At the time of approval, The New York Times hailed Suboxone (buprenorphine and naloxone) as a “blockbuster medication” and even a “miracle drug.” In 2013, sales reached $1.55 billion. Since hitting the market, the drug developed a reputation as a safer medication assisted therapy strategy than methadone to treat opioid addiction. According to IMS Health’s National Prescription Audit Plus, the US alone dispensed about 9.3 million prescriptions for buprenorphine in 2013. This represents a dramatic increase from prescribing rates in 2008, when just 3.5 million prescriptions were written.
Suboxone came amid heightening opioid abuse, and it holds promise for mitigating the epidemic. According to the CDC 78 people in the US die every day from opioid overdose — and the annual death rate has surpassed motor vehicle accidents as a top cause of accidental death. Deaths from these drugs have quadrupled since 1999. Many attribute the growing rate of prescription opioid abuse to liberalization of laws regulating the prescribing limits of opioids for non-cancer pain treatment over the past 20 years. In fact, a study published in Pain Physician notes that 17.3% of people who use opioids non-medically received their prescription from a doctor.
The 2014 National Survey on Drug Use and Health uncovered several other somber statistics relating to prescription drug abuse:
- 4.3 million Americans self-reported non-medical use of prescription opioids within the month prior
- Nearly 2 million people in the US qualified as having a prescription medication abuse disorder based on their use habits in the year prior.
- Of the people who used prescription opioids non-medically in 2014, almost 1.5 million people were first-time users. The average age of these users was a little over 21 years old.
Medication assisted therapies like methadone must normally be administered in a treatment facility of some kind. Meanwhile, nearly 16,000 physicians in the US have authorization to dispense Suboxone prescriptions. In July 2016, the US Department of Health and Human Services increased the prescription limit for providers from 100 patients to 275 patients. If each eligible prescriber increases their patient load by about 20 to 50 patients, the agency estimates that the overall increase in the number of people receiving a buprenorphine prescription could jump anywhere between 10,000 to 90,000 additional people this year.
Suboxone is a clinically effective treatment for opioid dependency. Despite its benefits, however, Suboxone is controversial and comes with its own risk profile. Health providers and families of addicts are just as likely to call Suboxone a lifesaver as they are a life-threatening drug. The misuse, diversion and non-medically supervised use of buprenorphine is a growing problem. According to the Drug Enforcement Agency, there were approximately 21,000 emergency department visits in 2011 associated with the nonmedical use of buprenorphine. Meanwhile, the American Association of Poison Control Centers Annual Report from 2011 reported more than 3,600 case mentions and three deaths related to exposure to toxic amounts of buprenorphine.
Because Suboxone is relatively difficult to abuse when compared with heroin or other opioids, people often overlook the risks. Understanding the nuances of Suboxone addiction is critical to helping you or your loved one overcome or avoid this disease. Importantly, the biological properties of the medication are not what hooks people. Rather, abuse is more dependent on social, political, cultural and economic forces.
What is Suboxone?
Suboxone is a partial synthetic opioid drug used to treat opiate addiction and sometimes pain. One of the psychoactive ingredients in Suboxone is buprenorphine. Buprenorphine eliminates cravings and reduces the need for an opiate addict to take drugs. Suboxone comes in patch, tablet, injectable and sublingual forms.
Although doctors sometimes use Suboxone to treat pain in opiate-intolerant individuals, the drug is more commonly known as a form of opiate replacement therapy. Scientists are also examining whether or not buprenorphine makes an effective treatment for antidepressant- and shock therapy-resistant depression. Methadone is another form of replacement therapy. Like methadone, Suboxone is extremely strong. A person who does not have opiate tolerance could very easily overdose and die from taking just one Suboxone pill.
