Suboxone And The Tapering Dilemma: Is It Worth It?

Bob gets bad news at the doctor.

Bob was on his way to the doctor to find out how his lab testing results turned out. He was a bit nervous, the way the doctor spoke to him on the phone.

When Bob arrived at the doctor’s office, he waited nervously in the waiting room, and was then brought in to sit at a desk, across from his doctor.

The doctor looked at Bob for a while, then glanced down at the report in front of him. “Bob, I have some bad news for you. It turns out that you have a rare form of cancer.”

Bob felt sick to his stomach when he heard those words. He wondered how long he had to live.

The doctor continued, “This cancer can be very aggressive. If we do nothing, there is an 80% chance that you will not make it beyond a year.”

The doctor explains to Bob that there’s hope.

“Fortunately, there is a treatment regimen that can be very effective if you are able to follow it.” Bob quickly sat up, suddenly alert, and responded, “Of course I am going to do the treatment. What do I have to do? How long can I live if I stick to the treatment regimen?”

Bob’s doctor had a worried look on his face. “The problem is that, while the regimen is effective, only about 10-20% of people stick with it. It involves a difficult regimen of diet and exercise. You are going to have to stop eating all carbs and follow a specific, high intensity cardio workout for two hours, every single day.”

The doctor continued, “I am going to send you to an institution for a month when you will be trained in following the diet and exercise program by certified instructors who have themselves completed the same program. After that, you will continue with support meetings. As long as you are able to stick with it, the cancer will remain in remission.”

Bob started to get worried. What if he failed? The idea of changing his lifestyle was not appealing. Why did this have to happen to him? It didn’t seem fair.

Bob then said to the doctor, “There must be another solution. I can’t imagine giving up my lifestyle and changing everything like that. I can already tell you that I don’t think I can do it.”

The doctor didn’t respond right away. Bob wondered what he would say. Would the doctor reprimand him for being weak?

Bob knew that it was wrong to say that he couldn’t follow the diet/exercise program. If he wanted to live, he was just going to have to accept that his life would change completely from here on out.

The doctor offers another solution.

When the doctor finally spoke, Bob was surprised by what he had to say. “Bob, there is another option. If you are interested, there is medication to treat this very aggressive cancer. You will have to take it every day, for at least a year or two.”

Bob wanted to know more. “Why didn’t you tell me this before? Will I still have to do the extreme diet and exercise program?”

The doctor said, “I would still recommend healthy eating and some daily exercise, but generally, your life will not have to change at all otherwise.”

Bob was shocked. “So I don’t have to check in to the institution for a month, I don’t have to go to meetings, and I don’t have to give up pizza, burgers, popcorn, chips, cake, and hanging out with friends and family? We can eat dinner together every night without my having to follow a special menu? I can just go on with normal life and still survive the cancer?”

The doctor held up his hand. “Wait Bob. There is something I should tell you. It’s true that you can take this daily medication and live your normal life without having to worry, but there is a downside. When you stop taking the medication after a year or two, you are going to feel very sick. In fact, you could feel sick for up to a few months, or even a bit longer.”

Bob thought about this. “What if I just kept taking the medication?” The doctor replied, that’s an option. There is actually, no harm in continuing it. The medication will protect you from the cancer as long as you take it.”

Bob weighs his options and makes a decision.

After a few minutes of thought, Bob had made up his mind. “I want to take the medicine and live my life without making major changes that I might not be able to keep up with. If I decide to stop taking it, I’ll deal with the sickness.”

Bob’s doctor then told him, “You don’t understand. You are going to feel really sick for a while and you may even wish you never took the medicine in the first place. You may even hate me for letting you get started with it. The withdrawal sickness isn’t dangerous, it is just very uncomfortable.”

Bob replied, “You’re saying that you can successfully treat my cancer with proven medication, but you’re telling me that I might not want to take it at all because I might get sick in a couple of years if I decide to stop taking it? Do you realize how crazy that sounds?”

The doctor shuffled some papers on his desk and ran his hand through his hair. “Bob, the diet and exercise coaches have a lot of influence when it comes to treating this particular cancer. They do not believe in doctors treating this cancer with medication. I know it sounds strange, but when it comes to this medical condition, there is a long tradition of allowing diet and exercise coaches to have the final say in what is best for our patients.”

The doctor gives Bob some unusual advice.

The doctor continued, “I can prescribe the medication to you, but you may be surprised how many people out there, workout coaches especially, who are going to tell you that you are making a mistake. You may want to keep things about your medical treatment private.”

Bob was getting frustrated. “So, I shouldn’t tell anyone that my doctor can successfully treat my cancer? Since when did exercise coaches tell doctors how to treat cancer? Life threatening illness should be treated with the latest treatments made available by medical science.”

“I want to live my life. I want to go to work every day and I want to come home to my family. I do not want to work out two hours every single night and then not be able to eat dinner with my wife and kids. I will deal with the withdrawal sickness, if and when it comes up in the future.”

