Addiction Treatment Articles

Suboxone as One of Few Outpatient Medications Prescribed for Painkiller Addiction

Addiction to opiate painkillers affects millions of people annually, running the gamut from patients in their teens to the elderly, and from celebrities to typical American families who suffer the consequences of a loved one’s addiction. Typically, recovery requires medical supervision and a combination of medications and counseling.

One outpatient medical treatment for opiate addiction is Suboxone, known generically as buprenorphine and naloxone. The drug has been used for opiate-based painkillers such as Vicodin and Percocet. The drug has also been used to treat patients who become addicted to methadone, another medically-prescribed medication for curbing cravings and helping patients overcome prescription painkiller addictions.

Suboxone may help patients work through opiate addiction because it lessens their withdrawal symptoms as they begin their recovery. Symptoms of opiate withdrawal can be severe and painful, requiring hospitalization. In the beginning stages, the patient can become aggressive, overly anxious, unable to sleep and perspire excessively. As withdrawal progresses, many patients suffer from severe abdominal pain and cramping, diarrhea, bouts of nausea and vomiting.

Like methadone, Suboxone is believed to be linked to dependence or addiction, if used over time. The medication is only available with a doctor’s prescription and supervision, and can be taken in pill form or a film placed on the tongue that dissolves rapidly. These forms of Suboxone can be used interchangeably under a doctor’s supervision.

If a patient stops using Suboxone too rapidly, withdrawal symptoms can occur, and doctors are asked to slowly taper off a patient’s usage as they begin to stop using the drug. Like many medications for opiate addiction, patients are advised to complete a hospital or center-based medical detoxification to allow the severe opiate withdrawal symptoms to subside before using Suboxone, which is best suited for moderate withdrawal symptoms.

While Suboxone and similar drugs can be helpful in curbing recovering addicts’ cravings and urges for prescription painkillers on a physical level, the drug isn’t considered a stand-alone solution. Counseling, group therapy and psychological treatments are needed for most patients, often times in combination with their families. A willingness to share their recovery successes and challenges with others can also be very powerful.

For people who also use alcohol, Suboxone can cause significant dizziness and drowsiness. It can also cause a dangerous interaction with other medications for insomnia, depression, or for treating pain, so physicians should carefully review a patient’s list of medications before prescribing Suboxone.

It is believed that more than nine million people in the U.S. have abused, or are abusing, prescription pain medications. Medical treatments like Suboxone can be part of the recovery process, but a team-based and multi-level approach to ending prescription drug addiction is believed to be the most successful.

Many Addiction Professionals Object to Extended Use of Suboxone

Suboxone has become one more tool in the arsenal of fighting addiction to opiate drugs such as OxyContin and Vicodin. A recent story in the Sun Sentinal reported that South Florida residents take an astonishing 70 percent of all oxycodone pills used in the United States.

The article cites a warning from Dr. Steven Scanlan, a psychiatrist certified in addiction medicine, who runs an outpatient clinic in Boca Raton, Florida. Scanlan believes suboxone is being improperly prescribed for too long a period by doctors in the area. In than they should. Scanlan’s business partner, David Remland, equates it to “selling suboxone to their patients.” They say some doctors are selling it for as much as $10 for a single suboxone pill.

Both Scanlan and Remland are recovering addicts. They believe suboxone should only be used as a detox medication; the ultimate goal is true freedom from addiction.

Remland’s philosophy is that if you don’t want to get off pain kills, don’t come to his clinic.

Many people in the recovery community and clinical professionals are becoming alarmed at the number of doctors who are prescribing suboxone as a maintenance medication, not giving the addict the opportunity to be sober and drug-free. They voice concerns that Big Pharma has too big a stake in the game – and ultimately benefits by long-term maintenance with suboxone vs. using the drug in the short-term to get over the initial withdrawal symptoms that come with detox from opiates.

Earl Hightower, who has done addiction interventions for over 20 years, believes the use of suboxone and other replacement therapies for extended periods of time robs people of the opportunity to live a full life.

