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Suboxone: Concerns Behind The Miracle
I found this Dr who wrote this report and thought I would share if anyone is interested in another point of view on Suboxone.
I will be going to rehab on 10/3 and they will use Sub to wean me however; I will print this to make my point about only using this med for short term use only...if you go to this Dr's website there is a video you can watch too.
--------------------------------------------------------------
by Steven R. Scanlan, MD
One addiction may be traded for another as the FDA-approved opiate addiction treatment Suboxone is becoming one of the most prescribed medications in the country (#41 overall in sales in 2009 according to drugs.com). Called a “miracle drug” by some, Suboxone is estimated to be 25 to 40 times more potent than morphine.(1)
I am board-certified in psychiatry by the American Academy of Psychiatry and Neurology and board-certified in addiction medicine by the American Board of Addiction Medicine. I am the co-founder of Palm Beach Outpatient Detox (P.B.O.D.) in Boca Raton, Fla.
I once was addicted to opiates during my medical residency in anesthesiology and was detoxed with the help of Suboxone. Now I successfully detox my patients from opiates (e.g., morphine, OxyContin) using regulated amounts of Suboxone, and I also detox my patients from Suboxone addiction when that drug has been misused.
I have found that the optimal time to have someone on Suboxone is between 20 and 25 days, tapering down on the medication every few days. This makes the physical symptoms of detox very manageable, without causing the patient to become cross-addicted to Suboxone. I have found that Suboxone use for a longer period than this begins to cause a strong dependence on the medication.
Once a patient is stabilized with Suboxone and no longer getting high, he/she has to be convinced that recovery is possible. A detailed program is then created at the P.B.O.D. office, focused on abstinence and better coping techniques. P.B.O.D. prepares patients for the restlessness, irritability and discontent they will experience when they are off all narcotics, including Suboxone.
Suboxone detox makes the physical aspect of the disease manageable, but does not help with the emotional and spiritual consequences of addiction. Often patients are concerned about coming off Suboxone, but I educate them about how Suboxone is a tool to get them clean but not a suitable maintenance drug if a patient wants to get into recovery.
Suboxone is a powerful opiate-an anesthetic to emotional pain. It immediately alleviates anxiety and depression, and makes a person feel more emotionally stable. A lesser dose of Suboxone (2 mg a day) will block an estimated 80 percent of a person’s feelings, while higher doses can make a patient practically numb. Patients often say they feel great on Suboxone and since they are not getting high they want to continue on it. I tell them, “You are not dealing with your feelings because you are still not feeling-you are still numb. You need to start experiencing emotions to understand what you were trying to self-medicate in the first place. It’s time to live life on life’s terms.”
Duration of Use
When used in the short term, Suboxone is the best detox drug I have ever seen-it can immediately stabilize a patient’s life, and this can be done in an outpatient setting. When used long-term, though, it is the hardest medication I have ever dealt with in terms of detoxing a patient from it.
Suboxone does not work like natural opiates; it is created in a lab and interacts with the receptors in the brain unlike any other opiate. I speculate, based on treating hundreds of patients who have been on Suboxone maintenance, that when Suboxone is given long-term it causes abnormal adaptations to opiate receptors and other brain receptors. In my experience, long-term use can cause emotional deregulation, loss of libido, hair loss, and an abnormality in how the body regulates its response to stress.
Suboxone is a mixture of buprenorphine and naloxone. Buprenorphine is a powerful opiate, and naloxone is an opiate blocker used to resuscitate people in the ER from an opiate overdose. With no other opiates in the addict’s system in the last few days, he/she can either snort or intravenously shoot up Suboxone and become extremely high since it easily dissolves in water, making it easier to shoot up than heroin. The combination of there not being enough naloxone in Suboxone and the fact that Suboxone binds to the opiate receptor so strongly means that there is no built-in deterrent to keep a patient from abusing Suboxone. Dozens of my patients have discussed using Suboxone intravenously, and there are hundreds of reports about this on the Internet.
The misuse of Suboxone and the lack of attention to the problem are causing physicians untrained in addiction medicine to feed into overprescribing. Many do not understand the long-term ramifications of Suboxone addiction, and it also is a very lucrative business for the prescribing physician. Many doctors charge $200 to $300 monthly, per patient, for a 5-to-10 minute checkup to renew a Suboxone prescription.
Most places prescribing Suboxone maintenance do not offer any addiction treatment because the doctor is not trained in addiction medicine and because it is not time- or cost-effective to do so. Furthermore, the lucrative nature of Suboxone on a maintenance basis creates a disincentive to tapering the drug and its income-generating potential.
