The Effectiveness of Suboxone in the Treatment of Opiate Addiction.

Google GmailBookmark/FavoritesGoogle+LinkedInBufferBlogger PostShare


JoeHerzanek, Addiction Counselor and InterventionistFor the past several months I have been receiving a lot of calls and emails from family members about their opiate addicted loved one. Opiates ranges from heroin, Oxycontin, methadone, vicodin and so on. These inquiries have lead to many questions about another drug that is supposed to help people get off these powerful opiate drugs. The name of that drug is Suboxone. I’ve read many articles on the effectiveness, or lack there of, of Suboxone. The attached link from the December 2010 issue of ‘Addiction Professional’ confirms what I have been saying for quite some time. Although this drug is/can be helpful for very short term use, it’s even more addictive than most people realize. And it too is an opiate based drug.

Anyone who has questions about this please read the article below—Suboxone: concerns behind the miracle.

Best,  Joe

SUBOXONE: CONCERNS BEHIND THE MIRACLE

~ by Steven R. Scanian, MD

One addiction may be traded for another as the FDA-approved opiate addiction treatment Suboxone is becoming one of the most prescribed medications in the country (#41 overall in sales in 2009 according to drugs.com). Called a “miracle drug” by some, Suboxone is estimated to be 25 to 40 times more potent than morphine.

I am board-certified in psychiatry by the American Academy of Psychiatry and Neurology and board-certified in addiction medicine by the American Board of Addiction Medicine. I am the co-founder of Palm Beach Outpatient Detox (P.B.O.D.) in Boca Raton, Fla. I once was addicted to opiates during my medical residency in anesthesiology and was detoxed with the help of Suboxone. Now I successfully detox my patients from opiates (e.g., morphine, OxyContin) using regulated amounts of Suboxone, and I also detox my patients from Suboxone addiction when that drug has been misused.

I have found that the optimal time to have someone on Suboxone is between 20 and 25 days, tapering down on the medication every few days. This makes the physical symptoms of detox very manageable, without causing the patient to become cross-addicted to Suboxone. I have found that Suboxone use for a longer period than this begins to cause a strong dependence on the medication.

Once a patient is stabilized with Suboxone and no longer getting high, he/she has to be convinced that recovery is possible. A detailed program is then created at the P.B.O.D. office, focused on abstinence and better coping techniques. P.B.O.D. prepares patients for the restlessness, irritability and discontent they will experience when they are off all narcotics, including Suboxone.

Suboxone detox makes the physical aspect of the disease manageable, but does not help with the emotional and spiritual consequences of addiction. Often patients are concerned about coming off Suboxone, but I educate them about how Suboxone is a tool to get them clean but not a suitable maintenance drug if a patient wants to get into recovery.

Suboxone is a powerful opiate-an anesthetic to emotional pain. It immediately alleviates anxiety and depression, and makes a person feel more emotionally stable. A lesser dose of Suboxone (2 mg a day) will block an estimated 80 percent of a person’s feelings, while higher doses can make a patient practically numb. Patients often say they feel great on Suboxone and since they are not getting high they want to continue on it. I tell them, “You are not dealing with your feelings because you are still not feeling-you are still numb. You need to start experiencing emotions to understand what you were trying to self-medicate in the first place. It’s time to live life on life’s terms.”

Duration of use

When used in the short term, Suboxone is the best detox drug I have ever seen-it can immediately stabilize a patient’s life, and this can be done in an outpatient setting. When used long-term, though, it is the hardest medication I have ever dealt with in terms of detoxing a patient from it.

Suboxone does not work like natural opiates; it is created in a lab and interacts with the receptors in the brain unlike any other opiate. I speculate, based on treating hundreds of patients who have been on Suboxone maintenance, that when Suboxone is given long-term it causes abnormal adaptations to opiate receptors and other brain receptors. In my experience, long-term use can cause emotional deregulation, loss of libido, hair loss, and an abnormality in how the body regulates its response to stress.

