The New York Times calls Suboxone “the blockbuster drug most people have never heard of.” Widely popular for its use in treating heroin and other opioid addictions, Suboxone has taken on a life of its own, with many patients developing a dependency on the more controlled – and supposedly safer – high offered by Suboxone. The reality is that using Suboxone as a crutch brings with it a number of health problems, and the risks of Suboxone addiction are very real.
What Is Suboxone?
Suboxone is a mixture of buprenorphine and naloxone. It is prescribed for people who are addicted to legal opioids (in the form of prescription medication, like morphine and OxyContin) and illegal opioids (like heroin). There are over a million opioid abusers in the United States, enough for the Harvard Medical School to claim that opioid addiction is one of the most persistent drug problems in history. And Suboxone leapt into prominence as patients and doctors around the country looked for a way to deal with the epidemic of opioid abuse. According to the New York Times, Suboxone is even more popular than Viagra and Adderall, generating sales of $1.55 billion in the United States. Figures from a July 2013 report from U.S. Drug Enforcement Administration state that 9.3 million prescriptions for buprenorphine were filled in the preceding year.
Opioid Withdrawal Symptoms
As a patient is weaned off his opioid addiction (either by way of a medical detox program or an attempt to self-detox), he will undergo various withdrawal symptoms. Withdrawal symptoms arise because the body’s chemical systems that were long repressed by the influx of opioids are now freed from the influence of the drugs. As a result of the long period of addiction, those systems cannot simply resume normal functioning. Instead, they overwhelm the patient, leading to what we commonly see in withdrawal:
- Muscle cramping
The New York Times explains that while withdrawal symptoms are rarely fatal, they are almost always painful and stressful, so much so that the patient becomes desperate for another dose of the opioid to cope. To help ease the process of detoxification, and to introduce a less harmful alternative to the initial opioid, treatment staff members may give a patient Suboxone. Suboxone is effective because of its ingredients: buprenorphine is an opioid, but in a mild form that does not cause the intensely euphoric highs (and resultant addictiveness) of heroin, and naloxone, which dulls the effects of opioids. Suboxone is a popular choice in detoxification programs because it provides the patient with a milder alternative to the opioids that got them addicted, so treatment staff use it to distance the patient from those opioids. Suboxone does not offer the same euphoric highs of heroin, lowering the risk of addiction and keeping withdrawal symptoms at bay; for that reason, it can be considered a temporary replacement for heroin. There is an element of risk involved with the use of Suboxone for addicts whose withdrawal symptoms make them especially vulnerable to the influence of another addictive substance, but the effectiveness of Suboxone has clinical validity. A study published by the Journal of the American Medical Association in 2008 showed that young adults who were on a 12-week Suboxone program were less likely to use marijuana, cocaine, or opioids, or to leave treatment early. These patients had “substantially better outcomes” than patients who received standard treatment, in the words of the National Institute of Health.
Sometimes, however, the idea of Suboxone being “temporary” doesn’t quite work out. The Kentucky-based Courier Journal reported that opioid addicts take treatment and detoxification into their own hands by abusing Suboxone to stave off the withdrawal symptoms of trying to kick their heroin habit. The Courier-Journal profiled a man who started taking Suboxone after he overdosed on OxyContin. Eventually, the lure of simply getting high off Suboxone outweighed its use as a counter to the OxyContin addiction. A 2004 bulletin from the National Drug Intelligence Center noted that patients are crushing and snorting Suboxone tablets, in order to bypass the intended safeguards of having the body’s digestive system break down the buprenorphine and naloxone. Similarly, while Suboxone strips are supposed to be placed under the tongue, some addicts dissolve the strips in water, and then inject the resulting solution intravenously, achieving a quicker high. For this reason, some people consider buprenorphine to be “one of the most abused pharmaceuticals in the world.” A study reported on by the Drug & Alcohol Dependence journal found that 75 percent of participants at a needle exchange program used buprenorphine “to self-treat addiction or withdrawal.” And in 2010, the National Pain Report quoted the Substance Abuse and Mental Health Services Administration as saying that buprenorphine was responsible for 30,135 emergency room visits, with over half of those visits as a result of non-medical (recreational) use.
