vanish. When all signs and symptoms of the disease of addiction vanish, we call that remission, not switching addictions.
It is the uncontrollable compulsive behavior that we’re looking to stop, because that’s what’s destructive, not taking a medication. Switching addictions would mean you have lost control of your Suboxone use, continually crave more of it, and use it compulsively. Usually none of this is experienced by typical Suboxone patients, although it is possible and should be watched for. Instead most Suboxone patients don’t use it compulsively, don’t crave it, and have complete control of their Suboxone use.
Yes, a physical dependence to opioids remains and is maintained by Suboxone use, but physical dependence is not the same thing as addiction. It does not destroy lives, and is relatively easy to reverse with a slow taper off of the medication at the appropriate time.
With all the drug war propaganda we’ve been exposed to it’s easy to mistake the opioid epidemic as a drug problem when really it is the addiction that is destructive. We mustn’t make the mistake of ignoring evidence-based treatments because we think you have a drug problem and so taking a drug for a drug problem seems counterproductive. It’s not a drug problem, it’s an addiction problem and if a drug is needed to stop the addiction then we should accept this.
Is Addiction a Real Disease?
Addiction alters the biology of the brain in long-lasting ways. Abnormal changes to the biological structures of the brain have an effect on the functioning of the brain in negative ways. The functioning of any organ that is affected in a way which produces unhealthy results is called disease. Long-lasting changes in functioning are called chronic. This is why addiction is classified as a chronic brain disease. It has little to do with someone’s decision to take drugs, nor is it an excuse which absolves patients from all responsibility.
Instead, it refers to the unhealthy biology causing the abnormal relentless cravings. The action of seeking and using drugs is not the disease, that’s a choice, but it’s a choice which is influenced by diseased brain structures. The fact that anyone can choose to not take drugs for short periods of time does not prove addiction is not a disease because the cravings still remain and it’s unhealthy brain biology that is responsible for those cravings which is the disease.
How Does Suboxone Treatment Work?
The purpose of Suboxone treatment is to stop the debilitating symptoms of cravings and withdrawal, allowing a patient to engage in therapy, counseling and support services, so they can implement positive long-term changes in their lives. Patients develop new healthy patterns of behavior they need to achieve sustained addiction remission. Suboxone is only a small part of opioid addiction treatment and by itself would only serve to temporarily suppress symptoms of addiction that would likely resurface after stopping the medication. Recovery is the process of reversing and/or coping with the abnormal brain adaptations that cause disruptive addictive behaviors. Suboxone merely helps make this effort a real possibility by suppressing symptoms of addiction.
Is Suboxone Addictive?
Suboxone can be addictive when used by someone not addicted to another opioid, someone, Even in these opioid naïve individuals, the risk of Suboxone addiction is lower than compared to other opioids. To make the argument that Suboxone poses unusually high risk of addiction to justify the current restrictive public policy, you’d have to show that Suboxone has some sort of disproportional attraction to the opioid naïve than other opioids, and as just pointed out the opposite of that is much more likely.
To summarize, anyone already addicted to an opioid is not likely to become addicted to Suboxone, while anyone who decides to abuse Suboxone as their first opioid are nearly as likely to become addicted to it as they would some other opioid, although with less risk of fatal overdose.
Wouldn't just quitting be better than long drawn out treatment?
Medication Assisted Treatment, using Suboxone in conjunction with therapy and counseling, is not for people who can just quit and be done with it. Those people don’t need medication. Just as someone who can control their diabetes with diet and exercise doesn’t need insulin therapy, those who can just quit, and remain addiction free, don’t need addiction medication.
Suboxone is only for those who would relapse without it. With each relapse lies the risk of overdose death. Minimizing relapse with treatment reduces risk and saves lives. Clearly ongoing treatment is better than relapse. Even abstinence-only groups would agree with that, right? Once the patient can remain addiction-free without Suboxone can be tapered off of. No one is saying that those who can just quit and remain addiction-free should take Suboxone. It is for those who have tried just stopping but are unable to do so without relapsing.
