Suboxone – Is it Obsolete?

Last week Recovery Unplugged spoke about Vivitrol and how it is helping many people in their recovery from opioid use disorder. In the not-so-distant past, there was a medication that promised the very same thing: Suboxone.

There has been some recent misinformation regarding this medication, including the relationship between Suboxone and anxiety the question of  “what is Suboxone used for.” It’s been widely reported that South Carolina massacre suspect Dylann Roof had, at one point, been taking and possibly abusing this medication. Some of the claims were: Suboxone is a powerful mind-altering drug, it causes mood swings, it can make you snap and cause severe depression and more. Like any medication, Suboxone should only be taken under the strict supervision of a qualified certified doctor that meets the requirements set forth by the Substance Abuse and Mental Health Services Administration (SAMHSA). The reality is that Suboxone can, in fact, alter the brain’s chemistry and affect behavior, especially upon abrupt cessation. Side effects can include mood swings, such as depression, anxiety and insomnia. 

Suboxone also has a very high potential for diversion and abuse. This is largely because the drug is a two-part medication. One part buprenorphine (a synthetic opiate) and one part naloxone (an opiate antagonist). The buprenorphine in Suboxone exists simply to give the brain what it is craving-opiates and the naloxone exists simply to block the user from using any other form of opiates. Much like Vivitrol, the naloxone in Suboxone does not allow you to feel the effects of opiates outside the buprenorphine in the medication.

There are a few ways doctors prescribe Suboxone. One is for detoxification purposes only. A doctor or detox facility utilizes Suboxone to help with withdrawal symptoms associated with coming off of opiates. The second less favorable way it is prescribed is for long term maintenance of an opiate addiction.  Someone meeting criteria may choose to stay on Suboxone to control cravings whilst forming a block in the brain to prevent relapse. Off label Suboxone and/or Subutex can and has been used in lieu of traditional narcotic medication to help with pain. Unfortunately, just as pain medications have been and continue to be abused. Some will abuse Suboxone and it has made its way to the streets. When abused or taken by a person that it is not prescribed to the effects of the drug can be very dangerous and harmful. There are a multiple pros and cons to use of this drug, including but not limited to:

Pros 

• Controls Cravings
• Blocks Narcotic Opiates
• Anti-Depressive Qualities (In Some Variations)

Cons 

• Very Powerful Synthetic Opiate
• Withdrawal upon Cessation
• Depression and Other Mental Health Side Effects
• Opiate-Induced Constipation

Many physicians are now transitioning their clients from Suboxone detox to Vivitrol. Recovery Unplugged offers Vivitrol for our clients and think it can be great tool. Suboxone was a useful medication when it was first released but now with the introduction of Vivitrol; you can have the benefits of the opiate blocker without buprenorphine which many say is just another mind altering drug substituting for your original drug of choice.

Suboxone detox has long been a topic of debate and discussion among those in recovery. Should it be considered a useful maintenance medication for long term use (remember if you stop it, you will experience withdrawal) or should it only be prescribed as a medication to assist only during detoxification? Many have said coming off of Suboxone is actually a longer and tougher withdrawal than coming off of an opiate such as heroin. Is it just substituting one drug for another? Should it be case by case? Is there a difference from Suboxone detox and any other medication for a disease such as Lithium for Bipolar Disorder or insulin for a Diabetic? What are your thoughts?