Suboxone: Miracle Drug or Manacle?

Yesterday in my office, I saw patients for whom I prescribe buprenorphine (better known under the brand name Suboxone). It was not my typically pleasant day. Usually, I see the positive changes occurring in the lives of my patients: they are getting families back, getting jobs or better jobs, getting health and dental care needs addressed, and overall feeling happier and more productive.

 But yesterday I had two patients who were bitter about being on Suboxone. Both were having great difficulty tapering off of Suboxone. Both had also been reading materials on the internet that described the hopelessness of ever tapering off this medication.

 This frustrates me for several reasons. First, not everything you read on the internet is correct. Second, people don’t appear in my clinic requesting Suboxone for no reason. All of my Suboxone patients were addicted to opioids before I ever prescribed Suboxone. Even assuming no patient ever gets off Suboxone, it’s still so much better than what they were doing before. Third, I’ve never said it’s easy to get off Suboxone. It can be done, but it’s still an opioid. When you stop opioids, you will have withdrawal. There’s no way around that. 

Overall, most people say withdrawal off Suboxone is easier than other opioids. But people and their biochemistries are different, and I accept that some people have a worse withdrawal than other people. I’ve had a few people say methadone withdrawal was easier than Suboxone withdrawal. I have to believe that’s their experience, but I think that’s unusual, and not the experience of most people. 

Some doctors think patients on maintenance medications, like methadone or Suboxone, should always stay on these medications, given what we know about the rates of relapse and even death for patients who leave these programs. And some patients have continued sub acute withdrawal symptoms for weeks or months off opioids, and just don’t feel right unless they are on maintenance medications. These people seem to do better if they stay on maintenance medication. 

And on the other hand, many people are able to taper off opioids and remain off of them, and lead happy, healthy lives. I keep thinking about two groups of recovering opioid addicts who do well off of all opioids, on no maintenance medications: members of 12-step recovery groups, and recovering medical professionals.

 Off the top of my head, I can think of a dozen recovering opioid addicts who are members of Alcoholics Anonymous or Narcotics Anonymous, and who aren’t on any maintenance medications. They feel fine, and have been abstinent from opioids for years. If you don’t believe me, go to an open Narcotics Anonymous meeting. Ask the recovering addicts there if they have been addicted to opioids in the past. Chances are that around a fourth of the people you talk to are recovering from opioid addiction. There may be a few people who are on methadone or Suboxone, but many are completely free from opioids.

 Look at doctors in recovery. Opioids were the drug of choice for many addicted doctors, and they are “real” addicts, having used remarkable amounts of opioids before getting into recovery. But doctors have one of the highest rates of drug-free recovery. This isn’t because we are so smart or special, or because we have Charlie Sheen’s tiger blood. It’s because we are held tightly accountable by our licensing boards. If we want to practice medicine, we have to participate in recovery. Licensing boards often hold our licenses hostage unless we do the work of recovery. This may mean three to six months of inpatient residential treatment, after a medical detoxification. It may mean four recovery meetings per week for the first five years of recovery, along with monthly random drug screen, and a monitoring contract for five years.  (1,2)

If every addict seeking recovery could have that degree of treatment and accountability, I suspect relapse rates would be uniformly low. Sadly, that’s just not possible for most opioid addicts, because of financial constraints, and because there’s less leverage with most people than with licensed professionals. 

Not all opioid- addicted doctors do great off opioids. Many have multiple relapses, and would probably be much healthier and happier if they got on maintenance medications like methadone or Suboxone, but isn’t allowed – at present – by the licensing boards in most states. Again, one type of treatment doesn’t work for everyone.

 My point is that it is possible for many people to get off Suboxone, and live a happy drug free life. And for other people, lifelong maintenance is probably the best and safest option. At present, we don’t have a way to predict who might do well off of Suboxone (or methadone). We do know that a taper should be slow, and probably takes four to six months for a taper to give best results.

 I believe in Suboxone. It’s saved many lives, just like methadone has. I wouldn’t prescribe it if I didn’t know it works. I think what I’ve been hearing and reading is a normal backlash against the unrealistic expectations many people had for Suboxone. It’s been called a miracle drug, but it’s not. It’s still an opioid, and there is still a withdrawal when it’s stopped. It’s a great medication for many people. It can allow many opioid addicts to get their lives back and enjoy a normal life, except for having to take a daily dose of Suboxone. But isn’t that still drastically better than active addiction? 

  1. Ganely, Oswald H, Pendergast, Warren J, Mattingly, Daniel E, Wilkerson, Michael W, “Outcome study of substance impaired physicians and physician assistants under contract with North Carolina Physicians Health Program for the period 1995-2000,” Journal of Addictive Diseases, Vol 24(1) 2005.
  2. McLellan, AT, Skipper, GS, Campbell, M, DuPont, RL, “Five Year outcomes in a cohort study of physicians treated for substance abuse disorders in the United States,” British Medical Journal,2008;337: a 2038.
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11 responses to this post.

  1. Great post, and so well said.

    I suspect that one reason doctors do so well in recovery is because they have fewer barriers to recovery.

