When you are using opiates, your brain needs ever increasing amounts of the drug to feel normal. Suboxone can help you get off the roller coaster without feeling wretched and that makes it an excellent recovery tool, but it isn't a cure. It's important to understand how this medication works if you are using it.
The Science of Suboxone
Suboxone mimics the effect of opiates but it has a ceiling, so that you can level and even taper your dose. The medication is a combination of buprenorphine and naloxone. Buprenorphine is a partial opiate agonist. This is a fancy way of saying that it sits in the opiate receptors and blocks them so you don't go into withdrawal. Buprenorphine binds especially tightly which keeps it at steady level in your blood all day.
Suboxone Keeps Your Brain Feeling Good
Vicodin and heroin are short-acting full agonists. Their effect wears off after a short time and you have to take increasing doses of them to feel good. Suboxone has a ceiling effect; you don’t need to take more and more over time. It also works very well to keep you from experiencing physical withdrawal.
Within a day of starting Suboxone, you will feel normal. No diarrhea, vomiting, no aching pain. You can sleep, eat, go to work and start to get your life back. The benefit of Suboxone is that you are much less likely to relapse back to using opiates while you are taking Suboxone. Based on the medical research, without medication like Suboxone, the vast majority of people relapse within one year of detoxing.
How is Opiate Addiction like Diabetes?
One way of looking at opiate addiction is that it's a chronic disease, like diabetes. People with diabetes take medications such as insulin to regulate their blood sugar so they don’t get sick. They still have diabetes, but it’s controlled with medication and they can go on and live their lives.
Similarly, taking Suboxone or another opiate replacement medication everyday regulates your brain chemistry. The medication gives you what you are missing, just like insulin for the diabetic, so that you can feel well. But it’s not a quick-fix or a cure-all. Like the person with diabetes, there are many other things you can do to regulate your brain chemistry so that your medication can work at its best and you can decrease your medication to the smallest possible amount needed.
Some people with diabetes are very motivated. They get down to a normal weight, eat healthily and take care of themselves to such a degree that they are able to maintain normal blood sugars without medication. Other diabetics, especially those whose bodies no longer make insulin, will still require medication despite all their best efforts.
Similarly, some people taking Suboxone who are very motivated can taper off the medication and live in a way which makes relapse less likely. Other people, especially those whose brains no longer make the natural feel-good chemicals, will need to stay on the medication to stay off opiates. There is no one best solution for everyone.
Criticisms of Suboxone
You may hear some criticisms of Suboxone so I wanted to address some of the concerns that are raised so you can make your own decisions. Some people who advocate for an abstinence-only approach say Suboxone is “just substituting one drug for another” and people are “still addicted.” It’s true that Suboxone is a medication used to treat opiate addiction. But, Suboxone is a legal medical treatment, it’s taken under medical supervision, people are not addicted to it.
Because of how the medication works, there is a ceiling effect and you don’t need to take increasing amounts of it just to avoid going into withdrawal. Patients don’t get high from taking Suboxone, because the medication is long acting with a slow onset and the correct dosage matches the level of addiction.
While Suboxone is very effective at helping with the physical symptoms of dependence, the limitation of Suboxone is that it doesn’t do anything to help you figure out how you got hooked in the first place or what you can do to stay clean for the rest of your life. Really, the medication is just one part of your recovery. For many of you, the medication works so well that it’s tempting to think your addiction is all gone just from taking the medication.
The problem is that if and when you try to decrease your medication, you may get anxious, have trouble sleeping, or generally feel less well. This makes it hard for people to decrease their dose. Also, if you have a bad day and the amount of Suboxone you have on board isn’t enough to compensate, then taking a little bit more won’t help you feel better that day. Because the medication has a long duration, you won’t feel it for a day or so. That’s how people end up on very high doses of methadone for instance.
Again, if you stop taking the medication completely, you are also much more likely to relapse back to opiates. So part of your job is to do the work to take care of yourself without taking more medication. You'll need to learn new ways to deal with those parts of the day and your life that are difficult. It’s possible to do and I started Recovery Superstar so that you could learn exactly how to do that.