The Suboxone controversy continues

Although, I’m not sure why, at least from the standpoint of addiction treatment. Here are a few reasons that treatment facilities don’t use Suboxone, taken from a Rehabs.com article:

 

“Short answer, no. Suboxone is a temporary solution for a permanent problem.

“You can get strung out on Suboxone as badly as on heroin.”

“Oh no, absolutely not. We do not discharge them on Suboxone.” When I mentioned that the scientific literature reports that people do better on maintenance Suboxone than not, Iwas told, “The scientific literature is false. I’ve been doing this for 20 years.”

“We’re abstinence-based. Our success is getting to the underlying issues and we can’t get to those when they’re under the influence of a narcotic or other medications.”

Treatment for opioid/opiate addiction has historically produced poor results, so, I can’t understand why healthcare professionals would dismiss Suboxone when the use of Suboxone has proved to be effective. Suboxone is not a magic pill, but it does make withdrawal more comfortable, and, when used for the first few months of recovery, it allows the addict to get into treatment and begin utilizing a support group like AA or NA.

For most opiate addiction problems outpatient treatment is sufficient. If I had to identify a problem with Suboxone, I’d say the main problem is that it works too good in the beginning and the person thinks that all is now well. It’s vital when starting an opiate addict on Suboxone to explain the process. Just because the person feels much better after taking the Suboxone doesn’t mean that treatment isn’t necessary. Much emotional and mental damage is done during addiction, and if this damage is not dealt with it comes back to haunt a person after the smoke of the “revival” has cleared. When an addict decides to do something about their problem, there can be a period of emotional exuberance, especially if Suboxone has eased the withdrawals, but this phase of recovery can fade quickly, then the ghosts and demons return.

Most studies done on the effectiveness of different methods of treating opiate addiction are usually studies which take data from the first few months, if that long. Follow up studies are suspect because they’re based on self-reporting, and that self-reporting is not really accurate. I’ve observed opiate addicts over a period of years from beginning to treatment to aftercare to AA or NA to long term recovery management. After a while it becomes obvious that some things are conducive to long term recovery and some things aren’t.

Treatment programs that don’t use Suboxone or some other maintenance medication usually have a low retention rate when it comes to opiate addiction (I use opioid and opiate interchangeably, because opioids are simply synthetic opiates). When an opiate addict goes straight to a physician for Suboxone and sees only the physician once a month for short term “counseling” the person usually goes in and out, returning to heroin or whatever opiate they were using before, or some other drug as a substitute, then goes back on Suboxone, or Subutex which doesn’t contain Naloxone (that’s another story for another post) and is more conducive to this back and forth usage.

Most doctors trained in addiction medicine recommend that the opiate addict who wants to use Suboxone get an assessment at an addiction treatment facility. The best success I’ve witnessed is when the opiate addict takes Suboxone for three to four months, goes through an intensive outpatient program, and after discharge manages recovery long term through medical care, nutrition, attendance at AA or NA,  a sponsor in AA or NA, exercise and continuous spiritual/personal growth. There are factors involved all along the way that either enhance recovery or hurt recovery. Low quality treatment or lack of treatment is a problem in many areas, as is a lack of doctors who truly understand addiction. In many areas there are AA or NA groups who are critical of Suboxone, even though AA has had a pamphlet out for decades that says AA members aren’t doctors and shouldn’t interfere with medical treatment.

The main problem dealing with opiate addiction is the same old problem of funding. If people can’t access addiction treatment or pay for medication, then all the other solutions are not attainable. Once this country gets its insurance problem worked out, perhaps the idea will win out that treating the addiction problem now with the most effective methods will save lives and billions/trillions of dollars in the future. The bottom line is Suboxone helps to saves lives.