As a point of comparison I charge $2,000 for a detox from OxyContin or methadone, taking about three weeks. A detox from Suboxone dependence costs $5,000 because it takes four to five months, incorporating about 10 different medications to detox the patient successfully. The success rate for detox from Suboxone is much lower than that for detox from other opiates because patients tend to give up hope during the lengthy withdrawal process.
Dearth of Research
Most Suboxone studies follow post-detox patients for only a month and are often funded by the drug company that manufactures Suboxone. There are no long-term studies of Suboxone maintenance. I learned myself about the potential disadvantages of Suboxone maintenance from meeting people in my practice who have been on it for years.
I am concerned that the medical profession has allowed this situation to develop. I wish I knew how to fix this problem. I only know how to prevent it from happening to my patients in the first place or how to correct previous Suboxone treatment.
Only time will tell what role Suboxone will play in the field of addiction medicine. Will it one day be used only in the short term as a detox tool, or will it continue to be prescribed as a maintenance treatment? Supporters of maintenance treatment will state that the manageability of an addict’s life improves tremendously with Suboxone maintenance, and there is an abundance of research to back this up. Nonetheless, I believe that an individual on maintenance treatment is not experiencing the full range of emotions, good or bad. It is imperative, in the least, that all physicians prescribing this medication become more educated about Suboxone and the pros and cons of short-term and chronic use.
I will be going to rehab on 10/3 and they will use Sub to wean me however; I will print this to make my point about only using this med for short term use only...if you go to this Dr's website there is a video you can watch too.
--------------------------------------------------------------
by Steven R. Scanlan, MD
One addiction may be traded for another as the FDA-approved opiate addiction treatment Suboxone is becoming one of the most prescribed medications in the country (#41 overall in sales in 2009 according to drugs.com). Called a “miracle drug” by some, Suboxone is estimated to be 25 to 40 times more potent than morphine.(1)
I am board-certified in psychiatry by the American Academy of Psychiatry and Neurology and board-certified in addiction medicine by the American Board of Addiction Medicine. I am the co-founder of Palm Beach Outpatient Detox (P.B.O.D.) in Boca Raton, Fla.
I once was addicted to opiates during my medical residency in anesthesiology and was detoxed with the help of Suboxone. Now I successfully detox my patients from opiates (e.g., morphine, OxyContin) using regulated amounts of Suboxone, and I also detox my patients from Suboxone addiction when that drug has been misused.
I have found that the optimal time to have someone on Suboxone is between 20 and 25 days, tapering down on the medication every few days. This makes the physical symptoms of detox very manageable, without causing the patient to become cross-addicted to Suboxone. I have found that Suboxone use for a longer period than this begins to cause a strong dependence on the medication.
Once a patient is stabilized with Suboxone and no longer getting high, he/she has to be convinced that recovery is possible. A detailed program is then created at the P.B.O.D. office, focused on abstinence and better coping techniques. P.B.O.D. prepares patients for the restlessness, irritability and discontent they will experience when they are off all narcotics, including Suboxone.
Suboxone detox makes the physical aspect of the disease manageable, but does not help with the emotional and spiritual consequences of addiction. Often patients are concerned about coming off Suboxone, but I educate them about how Suboxone is a tool to get them clean but not a suitable maintenance drug if a patient wants to get into recovery.
Suboxone is a powerful opiate-an anesthetic to emotional pain. It immediately alleviates anxiety and depression, and makes a person feel more emotionally stable. A lesser dose of Suboxone (2 mg a day) will block an estimated 80 percent of a person’s feelings, while higher doses can make a patient practically numb. Patients often say they feel great on Suboxone and since they are not getting high they want to continue on it. I tell them, “You are not dealing with your feelings because you are still not feeling-you are still numb. You need to start experiencing emotions to understand what you were trying to self-medicate in the first place. It’s time to live life on life’s terms.”
Duration of Use
When used in the short term, Suboxone is the best detox drug I have ever seen-it can immediately stabilize a patient’s life, and this can be done in an outpatient setting. When used long-term, though, it is the hardest medication I have ever dealt with in terms of detoxing a patient from it.
Suboxone does not work like natural opiates; it is created in a lab and interacts with the receptors in the brain unlike any other opiate. I speculate, based on treating hundreds of patients who have been on Suboxone maintenance, that when Suboxone is given long-term it causes abnormal adaptations to opiate receptors and other brain receptors. In my experience, long-term use can cause emotional deregulation, loss of libido, hair loss, and an abnormality in how the body regulates its response to stress.