Why is Being Addiction-Free Relevant, and Being Abstinent Not?
Opioid addiction is a deadly disease. Suboxone helps prevent overdose and saves lives. Opioid addiction is a major killer just like heart disease or cancer. Drug overdose is the number 1 cause of death of Americans under the age of 50. Suboxone helps prevent overdose and these overdose deaths.
Clean is a term created and used by abstinence only groups, and has no valid medical meaning. The term clean, has lost its meaning now that there are medications to treat addiction. We must recognize and accept that it often takes a medication like Suboxone to remain addiction-free. Suffering constant cravings and consequences from repeated relapses so that you can someday be judged “clean” is senseless.
What matters is stopping the uncontrollable cravings which lead to all the negative aspects of addiction. Reaching the status of clean is a distraction from what really matters to you and your loved ones. Being free from the cravings and compulsive behavior of addiction should be the goal, not whether you take a medication to achieve this. Don’t waste another minute of your life feeling guilt or shame if you want to use Suboxone. Don’t waste time wondering or worrying if you’re clean while in Suboxone treatment.
Is it Harder to Get Off Suboxone than Other Opioids?
It is not true that it is harder to get off Suboxone than other opioids. Addiction is a progressive disease that continues to get worse with time. Early on, before addiction really digs in, most opioid users can stop. have a few days of withdrawal and be fine afterwards. As the disease progresses, other symptoms linger for much long after the few days experienced early on. In the end, the person is unable to stop, yet the disease continues to progress. So if you were to stop, you would find that after the acute withdrawal ended in 3-5 days, other symptoms would last for weeks or possible months, but few patents can quit long enough to find this out.
It’s not until you are in Suboxone treatment and begin to taper that the extent of your addiction becomes evident. Suboxone is mistakenly blamed for the symptoms instead of the years of progressive addiction. You can’t compare a Suboxone taper with the early experience of being able to stop and be fine after a few days and assume the difference is due to the Suboxone.
The fact is, when dosed properly, Suboxone doesn’t make the situation any worse, and instead it stops the addiction in its tracks and prevents its progression. But, it doesn’t undo the damage that has been caused by years of addiction. So although a taper off Suboxone may be harder than before the addiction took hold, it’s not the Suboxone which is making it harder, in fact Suboxone makes it possible.
How Long Should I Stay on Suboxone so I Don't Get Addicted to it?
Stopping Suboxone too soon might be a tragic mistake. If two weeks of Suboxone is all you need, you probably never needed it in the first place. Understanding the differences between physical dependence and addiction is central to understanding why.
If you have not lost control of your Suboxone use, crave your Suboxone constantly or use your Suboxone compulsively you are not addicted to Suboxone.
If you’ve been diagnosed with opioid addiction, you don’t have to worry about becoming physically dependent to the Suboxone because you already are. Your brain can’t easily distinguish between which opioid it develops tolerance and physical dependence to. In other words, you don’t end one dependency and start another when you go on Suboxone. Instead the physical dependence is continued while on any opioid, even while in Suboxone treatment. This is not a problem because the addiction (the loss of control, inability to control use, and cravings) is successfully blocked.
While symptoms of addiction are suppressed, it’s important to address the brain adaptations causing the uncontrollable cravings of addiction, although the effects are blocked the brain adaptations still remain. Making life changes and gaining experience living with those changes rewires the brain. This takes time, much longer than a few weeks. Once that’s done however, you’ll be able to deal with the physical dependence with a slow Suboxone taper. Without making these important changes, after the cravings will come back after the taper, and you will have only temporarily stopped the addiction.
The main point here is that addiction is bad and physical dependence is just an inconvenience. Understanding the difference is necessary for success. People generally don’t lose control of their Suboxone use (addiction) and the physical dependence is deliberately maintained. So although you should be aware of the risk of addiction to Suboxone, it is unusual and should not be a reason to stop treatment early, unless in the unlikely event signs of addiction (lose of control, cravings, compulsive Suboxone use) begin to develop and cannot be alleviated.
For How Long Should I Stay in Suboxone Treatment?
