With medication-assisted treatment (MAT), people with opioid addictions are given the chance to rebuild their lives—often from the ashes and debris of drug-induced destruction—without having to fight cravings and withdrawal.
Suboxone is a prescription medication that treats opioid addiction. It contains buprenorphine and naloxone, active ingredients that are used to curb cravings and block the effects of opioids. Although a major player in addiction recovery today, and often referred to as the gold-standard of addiction care, many in the recovery community remain resistant and even wary, including a large portion of rehab facilities and many members of the 12-step community.
How does Suboxone work? When an opioid like heroin hits your system, it causes a sense of euphoria, reduced levels of pain, and slowed breathing. The higher the dose, the more intense the effect. Buprenorphine and heroin are both considered opioids, but the way they bind with the opioid receptors in the brain differs. Heroin is a full agonist, meaning it activates the receptor completely and provides all of the desired effects. Buprenorphine is a long-acting partial agonist. While it still binds to the receptor, it is less activating than a full agonist, and there is a plateau level which means that additional doses will not create increased beneficial effects (although they may still cause increased adverse effects). In someone who has been addicted to opioids, buprenorphine will not cause feelings of euphoria—the sensation of being “high.” Naloxone is paired with the buprenorphine to discourage misuse; if Suboxone is injected, the presence of the naloxone may make the user extremely ill.
Jail Physician and Addiction Specialist Dr. Jonathan Giftos, M.D. offers this analogy: “I describe opioid receptors as little ‘garages’ in the brain. Heroin (or any short-acting opioid) is like a car that parks in those garages. As the car pulls into the garage, the patient gets a positive opioid effect. As the car backs out of the garage, the patient experiences withdrawal symptoms. Buprenorphine works as a car that pulls into the same garage, providing a positive opioid effect—just enough to prevent withdrawal symptoms and reduce cravings, but unlike heroin, which backs out after a few hours causing withdrawal—buprenorphine pulls the parking brake and occupies garage for 24-36 hours. This causes the functional blockade of the opioid receptor, reducing illicit opioid use and risk of fatal overdose.”
Critics and skeptics of medication-assisted treatment (MAT) believe that using Suboxone is essentially replacing one narcotic with another. While buprenorphine is technically considered a narcotic substance with addictive properties, there are important differences between using an opioid like heroin or oxycontin and physician-prescribed Suboxone. Similarities between using heroin and Suboxone are that you have to take the drug every day or you will experience withdrawal and likely become very ill. Aside from the physical dependency, which is without a doubt a burden, Suboxone offers people in recovery the opportunity to live a “normal” life, far removed from the drug culture lifestyle they may have been immersed in while using heroin.
People are dying every day from heroin overdoses, especially now in the nightmarish age of fentanyl. People in recovery from opioid addiction are living, free from the risk of overdosing, on Suboxone. Suboxone is a harm reduction option that while initially raised some eyebrows is gaining more traction, and considered an obvious choice for treatment by addiction medicine professionals. While someone using heroin is tasked daily with coming up with money for their drugs, avoiding run-ins with police or authorities, meeting dealers and often participating in other criminal activity, someone using physician-prescribed Suboxone is not breaking the law. They are able to function normally and go to school or get a job, and they are often participating in other forms of ongoing treatment simultaneously. People are given the chance to rebuild their lives—often from the ashes and debris of drug-induced destruction—without having to fight cravings and withdrawal.
There is a common misconception about Suboxone, and medication-assisted treatment in general, that it is a miracle medication that cures addiction. Because of this idea, many people use Suboxone and are disappointed when they relapse, quickly concluding that MAT doesn’t work for them. When visiting the website for the medication, it reads directly underneath “Important Safety Information” — “SUBOXONE® (buprenorphine and naloxone) Sublingual Film (CIII) is a prescription medicine indicated for treatment of opioid dependence and should be used as part of a complete treatment plan to include counseling and psychosocial support.”
So, as prescribed, Suboxone is intended to be only part of a treatment plan. It is but one tool in a toolbox with many other important tools such as counseling or therapy, 12-step meetings, building a support system, nurturing an aspect of your life that gives you purpose, and practicing self-care. It is medication-assisted treatment, emphasis on the assisted.
With that being said, the type of additional treatment or self-care a person participates in should fit their own individual needs and comfort level and not be forced on them. Like a wise therapist once said, “Everybody has the right to self-determination.” Twelve-step meetings, although free and available to everyone, are not the ideal treatment for many people struggling with addiction. Therapy is expensive. People using Suboxone or other MAT shouldn’t be confined to predetermined treatment plans that have little to do with an individual’s needs and more to do with stigma-imposed restrictions.
It’s unlikely that you’ll find a person claiming that simply taking Suboxone instead of heroin every day saved their life. It is not the mere replacement of one substance for another that is saving lives and treating even the most hopeless of people who have opioid use disorder; it is the relentless pursuit of a new way of life, a pursuit which includes rigorous introspection and a complete change of environment, peers, and daily life. Through the process of therapy, 12-step, using a recovery app, or whatever treatment suits you best, a person can face their demons, learn healthy coping mechanisms, and build confidence without the constant instability of cravings and withdrawal. Suboxone is giving people a chance that they just didn’t have before.
So why is there such a stigma tied to the life-saving medication? Much of it comes from misinformation and is carried over from its predecessor—the stigma of addiction. It is hard for people who have a pre-existing disdain for addiction in general to swallow the idea that another “narcotic” medication may be the best form of treatment. In addition to addiction-naive civilians or “normies” as 12-steppers might call them, many members of the Narcotics Anonymous community are not completely sold on Suboxone’s curative potential either. Some members of the 12-step community are accepting of MAT, but you just don’t know what you’re going to get. You may walk into a meeting and have a group that is completely open and supportive of a decision to go through the steps while on Suboxone, or you may walk into a meeting of old-timers who are adamant that total abstinence is crucial to your success in the program.
Another reason people are unconvinced is the length of time Suboxone users may or may not stay on the medication. Again, there is a stigma that shames people who use Suboxone long-term even though studies have shown long-term medication-assisted treatment is more successful than using it only as a detox aid. If Suboxone is helping a person live a productive life in a healthy environment, without the risk of overdose, that person should have the right to do so for however long they need without the scrutinizing gaze of others. While their critics are tsk-tsking away, they may be getting their law degree or buying their first home.
Suboxone is a vastly misunderstood and complex medication that has the potential to not only save the lives of people with opioid addictions, but also allow them to recover and rebuild lives that were once believed to be beyond repair.
