Suboxone maintenance, not detox

In the future, addiction treatment professionals will speak of opiate treatment in terms of Suboxone maintenance, not detox. In the 80s, when I started in the addiction treatment field, opiate addiction treatment was not very successful. I worked at an inpatient facility. Opiate addicts coming into treatment hardly ever stayed past the detox phase, and when they did they hardly ever completed the full treatment program. There was a sever psychological craving that sent them back to the opiates. I’m not sure if detox is good enough for opiate addiction.

Research is beginning to prove my suspicion that a Suboxone maintenance program is more effective than detox:

Details of the Study

The participants in Fiellin’s 14-week random buprenorphine study consisted of 113 patients with prescription opioid dependence. Each subject received either ongoing buprenorphine maintenance therapy or detoxification.

The detoxification group received six weeks of equal doses followed by three weeks of tapering doses. Both groups had physician and nurse support available to them for the duration of the 14-week study.

Evaluating Your Recovery Options

Fiellin and his team discovered that the detoxification group tested positive for illicit opioid use more often than the maintenance group. In fact, few of the patients in the detoxification group were able to remain in abstinent and in treatment once the buprenorphine was discontinued.

Fiellin says patients often look for treatment providers that offer detoxification because they want to be off all drugs as soon as possible. However, his team’s findings indicate that patients would likely benefit from a longer maintenance program that better supports the nature of the disease.

Methadone maintenance was created for this reason, but Suboxone has less negative consequences from those who seek to abuse medication. Plus, with Suboxone you aren’t chained to a Methadone clinic. Suboxone acts differently on the brain than Methadone and contains Naloxone which negates the euphoric effects of opiates. To simplify, Suboxone fills the brain’s opiate receptors and tells the brain that these receptors are fine, so they don’t create opiate craving. Suboxone is a partial agonist and there is no euphoric effect after using the drug for a few days, thus there’s no need to take more because it won’t create a high.

There are ways to abuse Suboxone, most often in the film strip form or Subutex, which is Suboxone/Buprenophrine without the Naloxone, but they’re limited and don’t negate the good that Suboxone does for the opiate addict wanting help. This if from DruAbuse.com:

As with Subutex, Suboxone contains buprenorphine, and it’s very hard to overdose on this particular drug. The ceiling seems to max out at around 32 mg, which means that higher doses won’t produce measureable effects, making the drug safer to use. The addition of naloxone ensures that the effects of other opiates and opioids are blocked, although this is a bit redundant as buprenorphine has a much higher affinity for the opioid receptors than naloxone. It also makes the drug pointless to inject, thereby reducing Suboxone abuse. There is no typical treatment length as it depends on the addict’s situation.

“Consequently, the signs and symptoms of Suboxone treatment are more about the usual side effects of regular use.”

However, just because it cannot be abused by injection doesn’t mean it’s completely free of abuse potential. Suboxone can still be taken without a prescription, which is illegal, and a higher dose than prescribed can still be used. It can also be mixed with other drugs, such as alcohol and benzodiazepines, to give a more intense high.

Generally, signs of this sort of abuse involve random packages appearing at one’s home or work, faster than expected use of the drug, unusual behavior, and similar issues. Generally, benzodiazepines should not be prescribed with anything containing buprenorphine. In addition, benzodiazepines have a high potential for abuse, so if they are prescribed, the prescribing doctor must watch out for signs of addiction to these drugs as well as the initial addiction that led to the prescription of the Suboxone.

All in all, Suboxone maintenance is an effective treatment for opiate addiction, if there is counseling and relapse prevention treatment along with the Suboxone maintenance. Those who misrepresent Suboxone and criticize its use aren’t addressing the issue from an evidence-based position — Suboxone is helping many, many opiate addicts who would likely not recover without the extra help. As I’ve written, Suboxone is not a miracle drug, and all maintenance plans should entail an end date to discontinue the use, but during the beginning crucial months of recovery, the help of Suboxone is literally life-saving for many people. If the recovering addict can avoid the terrible craving for opiates long enough to complete treatment and develop an ongoing Recovery Management Plan, then the addict has a great chance at long term recovery.