As with other conditions, treatment with Suboxone should continue until it is no longer necessary, is no longer effective or its side effects outweigh its benefits. To determine if it is necessary you have to first understand what Suboxone is supposed to do.
Experts recognize that opioid addiction is a major killer just like cancer or heart disease. Drug overdose is the number 1 cause of death of Americans under the age of 50. Suboxone helps prevent overdose and these overdose deaths. It does this by preventing opioid induced respiratory failure and cardiac arrest. It blocks symptoms of cravings and withdrawal so that you can make the necessary changes in your thinking, behavior and environment that are the key to recovery. It is these changes that will affect the biology of the brain and in time help your brain return to a state in which it does not crave drugs. So to determine if the Suboxone is still necessary you need a way of assessing if your effort of change has been substantial enough to enter the medication-free stage of treatment.
It can take years before you are ready to stop taking Suboxone. If your brain biology is permanently affected or your life remains unmanageable you may need to be on Suboxone for life. So what, it is much better than any other alternative.
Relapse and drug use is the rule, not the exception. Overdose and drug death is not planned, it happens. Stopping Suboxone too soon increases the risk of relapse, overdose and death. The goal of treatment should be safety from overdose and death and your chance to lead a happy and productive life, not abstinence. Abstinence is not addiction free. You can be “clean” and still have strong uncontrollable cravings, and your life can still be chaotic and unmanageable.
You have to look at the changes you’ve made to determine if your life is significantly different than it was while in active addiction. You have to consider if you have eliminated sources of stress, anxiety, and depression or other things which could put you at risk of relapse. If your life has become manageable, a slow taper over month can begin with the understanding that the taper will be paused if strong cravings return. If you have been successful you will be able to manage any cravings. In time you should be able to taper down to very low doses and completely stop.
Results showed that approximately 49 percent of participants reduced prescription painkiller abuse during extended (at least 12-week) Suboxone treatment. This success rate dropped to 8.6 percent once Suboxone was discontinued..
“The study suggests that patients addicted to prescription opioid painkillers can be effectively treated in primary care settings using Suboxone,” said NIDA Director Nora D. Volkow, M.D. “However, once the medication was discontinued, patients had a high rate of relapse — so, more research is needed to determine how to sustain recovery among patients”.
Does Suboxone Show up in an Employer’s Drug Test?
There is a specific drug screen for Suboxone and it still isn’t commonly included on standard drug screening panels. Suboxone will not cause a positive result on tests for other opioids. The typical urine tests used to detect methadone, oxycodone, heroin, and other opioids check for a different metabolite than that found with Suboxone and will not show a false positive result for Suboxone. Most employers are not likely to know this and may think they are testing for it with the opioid panel.
Suboxone can be detected with drug screens for about 7-10 days at typical doses, although this could vary considerably with much higher or much lower doses.
Is Suboxone Just Harm Reduction?
Sometimes Suboxone treatment is incorrectly classified as harm reduction and frowned upon by some judges on moral grounds. The harm reduction label downgrades the treatment by implying it enables ongoing drug use though in a more controlled, safer way. But harm reduction is not treatment. Harm reduction is something else and shouldn’t be applied to Suboxone when used for the treatment of opioid addiction.
According to Harm Reduction International ‘Harm Reduction’ refers to policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community.
While harm reductionists recognize that some people need treatment for their addictions, the main focus of harm reduction is on those who are not experiencing severe enough consequences of opioid use to outweigh the desire to continue to use. Not everyone who uses opioids becomes addicted and the harm reductionists advocate for this group and try to minimize both the legal and health consequences to make occasional or ongoing drug use safer.
Drug prohibitionists view harm reduction as a slightly lesser form of an evil. They hold an ethical antagonism to the concept of harm reduction. Some judges prefer patients endure a significantly higher risk of death than enroll in what they believe is a harm reduction program. We see this in some states where Suboxone treatment is forbidden by courts, as it is seen as some sort of legalized addiction. Someday people will shamefully look back on this the same way we now look back on the treatment of witches in Salem.
