We need protocols that work for people who want to live opioid-free.
The evolving science of addiction medicine now includes an arsenal of medications that can be used to assist patients in establishing a stable recovery, and our ability to treat all of the biopsychosocial aspects of substance use disorders continues to expand. As a result of the ongoing opioid epidemic, the number of people who require Medication-Assisted Treatment—particularly Suboxone—has increased. For many such patients, remaining on Suboxone indefinitely is the logical and safest path, but there are others who, for various reasons, want to taper off. Dr. Stacy Seikel describes the individualized approach that she uses for patients who would like to move in that direction…Richard Juman, PsyD.
Just over a decade ago the landscape of addiction medicine changed dramatically when Suboxone (buprenorphine/naloxone) entered the picture. Touted as a wonder drug for those combating addiction to painkillers and heroin, Suboxone was scientifically shown to be highly effective in eliminating an addict’s cravings, allowing them to regain a sense of wellness and creating the psychological space necessary to begin the hard work of recovery.
Unlike methadone, Suboxone didn’t need to be administered in an opioid treatment clinic, making it simpler to prescribe and less stigmatized. This change is overwhelmingly to the good, but the availability of the medication in less controlled environments has also resulted in some predictable concerns.
From Miracle Drug to Public Health Concern
In the right hands, Suboxone continues to be a very effective medication for patients who are looking to withdraw from opiates safely and comfortably. But in the wrong hands, including those physicians who aren’t as knowledgeable about the importance of comprehensive care for successful addiction treatment, it has the potential to be misused.
As prescriptions for the drug began to increase, patients often found that they didn’t need as much of the medication as they were prescribed. As a result, the surplus Suboxone made its way onto the streets where it was obviously not used in the appropriate way for which it had been prescribed.
Suddenly, the once “miracle” drug became the subject of public health concerns as issues such as medication diversion, for recreational use hit the media. Additionally, concerns began to arise around the advisability of patients staying on the medication long term, or forever.
Many, if not most, individuals prescribed Suboxone as part of their addiction treatment have a goal of wanting to eventually wean off of it and live a life free of opioids entirely.
Is Getting Off of Suboxone Really Possible?
The short answer is yes. The long answer is that it takes time and a collaborative effort between the patient and the treatment team.
Unequivocally, one of the robust findings in addiction medicine is that people who attempt to go off of it relapse more than those who stay on it. Period. Many doctors have taken this to mean that it’s best just to put people on Suboxone and leave them on a maintenance dose indefinitely. I see a couple of problems with that strategy.
First, we are still learning about best practices in tapering people off of Suboxone, and the prevailing wisdom that people should stay on Suboxone indefinitely is impacted by the many people who have tried to get off Suboxone in a less-than-optimal way, with inadequate monitoring, therapy and psychosocial supports.
Second, although long-term Suboxone may prove to be the best “population health management strategy” for persons with opioid addiction, that doesn’t mean that every patient will want that, and we owe it to those patients who want to live opioid-free to identify the elements necessary for successful tapering. Read more “the fix”…