If you subscribe to Google Alerts or spend much time reading message boards about Suboxone you will see this headline frequently. Today a person who read my blog wrote to me and said, in consideration of starting Suboxone: ‘I know that Suboxone is a substitution for vicodin, but my concern is, what is the substitute for Suboxone?’ I have answered this type of question many times online or by e-mail, and I will answer it once again in a moment. One place I have not answered the question is in my practice when I am talking to opiate addicts treated with Suboxone; they almost always have the same ‘ah ha!’ experience that makes everything clear. They suddenly see what buprenorphine does to cravings. After several weeks they are already starting to feel like they did before their addiction to opiates. They experience the relief that comes with waking up in bed and feeling no urgency to scurry through drawers and pants pockets, searching for a stray football that won’t turn up… meaning another long day without drugs or money.
I wrote to the e-mailer that his question was analogous to a person with uncontrollable hypertension who finally finds a medication that will control the blood pressure and stop the damage to his kidneys, heart, and brain, who then asks, ‘what can I replace this medication with?’ There is an old saying that most of you young folk probably haven’t heard: Don’t look a gift horse in the mouth. Do I need to explain it? Someone buying a horse will look at the horse’s teeth to assess the animal’s hardiness; if the horse is a gift, don’t look for faults in the animal. Just be grateful for the horse! Here we have something that will free a person from the chains of addiction—and speaking as someone who didn’t have the Suboxone option when I hit the skids, what a great new option! But to some, it is not cause for celebration—it isn’t enough. ‘When can I get off of it?’ they ask. The answer: Opiate dependence is a chronic, potentially fatal illness. You may never be able to stop treating it. But at least it is much easier to avoid relapse than it used to be—before Suboxone.
“Suboxone is the worst thing in the world to get off of.” Oh really. So all of those treatment centers that now use Suboxone as a tapering medication are… wrong? Today there was a post on Google Alerts from some poor loser at Drugs.com who is giving the play-by-play report of his coming off Suboxone… self-absorbed post after self-absorbed post: ‘now I’m sweating… gee, this totally sucks… I feel so tired and so worthless… Oh no, I’m sweating again… this sucks…’ This is twisted on so many different levels! First, withdrawal sucks—no doubt! But I have a news flash: it REALLY sucks when you sit and concentrate on it! How to make it ‘not suck’ so much? Do like my patients have done after they have used Suboxone and eventually transitioned off: take immodium and ibuprofen, drink lots of fluids, get enough sleep, and most important: distract yourself as much as possible. Whatever you do, DON’T SIT AROUND ALL DAY AND WRITE ABOUT EACH MISERABLE SYMPTOM!
Another way that the post is twisted: I don’t know about the rest of you, but the voluntary tapering of an opiate and getting to day 5 or 6 was a big deal in my case! The person stopping Suboxone and writing about it seems to be missing that.
There are several reasons that people make the mistake of calling Suboxone withdrawal ‘the worst in the world’. The first reason is simply because it is difficult to remember and compare painful experiences. Think about it—did you ever break anything? Can you remember how bad it hurt in comparison to the next painful thing that happened? Or when you have a bad cold—every cold is always ‘the worst one ever’! In withdrawal, the severity of each episode is more related to the severity of prior episodes than to the drug one is withdrawing from. It is difficult for me to explain why that is without passing on an understanding of how the body and brain work. Think of it this way: withdrawal occurs when the neurons are ‘used to’ a certain level of stimulation at their receptors and the stimulation no longer occurs. The stimulating medication, buprenorphine, is gone; the individual neurons have no ‘memory’ for the specific now-absent medication.
The worst part of the nonsense about Suboxone: you will see posts all over where people have been convinced by the uninformed to stop Suboxone, and they start posting as well, all excited that they are stopping the medication. If you go back in time a few months, read some of those posts, check out the nickname of the posters and search for them you will notice something: most of them disappear after a few weeks. Where do you suppose they go? One minute they are posting about their new-found ‘sobriety’, about how they love the site, about how they will stick around to work on their ‘recovery’… and then—poof!—they are gone. This is how opiate addiction and relapse works; the addict gets cocky, thinking he/she will be fine… then the thought comes out of nowhere that using ‘just once’ would be OK, and all the misery comes right back again.
Suboxone didn’t come with a cure attached. It is an amazing medication; it will induce remission of opiate dependence, when before Suboxone the addict had no option but to lose everything until becoming desperate enough to put life on hold for three months of residential treatment. Even then there were no guarantees; most recovering addicts relapsed, often over and over again. If you can stop taking opiates, good for you—stop them and God bless you. But if you can’t– if you keep going back to them despite the promises to yourself, or if you think about them every morning as you get out of bed— you don’t have to live that way anymore.