Suboxone is a mixture of buprenorphine and naloxone. Buprenorphine is a powerful opiate, and naloxone is an opiate blocker used to resuscitate people in the ER from an opiate overdose. With no other opiates in the addict’s system in the last few days, he/she can either snort or intravenously shoot up Suboxone and become extremely high since it easily dissolves in water, making it easier to shoot up than heroin. The combination of there not being enough naloxone in Suboxone and the fact that Suboxone binds to the opiate receptor so strongly means that there is no built-in deterrent to keep a patient from abusing Suboxone. Dozens of my patients have discussed using Suboxone intravenously, and there are hundreds of reports about this on the Internet.
The misuse of Suboxone and the lack of attention to the problem are causing physicians untrained in addiction medicine to feed into overprescribing. Many do not understand the long-term ramifications of Suboxone addiction, and it also is a very lucrative business for the prescribing physician. Many doctors charge $200 to $300 monthly, per patient, for a 5-to-10 minute checkup to renew a Suboxone prescription.
Most places prescribing Suboxone maintenance do not offer any addiction treatment because the doctor is not trained in addiction medicine and because it is not time- or cost-effective to do so. Furthermore, the lucrative nature of Suboxone on a maintenance basis creates a disincentive to tapering the drug and its income-generating potential.
As a point of comparison I charge $2,000 for a detox from OxyContin or methadone, taking about three weeks. A detox from Suboxone dependence costs $5,000 because it takes four to five months, incorporating about 10 different medications to detox the patient successfully. The success rate for detox from Suboxone is much lower than that for detox from other opiates because patients tend to give up hope during the lengthy withdrawal process.
Dearth of Research
Most Suboxone studies follow post-detox patients for only a month and are often funded by the drug company that manufactures Suboxone. There are no long-term studies of Suboxone maintenance. I learned myself about the potential disadvantages of Suboxone maintenance from meeting people in my practice who have been on it for years.
I am concerned that the medical profession has allowed this situation to develop. I wish I knew how to fix this problem. I only know how to prevent it from happening to my patients in the first place or how to correct previous Suboxone treatment.
Only time will tell what role Suboxone will play in the field of addiction medicine. Will it one day be used only in the short term as a detox tool, or will it continue to be prescribed as a maintenance treatment? Supporters of maintenance treatment will state that the manageability of an addict’s life improves tremendously with Suboxone maintenance, and there is an abundance of research to back this up. Nonetheless, I believe that an individual on maintenance treatment is not experiencing the full range of emotions, good or bad. It is imperative, in the least, that all physicians prescribing this medication become more educated about Suboxone and the pros and cons of short-term and chronic use.
Thank you Connie, I never realised how high Subs were in regards to other meds, I always knew they were a lot stronger than most realised but seeing that brought it all into prospective, I jumped to high when I did at 4mg and knew it was going to be hard. Didn't realise how hard though, I'm sound though and will never touch another drug again, sick of the past now, time to move forward in life and learn new things!
Great thread!
Great thread!
Just in case you are interested....here's a conversion chart from a former MedHelper showing Suboxone/Bupenorphine (bupe) equivalency to other opiates:
1.2 mg of bupe is equal to 30 mg of hydrocodone
http://www.medhelp.org/user_journals/show/18499/Conversion-table-other-drugs-equivalent-to-sub
So roughly an 8 mg/2mg strip of suboxone would be equal to 200 mg of hydrocodone.
1.2 mg of bupe is equal to 30 mg of hydrocodone
http://www.medhelp.org/user_journals/show/18499/Conversion-table-other-drugs-equivalent-to-sub
So roughly an 8 mg/2mg strip of suboxone would be equal to 200 mg of hydrocodone.
I remember reading that if your on Sub's and get into an accident you have to tell them because certain drugs don't work if you are on Sub....
Great information here. I knew someone who went to rehab and they used suboxone in the short term. It was a good plan and worked. Unfortunately he stopped doing the aftercare and then relapsed and is still abusing. He did state the suboxone did make him feel high. I know there are some doctors using this for pain management. I know this isn't the forum for that but I wonder if we'll see more of that in the coming years. If we do, I sense it will be something like using methadone for pain management. (No offense to anyone who chose methadone for managing their pain; I just feel like it's not right for me and probably most people for a number of reasons.)
I have seen kids in our town are using suboxone without a doctor's supervision and there are disastrous results with that. A giant cycle of subs/heroin/pills/subs ... very sad to see these kids.
