I felt confident that I had no desire to use opioids again, not because the Suboxone had eliminated my cravings, but because I had changed my life. The pain I worked so hard to anesthetize with heroin had been addressed.
Suboxone, while often controversial among addiction treatment professionals and people in recovery, has moved to the forefront in discussions about opioid treatment. The recovery community has no shortage of naysayers insisting that medication-assisted treatment (with drugs such as Suboxone, buprenorphine, and methadone) is simply trading one addiction for another, characterizing it as heroin in legal form and just another way for the big pharma companies – who are already blamed for the initiation of the opioid epidemic – to pull in profits. But Suboxone is not an illicit street narcotic with fatal overdose rates surpassing even automobile accidents, it’s a life-saving tool that many experts insist is our best hope for the current public health emergency.
Medication-Assisted Treatment Is Effective, But Stigmatized
According to Dr. Gavin Bart, Director of the Division of Addiction Medicine at Hennepin County Medical Center and Associate Professor of Medicine at the University of Minnesota, opioid addiction requires long-term management; behavioral interventions alone have extremely poor outcomes with more than 80% of patients returning to drug use.
“Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function,” Bart writes. “Extensive research shows that each of the three available medications used to treat opiate addiction have superior treatment outcomes to non medication based therapies. Increased retention reduces mortality, improves social function, and is associated with decreased drug use and improved quality of life.”
Abstinence proponents may be skeptical about Bart’s research, but for me, it rings true. Reduction in illicit opiate use? Check. Decreased craving? Check. Improved social function and improved quality of life? Check, check. Abstinence-based treatment did not save my life. Medication-assisted treatment paired with specialized addiction therapy helped me save my own life.
As an active member of the recovery community, I am mostly outspoken and typically very candid, even when it comes to mortifying revelations. And even for me, Suboxone is a touchy subject. I am more comfortable discussing random substances I’ve injected than I am discussing how Suboxone was a key player in my opioid addiction treatment. I think my discomfort is a result of the negative rhetoric that surrounds the medication, and ironically enough its harshest critics are often other people in recovery. The prejudice against medication-assisted treatment is harmful, and even deadly when the negative discussion derails someone from seeking the help that, according to the evidence base, may give them the best chance of staying alive.
Is medication-based treatment the perfect fix to a horrific and increasingly deadly addiction? No. Suboxone has its burdens. I grappled with those too. When I first started taking Suboxone, I’d take it for a week and then relapse on heroin. I did that a handful of times before I was finally serious about getting clean.
My Suboxone Journey: From Relief to Frustration
My initial Suboxone dose was 8 mg buprenorphine with 2 mg naloxone. It was an orange strip with a tangy taste that I’d place under my tongue and wait while it dissolved into my bloodstream. Because I essentially switched directly from heroin to Suboxone (taking the first dose when I began experiencing opioid withdrawal symptoms), I didn’t have to suffer the weeks-long detox that frequently triggered my repeated relapses.
Taking my daily dose of Suboxone was like a sigh of relief at the beginning: one more day that I didn’t have to suffer through withdrawal. But after a few years, the sighs of relief eventually turned into sighs of disdain. My once-considered reprieve from the consequences of my addiction was starting to feel like a rusty pair of shackles. I was sick of going to the doctor and refilling my prescription, I was sick of keeping this secret from everyone in my life, I was sick of being terrified to travel. This thing that had once made me feel normal now had me feeling like I was still, after so much time, tied to my painful past of addiction.
Nothing else in my life reminded me of my past. There were no remnants of my previous addict self. I didn’t associate with any of my old using friends, I hadn’t seen or spoken with any dealers in ages, I never even got pulled over for traffic stops. I didn’t look like a junkie anymore and I didn’t act like one either. I had nurtured and repaired the ties with my family, I had a loving, healthy relationship, and I was well on my way to getting a college degree. I had successfully restored myself to sanity, as good ol’ Bill would say.
Fear kept me stagnant, which didn’t feel fair. I had come so far and was nothing like the junkie I once was, but I still had this inevitable withdrawal from Suboxone hanging over my head. My one final detox. The big whopper. How would I go through with it? I was in school so I couldn’t miss two to four weeks of classes, and anytime a summer or winter break neared, I’d chicken out, despite telling myself it was time and trying to prepare for it. In the meantime, I’d slowly been cutting down. I went from the initial dose of 8 mg buprenorphine/2 mg naloxone strips to 4 mg/1 mg, and then even further to 2 mg/.5 mg.
Suboxone Withdrawal
I had no idea what to expect. Like many of us, I have some form of post-traumatic stress disorder from my time in active addiction, and a major part of that was the horrendous withdrawals. I was completely fixated on these impending withdrawal symptoms, and there was nothing I could do — I had to pay the debt.
I finally made the decision to go through with it. I made the appropriate arrangements and was prepared to suffer for a couple weeks minimum, several weeks or maybe even months maximum. I watched YouTube to try to ease my frazzled nerves, but the videos pacified my anxiety like a game of Russian Roulette. Do not watch YouTube. Some videos had people detoxing, drenched in sweat and sobbing into the camera and others had people after just a week saying, “Not so bad guys!”
The night before I took my final dose, which was a teeny tiny square cut from a buprenorphine 2 mg/naloxone .5 mg strip, I curled up into the fetal position, buried myself under my duvet and cried myself to sleep. I couldn’t believe I was about to enter junkie limbo after living as a functioning member of society for so long.
The first few days weren’t pleasant, but it was nothing like I’d experienced in the past. I couldn’t sleep, I tossed and turned, I had tingling chills and clammy sweats, general anxiety and a sense of unease. I once detoxed from a $100 a day heroin habit and it was like I was the star of an exorcism horror film; compared to withdrawals like that, this one wasn’t nearly as bad as I’d anticipated. I think spending so much time tapering down to as small a dose of suboxone as I could handle really paid off when it came time to detox.
Another big fear I had, mostly thanks to Google and YouTube, was post-acute withdrawal syndrome (PAWS). After the initial detox, the last time I felt any symptoms I knew were directly related to my withdrawal was about a month and a half after day one. I had a mini-panic attack when Target was too crowded. I started pouring sweat, rushed to my car, and burst into tears. And after that, I’ve simply felt normal. That thing we all desperately want to feel: “normal.”
What If?
The detox was tough, it was emotionally taxing and physically draining. But I realized that it was the fear of the withdrawal that had me suffering the way I was. It was a fear of the symptoms and a fear of the unknown. I felt confident that I had no desire to use opioids again, not because the Suboxone had eliminated my cravings, but because I had changed my life. The pain I worked so hard to anesthetize with heroin had been addressed. I did deeply introspective work in therapy and I changed my social environment, all while using Suboxone. I built up my self-worth by investing in myself and investing in healthier relationships, things I never could have done while still using heroin. I fixed my broken coping mechanism, I knew how to handle stress and sadness. Yet, there was still this tiny sliver of me that wondered, “what if?”
What if it was all some magical mask that Suboxone created and none of this was reality and as soon as I stopped taking it I would revert to my old tormented life?
That is what prompted me to finally write this piece — realizing that regardless of the discomfort I feel discussing Suboxone, there are other people in recovery using medication-assisted treatment right now, scared to talk about it and scared to get off, experiencing the exact same fears that plagued me. Once I made the leap and decided to go ahead with my final detox, and then when it was complete, I felt free. Finally free. Not because Suboxone had me stuck, but because Suboxone helped me move past the hardest time of my life. This withdrawal was the final chapter to that saga and it was finally over — and I survived.
I closed the book, I’d won the war.
