1) Suboxone is more addicting than heroin.
Suboxone is not an addictive drug. Yes, it is an opioid, by definition. However, buprenorphine, the partial opioid agonist/antagonist ingredient of Suboxone, is unique in its actions. It does not work in the same manner as other opioids. Buprenorphine blocks opioid receptors, and while it is blocking, it partially activates the receptor. Unlike buprenorphine, most opioids bounce on and off of opioid receptors, stimulating them with each binding.
An analogy that I have used to explain the difference between buprenorphine and other opioids is one that involves misbehaving children on an elevator. Imagine a group of kids riding an elevator in an office building. They recklessly keep pushing all of the buttons over and over again. All of the buttons light up, and the lift stops at every floor. These children represent typical opioid molecules. The elevator buttons are the opioid receptors.
Then, a man enters the elevator. He quietly stands in front of the buttons, blocking access from the children. As long as he stands in the way, they cannot press the buttons. While he prevents the bad kids from causing trouble, he calmly and gently pushes the button for his floor. This man represents buprenorphine. You could say that everyone on the elevator is a button pusher, but the man behaves very differently than the children.
While this is not a perfect analogy, you can see that there are differences in how buprenorphine acts compared to other opioids. Buprenorphine has a ceiling effect. Because it only works while blocking a receptor, the buprenorphine molecules quickly saturate the body’s receptors. The risk of physical tolerance and overdose is much lower than other opioids. Yet, buprenorphine is an effective medication in treating opioid addiction.
2) Suboxone will fuel the next pill mill epidemic.
This concern is understandable with regards to the citizens and leaders in states that were worst affected by the opioid epidemic. Yes, Suboxone is an opioid that treats opioid addiction. Without understanding more about how medication-assisted treatment works and the unique properties of Suboxone, the idea of treating opioid addiction with another opioid doesn’t sound like a good idea. Unfortunately, leaders in the rehab industry who should know better help to propagate this idea.
Why are rehabs against proven medical therapy for opioid addiction? Rather than endlessly investigating the hidden dangers of a proven, decades-old, medical treatment, maybe we should take a closer look at rehabs that profit when their patients fail. What does a rehab graduate do after they relapse on drugs again? They go back to rehab and try again. Do they see these victims of drug addiction only as insurance cards to be billed over and over again? Suboxone is a threat to the multibillion-dollar industry since it has a high success rate, and any qualified private doctor can prescribe it.
Suboxone has been around for a long time and is backed by science and decades of clinical experience. We know that it works. And we know that people are generally not getting high on Suboxone out on the streets. We must get past this myth about Suboxone being just another addicting opioid. Suboxone uses in treating addiction are proven to saves lives.
3) Suboxone treatment is too expensive.
The perception of a service or product being too expensive is relative. Is Suboxone treatment too expensive? There are at least three components of medication-assisted treatment that cost money. First, there is the Suboxone itself. Not too long ago, Suboxone was very expensive. At least this was true of the brand-name Suboxone SL Film, manufactured by Indivior. In early 2019, Indivior lost a court case with a generic drug maker. The judgment opened the market to generic Suboxone films. In addition to the cost of medication is the price of a doctor’s visit. Also, medication-assisted treatment requires psychotherapy as well. Therefore, you will also have to see a psychologist.
How much will this all cost per month? How much will it cost each year? Fortunately, health insurance covers at least part of the cost of treatment. There are also patient assistance programs and funded pilot programs that provide free or low-cost treatment. It is also worthwhile to compare the price of rehab to the cost of a Suboxone program. Even if the total yearly cost of Suboxone addiction treatment works out to be $5000-$10,000 per year, most rehabs cost at least $30,000 for just one month. If you stayed in rehab for the whole year, the cost would be $360,000! And, some rehabs cost double or even triple that price. More importantly, rehab has a low success rate compared to medication-assisted treatment (MAT) with buprenorphine when it comes to treating opioid addiction.
Suboxone addiction treatment is far more cost-effective than rehab, not to mention active addiction. MAT is affordable and effective. Not only is it cheaper than rehab. It works better, and you can continue with your life. You don’t have to take off time from work or leave your family to check into rehab for a month. And, it turns out that MAT-based medical and psychological treatment is more effective than daily group sessions in rehab, moderated by minimally credentialed counselors.
The program of Alcoholics Anonymous and the 12-steps form the foundation of many rehab programs. Some people describe rehab as being a thin wrapper around the 12-step program. There is a joke that you pay $30,000 to go to rehab and find out that A.A. meetings are free. One exercise that rehab counselors assign to patients is to draw a picture of their higher power. This drawing exercise is an introduction to 12-step work. Imagine being in a room of strangers, drawing a picture with crayons and paper. You are missing work and separated from your family. There is a saying in rehab that comes up in group meetings. The moderator will say, “look to your left and look to your right. Out of the three of you, only one will make it.” This statement is supposed to motivate you. You don’t want to be in the 2/3 of the people who will fail and relapse on drugs, do you? You want to be in the 33% that succeed. What this should motivate you to do is go to the front desk and demand a refund for your $30,000. Why would you pay for a program that has such a low success rate? Especially when Suboxone addiction treatment has at least a 50% success rate and does not require you to be away from work or family. And, the fact is that studies have shown that rehab is far less effective than 33%.
4) Suboxone is the most effective MAT drug.
