Can a person be addicted to Suboxone?
What is Suboxone used for in drug treatment? It is used to help people to quit using opioids, such as heroin, fentanyl, or opioid pain medications. Suboxone is a prescription medication that contains buprenorphine and naloxone.
Buprenorphine suppresses opioid craving and prevents opioid withdrawal symptoms. It is a highly effective component of medication assisted treatment for opioid dependency.
There are certainly people who believe that Suboxone addiction is a widespread problem. It has been said that Suboxone is just like heroin.
They say that people who take Suboxone are simply trading one addiction for another. In some regions of the US, there is a fear that Suboxone clinics will fuel the next wave of pill mills, leading to widespread drug abuse.
Is there any truth to these statements? Is Suboxone a legal form of heroin? Are Suboxone patients getting high from their meds? Are Suboxone doctors nothing more than drug dealers in white coats? Or, is Suboxone a legitimate component of an effective addiction treatment program?
What is addiction and how does it different from physical dependence?
Addiction is a complex condition that can be described by looking at specific behaviors. While there are different kinds of addiction, there are certain characteristics that all addictions have in common.
When someone is addicted, they cause harm to themselves. Even being aware of this self-harm, they are helpless to stop. There is an overwhelming compulsion to continue feeding the addiction.
Obsession is another component of addiction that tortures those who suffer from it. For example, a person who is addicted to heroin cannot stop thinking about heroin.
When they have heroin, they obsess over how they are going to use it and store it. And, when they don’t have it, all they can think about is how and when they will get more. The obsession never ends while the addiction is still active.
Physical dependence is often mixed up with addiction.
When a person is physically dependent on something, opioid dependence for example, they may believe that they are addicted. When a person with asthma forgets their inhaler while on vacation, they may need to see a local doctor to get a new prescription. Are they addicted to their asthma inhaler?
A type I diabetic must give themselves insulin injections to survive. Are they addicted to having a needle pierce their skin to deliver precious insulin to their blood stream?
What about when a person quits taking their blood pressure medication and their heart rate and blood pressure shoot up? Is blood pressure medication addicting?
It turns out that there is an effect that is completely different from addiction, known as physical dependence. Physical dependence is not addiction. Diabetics are not insulin junkies. Asthmatics are not Ventolin addicts.
Is opioid pain medication always addictive to people who take it?
This is an interesting question. Are all the people who go to a medical pain management clinic addicted to the opioids prescribed to them? If you walked into a crowded pain clinic waiting room, would everyone sitting in a seat, waiting to see the doctor, be an opioid addict?
For years, the assumption by many people, even medical experts, was that patients with chronic pain who took opioids were addicted and engaged in opioid abuse. This assumption has caused many patients to be mistreated in the healthcare system.
I have witnessed patients who take opioids for pain go to the hospital for an unrelated condition, and then proceed to have a nightmare experience. For some reason, the fact that the patient takes prescribed opioids becomes the complete focus of the attending physician.
What happens when a patient who is prescribed opioids is suddenly taken off of their opioid drug? When the hospital doctor takes away their prescription medication, they go into physical opioid withdrawal, usually within a day or less. This has led to patients with no addiction issue whatsoever to be treated like an addicted “junkie.”
I have seen patients get psych consults and even get admitted to a psych ward because they were abruptly taken off of their prescribed medication and then got physically sick. The symptoms of opiate withdrawal are misinterpreted by uninformed doctors who think they are saving an “addict” from themselves.
Addiction to pain medications does happen.
While most chronic pain patients are not addicted to their opioid medication, a small percentage of people are at risk for becoming addicted. Experts disagree on what percentage of patients who take prescribed opioids will develop an opioid addiction, but it is fairly low, probably around 1%.
Purdue, the company that made Oxycontin, an opioid prescription pain medication containing the drug oxycodone, has been under attack by government disciplinary actions and civil lawsuits for years. One of the major reasons for this is the way the company downplayed the addictive potential of Oxycontin compared to other prescription painkillers.