I have seen kids in our town are using suboxone without a doctor's supervision and there are disastrous results with that. A giant cycle of subs/heroin/pills/subs ... very sad to see these kids.
It always makes me wary when the person selling you the med says you need to stay on it ;) and wow number 41 in 2009 That is a cash cow !!
I believe that it means 8 mg of buprenorphine and 2 mg of nalaxone.
This is great article. This guy tells it like it is . I like that . I know so many people who got on it,stayed on it and then it stopped "working" after a period and they became very sick of just existing. I am glad I never went that route because I would have just stayed high and satiated on it and I know nothing would have changed in my life regardless of whether or not I was working a suboxone recovery program or not. I know that when opiates are in my system I do not think right. Thank you for posting this and best wishes for you ;))
This is great article. This guy tells it like it is . I like that . I know so many people who got on it,stayed on it and then it stopped "working" after a period and they became very sick of just existing. I am glad I never went that route because I would have just stayed high and satiated on it and I know nothing would have changed in my life regardless of whether or not I was working a suboxone recovery program or not. I know that when opiates are in my system I do not think right. Thank you for posting this and best wishes for you ;))
I found this Dr over a year ago and was very grateful because most people don't know that Sub is a good thing to use for weaning but not long term.
I just pray that this rehab that I booked and gave a deposit to keep a bed open will work with dosing that matches what I take 4-6 10/325 Norco per day for over 3 yrs. I prefer to start out with 2mg then, 1mg and jump down to the lowest I can go before I leave. However; I'm confused when people say 8mg/2mg size why does it have those two amounts on it?
It is a 12 step program and I don't mind so much however; I prefer to use other programs these days that they have that is not 12 step. I am only addicted because I have taken the prescribed dose for over 3 yrs.
Best of luck to you...
I just pray that this rehab that I booked and gave a deposit to keep a bed open will work with dosing that matches what I take 4-6 10/325 Norco per day for over 3 yrs. I prefer to start out with 2mg then, 1mg and jump down to the lowest I can go before I leave. However; I'm confused when people say 8mg/2mg size why does it have those two amounts on it?
It is a 12 step program and I don't mind so much however; I prefer to use other programs these days that they have that is not 12 step. I am only addicted because I have taken the prescribed dose for over 3 yrs.
Best of luck to you...
Excellent article/report!! Thank you for sharing it with us. I was particularly impressed because this dr. was addicted himself during his medical residency and has since made understanding and treating addiction his life work. He is also attempting to educate the masses regarding the latest "maintenance crazed drug", suboxone.
I am a recovering addict who was at my worst....ingesting 300 mg/day of hydrocodone. When I got myself down to about 120 mg/day...I had a breathing crisis that landed me in the ER. They dismissed me with no help. In desperation, I called my PA who referred me to a Psych Dr who was licensed to dispense subs. Because of my insanely crazy state at the time, I trusted my PA and went for the appt the next day totally unequipped.....with NO KNOWLEDGE of subs! I was put on a very high dose and jumped off at a very high dose voluntarily and ignorantly. I took subs for a total of 28 days.
Being a researcher by nature.....this is totally unbelievable to me....as at 55 days clean I found MedHelp and learned more than I ever wanted to know about subs LOL. More than likely, NOT knowing.....got me thru.
I am SO glad you are researching and equipping yourself BEFORE you go to rehab. If I had it to do over again.....I NEVER would have taken subs at all for my hydrocodone addiction.
Kudos to you for informing yourself.....I wish you the best in your rehab and travels on this road to recovery~
I am a recovering addict who was at my worst....ingesting 300 mg/day of hydrocodone. When I got myself down to about 120 mg/day...I had a breathing crisis that landed me in the ER. They dismissed me with no help. In desperation, I called my PA who referred me to a Psych Dr who was licensed to dispense subs. Because of my insanely crazy state at the time, I trusted my PA and went for the appt the next day totally unequipped.....with NO KNOWLEDGE of subs! I was put on a very high dose and jumped off at a very high dose voluntarily and ignorantly. I took subs for a total of 28 days.
Being a researcher by nature.....this is totally unbelievable to me....as at 55 days clean I found MedHelp and learned more than I ever wanted to know about subs LOL. More than likely, NOT knowing.....got me thru.
I am SO glad you are researching and equipping yourself BEFORE you go to rehab. If I had it to do over again.....I NEVER would have taken subs at all for my hydrocodone addiction.
Kudos to you for informing yourself.....I wish you the best in your rehab and travels on this road to recovery~
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