Have you heard of the new miracle drug that's going to solve America's opioid epidemic? No, we haven't either. There is a relatively new medication, however, that is making a major difference in the lives of millions of opioid addicts. If you bring up the topic of Suboxone in mixed company, you may notice some extreme and polarized reactions to its use in addiction treatment settings.
"[Suboxone] made me feel normal. It lifted the physical obsession and cravings for me... It is not to be used lightly, but it saved my life. I would be dead without it." --Kristen Johnston
While Suboxone is not exactly a modern miracle, it is the first medication of its kind. Some recovering addicts swear by it, like '90s TV star and author Kristen Johnston. Certain medical experts, on the other hand, insist that the drug causes as many problems as it solves.
"[Suboxone] is the new methadone... If you had an opiate addiction, would you be using this stuff? No, you'd be in therapy and doing it opioid-free." -- Dr. Drew, Celebrity Rehab
As you can see, there are mixed opinions on the use of Suboxone film to treat opioid addiction, even within the drug treatment community. What makes this drug so controversial, and which opinion is the right one? Keep reading to get the truth on Suboxone - the good, the bad, and the scary.
Buprenorphine - a synthetic opioid that can reduce opioid withdrawal symptoms and soothe pain without causing the same level of euphoria as a true opioid drug.
Naloxone - an opioid blocker that prevents opioids from having any effect on the brain and body, reversing their effects and cancelling out euphoric feelings.
But aren't they opposites? Yes, exactly; buprenorphine and naloxone are opposites but can work together to trick the brain into thinking it is getting a dose of opioids while, at the same time, blocking the user from getting a full-on "high" or feelings of euphoria. Genius, right?
Right, but the problem lies in the effectiveness of the drug. Suboxone can make a long-term heroin addict feel "normal" again, but it can also be habit-forming in and of itself. This is the dilemma that we'll explore in this article.
Suboxone is one medication used in addiction treatment protocols like opioid replacement therapy (ORT) and medication-assisted treatment (MAT).
It is designed to relieve some of the most painful symptoms of opioid withdrawal and reduce cravings while conditioning the brain to function without opioids. This is how it works:
Since Suboxone is a psychotropic drug with its own risks and side effects, it is intended to be used temporarily as a way for opioid addicts to wean themselves off of substances without going through the harrowing and dangerous effects of full drug withdrawal. Long-term use of Suboxone may have negative consequences.
Although these side effects may not affect everyone, here are some things you might expect with consistent use of Suboxone:
Long-term use can cause severe psychological problems like depression, anxiety, and social isolation.
Suboxone is not a medication to take with other medicines. It interacts negatively with many other medications, potentially losing effectiveness or causing unpleasant side effects, even overdose. Some common prescriptions like Tylenol, birth control, antidepressants, and anti-anxiety pills are all examples of medications NOT to take with Suboxone. You should ask your doctor before taking any other meds with Suboxone, but these especially are known to have bad drug interactions with the medication:
Suboxone is administered as a sublingual film - a thin strip that dissolves when it is placed under the tongue. Other brands and generic forms of the drug do exist, such as Bunavail and Zubsolv; these are administered in much the same way.
Although it is possible to take a Suboxone dosage of up to 32 mg of the medication in one day, mostly people only need between 8 and 16 mg to stave off opioid withdrawal symptoms. The lower the dosage to start, the faster you can taper off of it.
This concept of weaning off of Suboxone, or tapering, is known as a Suboxone maintenance program. The dosage, administration, and tapering of Suboxone is a tricky process that must be undertaken carefully under the strict supervision of a Suboxone doctor. If the dose is too high, you may have a much more difficult time weaning off of it, or if the tapering process is not managed well, you could experience severe withdrawal symptoms that make relapse more likely. A carefully administered maintenance program could be the difference between Suboxone treatment and Suboxone addiction.
