Leaving a heroin addiction behind can feel like one of the most difficult challenges in the world.
Fortunately, treatment has come a long way in helping that process become more feasible. Even as new doors open in the science of addiction rehabilitation, patients are at risk for being on the receiving end of some very double-sided weapons. Suboxone abuse is a real danger for patients who are trying to leave behind a life of opioid abuse, but they are not without treatment options to help them finally and truly get clean.
Suboxone, Buprenorphine and Naloxone
When we use the term Suboxone, we are actually talking about two different drugs: buprenorphine and naloxone. The combination is what makes Suboxone a popular drug choice for treating an opioid addiction, but it is also what puts people at risk for becoming addicted to the Suboxone itself.
Buprenorphine is actually an opioid, but it has only the most minimal of effects when compared to other, stronger opioids (like heroin or morphine); indeed, that is why buprenorphine is what is known as a partial opioid agonist. Once inside the body, partial agonists seek out receptors on the brain, much like how full agonists do; but unlike full agonists, partial agonists are only partially effective at triggering the receptors.
By design (buprenorphine is semi-synthetic, meaning it is derived from chemical compounds that have been extracted from natural sources, such as plants or bacteria), this means that a patient taking buprenorphine can be steadily weaned off their dependence on full agonists.
By contrast, naloxone is a pure opioid antagonist. When an antagonist like naloxone hits the receptors in the brain, it blocks (or, at the very least, mutes) how the receptors respond. This means that naloxone is actually capable of reversing the effects of full agonist opioids, since it effectively shuts off the signals the receptors are sending to the nervous system and the rest of the body.
Naloxone: Too Much of a Good Thing
In theory, it sounds like naloxone is the answer to every case of heroin addiction: give the patient naloxone and watch the effects of heroin be undone. The truth of the matter is that heroin is so powerful a drug that simply administering naloxone and standing by puts the patient at severe risk of having a seizure or respiratory failure, potentially leading to death. While these may happen only in the most extreme cases of heroin addiction, what is more likely is that the patient will experience excruciating withdrawal symptoms if the body is suddenly deprived of heroin.
- Abdominal cramping and diarrhea
- Nausea and vomiting
- Agitation and irritability
- Dilated pupils
Another danger of the withdrawal stage is that the symptoms mentally and physically disarm the patient to the point where he is desperate for another dose of opioids. At this point, he is less interested in getting high and more concerned about calming the violent response of his body forcibly rewiring itself in the absence of the drug(s) on which he is dependent.
Since naloxone plugging up the brain’s opioid receptors would be very detrimental to a patient with an opioid problem, it cannot be administered alone. If, however, it was administered with a milder, easier opioid, perhaps a partial agonist like buprenorphine, the two can work in conjunction to help a patient taper off his habit and avoid the worst of the withdrawal symptoms – hence, Suboxone.
The Power of Suboxone
Suboxone’s modus operandi may seem risky, but it often is able to help. In 2008, the Journal of the American Medical Association conducted a study that found that 154 young adults who were put on a 12-week-long Suboxone program had significantly improved outcomes when it came to the use of other drugs (marijuana, cocaine, or other opioids) than patients who received treatment without Suboxone.
A co-investigator of the study said that patients who were enrolled in the Suboxone program accepted and tolerated the treatment without complaining about sedation, which is the case when other medications for opioid dependence are used. Furthermore, patients were happy when the milder opioid effects of the Suboxone meant that they retained their alertness and functionality immediately following the treatment.
While Suboxone’s greatest strength is how it can (temporarily) replace a heroin or other opioid problem, this is also where it poses its greatest danger. That is why The New York Times called it a “blockbuster” drug, saying that its sales of $1.55 billion made it more popular than Viagra and Adderall. A July 2013 report from the U.S. Drug Enforcement Administration found that 9.3 million buprenorphine prescriptions for buprenorphine were filled in 2012.
This market attracts not only patients desperate to find a way to get away from their heroin habit, it also pulls people who are just looking for another kind of high. Unlicensed and unscrupulous doctors are also attracted by the lengths their patients are willing to go to pay for an unnecessary (or dangerous) prescription of Suboxone. The Fix claims that Suboxone’s manufacturer, a British pharmaceutical company by the name of Reckitt Benckiser, is both aggressive and manipulative in how it markets the drug to physicians and the U.S. Food and Drug Administration.
