Methadone and buprenorphine/naloxone are two of the primary medication options for treatment of people affected…
What Everyone Should Know About Suboxone
Mark was an avid racquetball player, hitting the court nearly every day until his shoulder, weakened by years of baseball, finally gave out on him. He went in for surgery, but in addition to getting his body repaired, Mark acquired a liking — and soon an obsessive need — for opioid painkillers.
At first, the pills helped him cope with the “excruciating, unbelievable” pain after surgery, Mark said, and he took them as directed. But before long, he found himself looking forward to the next dose, counting down the hours until he was allowed to have another pill. It wasn’t long before he’d go through an entire monthly prescription in just a few days, and he resorted to doctor-shopping to stay in “full supply,” he said. Mark didn’t go to work for a long time, blaming his absence on his shoulder. “I was living for the pills,” he said. “I wasn’t eating or sleeping. The days just blended together.”
The situation came to a head when, as his marriage crumbled, Mark feared losing his kids. He needed help, he said. This had to stop.
Mark now takes Suboxone, also prescribed by his doctor, and he has no desire for the prescription painkillers anymore. In fact, when his son was injured and prescribed opioids for the pain, Mark picked up the pills from the pharmacy, opened the bottle, poured a few into his hand — and put them back. He wondered how he’d ever become so obsessed with them.
What Is Suboxone?
Medication-assisted treatment for opioid dependence includes the use of buprenorphine (sold as Suboxone) complemented by counseling and other support measures that focus on the behavioral aspects of opioid dependence. Although Suboxone is also used to control pain, it was created as a way to manage opiate addiction. It has two major components: buprenorphine and naloxone.
In medical terminology, buprenorphine is called an opioid “partial agonist,” which means it partially binds to the opioid receptors in the brain, but not to the same degree as other opioids. Buprenorphine “tricks” the brain into believing it has encountered a full opioid such as oxycodone or heroin. Naloxone is an opioid antagonist, which means it stops other drugs, such as heroin, from activating the receptors. When used according to direction, Suboxone works. The New York Times calls Suboxone “the blockbuster drug most people have never heard of,” and many former addicts credit it with saving their lives.
But Suboxone is controversial — some people say users are just trading one drug for another — and the number of doctors licensed to prescribe Suboxone isn’t keeping up with the growing epidemic of prescription painkiller abuse. Suboxone has also become a relatively popular street drug among teenagers and young adults looking to get high. Federal regulators sought to help guard against an oversupply of Suboxone by requiring doctors to first be certified before being allowed to prescribe the medication and limiting the number of patients they could treat: In their first year of prescribing, doctors can treat only 30 patients. In subsequent years, federal regulations permit doctors to go up to 100 patients.
In hard-hit areas of the country such as the East Coast, those slots fill up quickly and addicts find themselves on waiting lists, some not surviving long enough to receive help. A study published in early 2015 in the journal Annals of Family Medicine found that only 2.2% of American physicians had obtained the waivers required to prescribe Suboxone and that in the majority of U.S. counties (53%) — most of them rural — there were no physicians who could dispense the medication.
Making Suboxone Treatment Easier to Access
With the death rates from opioid overdose having reached epidemic proportions in the U.S., the federal government is trying to expand access to Suboxone by easing the rules that limit doctors’ ability to prescribe it. “The opioid epidemic knows no boundaries; it touches lives in cities, rural counties and suburban neighborhoods across the country,” said Health and Human Services (HHS) Secretary Sylvia Burwell in a September 2015 news release announcing the change. “… Updating the current regulation around buprenorphine is an important step to increasing access to evidence-based treatment — helping more people get the treatment necessary for their recovery.”
Details of the new prescribing policy are expected to be announced by year’s end. The move to expand access to Suboxone comes on the heels of a push by the Substance Abuse and Mental Health Services Administration (SAMHSA) — the federal agency responsible for most public funding of drug addiction treatment — to get states to include medication-assisted treatment in their grant applications. Most treatment facilities in the U.S. don’t offer such care. And while the treatment is only a recommendation, the new language makes it appear that SAMHSA will give more money to states that use opioid replacement therapy.
How Suboxone Compares to Methadone
Methadone, another drug used to wean addicted people off of opiates, is a legal replacement for pain pills or heroin. It’s a full agonist opiate, just like heroin, oxycodone, hydrocodone, morphine and opium. Suboxone doesn’t activate the brain’s opioid receptors to the same extent as methadone, and patients are expected to get off of Suboxone gradually. Methadone, on the other hand, is long-term therapy that people might take for the rest of their lives.
The advantages of methadone treatment include stabilizing the lives of the most addicted people and reducing the harm related to drug use. Also, people taking methadone are less likely to drop out of treatment than those taking Suboxone.
The downside is that methadone is much easier to abuse than Suboxone — fatal overdoses are far more common with methadone. In fact, a study published in September 2015 in the journal The Lancet has revealed that addicted people treated with methadone are five times more likely to die within the first four weeks of treatment than those treated with Suboxone.
Dr. Jason Powers, MD, chief medical officer at Right Step and Promises Austin drug rehabilitation centers in Texas, calls himself a “centrist” when it comes to medication-assisted treatment. “There’s always a time and place for medications, and I utilize medications often in helping my patients lead happy lives,” Dr. Powers said. “But while medications are easier to study than messy constructs such as trust and compassion, spirituality, or happiness, many board-certified physicians like myself who treat addiction appreciate that those messy components are most often the biggest mediators for success.”
To be sure, SAMSHA and HHS also support the use of psychotherapy to treat the whole person. Until an addicted person gets to the root cause of his or her drug use, true recovery is impossible. Psychotherapy can also treat the other mental health conditions that contribute to substance abuse.
No One-Size-Fits-All Addiction Treatment
Dr. Powers said that it’s true that people treated with methadone commit less crime, transmit fewer needle-spread diseases such as HIV and hepatitis, and go back to work more frequently. But he said, “I wouldn’t want my pilot or surgeon to be on a strong opioid like methadone. There’s no one answer or solution for everyone.”
Medication-assisted treatment for addiction is complicated by stigma — the thought being that a user isn’t really “clean” while on replacement drug therapy — even if it’s a legal, prescription drug. Burwell stressed that research has shown Suboxone therapy to be effective as an aid to counseling and other behavioral treatment.
By Laura Nott
Follow Laura on Twitter at @LauraSueNott