I know Suboxone is a tense subject to some, but as someone who has made it all the way through Suboxone treatment, and is 168 days clean from any opioid, I feel a responsibility to offer my honest experience. The doctors definitely weren't completely honest about its efficacy, and I wish I had completely honest input before I went on it.(Note, I am not saying doctor's are purposefully dishonest. I think many are misinformed by Rickett and its "data."
That being said...here is my experience and advice, for what its worth.
Suboxone will stabilized the insane life that many opiate addicts lead. Assuming you respond well to it, which most do...it really help you get your life on track and stop focusing on the next fix. When I started I was very happy to put the BS of addiction behind me....or so I thought. If you don't plan on staying on Suboxone for life, you may want to reconsider using it.
Regardless of what any doctor says about Suboxone's pharmacology...its partial agonist(rather than full) effect at the mu opiate receptor...its blocking effects of other opiates, etc...there is a whole other side of the coin that you are not being told.
We have mu, kappa, delta, and nociceptors. The mu receptor is talked up as the big deal...its the one that makes you feel high. And Suboxone is promoted as revolutionary because it is a partial mu receptor agonist, versus full agonists like heroin, oxy, etc.
So this fact allows Suboxone to be sold as this unique option that doesn't get you high.(eventhough physiological it does and most sub patients would agree it gets you high) Based on that, it is often not even presented as an opiate, which it is unequivocolly. We are also told that since it is only a partial agonist, the withdrawal will be quite minor.
The truth is a bit more complicated...
(I am going to refer to Suboxone as Buprenorphine from now on, buprenorphine being to active opiate ingredient in Suboxone)
Like all drugs, Buprenorphine metabolies into other chemicals once inside our bodies. (like heroin metabolized into morphine) Buprenorphine itself is a partial agonist at the mu opiate receptor, and a full agonist at the delta and nociceptors, and competitve antagonist at the kappa receptor. Buprenorhpine's metabolizes into norbuprenorphine, which is a full opiate agonist at the mu, delta. noci, and partial agonist at the kappa. So basically they are computing at all your opioid receptors, except the mu. The only thing fighting norburprenophine's full agonist effect on the mu aside from buprenorphine's high binding affinty. Meaning the less intoxicating buprenorphine latches on the mu receptor tight enough to block any other chemicals(whether this is true is immeasurable, and a moot point anyway.)
So what the hell does all this mean?
The mu receptor controls dependence, euphoria, GI physiology, etc. Bup has a partal agonist effect here, meaning to sum degree it is causing or effecting all these. Norbup has a full agonist effect here, which means to some degree it is having the exact same effect as any other opiate.
The delta receptor controls dependence, analgesia, and cns effecs. Bup and norbup are full agonists at these sites. Meaning they do exactly what any other opiate does.
The kappa receptor controls dysphoria, analgesia, and other important physiological actions. Bup is a competitive full antagonist at this site. Meaning it bindes very tightly, an block any other chemical. Norbup is a partial agonist, unlikely to counter the bup.
The nociceptor controls a variety of brain activities and and emotions. Bup and Norbup are both full agonists here...meaning the action at this site is no dfferent than that of any other opiate.
WHY DOES THIS MATTER?
Physiology is COMPLICATED...opiate abuse is not a virus or a bacteria. A series of pills is not just going to suddenly cure us. It takes a long time to change the body and brain with opiate abuse...and it takes a long time to fix it. Yeah, acute withdrawal may only take 1-2 weeks...but almost 80% of opiate addicts can't stay clean...and thats because you aren't healed when acute withdrawal ends. It may take less time to fully heal than it did to get addicted, but not much.
MY EXPERIENCE AND ADVICE ON COMING OFF SUBOXONE
My honest advice is that if you really want to be opiate free, and have the time and funds to go to a rehab...do it. Suboxone does stabilize in the short term, but doesn't make you any less dependent on opiates. And taken long term, when you do quit you may end out with more problems that when you started...like me.
So my story:
Got hurt, got on oxy, got hooked, asked for help, sent to stabilization, given suboxone, transfered to Sub doctor, given the whole SUboxoe is amazing story, didn't know any better, started treatment at 16 mgs.
8 months later, at 3 mgs tried to quit. Acute withdrawal not bad, lasted about 1.5 weeks. Weakness, exhaustion, aches, severe GI problems(diarhea, nausea), severe depression were constant for 2 months. During that time, I went from a muscular 205 lbs to a pathetic, horrible emaciated 155 lbs. I saw my doctor every couple weeks beginning for help and asking when it would get better. He prescribed klonopin, bentyl, tigan, buproprion, adderal, and catapress at some point during that period. Each time offering to put me back on sub...finally after over 2 months I gave in. The depression and GI problems were too much...I couldnt handle it with work. I went back on and was all better immediately.
My doctor posits that I should have weaned lower...so a year later I get down to .5 mgs and come off. The acute withdrawal isn't bad too bad again. The muscle aches aren't horrible. BUT just like last time depression, and GI problems last for weeks and weeks. I was in school and couldn't hack it so again I went back on.
At this point I had done a lot of research, talked to other docs...and was incredibley pissed at the situation. When my term ended, I went off again from 6mgs. But I took matters into my own hands and found an addictionologist that is vehemetly against Suboxone unless the person actually only wants maintenence.
And here's what we did:
She accessed that I was severely opioid dependent from long term Suboxone treatment and removing the opiate was inducing severe depression and anxiety, chronic fatigue, and severe GI disturbance.
Acute Withdrawals: Prescribed Lyrica 75mg x daily...worked amazing for the aches, and actually helped the GI stuff too. Klonopin to aid with anxiety and sleep....helped a lot with aniexty, none with sleep, but I didn't mind being awake because the pain was gone. Even more important than meds was diet. Drinking a ton of water, and eating healthy vitamin rich foods. Kefir, activia, fruits, veggies, chicken, rice, etc.
Long Term: Long term was hit and miss. I tried to be tough and push through a lot, but just could not get myself together. I couldn't function for months. I stayed in bed for 2 months...didn't really leave the house for 4. After trying a few differents things my doctor and I found that Cymbalta treated my exhaustion, aches, and some GI problems. After a month on 60 mg Cymbalta I was feeling better but couldnt focus for the life of me. We talked and as much as I hate stimulants, we tried 40 mgs of Vyvanse, which has worked wonders...took some getting used to, but helps a ton. Additionally, I am taking Oleptro occassionaly for sleep, Ammodium/Pepto/Tums for the stomach, and Klonopin for occassional anxiety.
My new non-suboxone addictionologist believes that all my symptoms are from the long term use of Suboxone and that we will remove the new meds as I start to feel confident.
Looking back on my time on Suboxone, I am disgusted with the way I behaved in some instances, and some of the choices I made. My thought process while completely off opiates is completely different.