Suboxone is a mixture of buprenorphine and naloxone. Buprenorphine is a powerful opiate, and naloxone is an opiate blocker used to resuscitate people in the ER from an opiate overdose. With no other opiates in the addict’s system in the last few days, he/she can either snort or intravenously shoot up Suboxone and become extremely high since it easily dissolves in water, making it easier to shoot up than heroin. The combination of there not being enough naloxone in Suboxone and the fact that Suboxone binds to the opiate receptor so strongly means that there is no built-in deterrent to keep a patient from abusing Suboxone. Dozens of my patients have discussed using Suboxone intravenously, and there are hundreds of reports about this on the Internet.

The misuse of Suboxone and the lack of attention to the problem are causing physicians untrained in addiction medicine to feed into overprescribing. Many do not understand the long-term ramifications of Suboxone addiction, and it also is a very lucrative business for the prescribing physician. Many doctors charge $200 to $300 monthly, per patient, for a 5-to-10 minute checkup to renew a Suboxone prescription.

Most places prescribing Suboxone maintenance do not offer any addiction treatment because the doctor is not trained in addiction medicine and because it is not time- or cost-effective to do so. Furthermore, the lucrative nature of Suboxone on a maintenance basis creates a disincentive to tapering the drug and its income-generating potential.

As a point of comparison I charge $2,000 for a detox from OxyContin or methadone, taking about three weeks. A detox from Suboxone dependence costs $5,000 because it takes four to five months, incorporating about 10 different medications to detox the patient successfully. The success rate for detox from Suboxone is much lower than that for detox from other opiates because patients tend to give up hope during the lengthy withdrawal process.

Dearth of research

Most Suboxone studies follow post-detox patients for only a month and are often funded by the drug company that manufactures Suboxone. There are no long-term studies of Suboxone maintenance. I learned myself about the potential disadvantages of Suboxone maintenance from meeting people in my practice who have been on it for years.

I am concerned that the medical profession has allowed this situation to develop. I wish I knew how to fix this problem. I only know how to prevent it from happening to my patients in the first place or how to correct previous Suboxone treatment.

Only time will tell what role Suboxone will play in the field of addiction medicine. Will it one day be used only in the short term as a detox tool, or will it continue to be prescribed as a maintenance treatment? Supporters of maintenance treatment will state that the manageability of an addict’s life improves tremendously with Suboxone maintenance, and there is an abundance of research to back this up. Nonetheless, I believe that an individual on maintenance treatment is not experiencing the full range of emotions, good or bad. It is imperative, in the least, that all physicians prescribing this medication become more educated about Suboxone and the pros and cons of short-term and chronic use.

 

Steven R. Scanlan, MDSteven R. Scanlan, MD, is co-founder of Palm Beach Outpatient Detox in Boca Raton, Fla. He is board-certified in addiction medicine by the American Board of Addiction Medicine.

NEED HELP NOW?
Drug Addiction Phone Counseling for Families Dealing with Substance Abuse

Google GmailBookmark/FavoritesGoogle+LinkedInBufferBlogger PostShare

Related Posts:

  • No Related Posts

Comments

comments

20 thoughts on “The Effectiveness of Suboxone in the Treatment of Opiate Addiction.

  1. Judy

    Dear “Rural”
    Just to let you know that I asked Joe “What about your question”
    “To my knowledge Medicare/Medicaid doesn’t shut down practices for improper billing. Any recommendations on how to avert this?”

    His answer was “Nope”. So sorry! )-:

  2. Joe

    Dear Rural NP,

    Suboxone is just one more attempt at ‘harm reduction’. You might think of it as heroin light. It may be helpful for short-term use when beginning recovery or going through detox. A few weeks at most.

    In the long run it’s just a new type of methadone, another drug that the person will have to eventually get off of as well.

    The drug companies push it hard. They’re making LOTS of money off of it :(

  3. TJ

    I’m an NP in a rural area. My clinics administration is sneaking around with one of the nice MDs in convincing him to do Suboxone treatment. We don’t have any known addicts in our practice. I have voiced my concern with him directly to not do this. It’s for money I known to increase patient visits. Concerningly there is rumor that another clinic they managed (that did Suboxone) was shut down, for improper billing. To my knowledge Medicare/Medicaid doesn’t shut down practices for improper billing.
    Any recommendations on how to avert this?

