Ask an Expert: Should My Son Stay On Suboxone If He Is Still Using Other (Non-Opioid) Drugs?

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Ask an Expert: Should My Son Stay On Suboxone If He Is Still Using Other (Non-Opioid) Drugs?

By Ross Fishman PhD 07/26/16

This week, our expert discusses the appropriateness of using Suboxone if you are not committed to remaining abstinent from all mind-altering substances.

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Ask an Expert: Does Suboxone Still Work When Using Other Drugs?
Should he stay on Suboxone?

My son is a 34-year-old addict. He has been using all kinds of drugs since he was about 20, including opioids and heroin. His story is long and hard and still in progress.

He has been in a few detoxes, halfway houses, sober houses and hospitals, always relapsing, until he went on Suboxone. He has now been on Suboxone for four years. He had about one good year on it (I think) but since then, he abuses other drugs: huffing, K2, weed, cocaine, gabapentin, and alcohol. I know it has been on and off over the years with these drugs so he may have given up some, but I learned in November—with his last relapse (by huffing)—that he is using cocaine, huffing, alcohol and gabapentin. He had a great job for about three years until his latest relapse. He also has been arrested twice, for a car accident and once for drunk behavior. He has lost everything—you know how it goes.

When he first went on the Suboxone, I was scared but hopeful. He goes to a Suboxone doctor who gives him seven days’ worth of medication and tests him weekly. He is also supposed to attend a weekly meeting at the doctor’s office. However, at this last relapse, I found out that many of his friends who go to the Suboxone doctor are also doing other drugs. I believe this doctor looks the other way.

He hasn’t lived in my home for over 10 years. We thought we were getting very strict with him and not enabling, but until this last relapse and I found out what he has been really doing. I believed his lies and manipulations.

So my question: is Suboxone still working for someone, as it is supposed to work, if someone is abusing other drugs while on it?

My son keeps saying he will relapse and die if he gets off it, that it is horrible to get off of it and he has to stay on it, that it is impossible to get off of it. I mean, is that all he can hope for while on Suboxone? He doesn’t do AA or NA meetings or get any therapy except for the Suboxone doctor, who supposedly makes him go to a meeting each week. He has told me in the past he doesn’t go to all the meetings.

He is currently in a sober house (not a good one, no rules) living with a young girl that does coke, and working construction. He is on probation too.

My head keeps wrestling with, should I be encouraging him to come off the Suboxone and do what we are asking? Or if doing that, am I setting him up for failure and possibly death?

We have tried everything we can to get him help. He doesn’t want any part of it.

I continue to try and “detach.” I go to self-help groups, belong to forums, do all the research, see a therapist and we see an addiction specialist (someone with 12 years of recovery), but I want to make sure I am doing all I can do.

I know it is up to him and until he is truly ready, there isn’t much I can do. We work at communicating with him and this addiction specialist is teaching us how to do that, no matter what my son is doing, but with healthy boundaries for us.

Just wanted your opinion on the Suboxone. Frankly, I don’t care if my son takes a medication for the rest of his life, if he is in recovery. But I don’t feel that someone who is abusing other drugs and drinking (which got him probation) is in recovery.

I read The Fix all the time and everything else I can get my hands on. There are so many articles on how great MAT treatment is, and how bad it can be. I just keep feeling, for my son, it isn’t working for him.

Any thoughts are greatly appreciated. Thank you. Sarah

Ross Fishman, PhD: Dear Sarah,

I am sorry you have had to deal with your son whose life has been impacted by chronic substance misuse for the last 15 years. It is surely frustrating to want to help and repeatedly being met with refusals. You have raised a number of issues in your quest for assistance. Your major question is whether or not he should remain on Suboxone because he is using other drugs at the same time.

He states that if he stops taking Suboxone, he will relapse and die. He fears a return to illegal opioids such as heroin or prescription pain medications more than his concern about the effects of the other drugs. Therefore, he wants to remain on Suboxone because it is doing its job of keeping him away from the opioids, preventing withdrawal symptoms and blocking him from getting “high.” He should continue taking Suboxone and there is no need to consider a time limit now.

It is not uncommon for people to misuse more than one drug at a time. Many of those abusing opioids view their use of other drugs as a separate issue. None of the other drugs you mentioned are narcotics, so your son regards them as safer. It seems clear that he has no intention of stopping their use. To his way of thinking, they are benefiting him in some way. That is why he continues to use them. You also state that he has a residence and is working, so he is functional in some ways.

You are correct that until he is ready, he is not likely to take any steps toward recovery. However, choosing to stay on Suboxone is a step in the right direction, though he has a long way to go. When he experiences significant motivation to change, which may come from an internal desire or an external source—conditions of probation could be one if used properly—he may take the next step.

I suspect your son has several psychological issues, perhaps stemming from one or more traumatic events that occurred before or around the age of 20. He may well be using the other drugs almost continuously to deal with unpleasant conflicts and emotions that plague him from that time. If that is true, he would benefit most from working with a substance use disorder clinician—psychologist, social worker or psychiatrist—who uses harm reduction psychotherapy. That person would allow him to continue to use these drugs while guiding him to use them less frequently and in lesser amounts. That approach, talking therapy, within a good therapeutic relationship, would give him an opportunity to resolve those disturbing issues and reduce his need to continue to be so self-destructive.

Last, I suggest that you continue to attend self-help meetings and therapy sessions to focus on yourself and to try harder to detach from his struggle.

Ross Fishman, PhD

Innovative Health Systems

Dr. Ross Fishman, a native of New York City, earned a B.B.A. from the Baruch School of Business Administration (CCNY). Full bio.

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