Understanding Suboxone: Answering the 7 Most Common Provider and Patient Questions
Suboxone, which is an FDA approved medication used to treat opioid use disorder, is often misunderstood by both providers and patients alike. Despite being on the market since 2002 and being listed on the World Health Organization’s List of Essential Medicines, questions still swirl around its role in addiction treatment. Many question its efficacy and addiction potential, while debating the pros and cons of usage. Suboxone falls under a general umbrella of medications called MAT which stands for Medication Assisted Treatment. Medication Assisted Treatment encompasses medications that are FDA approved for the treatment of substance use disorders. These medications are designed to be used in combination with psychotherapy and non-medication support tools for long term recovery and relapse prevention. Today we answer the seven most common questions that providers and patients often ask when considering suboxone as a treatment option.
1. How does suboxone help me or my loved one get and stay sober? Opioid Use Disorder is notorious for long, protracted, severe physical withdrawal symptoms. Unlike Alcohol Use Disorder, which averages a withdrawal period of 3-5 days, folks suffering from Opioid Use Disorder often experience withdrawal symptoms including nausea, vomiting, diarrhea, dry heaves, cold sweats, and muscle aches for up to 14 days after time of last opioid use. Even after these physical symptoms subside, folks who have previously struggled with opioids often continue to have very intense, daily opioid cravings for years. Suboxone sets folks up for success in long term recovery by almost immediately eliminating all opioid physical withdrawal symptoms and opioid cravings so people feel “back to normal” again.
2. How does suboxone work? Suboxone is called a “partial opioid agonist.” This is a fancy way of saying it contains just enough low dose opioid ingredients to treat physical withdrawal symptoms and cravings, while being less abusable than “full” opioids like Oxycontin, Dilaudid, Vicodin and Fentanyl.
3. How effective is suboxone? Studies show that folks suffering from moderate to severe Opioid Use Disorder have up to a 95% relapse rate in the first year of recovery in the absence of Suboxone. This means that if you put 100 people in a room who struggle with opioids and who recently quit, only 5 of them would not have experienced a recurrence or return to use within one year. I don’t know about you, but I don’t like those odds. I want my patient and/or loved one in the room of folks who are taking suboxone.
4. Are you still sober on Suboxone? Isn’t it addictive? Since suboxone contains a small amount of a very weak opioid, many family members worry that their loved one is still “addicted” while taking suboxone. This misconception is amplified by the observation that when patients stop taking suboxone, they also experience physical withdrawal symptoms. People hearing this often equate Suboxone to older prescribed opioids like oxycontin, fentanyl, and dilaudid, which cause physical dependence and can also lead to abuse and misuse. It’s tempting (and natural) to think that Suboxone carries the same risks. However, unlike other opioids, Suboxone has a built in “ceiling effect,” so you can’t get a euphoric “high” with escalating doses.
5. Is suboxone abuseable? Suboxone contains a small amount of the opioid blocker Naloxone, also known as Narcan. This is the same ingredient used to reverse opioid overdoses. The Naloxone/Narcan stays inactive unless a patient tries to inject Suboxone. If someone tries to inject Suboxone via IV, the Naloxone immediately activates and prevents the Suboxone from attaching to opioid receptors in the body, thus preventing abuse. Additionally, Suboxone is a sublingual medication. This means it is taken by placing the medication under the tongue and letting it slowly dissolve into the saliva. This absorption method slows the medication release and activation speed, thus also reducing abuse potential.
6. How do you get off suboxone? Once patients are on effective doses of Suboxone, they can work with their physician to slowly reduce the dose and taper off completely when the time is right for them. When to get off of Suboxone is an individualized decision that should be carefully considered with patient, family, and provider input. It’s tempting to taper off of suboxone after a few days or weeks of sobriety. However, shorter lengths of time on Suboxone often correlate to higher risks of recurrence. As a general rule of thumb, I often suggest that patients stay on Suboxone for at least twice as long as their duration of active substance abuse. Addiction is a lifelong journey. It is important to master the non-medication relapse prevention skills needed to stay sober prior to starting a Suboxone taper.
7. Is Suboxone right for me? In general, if you or your loved one struggles with noticeable, significant physical withdrawal symptoms when trying to stop opioids, Suboxone could be an important addition to a more successful long term recovery journey.
For any individualized medication guidance, it is important to talk to your healthcare professional about your specific situation. In general, Suboxone is a very underestimated and underutilized medication that can often make the difference between long term success with recovery versus a path filled with frequent pitfalls and stumbles. At Aware Recovery Care we offer virtual consultations with our Addiction experts to help you determine the best addiction treatment option for you. Contact Us today to get started on your path to success!
-Lauren