While Oxycontin, and oxycodone are effective for pain relief, as schedule II narcotics, they do have significant abuse potential. For someone with a history of substance abuse, these drugs may stimulate drug cravings.
While 1% may seem like a low number, it is not that low when a prescription opioid is dispensed to millions of people. Purdue educated doctors over the years with information implying that the addictive potential of Oxycontin was much lower than 1%.
So, how addictive is Suboxone?
Suboxone is an opioid. Therefore, there is abuse potential and possibly addictive potential. How widespread is Suboxone addiction?
It is a fact that there is some diversion of buprenorphine-containing drugs such as Suboxone. Yet, studies of buprenorphine use on the streets reflects that the overwhelming majority of street purchases of the drug are for the purpose of self-treatment of addiction, not for the purpose of getting high.
An analogy that might help is to think of the vehicle theft deterrent device, The Club. During the heyday of marketing for this steering wheel locking product, it seemed a bit ridiculous that such a contraption could stop people from stealing cars. Why not just cut through the steering wheel to remove it?
However, the idea of The Club was not to make it impossible to steal the car. It was to make it just difficult enough that a car thief would not bother and would look for an easier car to steal.
Suboxone is not like most opioids.
Think of buprenorphine, the opioid medication in Suboxone, as an opioid with The Club built in. Buprenorphine is a mixed partial agonist/antagonist. Opioid antagonist means it blocks the opioid receptor and opioid agonist means that it activates the receptor. Buprenorphine is a strong blocker of opioid receptors and, as a partial opioid agonist, it partially activates the opioid receptors.
So, it blocks out other opioids, like heroin or Oxycontin, so they don’t work as well or don’t work at all. And, it only provides a very limited opioid-like effect that quickly levels off if the dosage is increased. The leveling effect is called the “ceiling effect.”
Because of the ceiling effect of buprenorphine, opioid overdose due to respiratory depression from Suboxone alone is unlikely. Though, it can occur when Suboxone is combined with sedating drug, such as alcohol, Xanax, or Valium.
It may be possible for a person who does not take opioids to get a bit high from buprenorphine when they first take it. More likely, it would make an opioid-naive person sick if they were to take only a small amount.
Patients who are prescribed buprenorphine for opioid treatment are not opioid naive. They do not get high from buprenorphine. What it does is to prevent opioid addicts from experiencing opioid cravings and opioid withdrawal sickness. It allows the brain to have time to heal while the patient goes about their activities of daily living.
So, as promised in the title, here are six steps to helping a loved one whom you may believe is addicted to Suboxone.
First, do not assume that your loved one is addicted to Suboxone.
If your loved one is seeing a doctor for Suboxone therapy and you are worried that they have replaced one addiction with another, take a step back before taking any action. Is your loved one acting out with addictive behavior?
Are they lying, stealing, sick all the time, nodding off at dinner, obsessing over drugs, or any other similar behavior? Suboxone treats addiction, it is does not cause a person to remain addicted.
Generally, when a patient takes buprenorphine treatment long enough, they do not have opioid cravings when they taper off and stop taking Suboxone. While they may have physical Suboxone withdrawal symptoms, they do not exhibit addictive behavior or suffer with opioid cravings.
Second, if your loved one is taking Suboxone from the streets, offer to take them to a Suboxone clinic.
As stated earlier, Suboxone bought on the streets is most often taken by people who want to quit opioids. Maybe they are afraid to go to a doctor. Reassure them that there is nothing to fear. It is always better to get addiction treatment from a doctor rather than the local drug dealer.
Your loved one may be getting Suboxone or Subutex from the streets out of habit. It may simply take a conversation to help them to come to the conclusion that seeing a doctor is the best way to get Suboxone treatment.
If they are concerned about requirements to get on Suboxone, you can reassure them that they do not have to worry about this at all. The Suboxone doctor will sit down with them to carefully explain how the program works and the best way to proceed safely and effectively for long-term success.
