Suboxone Debate: What Is the Big Problem with Buprenorphine?

man with head in hands
Do the pros of using Suboxone for maintenance therapy outweigh the cons?

When it comes to this nation’s chemical dependence, few drugs have achieved the notoriety and reputation of opioid drugs. In fact, things have spiraled so far out of control that opiate addiction is now considered an epidemic.

Despite leaving a mountain of destruction and broken lives in its wake, opiate addiction continues to stump scientists—a suitable cure has yet to be discovered. What scientists have developed, however, is a recovery tool for opiate addicts known as Suboxone.

Suboxone is the brand name for the combination medication buprenorphine and naloxone. It was the first prescription medication to target opiate addiction and works by virtually stopping the withdrawal symptoms caused by other opiates such as hydrocodone, heroin, codeine and OxyContin.1

Taken in low doses, buprenorphine allows opioid-addicted individuals to discontinue the abuse of opioids without experiencing a painful detox.

The naloxone is added as an abuse deterrent; it brings on withdrawal symptoms when other opiates are used. And if Suboxone tablets are crushed, injected or snorted, the naloxone blocks its effects and quickly throws users into withdrawal.1

Although buprenorphine is an opioid, its overall effects are less than those of full agonist opiates like heroin and methadone. Taken in low doses, buprenorphine allows opioid-addicted individuals to discontinue the abuse of opioids without experiencing a painful detox.

So what is the big problem? Do we have to pick a side?

Do We Have to Pick a Side?

Among addicts and addiction experts alike, the practice of using Suboxone for maintenance therapy is a hotly contested issue. And, in truth, both sides of the argument have valid points. For example, Suboxone supporters believe that long-term buprenorphine treatment is a much better alternative to turning to a life of crime, unemployment, poverty and dope-sickness. Some even say Suboxone helps to stave off the chronic depression that often follows detox.

On the other hand, most people who oppose Suboxone say that prolonged use of the drug brings about potentially devastating results … both physically and mentally. For this group, Suboxone is nothing short of a looming disaster speeding toward the addiction community.

Let’s take a look at both sides of this argument.

The Pro-Suboxone Movement

Suboxone has a much lower risk of overdose than methadone. And once you take a dose, the effects last for about three days, greatly decreasing the chance of a relapse.2

Buprenorphine causes less respiratory depression than methadone due to its ceiling effect and, thus, has lower overdose potential.3Dr Alan Leshner

“Buprenorphine is the most important advance certainly in heroin and opiate treatment if not all addiction treatments in the last 30 years,” added Dr. Alan Leshner, former director of the National Institutes of Drug Abuse.4

The Anti-Suboxone Movement

Those who oppose the increasing use of Suboxone warn that switching from one opiate to another does nothing to “heal” the neurological aspects of addiction or root emotional factors. Many addiction experts and 12-step support groups say you can’t be “clean” if you’re using Suboxone for long-term maintenance.

From this point of view, the lesson is cut-and-dry: As long as opioids are taken, your body manufactures a lower level of endorphins and increases the number of available receptors in the brain. Your tolerance continues to build and higher doses of Suboxone are needed to maintain it.

“That’s just dishonest advertising,” says psychiatrist and addiction specialist Dr. Steven Scanlan. “The naloxone doesn’t prevent you from shooting it. I’ve talked to dozens of people who have shot or snorted it.”4

Can We Trust Big Pharma?

According to several reports, the Suboxone research that Reckitt Benckiser conducted and ultimately provided the FDA told only part of the story.5

As was the case with OxyContin, Suboxone was initially promoted as a non-threat.6 However, time seems to have proven otherwise. In fact, many recovering opiate addicts say that Suboxone was harder to kick than methadone – and methadone is no joke. At higher doses over long periods of time, it becomes extremely difficult to kick Suboxone without professional help.

Suboxone was also marketed as a safe treatment for long-term maintenance. According to Reckitt Benckiser, doctors can keep patients on the drug for months (even years); during that time, the patient’s severely damaged brain chemistry is given the chance to heal. It turns out that claim is likely false.

“There’s no way your brain chemistry can heal while on buprenorphine,” says Dr. Scanlan. “You’re continuing to give someone a narcotic.”4

A Quest for Sobriety…and the Truth

One of the best ways to ensure your safety—and the safety of your loved ones—is to stay informed and up-to-date on emerging and established recovery options. With so much false and misleading information out there, the ability to separate fact from fiction becomes a necessity.

So let’s clear up a few misconceptions surrounding Suboxone.

Suboxone Isn’t Working

This is a common and very misleading statement. In reality, Suboxone success rates have been reported as high as 40 to 60%. These numbers are measured by recovery program retention rates and one-year sobriety post-treatment.7

Smoking Cigarettes Prevents Absorption of Suboxone

This statement is simply an underground wives tale. Despite a complete lack of scientific evidence to support this claim, it remains a persistent rumor. In truth, there’s just no data to indicate the efficacy of Suboxone is hampered by smoking cigarettes.

You Can’t Get High on Suboxone

Not true. Drug abusers have learned a few tricks when it comes to working around the naloxone in Suboxone. Generally, the tablets can be crushed and snorted, while the sublingual strips are often melted down and injected in an attempt to feel the drug’s effects faster.

IV Use of Suboxone Causes Withdrawal

Though intravenous abuse of buprenorphine is not a very popular method of abuse, it does happen. Supposedly, the naloxone contained in Suboxone causes withdrawal when injected. In truth, it doesn’t really matter whether Suboxone is injected or taken as directed – buprenorphine has the same “ceiling effect.”

The Veins Under Your Tongue Absorb Buprenorphine

This is another misleading statement often presented as fact. Actually, buprenorphine is absorbed via all the soft tissues of the mouth. Eventually the medication makes its way into your oral capillaries. The veins under your tongue actually absorb little or no buprenorphine.

You Can’t Take Prescription Painkillers While on Suboxone

Again, this is a huge misconception. You can take prescription pain pills while on Suboxone, but the dosage must be high enough to sufficiently reduce pain. However, if you spend the whole day injecting heroin and suddenly decide to pop a Suboxone film under your tongue, you can expect serious problems – namely in the form of precipitated withdrawal.

Sources

1. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Opioid Addiction.

2. The National Alliance of Advocates for Buprenorphine Treatment. (2005). Dosing Guide for Optimal Management of Opioid Dependence.

3. Whelan, P.J., Remski, K. (2012). Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Journal of Neuroscience Rural Practice, 3(1), 45-50.

4. The Fix. (2011). The Great Suboxone Debate.

5. The New York Times. (2013). Addiction Treatment With a Dark Side.

6. Van Zee, A. (2009). The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy. American Journal of Public Health, (99)2, 221-227.

7. Stotts, A.L., Dodrill, C.L., Kosten, T.R. (2009). Opioid Dependence Treatment: Options In Pharmacotherapy. Expert Opinion on Pharmacotherapy, 10(11), 1727-1740.