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Do Suboxone and methadone really work to treat addiction?

Author of Alive Again: Recovering from Alcoholism and Drug Addiction

Meet the New Boss, Same as the Old Boss

My wife is a huge fan of the television show Grey’s Anatomy. Our home DVR is filled to the gills with stories where doctors at a fictional hospital struggle to balance their personal and private lives with the life-or-death struggles of their patients, all while learning — on a daily basis — that Sometimes People Perish. This, to my sensibilities, always begs the question that every medical student is supposedly asked when coming up in the field: How much trauma can the patient withstand?

And, if word on the street is correct, the answer is always, inevitably, the same: How badly does the patient want to survive?  So what’s the role of substitution therapies like methadone and buprenorphine for today’s addicts?

Methadone for dope sickness?

As a recovering heroin addict, whenever I was dope-sick in New York, I would always take to the streets and buy methadone – a liquid substitute for heroin (and other opiates) that was often used to regulate and retard withdrawal. And, I would buy it from other heroin addicts who, for reasons of their own, needed the money to go and buy real drugs.

Now, I was fortunate in that, eventually, I checked into a treatment center that demanded I stop using drugs altogether. My own detox experience was horrible, but I managed to walk through it because I had the strength and support of my counselor and my peers and the doctors who helped manage my withdrawal symptoms as they arose.  This was not the case for Oren Pius, the Admissions Director at my treatment center who (today) has almost 10 years clean and sober, but, before which, was a slave to methadone for over a decade.

You see, methadone can be addictive

Classified as a Schedule II Narcotic by the FDA, methadone is usually only available from hospitals or methadone clinics; addicts are required to show up at these places every day to receive their daily doses in an attempt to stave off or thwart withdrawal. Methadone clinics are everywhere because they seemed a great idea at the time. The philosophy was, “Let’s give the addicts methadone to keep them from committing crimes to get their drugs”, which made total sense. Harm Reduction has always been the government’s fallback position in the war on drugs, but for addicts like Oren (who had become so dependent on methadone that he couldn’t leave the city for fear of missing a dose) methadone became the bars of his new prison.

Methadone is more addictive than heroin

Now, if you ask any junkie on the street, they will tell you that methadone is much more addictive than heroin, if only because a methadone detox is one of the hardest detoxes there is.

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What about buprenorphine?

Which brings us hurtling into the 21st century and the new wonder drugs that have saturated the market:  Subutex and Suboxone (active ingredient buprenorphine). These have been classified as Schedule III Narcotics, which means (simply put) that, instead of having to go to specialized clinics to procure their doses of this drug, addicts can now walk into any neighborhood pharmacy and get their fix. Subutex and Suboxone are behind the pharmacist’s counter sharing shelf-space with allergy medications and antibiotics.

Do Suboxone and Subutex work?

Suboxone (burprenorphine hydrochloride mixed with naloxone hydrochloride) and Subutex (buprenorphine hydrochloride) are drugs that are designed as a “tag team” approach to opiate withdrawal. Subutex is usually administered at the front end when treating opiate dependency. The patient will use the drug for the first three or four days at the onset of withdrawal to manage their symptoms and keep their cravings at bay. The detox is then “handed off” to Suboxone, which has the opiate blocker Naloxone (not to be confused with Naltrexone) in it. What this means is that, if the heroin addict uses heroin, they can’t get high, so they don’t (Oren Pius reports that he used heroin off-and-on the entire time he was using methadone).

The thinking is that, eventually, the addict will come off the Suboxone and lead a full, productive life. But, in my experience, that isn’t always the case. I had a celebrity come through the program at my treatment center recently who claimed to have been using Suboxone for about 18 months and was terrified to come off of it. Symptoms of Suboxone addiction are tricky.  There was even an instance where he thought his dose was late, and he became violent, yelling and knocking things off of the walls. He simply could not live or function without it.

And I believe that’s only part of the problem. What we’re finding are doctors and psychiatrists passing themselves off as Addiction Specialists who are now able to prescribe this Schedule III Narcotic to their patients without introducing any kind of Suboxone taper, which is a more manageable detox than the heroin detox.

Addicts on Suboxone don’t feel sober

In my experience, addicts who are still on Suboxone all state that they don’t feel sober and, consequently, never get to feel like a part of the recovery community. These “Normie” doctors (medical professionals who have not overcome addiction themselves) and psychiatrists who are prescribing Suboxone (without factoring in the addict mentality) are actually doing the addict a great disservice, because they are robbing the addict of the opportunity to walk through the fear of the heroin detox and come out of the other side with the self-esteem that usually goes hand-in-hand with such an accomplishment.

