The editors at Addiction Professional online journal—Roland B. Vendeland, M.Ed., MA, LPC, and Roland Rager, MD, MPH—have published an interesting piece discussing the right time to stop buprenorphine treatment. Just how do you know when it’s the right time? Many people opt for buprenorphine treatment over methadone therapy because they think it will be short-lived, but often that is not the case.
Researchers and physicians talk about determining a point at which you will stop buprenorphine treatment because they want you to live drug-free and they don’t want you to experience any withdrawal symptoms or cravings. However, for the opiate addict that goal is often quite difficult to achieve. Opiate withdrawal symptoms can abate and then crop back up after months, or the person who is no longer using opiates might experience sudden and overwhelming cravings to use many months after their last illicit dose.
So how is a person to know just when they should stop buprenorphine treatment? It’s actually interesting to revisit the not-too-distant past, when treatment providers at just about all levels frowned on medication-assisted therapy. They believed that the only real road to recovery meant abstinence-based therapy. You went from using the most intense drugs on the face of the Earth to using nothing. Makes a lot of sense, huh? No wonder so many people have failed at that level of treatment.
A Case for Buprenorphine Treatment
The place with the most shining reputation for substance abuse treatment might have been the Hazelden Clinic in Rochester, Minnesota. Maybe it carried the cachet of sharing an address with the Mayo Clinic. Or maybe it was its association with Betty Ford, the long-ago president’s wife who let us all know that it was okay to reach out for help.
But the real break-through came when Dr. Marvin Seppala at Hazelden realized not only that buprenorphine treatment was helpful, but also that it worked in tangent with 12-step group therapy, and also that the person might remain in buprenorphine treatment for years. That’s right—it’s okay to remain in buprenorphine treatment for years.
How did the medical director of the Hazelden Clinic ever reach the conclusion that long-term buprenorphine treatment was acceptable? The Hazelden Clinic was in business long before the federal government approved buprenorphine as a treatment option in 2000, and nobody ever expected the clinic to veer from its long-term therapeutic model of abstinence and 12-step participation. However, Dr. Seppala realized that people were relapsing very quickly after discharge from treatment. He also became aware that people in treatment were more focused on getting drugs than they were on achieving sobriety. He realized that medication-assisted treatment held its own place in the string of valid therapeutic options.
According to Maia Szalavitz writing for Time.com, Seppala worried about getting addiction treatment counselors to buy in to his new suggested therapy. But they placed their faith in Seppala. Seppala and his team worked with clients who took buprenorphine and then focused on 12-step therapy before tapering off their medication—and when they seemed in danger of relapse, they were allowed to continue. Who knows just how many lives were saved with this bold new therapeutic option?
Don’t get it wrong—12-step therapy is a vital part of anybody’s recovery, no matter what their drug of choice has been. Whether they’re been drinking, speeding, tripping, chasing the dragon, or whatever, they need the validation that only partners in 12-step can provide. They need to know that they are not the only ones with dirty secrets. They need to know that they can step out of the darkness and into the light because others before them have already done it.
But buprenorphine therapy reinforces the concept that treatment can be and may be necessary over the long term, for years. Like methadone, it offers a way to avoid the horrible withdrawal symptoms and cravings that send a person right back into the arms of relapse. Unlike methadone, it’s more difficult to abuse, because it’s a partial opioid agonist rather than a full agonist. Even when someone increases their dose of buprenorphine—with or without the doctor’s permission—they will reach a point when they won’t notice any increased sensation of being high.
So if you’re on buprenorphine treatment, how will you know when you should think about quitting it? If you have a loved one in buprenorphine treatment, how do you know that they have a justified need to remain in therapy?
According to Vendeland and Rager, you should note these markers along the road to recovery:
- If the person used opiates for a long time, they will need to remain on medication-assisted treatment for a long time. If the person has tried to quit before, how many times have they relapsed? Nobody who has been injecting heroin for decades is going to make it through treatment as quickly as someone who was hooked on pain pills for a year.
- Does the person work the 12 steps? There is no intention here to find out if the person has accepted a specific spiritual higher power. Rather, the person cannot succeed in recovery unless they recognize their own responsibility for the addiction and also for their recovery.
- Can they cope? Does the person have a relapse prevention plan and a good support network?
- How solid is the person’s certainty that he or she can succeed without continued buprenorphine treatment? Doctors often ask people as they begin buprenorphine treatment what their goal is to quit that treatment. People often recognize the need to stabilize their lives and tie up all the loose ends that are flying about.
- Does the person abstain? Of course the person must abstain from opiates, but ultimately they must live a clean lifestyle. If the person has just substituted one addiction for another—i.e., using cocaine instead of opiates—then they will soon be back to their original drug of choice.
- Are initial addiction issues resolved? If someone got into pain pills because they had an unresolved pain issue that is still unresolved, then they will get in trouble if they try to wean off buprenorphine treatment.
- People, places, and things: If a person wants to avoid a cold, Vendeland and Rager tell us, then they shouldn’t shake hands with someone who’s sneezing and coughing. Likewise, the addict in recovery should develop a commitment to avoiding the people, places, and things that led him down the road to addiction in the first place.
There should no longer be any stigma or shame associated with buprenorphine treatment. If you are using opiates, or if you know someone who is, then go into buprenorphine treatment with the full acknowledgment that you are not going to end your therapy prematurely.
Your first step is to visit your local buprenorphine treatment program and take advantage of the full opportunity to ask questions of the assessment counselor. Only then will you have a complete idea of the therapeutic options that will keep you clean and straight. Remember that buprenorphine is a medication recommended by the federal government in order to treat the medical diagnosis that you have. Only by accepting and working the treatment can you make it into recovery.