It is incorrect to describe Suboxone treatment for opioid addiction as Harm Reduction. Suboxone treatment is not harm reduction as defined by the harm reduction movement. While Suboxone treatment literally reduces harm, it is not intended as a way to assist ongoing recreational drug use. Instead Suboxone is a way to ending addictive behavior by blocking withdrawal and cravings, and it helps a patient make substantial life changes that will in effect rewire an addicted brain back to normalcy.
Why do Some People Consider Suboxone Treatment Controversial when it Shouldn’t Be?
Simply put, it’s because some people don’t understand it. Opponents of Suboxone have a shared confusion that Suboxone is merely switching one addiction for another even though legal and controlled. They see it as a means to allow or encourage weakness by letting people indulge in negligent selfishness instead of taking responsibility and stopping. They view Suboxone as a way to evade action rather than action itself. This damaging attitude comes from not only a misunderstanding of Suboxone but a misunderstanding of addiction itself.
Those who don’t bother to study or easily dismiss the current body of evidence conclude that addiction is just lack of willpower, bad choices, or reluctance to see the damage being caused. They often are convinced that addiction treatment consists of convincing people that drugs are bad and that they should just stop, and they want to punish those who can’t or won’t. They see punishment as a reminder that drugs are bad, and shouldn’t be used, as if this isn’t already known.
Not until addiction is understood as a brain disorder, and cravings are identified as the manifestation of this brain disorder, can suppressing cravings be seen as a reasonable tactic. Once addiction is understood as a craving-causing brain abnormality (caused by chronic non-medical use of opioids in this case) suppressing cravings which allow the behavioral changes to reverse some of those brain changes, begins to make sense.
Suboxone treatment stops opioid addiction in its tracks, greatly reduces the chance of accidental overdose death, increases survival rates. Suboxone allows people to return to work, repair relationships, and improve their quality of life. It also assists in making profound behavioral changes which in time can reverse the craving-causing brain adaptations of addiction. Eventually, the patients may no longer require the medication to remain addiction free and taper off.
Anyone who would characterize this kind of lifesaving treatment as controversial clearly has no understanding of it.
Is Suboxone the Best Medical Treatment for Prescription Opioid Pain Pill, Heroin or Fentanyl Addictions
When both benefits and risks are considered, current scientific evidence shows Suboxone overall superior to Methadone and Vivitrol (intramuscular naltrexone).
Although the FDA has approved Suboxone, Methadone and Vivitrol for Medication Assisted Treatment of opioid addiction,
Compared to methadone, Suboxone is:
- As effective as in preventing opioid cravings and relapses;
- Far better tolerated by patients;
- Causes minimal cardiac problems and is not associated with serious adverse medication interactions;
- Prescribed in the privacy of a physician’s office for up to 1 month at a time not dispensed in government regulated clinics that usually require daily visits.
Compared to Vivitrol, Suboxone is:
- As effective as in preventing opioid cravings and relapses;
- Much better tolerated by patients;
- Causes less severe prolonged addiction withdrawal syndrome (PAWS);
- Can be safely prescribed during pregnancy.
Note: There are many benefits to Suboxone compared to the other medications, most importantly safety:
- People can overdose on Methadone and the risk of overdose is more than 4 times the risk of overdose on Suboxone.
- Naltrexone is associated with 8 times the risk of overdose after patients stopped using Vivitrol treatment when compared to Suboxone or Methadone treatment.
Studies have also shown that opioid addiction treated by long term Suboxone significantly reduces deaths from all cause and overdose mortality and significantly improved quality-of-life ratings with maintenance treatment.
- Suboxone maintenance has been found to be superior to detoxification alone in terms of treatment retention, adverse outcomes, and relapse rates;
- Patients on Suboxone had reduced rates of HIV and hepatitis C transmission compared to abstinence-based therapy or detoxification alone;
- Maintenance buprenorphine was also associated with better hepatitis C treatment outcomes.
Methadone is an opioid. It is a stronger pain reliever than Suboxone because it doesn’t have the same ceiling effect as Suboxone. Patients with chronic pain, often the reason which drove them to opioids, can benefit from this effect of methadone.