In November 2014, about a year after The Fix article, Reckitt Benckiser spun off its production of Suboxone into a new company called Indivior. The then-new CEO of Indivior told the Pharmaphorum website that he expected his company to become “the largest addiction pipeline in the world” by the year 2015.
In the opinion of the Daily Beast, Suboxone has even replaced heroin as the most popular drug of choice in jails (ironically referring to it as the “anti-heroin” drug), because Suboxone can be obtained legally and is very easy to disguise. The problem has prompted the National Pain Report to ask if Suboxone is the new drug epidemic, with a pharmacist and addiction specialist decrying the “insanity” of one of the most abused pharmaceuticals in the world being used to treat substance abuse.
As an example, the Courier Journal in Kentucky carried the story of a man who was prescribed Suboxone after an overdose of OxyContin, an opioid painkiller similar to morphine that is used for pain relief. As he began to grow more dependent on the Suboxone, he would dissolve the little orange Suboxone filmstrips in water and shoot the mixture directly into his veins. This is a method that the National Drug Intelligence Center warns will bypass the digestive system’s natural way of breaking down the Suboxone to regulate delivery. Naloxone is, as mentioned above, a pure opioid antagonist; it blocks the opioid receptors in the brain and shuts down the effects of opioids in the body.
As eMedTV.com explains, taking naloxone intravenously activates it, meaning that an addict is shooting two opioids (buprenorphine and naloxone) into the system.
Doing so provides the effects that many users were getting from their full agonist opioids (euphoria, sedation, a reduction in pain, etc.) but under the misguided assumption that since Suboxone is a prescription drug, even overindulging cannot be too harmful. There are various effects of abusing Suboxone like this, and none of them are pleasant.
- Persistent flu-like symptoms
- Nausea and vomiting
- Uncontrollable mood swings
In more serious cases, Suboxone abuse has also been connected with difficulty breathing in a medical condition known as respiratory depression. The Physician-Patient Alliance for Health & Safety warns that respiratory depression when occurring in conjunction with the presence of opioids can lead to death.
As a result of this prescription abuse epidemic, there were 30,135 emergency room visits in 2010 that were attributed to buprenorphine misuse. More than 50 percent of those visits stemmed from recreational abuse, per the National Pain Report.
Suboxone Abuse Treatment
Treating the overwhelming compulsion to keep using Suboxone will not get very far while the patient’s body still craves another hit of the drug. This is why a detoxification program is the necessary first part in a treatment program. Here, the patient will be kept safe in a controlled rehabilitative environment, where she will be monitored by trained mental health and medical professionals as she is gradually weaned off Suboxone.
It is important that this process be carried out under the supervision of consulting doctors and other licensed health care staff, as the patient will be particularly susceptible to the influence of medicines (some of which might contain opioids) that will have to be prescribed to make the detox process more manageable. Trying to detox alone, or at home, is almost guaranteed to fail because of the danger of relapsing at a very susceptible moment.
This is why The Fix cautions that detox is by no means easy: the patient is put through an emotionally, mentally, and physically exacting process in order for her body to learn how to function without the presence of a very powerful drug upon which it had come to depend. Depending on the severity of the addiction, the withdrawal symptoms should start to taper off after a week.
As distressing as though this may be, it is necessary to prepare the patient for the next stage of treatment. When she is physically ready, she can start counseling and psychotherapy sessions to learn how she can think and function better without Suboxone. If there are pain management issues to address, a therapist will help the patient find ways to address the issues in healthy and productive ways, or learn how she can think about taking her pain medication in a way that minimizes the chances of abuse.
Lastly, treatment extends beyond health care facilities. Systems like 12-Step groups and sober activities are designed to help the patient stay on track with her recovery and keep her connected to the concepts and practices of treatment. This connection continues even as she resumes her day-to-day life and is confronted with the same challenges and situations that might have precipitated the Suboxone abuse in pre-recovery days.
Treatment at Black Bear
No one would ever say that having a Suboxone abuse problem is easy. But believe it or not, taking the first step toward getting treatment can be easy: all you have to do is call. We can answer your questions on opioid dependence, Suboxone and how to get started with a treatment program. At Black Bear Lodge, we won’t promise you that it’ll be easy: parts of recovery can be very difficult, but you won’t ever be alone. Our staff is here to help you put one foot in front of the other, away from your dependence on Suboxone and towards a new life of clarity, health and healing.