Suboxone itself contains a combination of buprenorphine and naloxone. Naloxone counteracts the effects of buprenorphine, which should make the drug impossible to abuse via injection — however, law enforcement officials around the country are reporting increased illicit street sales and abuse of Suboxone. Naloxone is commonly used as an anti-overdose drug in people who abuse heroin and other opiates. However, the amount of naloxone in Suboxone is not enough to stop a Suboxone overdose, especially if the user combined the drug with another central nervous system depressant.
Also like methadone, Suboxone stays in the body for a long time after ingestion. That means the physical effects of the drug can continue long after the psychoactive effects end. Taking the drug exactly as prescribed is essential, and taking too much Suboxone can easily end in fatal overdose.
What Does Suboxone Do to the Brain?
As a partial opioid agonist, Suboxone produces the effects of euphoria, respiratory depression and decreased pain. Suboxone binds to the same receptors, which are responsible for pleasure, in the brain as opioids — but not as perfectly. Because of this imperfect fit, the buprenorphine component of Suboxone tends to occupy the receptors without the full range of opioid effects. This tricks the receptors into feeling satisfied with the opioids despite not producing the euphoric feelings or notable respiratory depression. As such, individuals who abuse heroin or prescription opioids while using buprenorphine are unlikely to experience the additional effect.
In sum, Suboxone and its pharmacological components buprenorphine and naltrexone help to:
- Lower the potential for misuse and abuse of opioids and other drugs.
- Mitigate the effects of physical dependency to opioids, including symptoms of withdrawal and cravings.
- Increase safety in cases of overdose.
How Effective is Suboxone as a Replacement Therapy?
As is true with other medication-assisted therapies, Suboxone is most effective when prescribed alongside a regimen of counseling and social support services. Counseling can help you cope with the everyday struggles of life and gain the tools you need to thrive even when you’ve thwarted your physical dependence.
The findings of the very first clinical trial of Suboxone in young adults addicted to opioids, published in the Journal of the American Medical Association in 2008, demonstrated significantly improved outcomes when combined with counseling. Participants that stuck with Suboxone for 12 weeks and received counseling were less likely to abuse other drugs like marijuana, cocaine or heroin or leave treatment than their counterparts who received just short-term detoxification and counseling.
“We saw a marked reduction in opioid and other drug use; less injecting behavior, and better treatment retention in the patients assigned to longer-term Suboxone treatment,” said principal investigator George Woody, M.D, of the University of Pennsylvania and Treatment Research Institute, and VA Medical Center in Philadelphia, in an NIH news release.
“Extended use of Suboxone appeared to effectively control study participants’ symptoms of opioid withdrawal,” said co-investigator Geetha Subramaniam, M.D., of Johns Hopkins University, who oversaw patients enrolled in the study, in the same NIH news release. “The teens and young adults readily accepted Suboxone and tolerated it well. They seldom complained about sedation [a side effect of methadone and other medications for opioid dependence] and were pleased that they remained alert and could function during the day.”
The ideal candidates for Suboxone as a replacement therapy have the following characteristics:
- Clinically diagnosed with an opioid dependency by a health professional.
- Willing and able to follow the safety precautions associated with the medication.
- It has been determined that they do not have any health conflicts to preclude them from using buprenorphine.
- They have gone over the other treatment options before agreeing that a buprenorphine regimen is likely best for them.
Data collected by the Cleveland Clinic show that, when combined with inpatient services and a 12-step based treatment program 5 days per week, 84% of Suboxone users had a negative urine drug screen rate during the initial 6 months of treatment.
How Addictive is Suboxone Versus Other Drugs?
Suboxone should, in theory, be difficult to abuse. Low doses of the drug can keep opiate withdrawal symptoms at bay — and there’s a ceiling for relieving effects. As such, the addictive potential of Suboxone is very low if taken as prescribed. Many people who begin to abuse Suboxone do so because they are using the drug to self-medicate their addition to other narcotics.
Understanding Suboxone addiction is impossible without considering prescription opioids and heroin — the abused substances that normally lead someone to start using Suboxone in the first place. There are well over 100 narcotic painkillers available by prescription and sold illegally on the street. All opioid drugs have their roots in the opium poppy, used for hundreds of years to treat pain, relieve cough and stop diarrhea. Even the weakest opioids are powerful drugs that can cause tolerance, physical dependency and addiction.