While Suboxone is highly effective in treating opioid addiction with medication-assisted therapy, it is not the most effective drug. There are three drugs approved for MAT in the U.S. These are methadone, buprenorphine (the drug in Suboxone), and naltrexone. Both methadone and buprenorphine are opioids. Naltrexone, an opioid blocker, is not an opioid.
There are pros and cons to each of these drugs. Each has its place in the world of medication-assisted treatment. As far as real efficacy in keeping people clean from opioids, methadone has the highest success rate. One great benefit of methadone is that you can get started the same day that you quit opioids. You do not have to go through withdrawal symptoms before you can start taking the medication. However, methadone is a dangerous opioid with high abuse potential and risk of overdose. Because of this risk, only specialized methadone clinics can dispense the drug. Patients must show up every morning to take their dose under strict observation.
Buprenorphine is a less controlled opioid drug that has little abuse potential. Patients can get a prescription for up to a month at a time. There is no need for daily clinic visits in most cases. While you do need to go through a period of opioid withdrawal before you can start a Suboxone program, it is typically not too long of a time. In many cases, you can begin Suboxone about 24 hours after your last opioid use. While Suboxone is highly effective, it has a somewhat lower success rate than methadone. One significant downside of Suboxone is physical dependence. When you are ready to stop taking Suboxone after completing maintenance therapy, you may have some difficulty in tapering off of the medication due to Suboxone withdrawal symptoms. The best way to stop Suboxone is to decrease to lower dosages very gradually. There are also medical therapies that can make physical Suboxone withdrawal symptoms more tolerable. This physical dependence on Suboxone does not mean that you are addicted to your Suboxone. Physical dependence and addiction are not the same things.
Naltrexone is not an opioid. There is no physical withdrawal when you quit taking it. Naltrexone has about the same success rate as a Suboxone program, according to some studies. Why is this not the gold standard of treatment? Shouldn’t more doctors prescribe naltrexone for opioid addiction? One major issue is that you must wait at least a week after your last opioid use before you can start naltrexone. Why is this a problem? Opioid withdrawal can be intense. At 72 hours, the drug cravings and withdrawal symptoms can be unbearable. It is unrealistic for many people to expect them to wait it out for a week or more. An ideal place to consider starting naltrexone therapy would be for residential rehab patients. If you are in rehab for a month and they have detoxed you in the first week, you could start naltrexone before you graduate from the program. Unfortunately, most rehabs do not offer naltrexone. Or, they leave it up to the patient to ask for it. Considering how much naltrexone can increase success rates, rehabs should put more effort into educating their patients.
5) Suboxone does not help without psychotherapy.
Medication-assisted treatment (MAT) consists of medical visits with a doctor, medication, and psychotherapy. Psychologists and psychiatrists can provide therapy. But, what if psychotherapy is not part of the program? Can Suboxone help without it? Many experts believe that the therapy component is essential. Some programs will not provide Suboxone, Subutex, or ZubSolv until the patient is already in therapy for their addiction. Unfortunately, this has led to problems in regions hard hit by the opioid epidemic. If there is a lack of resources, patients may have to wait to get started with medication-assisted treatment.
Some programs have tried out giving patients Suboxone without therapy. The rationale is that they will start it when they can, but it is worthwhile to get started on medication and to get off of street drugs. The results of studies generated by these programs are that Suboxone does work to help people stay clean, even without psychotherapy. So, should we do away with the requirement for therapy? No, the psychotherapy component is still essential.
If you use street opioids to get high, there is a reason why you got started. Maybe it was to self-treat for deep-rooted psychological pain. Possibly, you felt helpless in many situations, and you believed that there was no other way out. If you do not learn more about yourself and what led you to drugs in the first place, you may find yourself back in that situation again. It is essential to see a therapist for professional guidance. Together, you can discover triggers that lead you back to addictive behavior. And, you can learn more about yourself and why drugs became a part of your life in the first place. So, psychotherapy is essential, but Suboxone should not be withheld from you just because you have not started therapy yet.
6) Naloxone, the “blocker” in Suboxone, is what makes it take so long to start Suboxone after taking the last opioid dose.
Several myths are surrounding the drug naloxone that is in Suboxone. The common theme of these myths is that naloxone, being an opioid receptor blocker, is part of the therapy. Naloxone does not make you have to wait longer to take your first Suboxone. Naloxone does not contribute to your treatment by having a blocking effect. The fact is that the naloxone does not do anything when you take your Suboxone as directed. Naloxone acts as an abuse-deterrent in Suboxone. It is there to keep people from trying to inject Suboxone. Some patients find this confusing. The idea of the injection of a Suboxone film with a needle into a vein is strange to them. Why is an additional drug put into their medication to prevent something that is furthest from their mind? Just remember the naloxone does nothing when you take your Suboxone properly. And, buprenorphine, the active drug in Suboxone, is a blocker itself. So, any opioid receptor blocking effects that patients get from Suboxone are a result of the buprenorphine itself.
These are some of the myths surrounding medication-assisted treatment with Suboxone and other buprenorphine-based drugs, such as Subutex, ZubSolv, Probuphine, Sublocade, and Brixadi. You read many things about Suboxone that concern you, especially if you spend a lot of time in social media discussion groups. While these groups can help you to make connections and learn more about Suboxone therapy, they can also be a source of misinformation. Be sure also to discuss Suboxone with your doctor and read about it from reputable sources.