“My children are young and I want to enjoy these precious years with them. I am doing very well at work and I want to continue in my progress. I can’t afford to take off a month to go to your training institution.”

Bob’s doctor smiled. “I think you made the right decision. I just had to be certain that you understood the risks and alternatives. Here is your prescription. We will meet on a monthly basis to track your progress.”

Opioid addiction is a deadly condition and as serious as cancer.

The story of Bob is a fictional account that represents the dilemma of prescribing Suboxone and similar buprenorphine containing medications for opioid addiction. Treatment with Suboxone is known as medication-assisted treatment, or MAT. It is highly effective, but also still frowned upon by the traditional, 12-step program adherents, which include the drug rehab industry in the United States.

Opioid addiction can be as deadly as cancer. There is a high risk of overdose risk within one year if treatment is not initiated. Abstinence-based therapy, including 12-step facilitation, has a fairly low success rate, partly because many people have difficulty working the program fully enough for it to be effective for them.

Suboxone works well and it allows patients to continue with their regular lifestyle with minimal changes. The medication is safe to take long-term. However, for patients who choose to taper off of the medication after a long enough treatment phase of 1-2 years, they will likely face a prolonged withdrawal syndrome.

This means that they will experience withdrawal symptoms for at least several weeks, and in some cases, months. The withdrawal from Suboxone can be very unpleasant.

Medication-assisted treatment works to successfully treat opioid addiction.

Yet, many patients report that when they do taper off of Suboxone after an adequate period of therapy, while they do feel withdrawal sickness, they do not tend to experience opioid cravings. This indicates that the opioid addiction is being successfully treated during the time that the patient took Suboxone.

So, why would there be any issue at all with recommending Suboxone therapy? Why would any doctor hesitate to recommend this highly successful treatment to patients?

Unfortunately, as in the story with Bob and his doctor, when it comes to this particular medical condition of opioid addiction, there is a long history of non-medical institutions having a strong influence. AA’s adherents and leaders in the rehab industry do not believe in using medication to treat addiction.

They even claim that it is simply replacing one drug with another. This is not at all true. When patients take Suboxone as directed at an adequate dosage, they do not experience drug cravings or sickness. They do not experience the brain fog associated with opioid use.

Suboxone is an effective treatment for opioid addiction. It is not a “replacement drug.”

I hope that the story of Bob and his doctor discussing treatment for a deadly cancer helps you to gain a new perspective on medication-assisted treatment for opioid use disorder. As I stated above, opioid addiction can be as dangerous as an aggressive cancer.

Patients are sometimes relieved after a long run of using street drugs that they are physically healthy. They do not stop to consider that their addiction itself is a deadly condition that can be terminal. Opioid addiction is a deadly condition and there is medical treatment for it.

The treatment is not perfect. It has its downsides. Yet, it allows patients to continue living normally without significant life interruptions. And, most importantly, it works. It is safe and highly effective.

We should focus on the life-saving nature of medical treatment for opioid addiction.

It is time that we stop focusing and obsessing over the downsides of Suboxone treatment. Rather than worrying endlessly over the physical dependence and withdrawal syndrome associated with the medication, we should rather focus on its life-saving properties.

If you start taking Suboxone, you do not have to take it for life. You can reduce your dosage over time, and, when the time is right, you can taper to the lowest dose possible and eventually stop taking Suboxone.

Continuing medical care for opioid addiction is important, even after you complete medical therapy.

While you may stop taking Suboxone, you should not stop seeing your doctor. Opioid addiction, like cancer, can re-occur. Relapses are always a possibility. It is important to stay vigilant. In some cases, restarting treatment may be necessary.

The important thing is that we have treatment for this life-threatening condition that works. It is time for us to stop hesitating in recommending this treatment to our patients who are struggling with opioid addiction.

We must understand that the benefits often far outweigh the risks. We have an obligation to our patients to offer them the best treatment possible to give them the best chance of success in overcoming opioid addiction and enjoying a successful and fulfilling life.

When it comes to MAT, there are many options available.

Fortunately, there are many options available for patients that use buprenorphine as the key ingredient. There is the sublingual treatments that involve putting medication under the tongue on a daily basis. These include Suboxone, Subutex, ZubSolv, as well as generic and compounded brands. There is also Bunavail, which is similar, but it attaches to the inner cheek.

There are also injectable, longer lasting versions, including Sublocade and Brixadi. Additionally, there is the Probuphine six months implant. We have many therapeutic options to offer patients in the realm of medication-assisted treatment for opioid use disorder, using buprenorphine.

Now is the best time to get started.

Now is the best time to make the decision to finally give up street drugs, such as heroin and fentanyl, or the misuse of pain medications, such as oxycodone, morphine, and Dilaudid. If you are ready to give up your opioid addiction today, call your doctor and make an appointment to discuss medication-assisted treatment.

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