The Mechanisms and Effects
There is a particular science to obtaining legal drugs for the purposes of self-medication, or simply to get high. Patients who know the ins and outs of the system, and who are desperate for a hit, will try one or more of the following to fuel their habit:
- “Doctor shopping,” or secretly obtaining prescriptions from multiple doctors
- Forging prescriptions
- Mimicking opioid withdrawal symptoms
- Diverting resources to cover up and/or maintain the addiction
Addiction has many risks beyond behavioral effects. Spending money to procure multiple prescriptions or illicitly purchase Suboxone may cut into other financial responsibilities and lower the patient’s quality of life. However, if he persists with getting more Suboxone despite this, then his Suboxone addiction will run him (and potentially his family) into the ground. That said, because the buprenorphine and naloxone in Suboxone render it incapable of giving users the same kind of euphoric high associated with stronger opioids (morphine, methadone, heroin, Vicodin, etc.), the Suboxone itself is relatively hard to abuse. Nonetheless, taking more Suboxone than is medically recommended still carries a number of risks to the patient’s body, such as:
- Sleep disorders
- Memory problems
- Slurred speech
Furthermore, once a patient starts taking Suboxone beyond her prescription levels, she builds up a tolerance to the drug; that is, her brain acclimatizes to the amount of Suboxone she is taking, and the patient no longer feels the euphoric bliss she so earnestly desires. However, she is still compelled to seek out more Suboxone, either to feed the need for the high, or because she believes that abusing Suboxone is better than giving in to the heroin addiction. Village Voice carries the story of a heroin user who augmented his habit with Suboxone when he “just didn’t want to feel bad between bags [of heroin].” Speaking to Village Voice, New York City’s Special Narcotics Prosecutor says that some heroin addicts simply use Suboxone when the have a “pressing social engagement” for which they cannot afford to be totally high. So, the patient finds himself taking even more Suboxone, even though the actual effect of the drug in the body plateaus. Of course, the patient doesn’t know this, and so continues the cycle of abusing Suboxone, deepening his addiction.
Another risk of addiction is that it causes withdrawal symptoms in its users. We’ve seen how Suboxone is used to temper the withdrawal of getting off stronger opioids, but if a patient experiences withdrawal symptoms after he doesn’t use Suboxone for a short period of time, this is a clear sign that his use has gone too far. He may feel withdrawal symptoms similar to those associated with other opioids:
- Completely drained of energy and motivation
- Muscle cramps and pain
- Nausea and vomiting
- Anxiety and agitation
In a worst-case scenario of addiction, a patient can overdose on Suboxone, where the beleaguered brain is no longer able to process the buprenorphine and naloxone. If this happens, the user will experience:
- Low blood pressure and heart rate
- Circulatory problems
- Blurry vision
- Respiratory failure
- Cardiac arrest
Treating a Suboxone Addiction
There are two components to treating a Suboxone addiction. The first is detoxification, which may not be unfamiliar to a Suboxone abuser – in fact, detoxing to treat a heroin (or other opioid addiction) may be what prompted the addiction in the first place. Nonetheless, detoxification is the first step in the treatment process. To be done right, the user should be checked into a rehab center, where detox can be overseen by doctors and clinic staff. As part of the intake and assessment process of checking in, clinic staff should be made aware of the patient’s drug history. This information will determine what medications, if any, the patient should receive to ease the stress of detoxification. The second component of treatment can make all the difference in the world in terms of long-term recovery. No drug treatment program is complete without psychotherapy, which educates patients on the reasons and thought processes behind the cycles of addiction. In many instances, patients who leave a treatment program after detox, without going through psychotherapy sessions, invariably relapse. In the case of heroin addicts developing an addiction to Suboxone, the lack of understanding behind the mechanics of their heroin problem may be what caused them to fall prey to Suboxone. Done properly, however, therapy following detox will help a patient learn how to act and think in ways that give him more control and clarity in everyday life. After psychotherapy and discharge from a treatment facility, a patient should remain connected to aftercare support programs like 12-step groups. Such outlets provide a constant conduit of support and solidarity, further distancing the patient from the temptation to take Suboxone again. Getting addicted to Suboxone, ostensibly taken to provide relief from another addiction, can feel especially disheartening, but at Futures of Palm Beach, we want you to know that the future does not have to be bleak. We have trained medical and mental health professionals on our team, and if you have questions about both Suboxone addiction and Suboxone treatment, they are here for you. Please call us today, and we will be glad to help you in any way we can.