Is it true that Suboxone makes you high?
Unfortunately, there is a belief that Suboxone patients are getting high from their medication. Nothing could be further from the truth. This belief likely stems from the fact that Suboxone contains buprenorphine. Buprenorphine is classified as an opioid. Yet, bupe, as some people call it, is not a typical opioid.
Does Buprenorphine block opioid receptors or stimulate them?
Actually, it does both. Buprenorphine is primarily an opioid receptor blocker. When the drug molecule binds to a receptor, it holds on and does not let go, blocking other opioids from having access to that receptor. There is evidence that buprenorphine molecules block opioid receptors permanently. An opioid receptor has an average life-span of about three days, or 72 hours. In our bodies, cellular receptors, such as opioid receptors, are always degrading and being replaced by fresh new receptors. The reason that buprenorphine gets its opioid classification is that during the time that the molecule blocks an opioid receptor, it also partially activates that receptor, producing a mild opioid effect. A drug that stimulates a receptor is known as an “agonist.” A drug that blocks a receptor is an “antagonist.” Buprenorphine has a mixed effect on the opioid receptors and is known as a partial-agonist/antagonist.
Why do patients not get a Suboxone high when they take their medication?
Buprenorphine has what is known as a “ceiling-effect” This means that the mild opioid effect of the medication levels off quickly as the patient increases their dosage. The partial opioid agonist nature of Suboxone, combined with the complete and long-lasting receptor blockage is unique. A patient who takes Suboxone tends to feel normal, functioning normally in their lives, feeling as if they had never been addicted to opioids in the first place. The addictive behavior is gone. If you take Suboxone, you no longer feel cravings for opioids and you do not obsess over where and when you will get your next opioid dose. Your thinking is clear and you do not have any sort of Suboxone high whatsoever.
When someone quits Suboxone, they get withdrawal symptoms and feel sick all over again. Is this Suboxone addiction?
It is important to distinguish between addiction and physical dependence. Many medications cause physical dependence, not only opioids. For example beta blockers, a kind of blood pressure and heart medication, can cause a withdrawal syndrome if discontinued abruptly. The same is true for some antidepressants, such as Prozac, Paxil, Zoloft, and others. Physical dependence is not addiction. Unfortunately, some people believe that they have been cured of their addiction because Suboxone works so well. It is important to not make the mistake of stopping treatment too soon. Suboxone treatment works best when you take it long-term and get therapy for an extended time-period. It is important to work on yourself and learn more about what led you to drugs in the first place. You need to make changes in your life so you will not go back to using opioids later on.
Suboxone treatment is not trading one addiction for another.
With regards to Suboxone and addiction, Suboxone treats addiction, it does not make it worse. However, there is a physical dependence associated with Suboxone, so it will take time for you to gradually taper off of Suboxone and become accustomed to not having it in your system. This process after your last Suboxone dose, known as the “drop-off”, can take days to weeks. It is different for different people. Withdrawal symptoms can be helped by regular exercise and good nutrition as well as having positive support from your family, recovery support network, and your doctors. Interestingly, patients who have completed Suboxone treatment report that, although they had to deal with some withdrawal symptoms for a time, they did not have cravings for opioids. This is evidence that their addiction was being treated by medication-assisted treatment, psychotherapy combined with medical therapy.
Is Suboxone a mind or mood-altering drug?
This is a good question. Many medications can give a person a feeling of being “medicated” when they first start treatment. This is true of antidepressants, blood pressure medications, allergy medications, and many more. Even the pure opioid blocker, naltrexone, can make a person feel a bit off when they first start taking it. The concern with a drug being mood or mind altering is that in 12-step meetings, such as Narcotics Anonymous and Alcoholics Anonymous, they make statements that members, to be clean, must avoid mood or mind altering drugs. What does this mean? Let us be clear about this. Suboxone is not an addictive drug. It is not mind-altering. Regarding mood, it may improve mood slightly for some patients. It is believed that buprenorphine also has anti-depressant and anti-anxiety properties.
What does it mean for a drug to be mood and mind-altering?
