Is Being on Suboxone “Real” Recovery?

Certainly, both patients and doctors see drug free recovery as the ideal. In fact, patients and their doctors prefer to manage any disease without medication… if possible. Patients with high blood pressure often say they don’t want to stay on the medications forever, and ask me when they can stop their medication. I explain that I don’t know, because many variables are involved. Some patients lose weight and exercise, and can stop their blood pressure medications at some point. Some patients lose weight and exercise and still need blood pressure medication. Some patients never lose weight or exercise, and have to stay on medication. Are the last two types of patients “bad” for needing medication? Do we judge patients with diabetes for their lack of willpower to lose weight and exercise?

            This example of high blood pressure mirrors the difficulties of people with opioid addiction who need medication (like methadone or buprenorphine) to succeed, compared to people who can recover without medication.

 Some people do judge patients who don’t exercise or lose weight. Some doctors are now compensated on a “pay for performance” plan. This means that doctors gets paid more if their patients achieve certain goals, like good control of their diabetes or blood pressure. This encourages doctors to discuss the importance of diet and weight loss with their patients, but it has had an unexpected consequence. Some doctors have started firing patients who are not compliant with treatment, including weight loss and exercise. Keeping these poorly motivated patients in their practice decreases the doctors’ compensation.

 Do we really want to go down that road? How judgmental do we want to be? Given difficulty of behavioral change in human beings, such policies seem harsh.

 A recent study looked at the degree of adherence to a healthy lifestyle in US adults. People were surveyed about whether they complied with these five recommendations for a healthy lifestyle: eating more than 5 fruits or vegetables per day, maintaining healthy body weight, regularly exercising more than 12 times per month, moderate or no alcohol consumption, and not smoking. Only eight percent of US adults adhere to these widely known health recommendations. People with diabetes, heart disease, and high blood pressure were no more likely to adhere to recommendations as those without these diseases.

 The point of all this is to say that behavior change is hard for most humans. We like doing fun things, like eating and relaxing and taking drugs that numb emotional pain and produce a pleasurable feeling. Whether these behaviors are labeled “addictions” or “bad habits” sometimes depends on what socioeconomic class the person belongs to, and if we approve or disapprove of the behavior they are doing, or if we struggle with the same behaviors.

 Let’s be gentler with ourselves and others.

  1. King, Dana E., Mainous, Arch G. III, Carnemolla, Mark, Evererr, Charles J, “Adherence to Healthy Lifestyle Habits in US Adults, 1988-2006” The American Journal of Medicine, (2009) 122, 528-534.

 

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4 responses to this post.

  1. Posted by Steve on September 21, 2011 at 12:46 am

    Is it ok to stay on suboxon forever if it helps you to feel good?since I have been using it I have been feeling good not tired don’t get sick. Gives me energy. Its like a antipresent

    Reply

    • There doesn’t appear to be any long-term damage to the body from staying on Suboxone, as long as you take the precaution of having your liver checked once or twice a year. It can cause liver inflammation, especially in patients with active Hepatitis C. The main side effects are constipation, lowered sex drive (opioids in general supress testosterone levels), sweating, and itching. As medications go, it’s safer than many, though no medication is 100% safe.
      We’ve used buprenorphine for decades for the treatment of pain, but that’s not (usually) daily use. Buprenorphine for daily use has only been done since 2003 in the U.S. However, it’s been used daily in France and other European countries for decades, so we have that information available when we say it’s relatively safe.

      You will read about awful problems and side effects on the internet about buprenorphine, at various sites. People do have bad experiences with buprenorphine, to be sure, but there is some anti-buprenorphine hysteria out there too. Just make sure you go to reputable sites. Most of the bad stuff is about withdrawal from Suboxone. Some people apparently start Suboxone without realizing it too is an opioid. Anytime you stop an opioid, even a partial opioid, there will be withdrawal. And some people (not all) have a very bad withdrawal if they stop Suboxone suddenly.

      Reply

  2. I do regard suboxone as “real” recovery in that it is an important piece of a larger, more holistic approach to dealing with one’s drug dependency. Society’s negative judgments seem to be rooted far too often in misinformation or personal bias without having a full grasp of the facts.

    It might be said that suboxone alone is not real recovery, or complete recovery. But I believe much of this depends on the individual we are trying to treat/help. For some, the relief that suboxone provides may actually motivate that person to incorporate other positive changes into his or her life. In other words, medication assistance gets the ball rolling and gets the person in the game. When clients begin to feel better due to the elimination of withdrawal symptoms, then their energy comes back, their sense of hope is restored, they think more clearly, and begin to focus on how to make things better in their lives. Not all of them, but many of them!

    So if one looks at suboxone as a really helpful first step, then it can lead to other steps that we equate with “real”, lasting recovery. Medication assistance is part of the solution. I would rather someone step onto that path, and have a chance at more, than to remain lost in the vicious cycle of addiction. They have a saying in the recovery community “Progress, not Perfection”. After a lifetime of losses and despair, trying suboxone (under the care of one’s doctor) … is progress!!!

    Reply

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