Do you need a prescription for Suboxone? The answer is yes, without a doubt, taking Suboxone as part of a comprehensive Suboxone treatment program is the only appropriate, legal, and safe way to take it. When a person is in recovery, they must avoid being around people who deal in illicit opioids.
Third, keep in mind that if your loved one is taking Suboxone and no unprescribed drugs, they are considered to be in recovery.
There are mixed messages out there in the world of drug recovery. Unfortunately, there is at least one major organization that helps people to quit drugs that is openly against “replacement medications.”
Interestingly, they are only against medications such as Suboxone or methadone when prescribed for addiction. If they are prescribed for pain, there is no issue. Since when did non-medical institutions decide it was their job to determine the medical diagnoses of their members?
In the book, Overcoming Opioid Addiction, by Adam Bisaga, M.D., he refers to recovery on Suboxone as “the new recovery.” While I fully agree with Dr. Bisaga, I would say that it is just plain “recovery.” I have seen patients improve and thrive on Suboxone treatment and I have no doubt that they are addiction-free and in recovery as long as they follow the treatment plan.
How long should you stay on Suboxone maintenance? For many people, at least one year of treatment is best. Often, several years is ideal for continued success. The length of treatment depends on the individual patient and their long-term goals.
Fourth, be careful making recommendations to your loved one about what you think they should do with respect to their Suboxone treatment.
You may have had your own recovery experience where you did things differently. Were you addicted to opioids and quit without Suboxone? Or, do you know someone who was able to kick a difficult drug habit by just going to meetings or even just making a decision to put the drugs down?
Did you know that many people can take opioids, including heroin or fentanyl, and not get addicted at all? Addiction does not happen to everyone and when it does occur, it manifests differently for different people.
Those people who have the most difficulty overcoming addiction can take some comfort in knowing that the people who struggle the most with addiction tend to be highly intelligent and creative people. I have observed this in my patients and I have seen the patients who stick with treatment succeed beyond what anyone imagined possible.
Fifth, if you do not have anything nice to say, please do not say anything.
You may disagree with what I have written here so far and you may be confident in your convictions about what is right when it comes to Suboxone treatment. Please do not let your own beliefs get in the way of your loved one’s success in life. People can, and do, live successful, happy and fulfilling lives while taking Suboxone.
Please, allow them to enjoy success without being constantly questioned about their decision. Suboxone treatment has been around for a long time and it is proven to be safe and effective. While it would be best for you to support your loved one’s decision, if you cannot support them, yet they are doing well with treatment, you can at least stay out of their way.
Sixth, study the literature about Suboxone treatment and addiction treatment to see what the experts are saying.
You don’t have to take the word of your local Suboxone doctor, or the word of a blogger or podcaster. Look for published books by recognized experts. Books by experts such as Adam Bisaga, M.D., Lloyd Sederer, M.D., or Ana Yusim, M.D. can provide great insight and understanding of how important medication-assisted treatment with buprenorphine is to the success of people struggling with opiate addiction.
These top psychiatrists are not trying to get your loved one’s business, and they do not work for pharmaceutical companies. They want to educate the public on how to live better lives, addiction free.
Before questioning your loved one’s decision about going to a doctor for Suboxone treatment, consider learning more about it first. You may come to realize that opioid addiction is a serious life-threatening condition and medication-assisted treatment provides the highest probability of success in overcoming it.
Does Suboxone addiction and Suboxone abuse exist at all?
The media tends to distort reality in such a way that they scare people with possibilities that are not statistically significant. They show lottery winners. And, they show people who suffer from unlikely tragedies.
For example, we know that COVID-19 rarely causes serious disease in young children. Yet, the evening news will find that one case where a child became seriously ill from the coronavirus.
Or, they find people who have died from one of the the COVID-19 vaccines. While this is extremely rare, it is enough to scare people away from getting this very important vaccination.
Likewise, Suboxone addiction and abuse may exist, but it is rare and not related to medical treatment of opioid addiction. In most cases, the benefits of treatment far outweigh the risks. To make a difference in helping more people to quit opioids and get past opioid addiction, it is important that we stand behind this life-saving medication-assisted treatment.