The length and rate of the Suboxone tapering process will be dependent on the amount of the dosage you take daily and your own personal reaction to the medication. Some people experience unpleasant side effects if they take too much Suboxone, while others need a relatively high dose to manage opioid withdrawal symptoms. Your own experience with Suboxone will have an effect on your dosage and the rate at which you can taper off the drug.
Most experts recommend reducing Suboxone intake by means of a carefully tailored maintenance plan that is overseen by a medical doctor with a specialty in addiction treatment. Usually, an effective tapering plan will last somewhere between 21 days and 3 months. This is usually doable, especially if you're starting out with a low dose. For example, one method is to lower your dose every four days until you've reached 0.5mg. So if you start with 8mg of Suboxone per day, your tapering process would look something like this:
Start: 8mg, Day 5: 4.6mg, Day 9: 2.6mg, Day 13: 1.5mg, Day 17: 0.9mg, Day 21: 0.5mg
After you've taken 0.5mg for a few days, you should be ready to stop taking Suboxone altogether without experiencing intense withdrawal symptoms.
Of course, if you were recommended to start with 16mg per day, the process would be more intense:
Start: 16mg, Day 5: 8.0mg, Day 9: 4.0mg, Day 13: 2.0mg, Day 17: 1.0mg, Day 21: 0.5mg
As you can see, the percentage of change is about the same from one dose to another, but the changes are more significant. The same is true of a long-term tapering plan. If you choose a longer tapering route, one recommendation is to decrease the dose by 25% every 10 days. The plan will take longer, but will still result in some withdrawal symptoms each time the drug is tapered down. The higher the dose you start with, the more noticeable those symptoms will be.
For this reason, starting with a higher dose can lead to more withdrawal symptoms during the tapering process and a more unpleasant experience overall. Long story, short; take as little Suboxone as possible from the start in order to make your journey to sobriety a little less rocky.
MAT is a lot more than just throwing medications at an addiction. One of the question we hear most often is, "Why use opioids to treat opioid abuse?" It's a good question.
The reason opioids are used to treat opioid addiction is simple: opioid withdrawal is absolutely, positively excruciating.
It is so excruciating, in fact, that few people can withstand it without help. Help can come in many forms, but one way to make it more bearable is to supplement the withdrawal process with weaker, less-addictive synthetic opioids. There are several methods to undergo this process. The most well-known is ORT.
Opioid replacement therapy (ORT) refers to any program that provides patients with synthetic opioids like methadone or Suboxone to reduce opioid withdrawal symptoms. Some facilities offer ORT as part of a larger, more comprehensive drug treatment program while others, like most methadone clinics, simply hand out the ORT medications on a certain schedule and let the patients manage their own recovery process.
Medication assisted treatment (MAT) refers to the more comprehensive type of program that offers prescription medications to ease withdrawal symptoms while also providing patients with a variety of therapeutic activities, psychiatric evaluations, and addiction counseling.
According to the American Society of Addiction Medicine, MAT is more effective at helping people reach sobriety than either ORT or counseling therapy on its own. A MAT program may include any combination of the following therapies:
Suboxone is often compared to methadone, a synthetic opioid that has been used in ORT treatments since the 1970s. If taken as directed, methadone does not produce a euphoric high in an addiction treatment setting, which makes it useful for managing drug withdrawal symptoms.
Methadone and Suboxone are two very different substances, however; here are the major distinctions:
Suboxone may be addictive on several levels. For those who take it as directed, Suboxone can help a long-term opioid addict to achieve a level of normalcy that they haven't experienced in years. This feeling of well-being and functionality can make past addicts feel that they cannot live without Suboxone, since it soothes cravings and withdrawal symptoms so well. Someone like this will become so comfortable taking Suboxone that when they start to taper and experience some mild withdrawal symptoms, they may give up quickly and go back to their previous dose. This will lead to long-term usage of Suboxone and eventually, addiction.