One addiction specialist says, “You are just subsituting one drug for another, one that simply moves profits from illegal drug traffickers to pharmaceutical companies. What a great bargain for the pharmaceutical industry – an addicted customer is a customer for life.”

The more reputable treatment programs, including residential drug rehabs, opt to use suboxone only as a detox medication and work to wean the client from this substitute drug during treatment.

West Virginia Treatment Center’s Suboxone Program Saves Lives

In West Virginia, Prestera Center’s Suboxone program is helping people overcome addiction to opioid painkillers such as Vicodin and OxyContin by combining Suboxone treatment with intensive therapy.

Until recently, opioid-addicted people only had the option of using methadone to help control their cravings, but methadone itself is addictive, and is responsible for more overdose deaths in West Virginia than any other single drug.

Suboxone works like methadone in dulling cravings and preventing withdrawal symptoms, but it isn’t addictive and is impossible to overdose on. In addition, it’s impossible to feel a euphoric high while taking Suboxone.

Prestera, a mental health clinic in Huntington and Charleston, has been operating a Suboxone program for almost two years, which now serves more than 200 people. Patients receiving Suboxone must also undergo intensive group and individual therapy.

According to Josh Parker, coordinator of Suboxone program, as well as the program participants, it’s helping most people stay clean.

Anji Barney had a difficult pregnancy at age 19, and was being given morphine and Percocet for the three months she was in the hospital. She continued taking both painkillers when she returned home.

“I had a very generous doctor, and I would call and say I lost the pills and she would re-prescribe them, and that’s how it all got started,” Barney told Scott Finn of West Virginia Public Broadcasting.

Melissa Burns of Huntington said she started experimenting with drugs when she was 17. When she was 20, she says her then-husband held her down and shot her up with an intravenous drug.

“And after that, you either do it, or go without anything, because he had control of all the money,” Burns said.

Dodie Williamson was “a late bloomer” who did not start popping pills until she was 36 and was prescribed painkillers for her kidney problems, high blood pressure, and other medical conditions.

She said it was easy to trick doctors into prescribing her more than she needed. She would sometimes sell pills on the street, and sometimes buy them on the street.

Burns said her mother had to hold her diapers and infant formula, or else she or her husband would sell them for drugs. “That’s how we lived,” she said.

Barney said she knew she needed help when she started stealing from her family, including her father, who is a preacher.

“I don’t even want to get into things I’ve pawned and sold—beautiful diamond rings from my grandmother the pawn shop got. And then it got worse, stealing from my family, taking guns from my dad,” Barney said.

Williamson said her children gave her an ultimatum: get clean or stop seeing her grandchildren. “I’m getting too old for this, running the streets,” she said.

For Burns, her mother’s death led her addiction to spiral out of control. She began neglecting her children, unable to help them with schoolwork or keep the house clean. That’s when she turned to Prestera’s Suboxone program for help.

Barney couldn’t afford the Suboxone program, so she filed a report with Child Protective Services on herself. She said she found out about the possibility from a friend who works for CPS. “They will issue you a special Medicaid card just for your treatment, and it pays for your therapy and your doctor, and your Suboxone.”

The program is tough, Barney said, including group meetings and regular therapy on top of the Suboxone. But it works.

All three women agree that Suboxone is a tool, but that the therapy is what helps them stay clean.

The intense therapy makes this program different from methadone maintenance programs, Burns and Williamson said.

Burns said she failed several drug screens at the methadone clinic, but was never sanctioned and was still given methadone.

She also said patients at the methadone clinic would approach her in the parking lot and ask if she would sell them a take-home dose of methadone.

“The pills not a magic fix,” Barney said. “It buys you time to get yourself together, and it makes you okay for long enough to work through some of your issues with a therapist.”

Williamson agreed: “And if it wasn’t for the therapy, the counseling, the group meetings, I would be lost.”

Suboxone Saving Lives in Baltimore

Health advocates and doctors say a little pink pill called buprenorphine (brand name Suboxone), a relatively new drug for treating heroin addiction, has decreased overdose deaths and taken many addicts off the street, reducing crime and even preventing homicide.

