How to Get Off of Suboxone

MEDICATION-ASSISTED TREATMENT FOR OPIATE ADDICTION: A HISTORY

Treating opiate addiction with replacement opiates is a longstanding—and potentially dangerous—practice. The idea behind this medication-assisted treatment (MAT) is to prevent dangerous withdrawal symptoms or reduce relapse temptations by using a safer opiate to satisfy cravings for the original drug. While effective in the short term, if not managed with care this may lead to replacing one addiction with another.

When heroin was first introduced in the late nineteenth century, many doctors prescribed it for morphine addiction. By the 1970s, heroin was itself at the heart of a major addiction epidemic, and methadone was the preferred method of treatment. A long-acting synthetic opiate introduced in the mid-twentieth century, methadone is less incapacitating than heroin and slower to build tolerance (need for increased doses). However, as with many so-called miracle drugs, indiscriminate prescription led to new, often serious, problems:

• Methadone is physically addictive itself. If stopped abruptly, it causes all the typical opiate withdrawal symptoms: muscle pain, diarrhea, vomiting, mood swings, insomnia, chills. Many doctors consider methadone more dangerous than heroin in “cold” withdrawal.
• The long-acting characteristic that makes methadone effective as an “infrequent doses” option also means that withdrawal takes longer than with most other drugs.
• Risks associated with taking an additional dose at the wrong time are extremely high. Methadone has the highest overdose-death-to-prescription ratio of any medical opiate: around 5,000 people die each year from methadone overdose.

Although hundreds of opiate detox programs, and hundreds of thousands of detox clients, still use methadone, opiate-addiction MAT is turning toward a newer and (at least according to currently available evidence) safer alternative: Suboxone, a compound of 75–80 percent buprenorphine (an opiate that produces minimal “high”) and 20–25 percent naloxone (a drug that mitigates opiate effects and is also used to treat overdose).

SUBOXONE -VS- METHADONE

Suboxone was first introduced in 2002. Like methadone, it’s a long-acting drug that produces fairly stable effects (as opposed to heroin and other short-acting opiates, which are prone to inducing up-and-down effects through chemical imbalances). The main difference, scientifically speaking, is that Suboxone belongs to the partial agonist class of drugs while methadone is a full agonist. In lay terms, this means Suboxone has built-in limits on how many of the brain’s pleasure receptors it activates. While it still produces some high, the effect is more mellow than euphoric: thus, there’s less temptation to overdose, or stay dependent on the drug, by taking more to push the high even higher. Learn more about Suboxone vs Methadone.

Other differences include:

• Suboxone can have side effects not known to occur with methadone: oral numbness, swollen tongue, faster heart rate, blurry vision.
• Suboxone treatment is usually begun two weeks after initial opiate detox is complete, while methadone is often started during detox itself.
• Suboxone may not be strong enough to treat an opiate addiction that depends on particularly high doses.
• Methadone is a Schedule II drug (high potential for abuse). Suboxone is Schedule III (moderate potential for abuse).
• Methadone is prescribed as a painkiller as well as a treatment for opiate addiction. Suboxone was developed and is used, exclusively for treating addiction.
• Methadone (when used in addiction treatment) can only be purchased in a clinical setting (and only administered there, unless a client receives official doctor approval to take it at home). With proper licensing, doctors can prescribe and provide Suboxone (usually a week’s or month’s supply at a time) from offices not directly affiliated with detox clinics.

Sometimes, methadone patients will be switched to Suboxone as a safer alternative.

IS SUBOXONE RIGHT FOR YOU?

Though it has advantages over methadone, Suboxone is like all opioids in being addictive: once body and brain are used to it, it causes unpleasant withdrawal symptoms when discontinued. People who stop abruptly not only get painfully ill for three to seven days: they may suffer for weeks from nausea, lightheadedness, perspiration/chills, insomnia and depression/irritability.

If you’re currently exploring treatment options for prescription-opiate or heroin addiction, carefully consider the following points (and discuss them with your doctor and/or therapist) before choosing Suboxone over cold-turkey treatment:

• How long have you been taking the original addictive drug, and how large is your current typical dose?
• Do you have any physical conditions that could be aggravated by further opiate intake? (Enlarged prostate, breathing difficulties, stomach ulcers, and kidney disease are among the conditions that present special risks to Suboxone users.)
• Are you taking any other medications, or drinking alcohol regularly? Alcohol, sedative drugs, and many antidepressants can produce extremely dangerous effects if allowed to interact with Suboxone.
• Are you (or is there even a chance you are/will be) pregnant or breastfeeding? The drug’s effects on fetuses and infants are not definitely established, but it has been implicated in cases of neonatal abstinence syndrome (newborn babies suffering withdrawal symptoms).
• Are you sure you can stick to the limits of the Suboxone prescription? (If you’ve already developed a prescription-opiate addiction from taking “just a few” extra doses, don’t assume the same thing won’t happen with Suboxone. Plus, the opiate-naloxone combination means that crushing or injecting the drug will likely precipitate full withdrawal symptoms.)
• Does the full opiate-detox plan include therapy and lifestyle coaching? No addiction-treatment program can be truly effective without exploring the deeper issues behind the drug use, and implementing alternative ways of coping with those issues.
• Does the detox program emphasize that Suboxone is a temporary fix, not a lifelong crutch? Do they have a standard plan for tapering off the drug within a year, and do they consider individual needs when implementing this plan?