Naltrexone is more of an anti-relapse approach than it is a treatment for addiction. Unlike Suboxone it doesn’t suppress cravings caused by the biological adaptations of addiction. Because it makes opioids ineffective, it can short circuit the inner dialog of “should I or shouldn’t I take opioids”.
It can be particularly effective for those who have completed treatment with Suboxone and want an added safeguard
Why Don’t People Get Substance Abuse Treatment?
The primary reasons people do not want to go to substance abuse treatment are:
- They will be disrespected as individuals,
- Abstinence will be forced upon them whether they choose it or not, and
- Spirituality will also be forced upon them.
~ Kenneth Anderson, CEO Harm Reduction Network
What is Dr. Kittay’s Office Based Outpatient Opioid Rehab Program?
Office Based Outpatient Opioid Rehab Program is a form of addiction treatment that includes Suboxone, Addiction and psychiatric treatment with Dr. Kittay, psychological and addiction counseling and educational sessions on the nature of addiction.
It is helpful for individuals who:
- are highly committed to recovery, have a stable, supportive home environment and who can handle living/working at home during the period of treatment;
- have tried to quit using opioids on their own but can’t;
- have been through detox and/or residential rehab but continue to relapse;
- have overdosed and are therefore at very high risk for a repeat overdose and possible death and can’t afford risk of abstinence-based 12 step rehab followed by relapse.
All services are in your community. Your treatment does not interrupt daily routines or interfere with obligations. You recover at home, in your comfort zone, while you continue to work, attend school, or care for your children. You recover in the real world.
Are there Treatments Other than Suboxone?
Abstinence-only treatments aren’t really treatment at all, but the absence of treatment. There really isn’t a choice between abstinence and Suboxone because if you can just quit and be abstinent you don’t even need to consider Suboxone. Suboxone is only for those who cannot remain abstinent on their own.
Detox treatments are usually ineffective because although opioids are out of the system, the brain changes of addiction remain and continue to cause cravings.
Inpatient treatments are sometime needed if outpatient treatment has failed. However, it can be a huge waste of money and time to go to an inpatient resort unless far less expensive outpatient treatment has already been ruled out.
Remember, the whole point of addiction treatment is to make changes in behavior. If a few week or 30 days of change is followed by a return right back to the same situation as before, chances are relapse is going to occur.
Inpatient treatment should only be considered if the current living situation is extremely detrimental to recovery and there is a plan in place to change that after the inpatient stay. Since taxpayers and insurers are now on the hook for inpatient addiction treatment, many new addiction treatment facilities have sprung up, many without any regard to evidence-based practices.
Twelve step groups can be used with any treatment option. It’s important to understand the role of 12 step groups. They are not a treatment but a form of support that helps maintain motivation and make behavioral changes. Thinking twelve stepis a form of treatment and pitting it against medical treatments such as Suboxone is a mistake. It can and should be used in conjunction with Suboxone treatment whenever possible. Peer support is important and twelve step is just one example. Online support forums are another form of peer support.
What is Sublocade?
Sublocade is a once monthly subcutaneous medication, which contains an extended-release form of buprenorphine, the active ingredient found in Suboxone. A month’s supply of Sublocade is easily and painlessly injected under the skin where it is slowly released back into the body.
Sublocade prevents opioid cravings, withdrawals, and blocks the euphoria associated with opioid misuse. Most importantly, Sublocade prevents opioid overdose and overdosed deaths.
Sublocade is safe and easy to use. Because it is a monthly medication, abuse and diversion are avoided. There is no danger of taking more than prescribed. Overdose and death is not a concern. There is no risk of Sublocade getting into the wrong hands. Dealing for other drugs is impossible, and the danger of children accidental ingesting it is no longer a worry.
People are usually started on Suboxone, and then easily and comfortable transitioned to Sublocade without having to go through any withdrawal. It is prescribed for moderate to severe opioid dependence. Sublocade is safely and comfortably administered in the privacy of a physician’s office.
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