“It’s absolutely the best thing that ever happened to this city in terms of treating heroin addiction, and I think it’s safe to say it has been a factor in reducing violence,” said Dr. Michael Hayes, chief physician at the Center for Addiction Medicine at Maryland General Hospital.

Buprenorphine is a mild analgesic that acts as a “blocker,” preventing withdrawal symptoms and cravings in people addicted to heroin. Made available for treating addiction nationally in 2005, buprenorphine –unlike methadone, a more established treatment for heroin addiction—is not nearly as potent, and doesn’t cause feelings of euphoria associated with more powerful opiates.

The apparent effectiveness of buprenorphine has prompted a greater push by Baltimore officials to expand the availability of the drug, which currently gets only a small percentage of the city’s $47 million drug treatment budget. “Every week I get calls from doctors or clinics seeking funding to be able to provide buprenorphine to people who need it,” said Greg Warren, CEO of the Baltimore Substance Abuse Systems.

Baltimore’s buprenorphine program was given a “Model Practice Award” by the National Association of City and County Health Officials last week in recognition of the efficacy of its buprenorphine initiative. “In 2008, 84 fatal drug overdoses did not occur, and in my book that is 84 people whose lives were saved. This award is well earned and deserved,” said Mayor Sheila Dixon, referring to the 2008 reduction in overdose deaths from the previous year, which Warren also attributes to the wider availability of the drug.

Despite the drug’s success, the DEA wants to closely monitor the doctors prescribing the drug because it can be misused by addicts who obtain it illegally. Warren said that buprenorphine is still much safer than treatments like methadone.

“I do not believe that buprenorphine is being misused, even when it’s being bought on the street because you can’t really get high on it,” said Warren , noting that Suboxone contains an additive called Naxolone, a drug that blocks the effects of other opiates, making buprenorphine less attractive to people using other narcotics.

“It almost impossible to overdose on buprenorphine unless you are taking another substance,” Hayes added. “In general, we still don’t see deaths, but we do with methadone, burprenorphine is a much, much safer drug,’

Last year, a Baltimore grand jury investigated buprenorphine’s efficacy for treatment of heroin addiction. After a four-month probe that included interviews with health officials, drug treatment professionals, and even addicts, the jurors concluded that the drug is both “safe” and “effective” for treating heroin addiction, and recommended that the city expand availability of the drug.

Still, the FDA has yet to lift restrictions that limit each approved doctor to prescribing the drug to more than 30 patients; restrictions initially limited an entire practice to 30 patients being treated with buprenorphine.

But Hayes said that in a city where heroin addiction fuels a violent drug trade and criminal behavior, the more buprenorphine available the better.

Suboxone: A Life-Saving Drug for Many

Some former addicts and doctors say Suboxone, a prescription drug used to treat people who are addicted to opiates like heroin and OxyContin, is just another drug of addiction, but many others call it a life-saver, saying it helps addicts wean themselves off of opiate-based drugs.

Dr. Ronald Abramson is a psychiatrist who specializes in treating opiate addiction. My Fox Boston sat in on one of his weekly group therapy sessions for recovering addicts, all of whom use Suboxone as part of their treatment.

“Suboxone is a lifesaver,” said one patient. “It’s the reason why I’ve been able to make such progress. The doctor told me Suboxone is not only about getting over the physical withdrawals I was suffering from, but the Suboxone also allowed me to not have to deal with those urges that I had mentally going on in my head on a daily basis.”

Another patient said, “I felt kind of high the first time I took it, but after that it was just regular. I felt normal again. I didn’t feel like I was addicted to something, I didn’t feel like I needed more of it.”

Before Suboxone was introduced in 2003, opiate addicts trying to get clean could really only visit a methadone clinic every day and wait in line to get their dose. One patient said of methadone, “It’s a demeaning cycle is what it is. You stand in line, you get your dose, and then you’re off for the day.”

Another patient added, “Everyone in this group is doing something incredible and we don’t deserve to be standing in line at a clinic being looked down on.”

Suboxone, unlike methadone, can be prescribed by a doctor and taken by patients at home. “The capacity of this drug to salvage lives is enormous,” says Dr. Abramson. “At treating opiate addiction, I believe it does what it does better than any other psychiatric drug does what they do.”

