Is Suboxone effective in detoxifying opioid dependent people? 

Suboxone is without a doubt the best option to help people who have become opiate dependent.  Using this FDA approved drug to detox opiate users is virtually painless and the most effective tool in the arsenal against drug addiction.  The dependence just goes away in very short period of time and all of the withdrawal symptoms and side effects are effectively eliminated. 

We have been using Suboxone in conjunction with therapy and behavioral modification for approximately four years and have an unbelievably low relapse rate.  We have treated countless patients and after conversing with others at our treatment facility, we are aware of only one relapse.  The gentleman that relapsed chose to do the Suboxone detox alone and received none of the benefits of individual therapy, education or cognitive behavioral therapy. 

While it is often referred to as a “miracle drug”, one cannot forget that there were underlying issues that were responsible for driving the addiction initially.  Some of our patients are consequential victims of dependency and others chose opiates as a recreational drug of choice.  In either case, a physical dependency is always accompanied by a psychological dependency.   Some started taking prescription drugs for pain management.  The drug use continued after the pain had been dealt with and like all opiate addictions, they became progressively more physically addicted and greater quantities of the drugs were required to avoid the painful withdrawal symptoms. 

Consequential or recreational, they both end up with in a severe dependence that can be life altering. 

What is Suboxone and how does it work? 

Suboxone is comprised of Buprenorphine and Naloxone.    

Buprenorphine is a partial opioid agonist.  A partial opioid agonist can both activate and block opioid receptors, depending on the clinical situation. Under appropriate conditions, partial agonists can produce effects similar to those of either agonists or antagonists.   Buprenorphine’s opioid effects are limited compared with those produced by full opioid agonists, such as oxycodone or heroin.  A full opioid agonist stimulates activity at opioid receptors in the brain that are normally stimulated by naturally occurring opioids.  

Naloxone is an opioid antagonist.  An opioid antagonist prevents molecules of other drugs/medications from binding to the opioid receptor in the brain.   Antagonists can also displace other opioids and can precipitate withdrawal, or block the effects of other opioids.  Naloxone is included in Suboxone to discourage opioid dependent people from dissolving the Suboxone and injecting it.  When Suboxone is placed under the tongue, as directed, very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine. However, if naloxone is injected, it can cause a person dependent on a full opioid agonist to quickly go into withdrawal. 

Who can prescribe Suboxone? 

There are a limited number of doctors that are approved to prescribe Suboxone.  The physician must be compliant with the Drug Addiction Treatment Act (DATA) of 2000. This act states that the prescription use of medications in the treatment of opioid dependence is limited to physicians who meet certain qualifying requirements. Furthermore, they must have submitted written notification to the Secretary of Health and Human Services of their intent to utilize Buprenorphine HCL for the treatment of opioid dependence. 

Some physicians involved in general and family practices are licensed to prescribe Suboxone.  We find that in many cases however that these doctors are not totally familiar with the most effective treatment protocol.  Suboxone is rarely effective when the patient simply receives a prescription for the medication and is not monitored closely.  Opioid dependence often varies in severity and must be monitored to insure that the proper dosage is given.  Some patients will initially need only 4 mg while other more dependent patients may need as much as 16 mg to avoid opioid withdrawal symptoms.  We are often sought out by clients that have started Suboxone treatment with other physicians and feel that the treatment that had been prescribed was inadequate.   

How is Suboxone most effectively induced in new clients? 

At Breakthrough we have one of the most effective treatment protocols in the country.  We conduct a pre-induction interview and meeting to establish the level of dependence and provide instructions for the induction.  The client comes in the day of the induction in mild opiate withdrawals.  We start the induction in incremental dosing stages.  The dosages are increased throughout the next few hours until withdrawal symptoms have subsided.  The client spends the entire day with us in a quiet comfortable room and we monitor their condition and withdrawal symptoms.  When the client is comfortable for an extended period we provide the last dosage for the day and the client goes home or to their suite.  The client then returns the next morning for the second day’s dosage.  We start with the dosage that we found to be effective from the initial induction.  If this dosage is found to be adequate the patient is free to go. 

The initial dosage will be continued for a period of time and then will be tapered in 2mg increments over the next weeks or months until the dependence is eliminated.  The duration of the total treatment will generally take two to five months. 

Why is counseling and behavioral therapy important? 

As I said in the first section of this article, consequential or recreational they both end up with in a severe dependence that can be life altering. 

We find that the vast majority of our clients are dealing with underlying psychological issues that drive their addictions.  Whatever the underlying issue, they all seem to culminate in moderate to sever depression.  There are reasons that the drug use became excessive and reasons that they accelerated.  Other psychological issues are rooted in the addiction itself.  These often include guilt from the deceptive behavior and actions that had become necessary to provide the drugs and conceal their excessive use from friends and loved ones.  

Through counseling, we embark on a discovery process that uncovers the layers of psychological issues.  The problems are sometimes singular in nature but more often are comprised of a mixture of things.  Among these are anxiety, grief, remorse, shame, guilt, post-traumatic stress and depression.  Our therapists work with the client to resolve the past and help them to focus on a brighter, happier and more productive future. 

We also provide extremely effective cognitive behavioral therapy.  This therapy includes education on the neuro-chemistry of addiction, anti-relapse skills, sobriety skills, rational thinking and extensive work on relationships.