By Tina Stec, MD, MPH
LCO Addiction Medicine Recovery Clinic Medical Director
FACT # 1
No one intends to become addicted to opioids
Many people start opioids with a prescription and intend to only use it for a short time. Some people are initially given pills from a friend or family members, or they get opioids off the street. However the opioid use starts, the use can escalate to a point where it is hard to stop.
Opioid use over time will cause tolerance leading to the need to use higher and higher doses to feel the same effect. Opioid use will lead to opioid dependence in as quickly as a few weeks. That dependence can be physical and psychological and will cause withdrawal symptoms when the opioid is stopped. Opioid withdrawal is very unpleasant and people will often go to extreme lengths to avoid it. If a person was getting medications from their doctor and are suddenly cut off they may get pills from the street. When people are getting pills off the street, this gets very expensive so some turn to heroin.
People who have an addiction to opioids at some point are no longer using opioids to get high. Their continued use of opioids is driven by the need to avoid going into opioid withdrawal. At this point using opioids just allows them to feel normal.
Suboxone is a brand name for buprenorphine/naloxone and is the preferred medication to treat those with opioid use disorder. Suboxone is an opioid but only partially stimulates the opioid receptors so it is safer and does not produce as much euphoria (or high) if abused like other opioids can.
Myth # 1
Using Suboxone is trading one addiction for another
This statement is simply not true.
Opioid use disrupts the brain chemistry and it can take a long time for it to return to normal. In some people who have abused opioids the brain chemistry does not return to normal. In other words, the changes in brain chemistry for some people can be permanent. Suboxone helps normalize the brain chemistry and allows one to feel normal.
Addiction means that there are addictive behaviors. When a person is addicted to pills or heroin, they are consumed by cravings and how to avoid withdrawal, often getting medications illicitly, hiding use form others, sometimes doing whatever it takes to stay out of withdrawal. People addicted to opioids have behavioral changes that may cause problems at work, with relationship, or with the law, and there is often a lot of shame about what they are doing.
Suboxone is prescribed by a doctor and can help stop those addictive behaviors by normalizing the brain chemistry. People addicted to opioids literally say Suboxone helps them feel normal. People take Suboxone daily just like people take blood pressure medicine daily. A person taking Suboxone no longer has to hide what they are doing, or have the consuming fear of going into withdrawal. They no longer have ups and downs in their moods due to going into withdrawal or dealing with the problems their drug use causes them. Instead, they just take their medication as prescribed. With cravings and withdrawal no longer running their lives, they can focus on the things that are important to them such as relationships, school, career, kids, goals, etc.
Fact #2
Suboxone saves lives
Opioid overdoses killed 48,000 people in 2018 in the United States, which is more than the number of deaths from car accidents.
People with opioid addiction have a much higher risk of dying than someone without opioid addiction. Continued opioid use often leads to IV use and that is a huge risk factor for getting Hepatitis C and HIV, and other infections, including endocarditis which is an infection of the valves of the heart.
Suboxone was shown to decrease the risk of death in people who had previously overdosed by 50% n one study. Suboxone helps people stay away from opioids and it also has been shown to help people stay in treatment and get the support they need to stay sober.
Suboxone is different than other opioids, as it only partially turns on the opioid receptors. This means that an opioid tolerant adult cannot overdose on it alone (although overodse can happen if Suboxone is combined with other drugs such as alcohol or benzodiazepines). A person with opioid tolerance will not feel high on it. However, it is strong enough to take away opioid cravings and withdrawal so it can stop other opioid use.
It is the cravings and withdrawal that run the lives of people with opioid addiction. Suboxone can resolve those issues and allow a person to feel normal and focus on the things that are important to them.
Myth # 2
You are not really sober on Suboxone
Not true. Again, see Myth # 1. What does sobriety mean? If it means living a self-directed life, making decisions that support your goals in life, then Suboxone does not hinder those things in any way.
Remember, people who are on a stable dose of Suboxone feel normal. They are not mentally altered, or high. The Suboxone is only helping to normalize their brain chemistry so they do not have cravings and withdrawal and can focus on the things that matter to them.
Fact # 3
There is a monthly injectable form of Suboxone
There is an injectable form of Suboxone called Sublocade. Sublocade is given monthly at the doctor’s office. Sublocade allows people to not have to think about taking medication daily and can allow for more stable medication levels in the body. Sublocade allows you to travel without taking medication with you.
Myth # 3
Getting off Suboxone is harder than getting off heroin
In general this is not true. Suboxone is an opioid and suddenly stopping Suboxone will cause withdrawal. However, remember that a person starts Suboxone because he or she is already opioid dependent.
Suboxone can be used to manage withdrawal (or detox) at home over a week or so, but once this is complete the vast majority of people will return to opioid use due to the altered brain chemistry discussed above.
It is generally recommended people stay on Suboxone for at least a year. This gives people time to get their lives in better order and learn better coping skills. Some people stay on Suboxone for years, and some stay on even longer because they are doing so well they do not see a reason to stop. People overall do better staying away from opioids the longer they stay on Suboxone.
If a person chooses to stop Suboxone after they feel life is stable, that is possible. Suboxone lasts longer than most other opioids so is easier to taper. If you work with your doctor to taper down slowly any withdrawal can be eased. The last few milligrams of Suboxone in particular should be tapered very slowly and in no hurry. Your doctor can provide you with other medication to help with any withdrawal symptoms.