A strong cup of coffee can be mood altering. So can a healthy long walk through the park. Somehow, NA and AA members can consider themselves clean if they smoke or vape nicotine. Nicotine is known to be the most addictive substance on earth. Yet, if they take a non-addicting drug that is mind-altering, that may be considered to be a relapse. There is revolutionary research being done with psychedelic drugs and dissociative anesthetic drugs, such as Ketamine, LSD, psilocybin, ibogaine, and others for the treatment of addiction, chronic pain, and depression. Even medical marijuana has shown some promise in helping with these and other conditions. Some of these drugs are believed to “reset” the brain, erasing addictions from the neural pathways. While it is imperative that these drugs never be used in a non-medical setting, there is hope that we will have new and improved therapies in the future to treat addiction. For the time being, I hope that 12-step program members will keep in mind the principle of open-mindedness that underlies the first step. We should all be open-minded about the proven medical science behind Suboxone treatment for opioid addiction. Buprenorphine has been on the market for many decades and has been used to treat addiction for nearly twenty years. It has been demonstrated to be safe and effective in treating opioid addiction compared to abstinence-based therapy.
Will Suboxone usher in the next wave of pill mills?
There is concern amongst politicians, law-enforcement officers, and concerned citizens that we are in for a new wave of pill mills, manned by rogue doctors, in league with money-hungry big pharma, with the goal of enriching themselves by pushing Suboxone pills. This is understandable that doctors prescribing an opioid to treat addiction would be viewed with suspicion, especially in the states hid hardest by the opioid crisis, such as Kentucky, West Virginia, Ohio, Tennessee, Florida, and many others. By now, if you have read to this point, you know that the idea of Suboxone being used to start a new wave of pill mills is simply not realistic. There will not be a pill mill problem with buprenorphine-based medications. In fact, we need many more Suboxone doctors and Suboxone clinics in the areas hit hardest by the opioid epidemic. Suboxone is not considered to be addicting when taken as directed. There is generally no Suboxone high to be concerned about when Suboxone is taken as prescribed by a doctor to treat opioid addiction. While it is a fact that some Suboxone does get diverted to the streets, studies have demonstrated that overwhelmingly, street Suboxone is being used by people trying to get clean on their own. It is rarely used by anyone trying to get high. There will be no wave of Suboxone pill mills coming. This sort of thinking is exactly what will slow us down in ending the ongoing opioid epidemic. So, why would someone buy Suboxone pills or strips on the streets to quit heroin or fentanyl? Why not just see a doctor? Wouldn’t it make more sense to get a legal prescription for Suboxone?
We need more Suboxone doctors, more Suboxone clinics, and more funding.
While there has been some progress made in opening up access to Suboxone treatment in the United States, we still have a long way to go. I receive emails frequently from people looking for free or low cost Suboxone programs in their area. Whenever possible, I do my best to locate a program in their area by doing specialized, focused searches with various resources. The problem is that there is a lack of funded programs. There are various pilot programs in many areas that are experimenting with using ER overdose visits to initiate long-term Suboxone treatment. The problem is that there are not enough spaces to help everyone who needs help. And, there are not nearly enough of these programs. Large regions of the country do not have funded, low-cost or free Suboxone programs. In fact, many regions have few, if any, Suboxone doctors at all. When Suboxone clinics are far and few between, how are people supposed to get help?
Is telemedicine the answer to helping more people get access to life-saving Suboxone treatment?
There has been a lot of talk about telemedicine, or telehealth, being the solution to getting Suboxone therapy out into rural areas that have a shortage of qualified doctors and nurse practitioners. It makes sense that doctors talking to patients over a video conferencing call might work to allow each doctor to extend their reach to patients hundreds, and even thousands, of miles away. There are, however, some obstacles to be overcome. How do the doctors test the patient’s urine for drugs? Urine drug screens are important, both to make certain that the patient is taking their medication and to verify that they are staying clean from drugs of abuse. There are also legal obstacles that vary from state to state. Suboxone is a controlled medication. Therefore, there are additional restrictions on prescribing it over telemedicine. Over time, these issues will be resolved and patients will have better access to medical care through telemedicine, including Suboxone treatment.
If I take Suboxone, am I clean or not? Is it possible to be “Suboxone sober”?