Another more dangerous way that Suboxone can be addictive is with abuse. How do people abuse Suboxone? One way is to take more than the recommended dose. Some patients may be recommended to take 8mg but choose to take 32mg instead in hopes that increasing the dose will cause feelings of euphoria. Increasing the dosage will make prescriptions run out faster, prompting users to buy Suboxone on the street, another slippery slope that only leads to further abuse and addiction.
Another method of Suboxone misuse is its use as a heroin dose in-betweener. Most heroin and opioid addicts know about Suboxone withdrawal-delaying merits; they buy it on the street to take in-between doses to stave off withdrawals. This is the opposite of what the medication is intended for and, when used in this way, it enables addicts to maintain their habit without suffering the effects of drug withdrawal in-between drug scores.
The only other way to abuse Suboxone and bypass the unpleasant effects of the naloxone in the drug is to dissolve the sublingual films in water and inject the resulting solution. This dangerous practice results in a quick addiction because of the euphoric effects of intravenous buprenorphine. Injecting Suboxone in this way is highly dangerous; most overdoses of Suboxone have been caused in this way.
Despite every effort of the manufacturer, yes; Suboxone can get you high, if not nearly as high as other full-agonist opioids. Especially when taken in higher-than-recommended doses, or when dissolved in water and injected, the buprenorphine in Suboxone can create feelings of euphoria. Even when abused, the Suboxone high will not be as strong as that of heroin, hydrocodone, or other full-agonist opioids, but it is certainly strong enough to temporarily satisfy opioid cravings until the user can find their next fix.
When used this way, Suboxone is not only highly addictive, it can cause very severe withdrawal symptoms after the supply runs out.
The Suboxone half life is very long in comparison to most opioids - about 24 to 42 hours. This is one reason it works so well in addiction therapy settings; one dose will continue working for one or two days. In the case of drug tests, however, Suboxone can only be detected in saliva and blood for up to 24 hours, and in urine for 7 to 10 days. If you're undergoing Suboxone treatment and need to take a obligatory drug test for work, Suboxone could show up on a drug test as buprenorphine, but it will not show up as an opioid.
Because of its long-lasting properties, Suboxone withdrawal may last longer than other opioids if you have developed a dependence to the drug, especially if you quit cold turkey. Depending on the severity of the addiction, some symptoms of Suboxone withdrawal can last up to a month.
Suboxone withdrawal is known for being a particularly harrowing experience, much as it is with other opioids. In fact, if you choose not to taper off the drug and quit cold turkey instead, it may feel even more severe and last longer than the average opioid withdrawal. This is the Suboxone withdrawal timeline of symptoms:
First 72 Hours:
Day 4 - Day 7:
Week 2 - Week 4:
Although some of the psychological symptoms listed above could continue for months after detox, other withdrawal symptoms will subside after the third or fourth week. Severe drug withdrawal symptoms can seem unbearable and are often the main cause of relapse. This is why it is recommended that Suboxone be tapered off carefully and slowly, to prevent the withdrawal symptoms from becoming too painful and unpleasant. A tapering process will prevent most withdrawal symptoms from progressing past a mild discomfort.
Suboxone addiction may be tricky to recognize in some cases. On one hand, if it was prescribed to you by a doctor and you continued to take the medication for months at a time, it may not seem like a problem. After all, the doctor gave it to you and you're staying off of illicit opioids, so it's not so bad right? Unfortunately, it could be an addiction.
The most obvious sign of Suboxone addiction would be a misuse of the drug. If you're taking more than the recommended dose, mixing it with other substances, or dissolving the film strips into an injectible solution, you already know it's a problem. Other signs may be more subtle.
If you've been taking Suboxone for more than a few months as directed but have been unable or unwilling to taper it off, this could also be a sign of addiction. Here are some other indicators of Suboxone addiction or abuse:
If you recognize any of the signs or symptoms above in relation to your use of Suboxone, it's likely that you have a dangerous dependence to the medication. For your own health and safety, it is time to seek the help you need to taper off the medication in the safest way possible. Call an addiction hotline now to get started, or keep reading to find out more about getting clean from Suboxone.