Popular opioids include drugs such as Vicodin, OxyContin, Percocet, codeine and heroin. Some are stronger and last longer than others, but all opioids produce similar effects. Prescription pills are costlier to purchase and harder to get than heroin, which is why many people who become addicted to drugs such as Vicodin wind up switching to heroin instead.
Under normal circumstances, the brain produces a natural painkilling chemical called dopamine. During times of severe pain, taking a narcotic painkiller forces the brain to flood the body with dopamine, thus providing relief. Narcotic painkillers also affect other parts of the brain that control learning, memory and pleasurable feelings. Over time, the brain builds a strong connection between taking a painkiller and feeling euphoric. Eventually, the brain stops releasing dopamine on its own. This creates cravings to use drugs as well as nearly intolerable physical withdrawal symptoms.
The desired effects from Suboxone addiction often include:
- Feelings of extreme euphoria
- Increased feelings of peace and overall wellness
- Lowered ability to perceive feelings of physical pain
- Lower cravings for other opiates
As this physical dependency develops, the brain grows tolerant to the effects of the drug. Taking more and more becomes necessary. This is why people who become addicted to painkillers often have to take dozens of pills every day — amounts that would easily cause another non-addicted person to overdose. Heroin, by then, is easier to find and cheaper to buy. This is how an innocent painkiller prescription can often lead to a dangerous illicit drug such as heroin.
People who become addicted to Suboxone are often desperate to quit. Unfortunately, opiates have the highest relapse rate of any drug because the powerful cravings last for months or even years. For some users, an opiate replacement therapy or maintenance program can form the building blocks of an entirely new lifestyle. For others, Suboxone is just another abuse-able drug on the descent back into addiction.
As discussed, there are certainly therapeutic benefits associated with Suboxone in treating opioid dependence, the medical risks of abuse are also significant. When you inject Suboxone, it comes with all the risks associated with illicit injectable drugs, including HIV, hepatitis C, sepsis, soft tissue infection and other ails.
Suboxone: Concomitant Drug Use
Abusing Suboxone and another drug or alcohol concomitantly can have serious consequences. The majority of overdoses that occur from Suboxone use happen when the user combines Suboxone with benzodiazepines or other sedatives.
Suboxone and Alcohol
Alcohol is one of the most commonly abused substances among both adolescents and adults in the US. Opioid abusers and addicts tend to abuse alcohol with opioids, which can trigger stronger cravings. If you abuse alcohol while concurrently abusing Suboxone, you run the risk of intensifying the already bad side effects of Suboxone use, which include:
- Blurry Vision
- Intoxication (Feeling lightheaded or drunk)
- Heart Palpitations
Alcohol can also exacerbate the respiratory depression associated with Suboxone use.
Suboxone and Benzodiazepines
Benzodiazepines are a class of central nervous system suppressants (CNS) indicated to treat anxiety and panic disorders. Notable drugs in this class include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan).
Researchers associate concurrent Suboxone and benzodiazepine use with more accidental injuries due to impaired reaction time. This also leads to a higher number of visits to the emergency department. It’s important to know that this drug combination can be lethal.
For some people, co-abuse of these drugs is unintentional. The legitimate medical use of these drugs can still lead to dependency. For example, someone recovering from an opioid addiction may have a prescription for Suboxone. As part of their treatment, they may also receive a prescription for a benzodiazepine for the anxiety associated with opioid withdrawal.
Suboxone and Heroin
The National Institute on Drug Abuse estimates that more than 2 million people in the United States are afflicted by a substance abuse disorder relating to prescription opioid pain killers, while another 467,000 are estimated to suffer from an addiction to heroin. Heroin abusers trying to detox from this substance often have prescriptions for Suboxone to get them through the withdrawal process. The problem, however, is that many people end up just trading one addiction for another. Suboxone provides mild euphoria, and a former addict may just go back to heroin if they decide the Suboxone effects aren’t enough.
