Opiate Addiction Treatment & Suboxone Detox
At Promises, clients who are looking to withdraw from opiates can do so safely and comfortably through the use of Suboxone, a medication that virtually stops withdrawal symptoms from opiate drugs such as Vicodin, heroin, codeine, morphine, and OxyContin. The drug is only used during the detoxification period so that once a client is stabilized, he or she can be free from the debilitating effects of opiate addiction. Our consulting physicians assess the client’s need for Suboxone and determine the appropriate course of treatment.
Dr. David Sack, an Addiction Psychiatrist and CEO of Promises Treatment Centers, explains what Suboxone is and how it is used to alleviate withdrawal symptoms for Promises clients who are dependent on opiates.
What is Suboxone?
Suboxone is approved to treat withdrawal from opiates and is one of two forms of the medication buprenorphine, which is an opiate agonist that was originally developed to treat pain syndromes. Suboxone binds to the opioid receptor in the brain, which is the same receptor to which morphine, heroin, and other opiates bind.
What makes Suboxone unique and valuable in addiction treatment is that it is a partial agonist. This means that at low doses, it acts the same as any other opiate in suppressing pain. But as the dosage is increased, it starts to block the opioid receptor, and doesn’t allow it to be stimulated. This allows clinicians to stop withdrawal symptoms without having to worry that the patient will begin abusing Suboxone. In addition, Suboxone makes it impossible to get high on other opiates. If someone is taking Suboxone and then uses heroin or OxyContin, they won’t feel any euphoria from the illicit drugs.
How is it used at Promises?
If an opiate user were to stop abruptly—or “cold turkey”—he or she would go into withdrawal within a few hours, which includes sweating, racing heartbeat, nausea, muscle pain, inability to sleep, and severe anxiety. When a patient arrives at Promises, he or she has likely taken their last dose of opiates within 4-12 hours and may already be experiencing mild withdrawal symptoms. One of our consulting physicians will assess the client then prescribe Suboxone and monitor the client’s progress throughout detox.
Once mild symptoms are present, the patient is given a dose of Suboxone. It is important that Suboxone not be given until mild symptoms show, as it could actually precipitate withdrawal symptoms if given too early. During the first day, the dosage is adjusted to a point where it suppresses the withdrawal symptoms. The goal is to virtually stop all withdrawal symptoms within the first 4 to 6 hours. At Promises, the average length of use of Suboxone is 3-4 days, though some people might need it for 7-14 days, depending on their history and the intensity of their opiate use.
It is sometimes necessary to administer additional medication if the patient has been abusing other drugs such as alcohol, marijuana, or Valium. Our consulting physicians may recommend a sedative hypnotic to help them sleep or anti-anxiety medication. In addition, they might recommend a muscle relaxant because muscle pain and spasms are common opiate withdrawal symptoms.
Although Suboxone and Subutex are approved for maintenance treatment—meaning that the patient stays on the drug after being stabilized—at Promises, we only use the drug for the opiate detox period
. We believe that for most people, the goal of recovery is to be off drugs completely. Maintenance opiate treatment, even when controlled and supervised, can be a disappointment for those whose ultimate objective is to live a drug free life. In rare cases, patients who have been using very high doses of opiates may be tapered over an extended period lasting up to 4 weeks.
Why not Methadone?
While methadone used to be the treatment drug of choice for opiate withdrawal, Suboxone has several advantages over methadone. First, it’s much safer. If a patient uses a street drug while taking Suboxone, it’s very unlikely that they will overdose, as they can with methadone. In addition, methadone can only be dispensed from a licensed methadone clinic, where the patient has to show up at the clinic every day to get their dose of methadone. With Suboxone, a patient can get a prescription from their doctor for and do not need to attend a clinic every day.
Another advantage of Suboxone is that it also contains naloxone, an opioid receptor antagonist that blocks the effects of opiates when injected intravenously. If a patient decides to inject Suboxone instead of taking it sublingually (letting it dissolve under the tongue), they won’t be able to get high. When taken as directed, the naloxone doesn’t affect the patient because it isn’t activated when taken sublingually. The other form of buprenorphine that is sold in the United States is Subutex, which is pure buprenorphine and doesn’t have the “safety net” that naloxone provides.
Is it Addictive?
Drugs that have the greatest abuse potential are those with a short half-life and that are absorbed quickly into the brain. Suboxone has a very long half-life and absorbs slowly through the blood vessels under the tongue, so it has a much lower addiction potential than other prescription opiates (Viconden, Percocet, Oxycontin) and heroin. Because the naloxone prevents it from being used intravenously, its addiction potential is further reduced.
People can and do take Suboxone recreationally, but most people who take it this way are not typically dependent on more potent opiates since the effects of Suboxone are much less intense. It’s very unusual to see people regularly abuse Suboxone, as most people who use it illicitly do so when they can’t get their hands on their preferred opiate like heroin or Vicodin. Another benefit of using the drug for detoxification only is that the short-term usage prevents people from using it in ways that are not intended by their addiction treatment team.
What is the Success Rate?
Buprenorphine prevents withdrawal symptoms in the vast majority of people. Data shows that buprenorphine is 50-100% more effective than other available treatments such as clonidine, and that a higher percentage of people who use buprenorphine complete their withdrawal. For maintenance treatment, the results are similar to methadone in that about 60% of people who are given maintenance treatment with buprenorphine stay on the treatment and don’t use illicit drugs while they’re on it.