    Someone who is capable of the discipline it takes to make it through medical school just isn’t in the same position as someone who wasn’t able to make it through high school.

    The accountability a doctor faces is almost trivial in comparison to the level of accountability experienced by someone in drug court or otherwise subject to incarceration for a simple relapse (or even just being 15 minutes late to an AA meeting). Or someone who has a child in state custody and must stay sober to get their child back.

    Yet accountability is not enough to create the conditions for successful change if the barriers to recovery are too high (mental health issues, homelessness, unemployment, lack of access to effective treatment, family dysfunction, lack of child care, lack of transportation and so on.

    So many people do go back to jail. And many do lose their children.

    I just hope people aren’t left with the (not quite accurate and even a little dangerous) impression that the missing ingredient for most people is “accountability.”

    Reply

    • Most doctors spend between eleven to fourteen years in training, past high school, to get into the profession. They spend untold amounts of money in loans, etc. They’ve given up a lot of their lives to be able to be phsycians. Losing the license to practice their profession after that investment isn’t trivial. I don’t know how to compare it to the loss of one’s children. Both are severe losses.

      I agree that accountability alone isn’t enough. But accountability, when combined with access to excellent treatment, is effective. Most doctors don’t face all of the obstacles other people do, like homelessness. But some do struggle with unemployment (try being hired as a doctor with a public history of addiction!), family dysfunction, childcare, etc., just like other addicts.

      I still think access to treatment (without the barriers you listed) plus accountability creates the fertile soil where recovery can flourish.

      Reply

  2. Posted by brian phipps on April 1, 2011 at 4:20 pm

    Dr. Burson,

    Once again I would like to begin by saying, “Thanks for your blog.” You pour your heart and soul into this blog to save lives and help people suffering from this disease, your dedication is amazing and I pray that I will someday work step 12 half as well as you.

    I think it was Dr. Abe Lincoln who said, “You can please all the addicts all the time, but you’ll have to give them way too much methadone to do so.” [Please forgive the tastelessness of that joke, I could have used a Charlie Sheen one instead but this one will make a better point, plus I feel bad for Charlie Sheen, his family, and all the people that are learning about addiction through this example…detriMENTAL.] The point is resisting treatment tools or making treatment less legitimate or affective is a classic tactic of our addictive mind, i.e. ‘stinking thinking.’

    I am an addict and I know that sometimes we quit, we lie to ourselves, we even try blaming the very people who are working to make us better. But because it never gets better out there, and because professionals like you are steadfast in their commitment and faithful to the benefits of treatment many of us come back with a renewed vigor.

    There are so many situations when you [treatment caregivers] and us [addicts trying to spread the message of recovery and hope to the addicts still suffering] are reminded that sometimes folks don’t get it, sometimes the only ending options are jails, institutions, or death. But Dr. Burson I beg you to remember that sometimes the outcome is love, family, and happiness.

    The reason I want you to think of that part right now is because that is what you gave me. My son has his Daddy in his life, clean and sober everyday. He gets help with homework, help with basketball, football, baseball, and any other healthy endeavor he wants to participate in, though sometimes he has to share his x-box with me [guess he got a Daddy/ big brother in his life]. I could only have this quality of life from you giving me what I needed, NOT what I asked for.

    Another important thing to remember… the patient I am today isn’t necessarily who I’ll be tomorrow. I once said I would never be able to stop taking methadone. My mouth said it was because of my physical problems and chronic pain, but fear had a lot to do with it and the pain gave me an excuse to NOT deal with it. Anyway two doctors and a really good article, all describing how coping with pain becomes easier after stopping methadone, came to me within a period of about a week. And so, since God sent me such a strong message, I became a different addict. That was 8 months and 31 milligrams ago. I’m not going fast, but I’m going, and intend to go all the way, yet a year ago NEVER detoxing was one of the things in my life I was most sure of.

    “Steady as she goes, Dr. Burson!” Keep up the great work and thank you so much for everything you’ve done for me.

    Sincerely,
    an addict named Brian as well as more people than you will ever know

    p.s.- I’m sorry if it seemed as though I was jumping around, but I was sort of responding to several posts and even though you have helped me get clean, sober, and clear-minded, I’ve had my IQ deficiency since birth and it is incurable.