Does substitution therapy help or hurt?

What do you think? Should doctors be able to prescribe these medications without a tapering plan? How can we help addicts help themselves? Tips to prevent relapse generally work for those who want to quit drugs.  Is using Suboxone or methadone equal to using?  Your comments and input are important to us and we hope to hear from you below.

Photo credit: Nemo

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10 Responses to “Do Suboxone and methadone really work to treat addiction?
Sam
9:24 am July 29th, 2013

This is a tough one, and there are obviously no easy answers. If there were, the problem of addiction wouldn’t be a problem now would it? Obviously (one would think) the best of all outcomes would be for the addict to discontinue use of all drugs, make it through detox, and remain clean. Oh for such a perfect world! Ideally, Methadone or Suboxone would be used VERY short-term as a detox-only tool and tapered within two or three weeks of starting to avoid another dependency. Again, however, this considers a world unlike the one in which we live. One size does not fit all. I don’t like the idea of an addict being on a substitute for the rest of his/her life. However, if that substitute harkens back to the thoughts of Methadone’s past – maintain and provide a stable and productive life – then perhaps that is the best choice for perhaps not all but many. Addiction is a disease that I don’t think we truly understand as much as we would like to think we do. The brain holds all kinds of secrets. We do not know exactly what the long-term effects of drug abuse are to the physiological brain. Any physician or neuroscientist who claims that receptors return to normal function and that any craving after that is purely psychological or the result of habit is simply speaking without pure scientific basis. It may be highly suspected that this is true, but it is not KNOWN to be true. There may well be some permanent alteration in how receptors function, and perhaps it is actually necessary to provide a permanent substitute because of that. If it works to keep the addict off drugs, stable, employed, and productive – DO IT! It’s just that simple. You may not like the idea of a permanent substitute. I certainly don’t. But people should not be left without help, permanent or not, for the sake of appearance. Until we have a more firm understanding of the science, we are obligated to provide the help that we can. And nevermind what the current political climate has done to those in legitimate pain who need the relief that opiate medication provides – whether non-malignant chronic pain or malignant. I have seen patients on both ends of the spectrum left to suffer because of the fear that has been instilled in doctors. This is simply inexcusable and unforgivable. Addiction is certainly a concern, but the foremost issue is treating the pain. If it has been resolved, THEN deal with the addiction, if any has developed. In the case of those with malignant pain and especially shorter life expectancies – WHO CARES!? They represent the ONLY case in which I say addiction is simply a non-issue. EVEN IF they are abusing the medication for emotional relief, then let them! The pendulum in pain management has swung to far to the side of fear and let too many people to suffer.

Sara
8:47 pm August 13th, 2013

Suboxone can be bought over the counter? Really? I just finished rehab (outpatient) using suboxone and had a hell of a time finding a doctor/clinic with enough “slots”. I couldn’t get my prescription without following the plan, including seeing the doctor and both group and individualized counseling.

I have to say, I could not have stopped taking oxy without the help of this medication. I had been taking it for 5+ years under doctor supervision, and taking it as prescribed, mostly. I say mostly because, while I wasn’t shooting, snorting, etc. I also wasn’t taking it as prescribed. I’d constantly over medicate, and obviously run out. Not to mention the fact that truly, I did not NEED the medication. I found a doctor I knew would prescribe for my ailment (not appropriately medicated, I must reiterate).

I have been “clean” for 100+ days now, and put in parentheses since I used suboxone for part of that time and I realize some take issue with that not being fully clean. I tapered off suboxone successfully 2 weeks ago. I still don’t feel 100% and wonder if it has to do with the residual narcotics leaving my system/my system repairing itself, or other medical problems I suffer, or perhaps both. I was taking such a small dose of suboxone in the final stage that I doubt what I felt/am feeling is withdrawal, but I have no idea.

Anyway, I’m babbling. Just wanted to say that it may not be for everyone, but I am so grateful that I could use it. I wanted a new life, my old life back, and couldn’t figure out any other way to successfully get there.

Mary
10:39 pm September 6th, 2013

I have been battling both alcoholism and opiate addiction for the last 7 years and have been held hostage by them for almost 20 years. More than half of my life has been spent in a drug-induced haze searching for, spending money on, and socializaling around drugs and alcohol. I’ve made numerous attempts at a clean and sober life, but I really can only consider 3 of them all out efforts or battles as I like to think of them.

My first attempt I scoffed at the thought of suboxone or methadone. Subs were new on the market and methadone had a stigma attached to, ( I thought of old dirty men with greasy filthy fingernails and a stench that one could smell for days). I also thought, as mentioned in the article, it’s not clean living- you are indeed still substance dependent and more than likely seeking. Well, by God’s grace I made it about 4 months clean and a little less than 2 months sober.

