Suboxone is one of those super controversial topics in addiction treatment. You can ask 10 addiction professions and get 10 different opinions. 

So, here’s mine…

I guess I would say that I’m “middle of the road” on the issue. I’m not so “old school” that I believe that a person should never consider this option, or that it means the person “isn’t in recovery.”

I do think Suboxone has its place in addiction treatment, but I do think there are some substantial drawbacks.

Just in case you don’t know what Suboxone is….

Suboxone is an opiate replacement medication. It’s given to individuals who are dependent on opiates/heroin (sorta like methadone). Suboxone is made up of 2 specific drugs that do opposite things in the brain. It’s part Buprenorphine (which is a long acting opiate) and part Naloxone (which is an opiate blocker).

Basically, the way I explain it is: It feeds half the opiate receptors in the brain, and blocks off the other opiate receptors.

Most people (that I know) try Suboxone to manage an opiate dependence problem, but most of them wind up going back to drugs or they ultimately decide that they need to do “old school” recovery and come off of the medication all together. Actually, it’s usually the first and then the other (go back to using  drugs and then decide to get clean without the medication).

I’m not saying that’s how it works for most people, I’m just saying that’s how it works for most people that I know.

Here is why I BELIEVE that it happens that way.

I think on a biological level, the medication is very effective. Most of my patients tell me that it gets them out of the horrible opiate withdrawal cycle, but doesn’t get them high. For this reason, it’s very useful for stabilizing people dependent on opiates. They can stop obsessing, and start functioning.  Sounds great right?

The fact that it works so well, is the inherent problem. It makes people comfortable and “functional,” therefore it gives them a feeling that they are “fixed.”

Sidebar:  There is a difference in Opiate Dependence and Addiction. A person can be opiate dependent and not be addicted. Anyone who takes a pain pill over an extended period of time, will become biologically dependent on the medication. This does not necessarily mean, they will have the obsession of addiction.

I usually explain it like this. “Tomorrow your grandmother could fall and break her hip. In about 6 months, she WILL BE OPIATE DEPENDENT, but this does not mean she is an addict!” Addiction is not about a substance. It’s about an obsession!

I do have a client who is opiate dependent but not addicted. This client had some major injuries many years ago and has had to be on pain medication for a long time. Her pain is chronic and will continue to cause her problems. She takes Suboxone regularly, and it controls the pain. However, she doesn’t have symptoms of addiction. She comes to therapy about once a month to meet the Suboxone requirement for counseling, and this plan is working very well for her.

So basically it comes down to this… I think that Suboxone is great to treat opiate dependence but it’s not enough to treat addiction. Anyone being prescribed Suboxone is supposed to be required to receive counseling in addition to the medication. However, this counseling requirement is very minimal and not likely to be sufficient to effectively address a significant addiction.

Here is what happens. People get on Suboxone, they feel better, and it stabilizes the situation for a short period of time. But when life gets stressful again, the person probably won’t have the skills to navigate life’s stressors and many go right back to using.

My advice is this… If you truly want to treat addiction, it is vitally important to getsufficient addiction specific counseling and recovery supports in addition to taking Suboxone (more counseling than the requirement of the Suboxone program that is).

Addiction is the strangest of illnesses. It’s biologically routed, but a large part of the answer is addressing the psychological and spiritual needs of the person. Weird, Right?!?!

Fine print (made very big, so that you’ll definitely see it):  I’m not a medical doctor and have no abilities to prescribe medications or give advice about what medication should be used or how much. But, I am an addiction counseling specialist, and my opinions are in reference to treating the psychological and spiritual aspects of addiction.