  4. Joe

    Dear cc,

    Thanks for the insight. You’re right in saying that in rare cases some pain medication may be appropriate on a long-term basis. Such cases are very rare though. In some cases people need to consider reducing the pain level and settling for less pain and not seeking to eliminate it altogether. If a person can move from a level 8 pain to a 3 or 4 they often can learn to accept or manage that without any opiate-type meds. Dr. Mel Pohl has written a superb book titled, “A Day Without Pain” You can also hear my interview with him by going to http://www.eyeonaddiction.com/eye-on-addiction-show-archive/pain-medication-abuse-suffering-is-optional.html.
    Best regards, Joe

  5. CC

    Not everyone can totally abstain and actually NEED pain management to function let alone remain gainfully employed (speaking of illness or injury induced 24-hour pain, not temporary pain growing into dependency). One can only be on Oxys for so long and max out, suffering such side effects as sweats, nausia and constipation and to such a degree that life is not a pleasant experience. For those who need to get off of the Oxys, the Subs are truly a life saver…but, as we are now hearing, are just as hard, if not harder to get off of.

    My spouse has been on Suboxone for over 4 years and at the SAME originating dose (unheard of if on an Oxy…as one would constantly need to increase dosing due to tolerance), but needs some form of daily pain relief due to accident injuries and the ensuing multiple surgeries.

    In short, coming off of all pain meds simply is NOT an option for those in chronic pain. Perhaps, someday, we will see a new medication that is NON opiate based (and/or better ways to isolate pain and pin-point specific nerves for burning), but until then, Sub is the best that the chronic pain community has.

  6. Joe

    Thanks for the comment Matt. Suboxone is often used for detox and sometimes a little longer. The goal, in my humble opinion, is to become completely abstinent from all substances. The only thing that seems a bit unusual is where you say, “fighting the cravings for life.” Cravings are very real and VERY intense in early recovery. What I’ve seen for myself and countless others is that after several weeks, sometimes it takes several months, the cravings go away.
    Best, Joe

  7. Matt

    I have turned my life around, I’ve been on suboxone for years. I feel that it is a cost benefit analysis. Some people will simply lead better lives if allowed to be on a maintanence program rather than fighting the cravings for life without a blocker in them. I understand your attempts, but the evidence is quite lengthy in support of my point.

  8. Toni

    My daughter is a oxy addict by injection, and now she says she is getting soboxone illegally to try and kick the habit. I fear for her. She is 28 and has fought some kind of addiction since early teen years. Have tried everything and she stills goes back. She is on bipolar meds and xanax prescribed but the soboxone is not prescribed. I do not even know if she is taking soboxone or still on oxy because she lies and tells me what she thinks I want to hear. She has three children who need their mother. She is useless most of the time as a mother because of her addictive state. I need help. I do not want to bury my daughter.

  9. David Overto

    I have heard a lot of good information on the benefits of Soboxone, yet based upon personal obsevations while working as a state certified AOD counselor, these benefits did not match the benefits of total abstinence. Clients that remained on soboxone successfully completed treatment, yet the majority of those that attempted to stop their use of this drug did not. I understand its usefullness during the stages of physical withdrawal, yet once this phase of recovery has taken place the use of Soboxone appears to be contridictory of the best efforts of treatment providers. My primary concern is for that of clients, yet it appears when we return clients to the community with a dependece issue merely exchanged, we have failed to fullfill our scope of practice.

  10. Joe

    Dear Magdaline,
    There are two meds that will help with sleep that are not habit forming. Your son could try Tylenol-PM and melatonin. Unfortunately he also must stop all of his other drug use. This will be difficult but still quite possible to do. He will have some sleepless nights in the process but then will go back to normal sleep patterns. Your short post does not give me enough info to be more specific. I would talk with an addiction professional for more clarity.