My next serious attempt I used what I learned from my relapse. I still had prejudices against methadone, but after great pressure from my substance abuse counselor (not an addict in recovery) I gave in an went on subtext the suboxone. I did my 12 step meetings, got involved, became part of something greater than myself and I was doing great. Then a suboxone shortage happened. I relapsed.

My current attempt and final ; ) I’m trying methadone and I have to admit I’m more relaxed. I did wrestle with the “Am I truly clean?” In the beginning, but my sponsor helped me sort it out. (She is neither for or against methadone). She told me to think of it like a pill prescribed by a doctor, if I need to, a heart pill or asthma pill. As long as I am taking my daily dose and not “supplementing” it with anything I add on my own its OK. Ever since then I’ve lost that inner confusion of “Am I clean?”

I have 7 months and 2 days. This is the longest I have been clean and sober in my life. I don’t think I’d be able to do it without the methadone. There may come a time when I decide I want to go off, but no one is rushing me. I was advised at my admit to stay on a minimum of two years based upon my past usage.

FYI not every MD in California can write for suboxone. Practicing suboxone MD’s have a limit on the number of patients they can see at a time. (At least that’s how it was when I was on it. It was very regulated.)
Methadone patients in good standing (clean) get take home doses after a certain amount of time and only need to go to the clinic once weekly.

Greg
1:06 pm November 19th, 2013
Johnny
11:20 am August 26th, 2014

Suboxone is not helping anyone, should be banned. I was addicted to pain meds, mostly Norco & Vicodin, I was taking 20 to 25 a day, 10/325mg for almost 10 years! finally got help, or so I thought. I was prescribed suboxone strips, 2 8mg strips per day, over the next 2 years I was slowly tapered down to 1/2 of a strip p/ day, and for 5 months was at 1/8 of a strip p/ day, which I thought would be no big deal at all to take the final step and not take any. holy cow! I laid in bed with full blown withdrawal and cold sweats for over 3 weeks!! Would have been easier to go through WD from the pills. Plus at over $500 for a 30 day supply without insurance, it would be cheaper to just wean off pain meds. pointless drug, it just replaces one drug with another. making people “think” they are clean.

Josh
9:26 pm December 4th, 2014

I am now 18 years old, I was on heroin and meth for 3 years. I am on methadone now and it fucking saved my life. If it weren’t for methadone and suboxone I would probable be dead. The only way they don’t work is if the person chooses not to get off it and continues to use it as their crutch. Maybe people are scared to get off it sometimes, I know I was. But for all you people who say it’s bad or like one of you who say it should be banned, your a fucking idiot. it’s saving me from a life of crime and drug addiction. I love my life today and am almost off of it. It is helping people get their lives back!

Lora
2:00 am September 4th, 2015

Well let’s see here… I’ve tried it all!!! I’ve been strung out on pain pills for about 10-11 years and just about 10 months ago I said enough is enough… I was shooting up roxy 30’s 3 and 4 at a time… I’d put 3-4 k8 dilaudid in my spoon at the peak of my addiction… And of course if I couldn’t find a pill around I’d be in my car driving into the city into the worst part of town to ride they the main strip and score some heroin… If I ha to go more than a day without anything I was violently sick. So I said this is it, cold turkey, violent withdrawals for bout 3 weeks. Started goin. To meetings.., made it a couple months then BOOM relapse… I was so depressed and emotionally I had never stoppe withdrawing. I couldn’t focus after I quit and I was very cloudy and depressed so I wenback to what I knew would make me feel “happy” month or two later got hooked up with a suboxone dr… Ehh it helped a little but I still never felt good or happy really and I found myself going off it for days at a time just so I could get high a few times a month… My back foe our on me… 3 herniated discs… Tempted to go back to pain mgmt soon Quit going to the suboxone doctor…. Tried to no so the pain mgmnt be I knew I couldn’t control if BUT I was in excruciating pain and withdrawal if I didn’t take anything…Went back to chasing pills….2-3 days at a time id b sick and in awful withdrawals though when I couldn’t find anything and my back hurting so bad I coul barely walk much less drive to the city… Plus I was getting leery of the heroin after I ha to rescuscitate a friend in my bathroom at my house because one shot dropped her to the floor, she stopped breathing and wa turning blue… Scared me. But after CPR for about a minute and a half she finally took a breath and I got a pulse…. Anyway… About a week and a half ago as a last result I started the methadone clinic. It offers me pain relief for my back, takes me out of my emotional funk, an eliminates completely any withdrawals… I think this could be my miracle drug, I’ve still been fuckn up tho and skipping days at the clinic to do method and shoot Roxie’s but I think I’m ready to commit to methadone an working my 12 steps. There’s got to be more to life than this…. Pray 4 me