What are the Suboxone Addiction Signs?
Do you suspect that your loved one may be addicted to Suboxone? The signs of Suboxone abuse essentially mirror the signs that indicate an addiction to prescription opioids or heroin. The indications you can watch for include:
- Muscle pain and cramps
- Watery eyes
- Difficulty sleeping
- Persistent feelings of depression
- Slurred speech
- Increased blood pressure
- Poor memory
- Small pupils
- Apathetic mood
What are the Suboxone Addiction Symptoms?
Suboxone, like any other opiate, causes respiratory suppression. According to the National Alliance on Mental Illness (NAMI), 11 symptoms and behavioral patterns indicate a substance abuse issue. These 11 patterns include:
- The inability to manage life obligations in both home and work life, such as taking care of children, showing up to places on time, not going to work or not paying bills on time, if at all.
- Using the substance of choice under increasingly dangerous circumstances, such as driving or while caring for dependents.
- Experiencing ongoing conflicts and issues in relationships due to or while using drugs or alcohol.
- Needing higher doses of the drug of choice in order to experience the desired high due to a developed tolerance for the substance.
- Experiencing withdrawal symptoms after not taking the drug for a relatively short amount of time.
- Using more of the drug than is necessary in a single session because you’re trying to get a better or more intense high.
- Not having the ability to stop using the drug of choice or even to cut down despite the known consequences.
- Dedicating a significant amount of time seeking out the drug of choice, being high or recovering from the high.
- Avoiding engagements with friends and family, social events or any other former hobbies in favor of substance abuse.
- Continuing to use the drug despite gaining an awareness of the physical, social and psychological damage associated with the behavior.
- Uncontrollable and insatiable cravings for the drug of choice.
For Suboxone in particular, if you notice any of the following symptoms, you or your loved one may be suffering from an addiction:
- Acquiring multiple prescriptions for Suboxone
- Taking more Suboxone in greater amounts or more frequently than prescribed
- Trading Suboxone for another drug such as heroin
- Hiding or lying about your Suboxone abuse to others
- Combining Suboxone with another substance such as alcohol, a painkiller or a benzo such as Valium or Xanax
- Trying to wean yourself off Suboxone but always going back to using
- Worsening relationships, reputation or financial problems
- Shirking responsibilities to focus on getting more drugs
Addiction and Mental Health Issues
In general, individuals with mental disorders are more likely to develop a substance abuse issue than their counterparts without mental health issues. Many people who become addicted to drugs do so because they are self-medicating for said condition. These are called co-occurring disorders, or dual-diagnosis. The Substance Abuse and Mental Health Services Administration estimates that nearly 8 million people living in the US have co-occurring disorders. Similarly, the National Institute on Drug Abuse estimates that as many as 60% of people with substance abuse issues also have a mental disorder.
Some of the most common mental disorders associated with an addiction dual diagnosis include:
- Bipolar disorder
- Personality disorders
Mental health issues and addiction both come with their own set of complex symptoms, and as a result co-occurring disorders can be hard to diagnose. The majority of people with co-occurring disorders receive treatment for just one disorder while the other disorder remains unidentified and untreated. Undiagnosed, untreated or undertreated dual diagnoses are associated with dire consequences, including:
- Medical illnesses
- Early death
To properly address co-occurring disorders, health professionals must provide integrated treatment. Ideally, all professionals work together in one setting so that treatment can be coordinated for all presenting disorders.
Recovery Rates for Dual Diagnosis
While there is a staggering number of people suffering from dual diagnosis, there is hope for recovery. The Substance Abuse and Mental Health Services Administration provides the following statistics:
- 17.5 million Americans have a serious mental illness. About 4 million of those people also have an addiction disorder.
- People with dual diagnosis are often misdiagnosed. Among those with dual diagnosis, 34 percent received only mental health treatment, while 2% received rehab.
