How long to take Suboxone? Seven years?

‘Seven years’ refers to a scrape over on SuboxForum.com with a moderately disturbed woman from Roselle, Illinois…  Those of you who haven’t visited are really missing some good action!  We also have a new ‘Q and A’ section that I think will be a hit.  Please visit and register, but more than that, WRITE!  People on Suboxone need to talk to each other so that they don’t feel like isolated members of an ‘underclass’.  I tell you– there are more people on Suboxone than you would ever imagine.  I can’t remember the exact number, but somewhere around 500,000 people have been treated in the past few years (7 years if you believe our crazy lady from Roselle!).  So let’s talk… as you will read below, the stakes are high.  There remaines a great deal of ignorance out there, and it would be a shame if ignorance made the rules.

Here is the first question from the new Q and A section:

Hello Suboxdoc, I he a guy friend who has been taking suboxone for years, I read some of these stories where people have been taking it for years as well. First …is it safe to talke for that long? Can you tell me why some doctors would say “NO” to keeping a patient on it for life or what do they call it …a mantenance dose? My friends doc wants to take him off and he tells me he is not ready. He cant seem to find a doctor out here in Chicago that will work with him and tell him ok well keep you on it. I know you would need to know a lot more about my friend “XXX” and cant just guess at what he needs, I am just asking your opinion if you think keeping someone on suboxone for years is ok to do. What is your opinion. I am so glad I found this site, my friend XXX does not have a computer and I want to do as much research for him as I can and give him some positive feedback. Can you refer any doctors to me for him as I read you were out here for a meeting, do you know of any good doctors out here in Chicago? Thank you in advance!

My ‘A':

First, let me say that this is only my opinion, and that there are other opinions. I DO think that my opinion benefits a bit from being an addict myself– but maybe it is the opposite and my opinion is LESS valid. So… I will leave that issue for you to decide.

While buprenorphine has been around for pain treatment for 30 years, using Suboxone to treat opiate dependence is new. As many people probably noticed, there was initially some hype about using Suboxone for a few months, as a detox tool. three years ago 30% of the scripts were written for long-term use. Now, 70% are for long-term use, or ‘maintenance’. The reason: studies showed that people who took Suboxone for less than 6 months had very high rates of relapse. Another reason, in my opinion, for the change in prescribing pattern was the increase in the patient cap to 100 patients, from 30 patients. I’ll explain:

The law that led to the use of buprenorphine was passed in 2000, and is called ‘DATA 2000′ for those who want to look it up and learn all the specifics. DATA 2000 dreated an exception to the Harrison Act, an 80-y-o law that bans the use of narcotics to treat opiate addiction. DATA 2000 allows the use of DEA schedule III-V meds to treat opiate dependence. In 2003 buprenorphine was moved up to schedule III from schedule V, where it had been for decades, in preparation for greater use of the drug. Finally, in May of 2003 the FDA gave the indication for Suboxone to treat opiate dependence. The initial law said that each doc could have up to 30 patients on buprenorphine at any one time. The docs had to get certified through an 8-hour course and a bunch of paperwork, and a waiting process of several months– a big hassle to a busy practice for just 30 patients! Plus, once a patient is stable there is little revenue generated… creating an incentive to ‘turn over’ patients as quickly as possible (the law of unintended consequences). So… patients were treated, tapered, and discharged, clearing the way for more patients. Never mind that the people who were discharged only relapsed again– unless they were sent straight to residential treatment after the detox was completed.

A year or two ago the law was changed, allowing doctors to have 100 patients after their first year of prescribing Suboxone. This change in the law, and the recognition that long-term treatment yields long-term sobriety, has resulted in more people being on Suboxone long-term. Given what we know about short-term use, I am always a bit suspicious about the motives of docs who use Suboxone short term– either they don’t know the science, or they want more money— again, in my ‘humble’ opinion. What is ironic is that the ‘anti-suboxone’ crowd, like our ‘7years’ friend from last week, think that the long-term docs are ‘evil’, trapping them on Suboxone to make more money! In reality the exact opposite is true. In most parts of the country if you hang a sign saying you are treating with Suboxone you will have 100 patients in two days! If you want to ‘clean up’ and make a ton of money, you treat everyone for a couple weeks of detox– then bring in another 100 patients! The ethical docs– the ones who understand addiction and who are willing to make less money to help people– treat people for the long term. They also have to put up with the head cases like ‘7 years’ harassing them. Those people are amusing, but they can be a bit annoying at times as well.

I believe that we are in the middle of a very important struggle over how addiction will be seen and treated. There is the ‘medical model’– where addiction is an illness as valid and as worthy of treatment of any other illness– and the ‘it’s your fault’ model, where addiction is a ‘spiritual deficiency’ treated through fixing character defects. I used to subscribe to the latter model, in part because it was all we had. But I have met many addicts who were just as ‘spiritually good’ as any non-addict! I mean, really– read what that ‘stone cold sober’ crazy lady wrote, and tell me– does she sound like the person YOU would want to become?!

Your specific question: We do not know of any long-term negative effects from buprenorphine. One problem I have with the nuts who spread the anti-sub stuff is that they are always wrong about everything they say– yet they write things like ‘do your research!’. To a newcomer, it must be horribly confusing. Bottom line: we hae had buprenorphine for thirty years. It is nothing new. It has been used to treat opiate dependence in other countries for 15 years– not as Suboxone, but in liquid form, using ampules and syringes to squirt it into the mouth. There is a long track record, and nothing bad has come up. And again, I have written explanations behind the claims of those who say the withdrawal is worse than that from other opiates; they are wrong about that, and if you want the reasons for their mistake you can read my recent posts on the issue.

I am a fan of long-term treatment. You will read comments like ‘I think Suboxone is fine, but only if used short term’– those comments are always by non-medical people who have no experience with the medication, and who don’t take the time to read the studies and understand the science. An argument CAN be made that a better model would be short-term detox followed by residential treatment… but it is just so darn hard to get a person into residential treatment. It really takes a commitment of 90 days to be effective, and while it can be a wonderful thing, it can also be a total waste of time and money. I believe that Suboxone and residential treatment do not mix, because residential treatment requires some level of desperation, and people on Suboxone are not desperate.

I hope that answers most of your questions… thanks for asking.

SD