  11. magdaline

    My son is fighting xanex and purcocet addiction. He is on methadone treatment with a doctor. He gets a month supply at a time and tries not to take it if he doesn’t have to. However, he has terrible insomnia:( what is safe to take to help him sleep that is not addicting?

  12. Wes Cook

    Suboxone Doctor Help Spot has been a place where patients and potential patients, but in addition there will be resources to help you find doctors who specialize in the use of suboxone and addiction recovery

  13. Joe

    Dear Karen,

    I know exactly how to handle this. I counsel on this problem almost every day. If you want to pursue this option please send me an email and I can give you more details. jzanek@gmail.com

    FYI, if you don’t take the right steps soon it will get MUCH WORSE. I guarantee it. Best, Joe

  14. KAREN

    My son and daughter in-law are both heroin addicts. They are living and their three children are now living with me. They have been trying to get off
    heroin since July. They started using suboxine for the first two months and going to NA meetings. They stopped the suboxine and it has been a roller coaster ride. They have both went to inpatient treatment and my daughter in-law is now in a recovery house (off suboxine) my son just started a suboxine program suggested by a program his is in Partners in Recovery. The three children are missing their mother and I am feeling lost. I was just cleaning my sons room and picked thru the trash. I found a empty pack of cigarettes with two capsules (empty) in it. Can he be using on suboxine? My daughter discovered that he stole things from her home a few months ago and went to the police. They pulled a report of the pawn shops and found tons of things both her and mine as well as the
    children’s things they hocked. Not real sure how to handle all of this.

  15. Joe

    Dear Janice,
    Maybe he could just go ahead and quit using all dope. Both the legal dope and illegal dope. People do it all the time.

    They meet in groups and encourage each other to not use any dope. These groups have proven to be very successful.

    Worth a shot (-:

    Best,
    ~Joe

  16. Janice

    My son has detoxed from Suboxone at least 3 times. they send him home in 5 days…he is back on it 5 days later. Now he can not find a Doctor who will prescribe it and he is looking for anything to feel better. What to do???

  17. Joe

    This guy, like so many others with several letters behind their names, have become convinced people can’t quit. That’s what they are told by all their profs when getting their ‘higher education, post graduate degrees.’

    It would be funny if it weren’t so sad. The drug companies are the only ones who benefit from this very skewed way of looking at drug addiction. They couldn’t be more wrong concerning their goofy ‘harm reduction’ approach to what they call “recovery.”

    Read this excellent article from HBO/Addiction:
    Treating Opiate Addiction With Replacement Therapy

  18. Joe

    Thanks for the feedback Rita. I’m sure the drug company who makes the stuff is working day and night to keep people on it. You made a good point in your comment. Just like ALL opiate drugs you build a tolerance. People end up needing more and more of this “legal” opiate to get the same effect. How did this ever become a “harm reduction” option anyway?? $$$$$$$ When did the idea of just quitting ALL Euphoric drug use become a non-option? There are some things that can’t be done but stopping all drug use is not one of them. Anyone can quit if they want to bad enough ); And that’s a FACT. Is it hard? Sure, but so what.

    Wiki has some more info: Buprenorphine

  19. rita smith

    I live in a relatively small community where addiction is rampant. I also am a member of a 12 step recovery group. I have personally known 4 people who have or still is using Suboxone. One after completely detoxing from heroin was put on Suboxone for an injury. Having at one time detoxed from the Suboxone to being put back on it for pain. They are still on it after a year. They also are involved with the 12 steps. Sharing in the group nodding out. Also another one was on it for 2 year’s with the last year being in recovery. they detoxed off of it finally and has required some awesome recovery. Another one has been on it like 3 year’s and haven’t seen them in awhile. One other was trading theirs for the drug of choice. The doctor they all used keep’s them on it way to long and on way to big of doses. The one that has been on it for 3 year’s or more is on 18 MG’s a day. I’m so glad that you shared this with us. I am going to copy this if that is okay. Thanks again for the concern you have shown.

Add Comment Register



Leave a Reply