Mel
10:52 am September 26th, 2015

It always horrifies me when I read the adventures of American addicts, so judgemental. So punitive. Then when one adds 12 step programs into the mix it’s truly amazing that anyone ever gets sober in the USA. Please, all those of you out there tossing out slogans such as ‘replacing one drug for another drug’, and that those who chose the methadone or suboxone route are just putting a plaster on their wounds. This should be a personal decision made by an addict and their doctors and/or therapists. I am always amazed when, after a few months to a year of ‘working the program’, one automatically becomes a doctor, a psychiatrist, a therapist and a pharmacist and consider themselves competent to make decisions for another person’s life under the title of ‘Sponsor’! or being ‘in the program’, etc.
As for the ‘band-aid’ theory that drugs, methadone, suboxone, etc. are just covering one’s problems and must be stopped now! Many, many people have problems far beyond the abilities of a sponsor or other 12 steppers and such problems can take years and years to overcome.. One must wonder just what the goal is. Is it to lead a happy, productive life and a ‘productive member of society’ or is it to stop all drugs, (except, ofcourse, cigarettes and coffee!) regardless of the consequences. Such problems have often been crippling people for years and years and to quit cold turkey, go to meetings, call your sponsor and be told that in so doing, they will all melt away after the fourth step!,hmmmmm. interesting!
Yes, obviously 12 step meetings have, and continue to help many, many people. But, not everyone. For many, myself included, being on methadone afforded me the ability to get back to work, take holidays, be responsible, etc. and, most importantly, gave me the stability in my life to find the appropriate therapy I needed. Not everything can be solved by a sponsor and ‘the rooms’. and many things just do not belong in a room where they are flung around from person to person.
So please 12 steppers, don’t judge those who achieve sanity and sobriety outside ‘the rooms’. Don’t judge those who do need the crutch of methadone or suboxone. Afterall, we are all striving for the same goal. Some of us achieve it by following different paths.
One last word…WOW!!!!! $500 a month for sub?????????????? OUCH! we get it for free.

Nicky
7:19 am December 14th, 2015

“They are robbing the addict if the opportunity to walk through the fear of the heroin detox and come out the other side with the self-esteem that usually goes hand-in-hand with such an accomplishment.”
As a recovering heroin addict, I agree absolutely. And even more so because of what I have witnessed with a loved one recently.
When I was looking up at the gutter, I was on a mission to get Bupe from that doctor in Seattle, my home. I never made it. I decided to “get well” instead. When the day finally came-ugly as it was-to pull head from rear and get clean, I went down to Portland, Oregon instead.
I went through medical detox (as well as outpatient treatment, daily meetings, close contact with a psych dr, medical dr, and transitional housing), because I knew it was my only real chance, but there was no Bupe. Thank God!
It was hard, I was sick, but the pain was great enough. I had to stop. No, my way isn’t the only way. There are options. My experience has proven over and over, with others as well, that it works.
I did try Methadone, that’s a vicious cycle and terribly painful, and for me, drug use, truly was a symptom of what was really going on.
A had several years clean before I connected with a man who fought Suboxone. He was prescribed opioids for an injury that lead to dependence that lead to Bupe. He was ashamed, fought, tried on his own, and now is on smack. I left him, because he became violent, and now, now that he’s stung out, with absolutely nothing left, except an all too extended arms reach away of love from those who truly love him, he’s reaching out for help…and he’s begging me to help him find a place that WON’T give him Bupe. I strongly agree.
We learn that one drug will substitute for another. I have deep respect for the power addiction held over me. My process, and the others who walk along with me agree. Please, allow the addict their process. It changed my life, inside and out. My self esteem is so much more than I even hoped for. I am truly grateful I didn’t take Bupe!

Lydia @ Addiction Blog
11:44 pm December 14th, 2015

Hello, Nicky. Thanks for sharing your story. I’m really glad that you made it, and I hope our readers will find your comment useful.

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About Dr. Howard C. Samuels, PsyD

Howard C. Samuels, Psy.D., author of Alive Again: Recovering from Alcoholism and Drug Addiction, is an internationally renowned recovery expert. He is the founder and president of the prestigious The Hills Treatment Center in Los Angeles and he appears regularly on national TV news shows about the challenges of drug addiction. For more, visit The Hills Treatment Center.

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