The substance abuse professionals who supervise Suboxone therapy understand that the family members and significant others of persons with opiate addiction have many questions about treatment with Suboxone. Families wonder if Suboxone therapy is well regulated, and whether buprenorphine, the generic medication in Suboxone and Subutex, represents a good treatment option for their loved one. The questions and answers below should provide you with a great deal of information about treatment with Suboxone.
Does the Government Approve of Suboxone?
The federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA) has approved methadone, naltrexone (Vivitrol), and buprenorphine (Suboxone or Subutex) as medication-assisted treatment (MAT) options. Treatment with methadone goes back more than forty years, and protocols for treatment with Suboxone were established back in the year 2000. Naltrexone or Vivitrol has been utilized for treatment of alcoholism for quite some time compared with its use as a monthly injection for opiate addiction.
SAMHSA believes that treatment with Suboxone or one of the other two drugs give persons with opiate addiction a better chance at recovery than abstinence-based treatment. This recommendation is based on years of research.
Isn’t Suboxone Treatment Just Another Way to Get High?
While methadone and Suboxone both fall into the opiate category, they have a much longer half-life than other opiates, and they remain in the system longer. Additionally, these medications work by blocking the receptors in the brain that are affected by opiates, enabling users to experience a less painful detox process and preventing enjoyment of illicit drug use once an effective dose has been established. Both options allow the person to maintain a consistent feeling of wellness throughout the entire day. Patients can then focus on the daily activities they have been neglecting and also participate in counseling and other programs focused on addressing the underlying causes of the addiction.
Why Doesn’t Suboxone Require Daily Visits (Like Methadone)?
One of the greatest advantages offered by treatment with Suboxone is the drug’s availability as a prescription medication so that the patient does not have to make daily trips to the MAT program or doctor’s office. The fact that someone is not tied to a daily clinic visit improves the rate of follow-through with treatment visits.
There is also the fact that the Suboxone falls into a unique drug classification. Like methadone, Suboxone remains in the system for at least 24 hours so that the addicted person can get through each day without being affected by urges or cravings to use their drugs. However, unlike methadone, which is a full opiate agonist, Suboxone or the generic buprenorphine is only a partial opiate agonist. It does not provide the same possibility of getting high and so it is less likely to be abused. To prevent people from sharing their Suboxone with others, it is distributed in a film format that dissolves easily under the tongue but cannot easily be given from one person to another. People participating in treatment with Suboxone are also asked randomly to bring their used film strips to the doctor’s office to be counted. The film strips are numbered so that the staff who review them can tell if they were the film strips originally dispensed to the patient or if the patient substituted someone else’s strips for their own. They are also able to determine if the patient has the correct number of doses remaining, indicating they are not taking more than recommended.
Can They Start the Program if They’ve Used Drugs That Day?
Treatment with Suboxone requires that the person should be feeling withdrawal symptoms before they can take their first dose of Suboxone. The Suboxone medication works by blocking opiate drug molecules from entering the brain’s opiate receptors, and if a person takes Suboxone while they still have other drugs in their body they will go into an intense, very unpleasant withdrawal called precipitated withdrawal.
Treatment providers understand that many people have difficulty withstanding the symptoms of withdrawal in order to get their first dose of Suboxone. But the precipitated withdrawal would be much worse.
How Often Are Doctor Visits?
Initially your family member reports to the Suboxone treatment program for an assessment and drug screen, and also follows up with a physical exam. Most programs that provide treatment with Suboxone also administer tuberculosis and hepatitis tests, and testing for HIV/AIDS is available upon request. Once those visits are completed, your loved one will report to the program at least twice in the first week, and then weekly thereafter as long as they are adjusting successfully to the Suboxone medication dosage.
When a patient consistently meets program requirements and attends all doctor visits, he or she will go to biweekly visits, and eventually they will only need to see the doctor once a month.
What are the Program Requirements During Treatment with Suboxone?
On the recommendation of SAMHSA, licensed and certified programs for treatment with Suboxone assign the patient to a substance abuse treatment counselor for regular one-on-one counseling sessions. They will also be given information on other resources such as 12-step meetings and support groups, where they will meet people who are also battling the medical disease of addiction. Additionally, programs require evidence that the patient have been abusing opiates for more than one year, and patients must be over the age of 18.
Is Suboxone Safe for Pregnant Women?
The use of the generic buprenorphine is preferred over methadone for use in pregnant women, although many pregnant women stay with methadone. For the women who opt for buprenorphine, they are prescribed Subutex rather than Suboxone, because Subutex is pure buprenorphine while Suboxone contains another drug that reduces a person’s urge to use. The idea is to use the Subutex because it exposes the unborn baby to just one drug instead of two.
Pregnant women receive priority getting admitted into Suboxone treatment programs. When the childbirth is anticipated, the woman may receive increased doses of Subutex so that she does not need pain pills after the birth. The newborn will be monitored closely for withdrawal by the pediatric intensive care team, and treated if withdrawal symptoms occur. Most Suboxone treatment programs offer coordinated pregnancy care, working with the OBGYN to ensure that the patient receives the best possible care.
Why do they have to go for counseling?
Opiate addiction can cause the user to behave with uncontrollable compulsions, and most addiction is triggered by other problems that should be addressed to ensure long-term recovery. SAMHSA requires programs that provide treatment with Suboxone to offer one-on-one counseling or even group counseling. It’s up to the individual programs what consequences are set for those who do not attend counseling.
Most people who struggle with addiction find through counseling that the addiction has been their solution to problems, a symptom if you will. Through counseling, they can learn how to deal with issues from the past and control the behaviors that can lead to relapse. Basically, they’ll learn new, healthy solutions to problems that will continue to come up in sobriety. Patients also receive referrals to other social service agencies that can help them locate and obtain assistance with basic needs that may come up in recovery. These agencies can provide direction and assistance with medical issues, legal issues, child care, jobs, vocational training, housing and other basic needs.
How long will they be on treatment with Suboxone?
Some physicians talk about short-term Suboxone treatment. However, because the very nature of addiction is so compulsive, many people stay in medication-assisted treatment for a year or more. Studies have shown that the greatest success in MAT comes to those who do participate in treatment for a year or more. As long as they see their doctor regularly, this will not harm them, and they will be able to regain the skills and personality that you loved before they were affected by this medical disease. Once they make the decision to get off Suboxone, they will taper from it slowly over a period of time discussed between them and their doctor.
Can I Make Their Appointment Today?
Actually, as a family member, you cannot make their appointment at all. Federal laws protecting their privacy require them to call or visit the Suboxone treatment program personally. After all, recovery won’t work if they’re not ready to participate in treatment. You can provide transportation, but nobody at the program can talk to you until your loved one signs a release authorizing them to exchange information with you. We suggest that you call us if you want to get information about treatment options, and then put the information in front of them. Even if they resist your opinion, it matters to them. If you persist, then hopefully sooner or later you can influence them to come in for treatment with Suboxone.