This should not even be an issue. Why do we even talk about our patients coming in for addiction treatment being clean and sober? This is because the addiction treatment industry in the United States is, and has been for many years, closely tied to the 12-step program of Alcoholics Anonymous and other programs derived from AA, such as Narcotics Anonymous. These abstinence-based programs were founded long before we had these current safe and effective tools to treat certain types of addiction. A fundamental part of the 12-step philosophy is that a person is clean and sober only if they abstain from all drugs of abuse and alcohol. If the smallest amount of alcohol is consumed, even a sip or a glass of wine, years of clean time are erased in an instant. Is this a healthy way to treat addiction? Is there scientific evidence through large-scale studies to show that this is how we should treat addiction? In fact, there are some solid studies that show the opposite. The methods of AA can actually be harmful to some people. For others, they are minimally effective. It is time for us to redefine what recovery means. As addiction expert and author, Adam Bisaga, M.D. has stated in his groundbreaking book, Overcoming Opioid Addiction, we must now think in terms of the “new recovery.” People who take Suboxone as directed and prescribed by a doctor are clean without a doubt.
Why is Suboxone the best choice for medication-assisted treatment?
First of all, I should say that by Suboxone, I am referring to any medication for opioid addiction treatment (OAT) that contains buprenorphine. There are tablets, or pills, films, or strips, and even weekly and monthly injectables. Some brand names you may have heard of are Suboxone, Subutex, ZubSolv, Sublocade, and Brixadi. There is even a six-month implant named Probuphine. The tablet and film forms of the medications are always taken sublingually, or under the tongue. Alternatives to Suboxone-type drugs include methadone and naltrexone. Methadone is still considered to be the gold standard of MAT, with a success rate of about 75%. The downside of methadone treatment is that you have to go to a clinic on a daily basis to take your medication under observation. This is because methadone is a highly controlled narcotic that can be dangerous if not taken properly. Methadone has the advantage that it can be taken right away, the same day that you quit heroin, fentanyl, oxycodone, Dilaudid, or whatever opioid you may be using. Buprenorphine requires that you wait to go into a mild to moderate withdrawal state before starting the medication. Usually, this means waiting about 24 hours after taking your last drug, though it can be longer in some cases. The other MAT drug, naltrexone, has a high success rate, similar to Suboxone, but you must wait at least one week after your last drug use before starting it. Naltrexone would be an ideal treatment to start after being detoxed and staying in a residential rehab for some time. Overall, when you weigh out the pros and cons of each available medication, Suboxone and other buprenorphine meds are ideal for most patients, balancing lifestyle considerations, side effects, and safety.
Why can’t people just quit drugs and have a little willpower to get through it?
I call this the “snap out of it” mentality. There are people who see mental illness in general this way. They believe that people who are depressed, anxious, bipolar, and even schizophrenic, to be attention-seeking, weak-minded people who just need to snap out of it and act more normal. This is unfortunate that conditions that effect the mind are not taken as seriously as physical illness and injury. We all know that a heart attack is serious and requires immediate, emergency treatment, followed by long-term medical care and lifestyle changes. Addiction is just as serious and just as real. Just like you can’t pray away a heart attack, you cannot pray away addiction. While saying a prayer never hurts, it is not enough to treat a real health condition that can have immediate life-threatening consequences. When a person suddenly stops an opiate or opioid, such as heroin or fentanyl, they go into a state of opioid withdrawal within 24 hours or less. By the third day, the symptoms become intense. Opioid withdrawal symptoms have been described as being like the flu times one-hundred. Along with intense physical sickness comes severe drug cravings. Imagine suffering like this, knowing that just using opioids “one more time” will take away all of the bad feelings. Anyone who has not experienced this has no right to say that anyone else should just “tough it out”.
The future of medical addiction treatment.
As I discussed earlier, there is research being done now on novel drugs that may be useful in conjunction with Suboxone or even in place of it. Suboxone-type drugs are also being improved. Brixadi is an existing injectable buprenorphine that can be given weekly or monthly. It should be available in the US soon. Advances continue in the fields of psychology and psychiatry as well. Lance Dodes, M.D., of the Boston Psychoanalytic Society and Institute has described in his books a model of addiction based on years of study that are innovative and can help us to see addiction in a new light. People who are addicted to drugs or behaviors are no different from anyone else. They are real human beings who deserve our attention and respect. We can do our part by providing harm reduction strategies, such as Narcan/Naloxone spray and injection as well as other supportive programs to keep our loved-ones safe. Additionally, we can work together to make medical treatment for opioid addiction and all forms of addiction more readily available for everyone who needs it.