Polysubstance abuse is dangerous with any drug, but especially so with Suboxone. Just as when it is mixed with other medications, Suboxone reacts strongly and negatively when combined with illicit drugs or alcohol. First is the presence of naloxone in Suboxone which is intended to discourage concurrent use with other opioids. So, if you were to mix Suboxone with say, heroin, the results could be quick and incredibly unpleasant. The naloxone could interact with full-agonist opioids like heroin to create instant and severe opioid withdrawal symptoms like vomiting, diarrhea, muscle cramps, flu-like symptoms, or worse.
The second negative consequence of mixing Suboxone with other opioids is the double-slowing effect that buprenorphine and other opioids would have on the central nervous system (CNS). Both buprenorphine and other opioids slow CNS functions like breathing and heart rate. If stacked on top of eachother, these effects would be amplified to the point that the combination could cause overdose, coma, or death.
Mixing Suboxone with alcohol would have a similar double CNS-slowing effect; the combination could easily result in overdose or death. The FDA has warned strongly and clearly against combining the two substances.
Finally, other substances like stimulants, club drugs, or cocaine can also interact negatively with Suboxone. For one thing, any drug that acts as a stimulant could reduce the effectiveness of Suboxone, blocking its ability to stave off opioid withdrawal symptoms. If this happens, the user may enjoy a short polysubstance high before feeling the symptoms of opioid withdrawal kick in shortly after. Also, buprenorphine is essentially the opposite of a stimulant and could cancel out the euphoric effects of stimulants like cocaine. This could lead the user to consume entirely too much cocaine, to the point of overdose, without realizing how much they were taking.
No matter which substances you try to mix it with, you'll never win by mixing Suboxone with other drugs. This will always be a terrible and incredibly dangerous idea.
If you have repeatedly tried to quit abusing opioids "cold-turkey" without attaining long-lasting sobriety, you may be considering MAT with Suboxone. Perhaps you are hesitant to start because of everything you've heard about Suboxone addiction, which is only natural. Suboxone can be addictive; its use as addiction therapy should be considered very carefully and only with medical supervision. Northpoint Recovery does not offer never-ending, indefinite prescriptions to Suboxone. We offer tapering plans to help patients wean off of the medication as quickly as possible. Here are some patient tips for anyone considering a Suboxone maintenance program:
With a little professional help and medical supervision, you can complete a Suboxone maintenance program and attain total sobriety without forming a long-term addiction to the medication.
If a Suboxone addiction has already set in, the game is far from over. A quality drug rehabilitation facility can help you to find the path to recovery, no matter how severe or long-lasting the addiction is. The process will not be easy, however. Even if your Suboxone dosage has been carefully monitored and maintained, a long-term Suboxone dependence will result in unpleasant withdrawal symptoms when the medicine is tapered off. The first step will be a drug detox period.
Quitting Suboxone cold-turkey is highly discouraged because of the severity of the withdrawal symptoms. Especially if the drug has been abused by injecting it or taking higher-than-recommended doses, the withdrawal symptoms could be acute to the point that they present a real bodily danger.
However, after a full-blown Suboxone addiction has set in, even tapering it off slowly will cause withdrawal symptoms. The severity of those withdrawal symptoms will depend on how the medication was being abused and how long the addiction has been going on. In order to manage Suboxone withdrawal symptoms in the safest, least painful way possible, professional supervision will be necessary.
In a professional drug detox facility, you will be tapered off of Suboxone as quickly as possible while undergoing medical supervision, therapeutic activities, and medications to ease the worst symptoms of withdrawal. Some of the treatments used to treat drug withdrawal include:
Many patients ask "Can I detox at home?" While the answer is yes, you can detox at home; it is not recommended for Suboxone addiction. The symptoms of Suboxone withdrawal can be so severe that they actually pose a danger to your physical and emotional well-being. Not only will the symptoms be more excruciating without professional therapy to ease them, at-home withdrawal often leads to relapse - either with Suboxone or with other more dangerous opioids. These are some reasons why doctors do not recommend at-home detox from Suboxone:
Did you catch that last fact? This is important, so we're going to repeat it:
Relapse during detox greatly increases your chances of overdose and death.
