Is Suboxone a Good Idea for Addiction Treatment?

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The quick answer: It depends — on the patient and the addiction.

A longer answer follows...

Does it work?

The statistics on Suboxone’s effectiveness depend on what the goal is. Since Suboxone is a replacement therapy for narcotic abuse, someone who is able to get off street drugs and stick with Suboxone can be counted as a successful outcome. But if the goal is to get off all narcotics, we can’t count a win until they get off Suboxone itself.

As a maintenance or replacement for illegal narcotics, Suboxone works very well. Patients can stop taking their preferred substance of abuse without fearing withdrawal. But studies looking at long-term outcomes with abstinence as a goal are less impressive.

One study by the National Drug Abuse Treatment Clinical Trials Network (link requires free registration) showed that keeping patients on Suboxone for as long as nine months was ineffective in preventing relapse after stopping the drug.

In persons dependent on prescription opioids, tapering with buprenorphine during a 9-month period, whether initially or after a period of substantial improvement, led to nearly universal relapse...

This study was done with patients addicted to prescription narcotics, but previous “dabbling” with heroin marked patients as even more likely to relapse.

Others dispute this. Dr. Steven Scanian, a psychiatrist involved in addiction treatment, says that the best regimen is only 20 to 25 days of Suboxone replacement, with a dose reduction every two days. His model would be less about replacement therapy and more about using Suboxone as a way to reduce withdrawal symptoms over a three-week period.

In the end, Suboxone treatment does reduce other measurements of harm, even if it may not lead directly to abstinence. The ability to live a more normal life, even if that includes continuing to take a narcotic, shouldn’t be underestimated. Anyone addicted to heroin or other narcotics would think it a huge blessing to “stop the crazy” with the stability that comes with replacement therapy.

Why switch one addiction for another?

It’s important to realize that Suboxone is addictive. That means therapy is replacing one addiction (typically injectable heroin) with a narcotic that is less harmful. The harm reduction comes because Suboxone has a “ceiling” dose – after increasing to this dose, addicts can get no more from the drug. You can’t keep upping the dose to get higher. That might not sound like much, but it’s a good first step in breaking the cycle of addiction: stabilizing the patient and getting them away from all the risks associated with injectable street drugs – arrest, overdose, and infection being the worst of the lot.

The main reason to use Suboxone is that it immediately gets someone off other narcotics without causing the euphoria and without inducing withdrawal. It also blocks the effects of other narcotics, patients can more easily resist returning to their previous habit. This gives therapists a chance to talk to the “real” person hiding under the addiction. It also allows patients to continue on with a normal life. While on Suboxone, they can keep working or going to school and do not require inpatient treatment.

Suboxone offers addicts a way forward. Some feel that the choice between using and going cold turkey is no choice at all. They are more likely to accept treatment that doesn’t involve the sickness that comes with withdrawal.

Who will benefit most from Suboxone?

Because Suboxone has a ceiling effect and blocks other narcotics, it is only useful in a subset of narcotic addicts. Those who have a “heavy habit” will experience withdrawal if given the Suboxone – they are above the ceiling.

On the other end of the scale, those who are not consistent users may experience a “high” from Suboxone – they are so far below the ceiling that Suboxone is too strong. This has led to abuse of Suboxone itself and there has been an increase in emergency room visits for non-medical use of the drug.

As with all addiction treatments, only a physician familiar with the case can make a valid assessment and recommendation. Generally, Suboxone is best used in the mid-range narcotic addict. Successful treatment is predicated on the same factors that come into play in other types of addiction treatment: highly motivated patients do better, as do those with a support structure and a willingness to participate fully in their treatment.

Suboxone is not a cure for addiction and not a miracle drug. But when used appropriately, it can feel like a miracle to those who are able to rebuild their lives while on it.

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