He acknowledged that the drug is being diverted into the illegal drug market and being abused by some drug addicts. In May, My Fox Boston interviewed Jennifer Ulich, a recovering heroin addict. “I was buying Suboxone off the street, trying to de-tox myself, you know, wean myself off the heroin using Suboxone,” she said. “And I would take all of the Suboxone at once and get high off of it.” She also said all the Oxycontin and heroin dealers she knew started dealing Suboxone.

Dr. Abramson said that doctors who are authorized to prescribe Suboxone must do it responsibly and monitor their patients closely. “In general, I think people need counseling and therapy to go along with (Suboxone),” Dr. Abramson said. “They all have issues that need to be taken up, and if those issues are not addressed, they’ll get very tempted to go back to the life.”

Overview of Suboxone Treatment for Opiate Addiction

Using drugs to treat substance abuse problems can seem like a contradiction in logic, but these treatments have been proven to be very effective – when they are properly managed. One such medication used in these treatments is that of SUBOXONE. This drug is designed to reduce illicit opioid use and to help patients to stay in treatment.

Opioid Dependence

In today’s research and drug treatment fields, opioid dependence is being accepted and treated like a chronic disease. Approaches are similar to those with high blood pressure or diabetes. The difference however, is that opioid dependence carries a much more powerful stigma.

Many people believe that a dependence on an opioid – or any other substance for that matter – is the result of a moral failure. Only in the recent decades of medical research has opioid dependence been recognized as a medical condition caused by changes in the brain.

Opioid dependence in the United States has been growing at unprecedented rates and often the fear of the stigma keeps people from getting the help they need. If the dependence can be removed, the individual has a much greater chance of improving his or her outlook and removing the stigma altogether.

The Science of SUBOXONE

Used to treat opioid dependence in an office-based setting, SUBOXONE is the first opioid medication to be approved under the Drug Abuse Treatment Act (DATA) 2000 for this type of treatment. The drug can also be prescribed for take-home use. The drug’s effectiveness is the result of its ability to suppress symptoms of opioid withdrawal and the decrease cravings for opioids.

Buprenorphine is the primary ingredient in SUBOXONE, a partial opioid agonist, which is a drug or medication that is designed to stimulate activity of opioid receptors without producing the same maximal effects as a full opioid agonist. This activity takes place at receptors that are normally stimulated by opioids that occur naturally. Because of this characteristic of buprenorphine, its opioid effects are limited when compared to oxycodone or heroin, which are full opioid agonists.

SUBOXONE has contains naloxone, which is meant to discourage people from dissolving the tablet and injecting it into their system. When SUBOXONE is taken as directed – by placing it under the tongue and letting it dissolve – very little naloxone actually reaches the bloodstream. If the person injects the SUBOXONE, the naloxone can cause a person dependent on a full opioid to quickly go into withdrawal.

How SUBOXONE Works
To be effective for the person addicted to opioids, SUBOXONE has to counter the effects of the drug. Opioids attack to the mu receptors, causing dopamine to be released. This creates pleasurable feelings within the user. When this feeling diminishes as a result of the opioids leaving the receptors, withdrawal symptoms and perhaps even cravings can begin.

Without revisiting the opioid for another “hit”, the opioids will continue to leave the mu receptors until the person has entered a mild-to-moderate state of withdrawal. It is at this point that the SUBOXONE therapy can begin to allow the buprenorphine to attach to empty opioid receptors to suppress withdrawal symptoms and reduce cravings. SUBOXONE also produces a limited euphoria in the patient.

The buprenorphine is attaching firmly to the receptors during adequate maintenance doses. In the process, it fills most receptors and blocks other opioids from attaching to receptors. And, because buprenorphine has a long duration of action, its effects do not wear off quickly.

The use of SUBOXONE to treat opioid dependent patients is still a controversial issue as some in the field believe that a drug addict should not be treated with another drug. While this debate goes on, SUBOXONE has been proven effective for a number of individuals struggling with an opioid addiction.