THE FINAL STEP: GETTING OFF SUBOXONE

If you do begin taking Suboxone under the guidance of an addiction-treatment provider, with a plan for tapering off the drug, stick to the plan! The greatest danger is that (especially if initial reduced doses produce unpleasant symptoms) you’ll start thinking in terms of “Why should I put myself through this when it’s so much easier to keep taking the medicine?” That could seduce you into a long-term Suboxone addiction that causes almost as many problems as the addiction the drug was originally intended to treat. To further guard against this pitfall, be consistent in keeping up lifestyle changes and stress-management techniques, and attending therapy and support groups.

If you already have a Suboxone addiction, whether through carelessness on the original prescriber’s part or your own:

• Do not try to stop cold without medical advice. Especially given the lengthy withdrawal period, that could mean serious illness, overdose from a thoughtless relapse, or reversion to more dangerous opiates.
• Get the advice—and careful supervision—of a doctor or clinic experienced with Suboxone.
• Be patient. Full weaning from Suboxone takes time.
• Expect to experience some discomfort, if not actual withdrawal symptoms, during the getting-off period. Know that this is temporary and the results will be worth it.
• Do not—repeat, not—even think about trying to mitigate unpleasant symptoms by taking extra Suboxone on your own: this just drags out the struggle and may cause an overdose. If you’re worried about any symptoms, or otherwise having real difficulty, call your doctor or support partner for advice.
• Be prepared for feelings of depression and other emotional side effects. Plan in advance how you will deal with these.
• Stay in close touch with your support network throughout. Make sure (without being selfish or demanding) that your friends, family and sobriety partners know the best ways to support you.
• If your dependence is really serious, consider inpatient treatment at a Suboxone detox clinic.
• Throughout, keep your sobriety resolve up by eating healthy, staying active and getting involved in hobbies and goals that stir your passions. Once you’re fully off Suboxone, continue these practices, to make the most of a sober lifestyle for the rest of your life!

SOURCES

Addiction Treatment Forum (2013, February 12). “Buprenorphine vs. Methadone.” Retrieved from http://atforum.com/2013/02/buprenorphine-vs-methadone/

CRC Health. “Soldiers, Hippies and Richard Nixon: An American History of Methadone.” Retrieved from https://www.crchealth.com/addiction/heroin-addiction-treatment/heroin-detox/history_methadone/

Darke, Shane, Sarah Larney, and Michael Farrell (2016, August 11). “Yes, People Can Die From Opiate Withdrawal.” Addiction, Vol. 112, No. 2, February 2017, pp. 199–200. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/add.13512

Evans-Buford, Shari (2014, October 31). “What Is Buprenorphine (Subutex)?” EverydayHealth.com, medically reviewed by Ruthan White. Retrieved from https://www.everydayhealth.com/drugs/buprenorphine

Marks, Lynn (2015, January 9). “What Is Suboxone (Buprenorpine and Naloxone)?” EverydayHealth.com, medically reviewed by Robert Jasmer. Retrieved from https://www.everydayhealth.com/drugs/suboxone

National Institute on Drug Abuse. “Methadone Research Web Guide, Part A: Questions and Answers Regarding the History and Evolution of Methadone Treatment of Opioid Addiction in the United States.” Retrieved from https://www.drugabuse.gov/sites/default/files/pdf/parta.pdf

Patafio, Michaela (2017, August 19). “What Is Methadone?” WebMD.com. Retrieved from https://www.webmd.com/mental-health/addiction/what-is-methadone#1

Stanford Children’s Health. “Neonatal Abstinence Syndrome.” Retrieved from https://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-P02387

United Nations Office on Drugs and Crime (1953, January 1). “History of Heroin.” Retrieved from https://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1953-01-01_2_page004.html

University of Arizona. “Heroin Overview: Origin and History.” Retrieved from https://methoide.fcm.arizona.edu/infocenter/index.cfm?stid=174

University of Illinois–Chicago, Drug Information Group (2016, September 20). “How Are Methadone and Suboxone Different?” Healthline.com, medically reviewed by Darren Hein. Retrieved from https://www.healthline.com/health/pain-management/methadone-vs-suboxone#withdrawal

University of Maryland, Center for Substance Abuse Research (2016, January 6). “Methadone.” Retrieved from http://www.cesar.umd.edu/cesar/drugs/methadone.asp

Whelan, Paul J., and Kimberly Remski (2012). “Buprenorphine vs. Methadone Treatment: A Review of Evidence in Both Developed and Developing Worlds.” Journal of Neurosciences in Rural Practice, Vol. 3, No. 1, January–April 2012, pp. 45–50. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271614/

Wiley, Frieda (2015, October 23). “What Is Naloxone (Narcan and Evzio)?” EverydayHealth.com, medically reviewed by Robert Jasmer. Retrieved from https://www.everydayhealth.com/drugs/naloxone

For related information on Suboxone, other opiates and medication-assisted treatment, see the following articles:

Alternative Methods for Managing Pain Without Opiates

Dangers of Drug Detox at Home and Quitting Cold Turkey

Heroin Detox: Withdrawal Symptoms and Timeline

Methadone Detox: Withdrawal Symptoms and Timeline