    Reply

  3. Posted by Getting Better on February 23, 2014 at 11:00 pm

    I’ve commented under a few of your blogs now, and in some of them, I personally, have used the term “miracle drug” to describe Suboxone….. When push comes to shove, I believe you are correct in saying that it is NOT in fact a miracle drug…. HOWEVER, while I’m experiencing such amazing results under Suboxone treatment myself now, I can’t help but feel that the drug IS miraculous…. Where I was WITHOUT Suboxone, as opposed to where I am WITH Suboxone, explains my theory clearly.. While in active addiction, and before taking Suboxone, I believed that there was nothing in this world, that could take my mind, body, spirit, soul, and life, away from opiates… Under Suboxone treatment, I don’t even THINK about abusing opiate pain killers… It literally doesn’t even cross my mind… I feel no sense of euphoria or anything from Suboxone, so it’s clearly not “replacing” the high that I love so much… I don’t shoot it into my veins, so there’s no way that it’s giving me that “fix” I used to be obsessed with…. It’s not doing ANY of the things that I once felt I could NEVER be without, yet somehow, it 100% erases my desire for them… I see that as a miracle…. It makes me feel like a normal person… it allows me to live a productive, meaningful life…. it allows me to work hard and stay focused…. it allows me to be HAPPY about life in general…. and most of all, it’s 100% successful, at keeping a very powerful, life altering, dangerous, horrible, destructive lifestyle, entirely out of the picture, when I was able to find NO OTHER way to do that…… I see that as a miracle…. It costs me approximately $10.00 per day, as opposed to active addiction, which costed me hundreds per day, and almost cost me my entire home….. I see that as a miracle…… So, for as correct as you are, about Suboxone not REALLY being a miracle drug, it’s also correct that results like I’ve described most certainly FEEL miraculous…. Nobody ever said, that a miracle had to be entirely without fault, right?

    Reply

  4. Posted by Getting Better on February 23, 2014 at 11:02 pm

    And thank you for the time you sacrifice to write these blogs… I benefit from them tremendously 🙂

    Reply

  5. Posted by Kristi on June 22, 2015 at 4:03 am

    Dr. Bruson,

    I just came across your blog and I want to say Thank You. Not only for some much important information but also for letting me know I am not “strange or weird” when I say I will be on something the rest of my life. Pain pills or Suboxone. I choose Suboxone. I was your typical addict, first pot, then snorting pain pills, then injecting crazy amounts of oxycotin (not to mention the other drugs).I went to an inpatient treatment program and for 22 months I went to daily and sometimes 2x daily NA meetings. They actually called me an NA Nazi I didn’t want to hear people’s excuses about how they couldn’t make it to meetings etc. I came out of rehab homeless, jobless, car less, I had lost custody of my kids. I was in fact at my rock bottom but I made my way back I got a job, a home, a car and finally I got my kids back. The meetings worked great until someone who ran one of the meetings who supposedly had 20+ yrs clean got arrested for selling pot. I stopped going and of course relapsed. 6 months into my relapse I went to jail with my kids with me I spoke to a judge about getting me into medical detox at our local hospital (which we no longer have) 12 days later there I was of course they gave me tons of meds one of which was Suboxone. I resisted at first why are you trying to give me dope to get me off dope??? It made no sense to me, but then the Dr there said to me You have a lapsing disease, it’s an addicts nature to lapse several times and Suboxone is the medication to stop that. If you had diabetes you would take insulin right? Or if you had high blood pressure you would take medicine for it right? Of course I would so I have been on Suboxone for 10 yrs 3 months & 9 days with NO relapses. I consider that a MIRACLE. Addiction is a very treatable disease but it’s not curable and I told my Dr I will either be on Suboxone or dope for the rest of my life. Of course people say that’s an unhealthy outlook I like to think it’s a more realistic outlook. If I can take 1 medication daily and live a normal happy life I am a wife & mother and I’ve cut anyone who does drugs from my life including my family. I do have concerns though recently I was told we would be doing a drastic cut it’s supposedly a new law here in KY and I am terrified of relapse. Do you have any suggestions on how to mentally prepare one’s self for this? Is it fees-able to assume I can stay on Suboxone the rest of my life? Or am I just being unrealistic??? Thank you.

    Reply

    • So far, the best evidence shows patients treated with buprenorphine for opioid addiction do the best if they stay on this medication. There are some long-term effects, like persistent constipation, and it can suppress testosterone levels in men. But in most people, the benefits far outweigh the side effects. So no, I think your plan to stay on buprenorphine (Suboxone) is reasonable and in line with what studies are showing.

      Reply

  6. Posted by Kyle Beickel on August 22, 2017 at 3:41 am

    This doctor sound’s to not take much responsibility nor does the doc
    sound very educated about what she is prescribing and i know for a fact many of these doctors aren’t properly educated on the medication they are prescribing. #1 Any one coming off opiates will have to go through withdrawal there is no way around it. Absolutely false there are medications all over the rest of the globe that completely heal patients within days that’s right days. The truth is the United States pharmaceutical companies don’t want doctors to know what they can give their patients to help them get clean because that would mean a huge drop in sales not that the doc should take a little more time and learn about what’s in the medication they are prescribing, knowing more about the structure and make-up of the drug could tell them how to treat patients who are ready to be done with the pharmaceutical game. But with that said there are many things you can take right here in America that can make your WD just about non- existent. Baclofen, NAC, gabapentin, kratom, DLPA or DPA, and actually several other combinations of different drugs that would completely eliminate WD but i am a little nervous putting them down for fear of the wrong people finding out and making it that much harder for addicts to get free but go do your own research and start by looking up miracle cures for suboxon WD and see what you find. Truth is any drug a person has to be on for the rest of their lives is bad and extremely harmful a 3% success rate in this country doesn’t sound like a better way of doing things to me and was completely a irresponsible thing to say by this prescribing doc i bet if she was in those patients shoes she might have a different opinion on the matter.

    Reply

    • I’m having a hard time understanding what you are saying. However, there are no miracle cures for opioid use disorder. I surely wish there were.

      Reply

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