- Only 12 percent of people with dual diagnosis correctly received treatment for both diseases.
- Approximately 40 to 60 percent of people with addictions recover. Mental illness recovery rates are similar.
If you suspect your loved one may be suffering from one of these co-occurring disorders, you should keep an eye out for the following common symptoms:
- Unprovoked and often extreme mood swings
- An inability to control their mood
- An inability to stay employed or handle a long term relationship
- Unexplained financial or legal problems
- A lack of improvement in these symptoms despite remaining sober for 2 weeks or longer
What Are the Stages of Suboxone Withdrawal?
Suboxone addiction withdrawal symptoms can be intolerable. The speed of onset and the duration of action of Suboxone is much longer than most types of abused opioids. The Suboxone withdrawal symptoms normally start between 1 and 3 days after the final dose, and persist for about 10 days.
Importantly, the factors that affect the full extent of the symptoms include:
- The average amount of time that Suboxone was used
- The duration of time that the abuse has persisted
- Any pre-existing medical conditions or mental health disorders
- The extent to which Suboxone was mixed with other drugs or alcohol
Broken down, the withdrawal process for Suboxone typically falls into 3 stages:
The early stages of withdrawal normally begin within 8 to 16 hours after the last use. The presentations of symptoms are directly related to the half-life of the drug. Individuals who abuse drugs like heroin in which the high lasts for a relatively short amount of time experience withdrawal symptoms more quickly than their counterparts that abuse prescription medications. Meanwhile, people that abuse methadone could go up to 30 hours before experiencing any symptoms at all.
The physical symptoms associated with the early stage of withdrawal include:
- A runny nose
- Tearing/watering of the eyes
- Dilated pupils
- The shivers and goosebumps
- Involuntary twitching
- Hot and cold flashes
- Localized, aching pain in the abdomen, back and legs
Mentally, those withdrawing from Suboxone may experience:
At first, these symptoms are mild, but they gradually worsen over the course of the first hours.
TheHeight of Symptoms
The symptoms of Suboxone withdrawal peak approximately 2 to 3 days after the last use. After this, they begin to subside gradually. Nausea, vomiting and diarrhea are commonly reported complaints. Agitation also worsens. To a lesser degree, temperature, respiratory rate and blood pressure rise just a bit.
The duration of withdrawal can be controlled using certain medications, including naltrexone (Revia) and naloxone (Narcan), but it does so at a cost of intensification of the subjective symptoms. Doing this, however, causes an intensification of the withdrawal symptoms. A conversation with a medical professional is necessary to decide whether that is a worthwhile option.
Usually by day 10, the majority of withdrawal symptoms have completely subsided — but symptoms like insomnia, weakness and feelings of nervousness and anxiety can last for up to a year. Unfortunately, the relapse rate for people addicted to Suboxone and other opiates is quite high. The National Institute on Drug Abuse estimates that between 40 and 60% of drug users relapse after withdrawing.
The Suboxone Detoxification Process
There are several different avenues for Suboxone detoxification. The rate of long-term success and continued abstinence seems to depend on the level of comfort experienced during the actual detox process and tapering. At the time of intake, you can expect that professionals will evaluate the severity of your substance abuse problem as well as your entire health profile. Often, this is when co-occurring disorders are detected. This evaluation, combined with conversation with health professionals will help determine the best treatment strategy for you.
The initial stage of detoxification involves a tapering period. At a rehabilitation facility, this means staff members will gradually reduce the dose over a set period until your body is completely clean of the Suboxone. You may receive medications to help get you through the difficult withdrawal symptoms. Clonidine, for example, treats high blood pressure, but also quells certain withdrawal side effects including anxiety, sweating and aches.
Supervised detox is extremely helpful for people trying to rid themselves of their Suboxone addiction. The primary benefit of supervised detox is that you can have constant access to a medical professional trained in detoxification who will devise the best treatment according to your needs. Detox is hard enough — having the appropriate treatment is important to help support sustained abstinence.