When considering your options for detox and addiction treatment, you must be aware of the dangers of relapse. Once you've begun tapering off of Suboxone or quit altogether, a relapse to using opioids is much more likely to result in overdose. This is because your tolerance goes down when you stop or reduce drug abuse. If you relapse and take the same amount that you were taking before your tolerance decreased, overdose is not only possible; it is likely.
If you do choose to detox from Suboxone at home, inform your doctor beforehand and ask for a health examination to assess the potential risks posed by drug withdrawal. A good outpatient detox provider can also oversee your tapering plan and prescribe certain medications and activities to help you through the withdrawal process. Even if you choose to undergo detox at home, finding the right help can ensure a safer, more successful outcome.
Reducing or stopping your intake of Suboxone is not the end-all solution. Even after you go through drug withdrawal and get clean from the medication, there will still be psychological aftermath and cravings to cope with. That's what drug rehab is for.
Drug rehab for Suboxone addiction will be similar to rehabilitation from other opioids, although you will likely begin rehab treatments while you're still undergoing the tapering process. Since tapering off of Suboxone could last for months, rehabilitation therapy can usually begin as the doses become smaller, after the initial most severe withdrawal symptoms have passed.
The goal of drug rehab is to analyze the reasons behind the addiction - be it psychology, background, environment, a co-occurring mental health condition, or a combination of all these factors. Once the underlying causes of addiction have been discovered, counselors and addiction therapists can work with you to make the necessary changes in your mentality, attitude, and lifestyle to build a healthier, sober future. There are a variety of treatments that can be used together to achieve this, such as:
MAT - Medication assisted treatment can be used throughout rehabilitation to facilitate the process. This could include any combination of ORT, pain management, or psychiatric medications to support long-term recovery.
Dual Diagnosis - More than 60% of individuals suffering from substance use disorder also have other co-occurring mental health disorders. Dual diagnosis is the practice of diagnosing those co-occurring conditions through a series of emotional, psychiatric, biosocial, and behavioral examinations.
Integrated Treatment - Integrated treatment is vital if you're suffering from co-occurring conditions. By treating both the addiction and mental health disorders at the same time, doctors hope to help you learn how to cope with both conditions in a way that will support a functional lifestyle.
Counseling and Behavioral Therapy - One-on-one counseling with certified addiction therapists and clinically proven therapeutic practices like cognitive behavioral therapy and contingency management are integral to any drug treatment program.
Process Groups - The process of telling your addiction story and hearing about other people's battles with addiction is a natural part of the recovery process and helps you to approach your own problems in a more objective light.
Family Therapy - Whether it's the need to hash out difficult family histories or mend broken relationships, understanding family bonds and building a familial support system could make a major difference in achieving long-term recovery.
Holistic Therapy - From nutrition to mindfulness and physical fitness, your whole-body wellness is important to your mental health as well as your future. These practices are also building-blocks for a healthy lifestyle in recovery.
Relapse Prevention - Coping with cravings and preventing relapse will become part of your everyday existence in recovery. Rehab can teach you how to manage them for the long-run.
Through a combination of the above treatments, drug rehab will help you build a new sober lifestyle for a long and fulfilling future. No matter how long your addiction to Suboxone has lasted or how severe the abuse has become, there are proven ways to escape from its clutches.
If you've read this entire article about Suboxone treatment and addiction, chances are you or someone you know has a problem with Suboxone abuse. Suboxone is a dangerous medication to abuse, especially if it is mixed with other substances. The longer the addiction goes on, the more difficult it will be to put an end to.
Are you worried that your use of Suboxone has become a dangerous dependency? Call our addiction hotline now for a free assessment and begin creating your plan to end the abuse. The beginning of your life in recovery starts now. What's your Day One?
Give it a Rating!