Self-Detox: An Extremely Bad Idea
You may see or hear about a slew of products that purport to help detox your body, but it is vitally important for you to ignore those claims. Using a product to cleanse your colon does not carry nearly the same number of risks as a product to cleanse your system of drugs and alcohol. Notably, alcohol detox is the only process from which you could die.
There are a few reasons why individuals might try to detox on their own:
- They might think they can beat their addiction using just willpower.
- They may think their addiction is a secret, and detoxing in private can help them keep that secret.
- They might think that going through a supervised detox process is cost prohibitive.
- Some people believe that seeking help for addiction is a sign of weakness, or that detoxification programs have a stigma attached.
The truth of the matter is, however, that if you or your loved one need to free yourselves of a chemical addiction, you’re going to need to seek professional help. Detoxing alone is both ineffective and dangerous.
Withdrawing from heroin, one of the drugs commonly abused alongside Suboxone, can be extremely painful and dangerous. Your body is accustomed to the chronic exposure of the opioid narcotic. Suddenly stopping this body dynamic can shock your central nervous system. Not to mention, the risk of relapse is much higher when you detox alone. Licensed professionals can help you through the withdrawal period. Medically speaking, the excessive vomiting and diarrhea characteristics of heroin withdrawal can lead to extreme dehydration if you don’t replace the fluids at an equal rate. An individual going through withdrawal is highly unlikely to have the frame of mind to replenish their body fluids or head to the emergency department for help.
When It’s Time to Seek Rehabilitation for Suboxone Addiction
If these symptoms sound familiar, it’s time to get help from a qualified Suboxone rehab. At 12 Keys, we help people beat addiction to dangerous drugs and alcohol each and every day. Abusing Suboxone can be fatal, so you should never wait until it’s too late.
Addiction is a chronic disease, and the experienced and compassionate staff members at 12 Keys Rehab are well qualified to customize a comprehensive recovery plan designed for your unique needs. At our recovery center, you’ll learn why drug abuse became a problem in the first place, discover how to manage cravings and drug-seeking behaviors, and rebuild a sober, safer and more satisfying lifestyle.
Undergoing your detox with the help of rehabilitation facilities like 12 Keys improves your chances of giving up Suboxone once and for all. Going through supervised detox with a medical professional ensures that your treatment plan can be adjusted as needed. Medications to get you through the process can be integrated when deemed appropriate.
For most people, a detox program is just the first step they need to take to achieve a successful recovery. There are numerous stages to detox, and the length of said detox depends heavily on your specific needs. At 12 Keys, all detox programs are medically assisted. A licensed and trained medical professional will be by your side throughout your withdrawal process and especially at the junctures you need it most. As previously mentioned, mental health disorders often accompany Suboxone addiction. If this is the case for you, trained staff is available to help you manage both conditions concurrently to ensure you don’t go back to self-medicating.
At 12 Keys Rehab there is a naturally-occurring support environment designed to shield you from triggers and stress as you move through the recovery process. Call 12 Keys Rehab today to get yourself or your loved one on the road to sustained recovery and a better, more meaningful life. Aside from answering all of your questions, other topics we may discuss on the call include:
- You or your loved one’s addiction
- Recommended treatment options and length of stay
- Our accommodations and amenities
- Our private facility and location
- The recovery process and family involvement
- Insurance coverage and payment options
At 12 Keys we also promise you:
- We don’t judge — after all, many of us are recovered addicts ourselves
- We are holistic — we will heal your body and help you heal your mind and spirit with the most progressive therapies available
- We are experienced — our addiction counselors and mental and behavioral health therapists have helped many clients just like you
- We are private — we guarantee your care will remain 100% confidential
- We are available — 24 hours a day, 7 days a week
At 12 Keys Rehab, we specialize in providing compassionate, attentive care in a small and supportive environment. We can help you find your path to freedom, starting now. Contact us today to learn more.