Ask an Expert: Is Suboxone the Best Choice for Me?

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Ask an Expert: Is Suboxone the Best Choice for Me?

By Percy Menzies 05/24/16

Our expert suggests an alternative to opioid replacement therapy for a reader who wants to be completely opioid-free.

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Ask an Expert: Should I Go On Buprenorphrine?
One dependency for another?

Dear Fix Expert,

I am in early recovery from heroin and oxycodone abuse, and it is not easy going. The urge to use again is with me constantly. The clinic where I get treatment is strongly encouraging me to go on Suboxone, but tough as it is, I don’t feel like going on a medication that I will be dependent on long-term. I don't want to give up on the idea of being completely opioid-free. What do you suggest?

Percy Menzies: Dear Reader, 

I think that the ultimate treatment goal for every addictive disorder or behavior should be abstinence from the offending substance or a substance that mimics the offending substance. People quit smoking, recover from alcoholism, cocaine, methamphetamine and other substances without being on what I think of as "low level addiction."

The only exception is the "treatment" of opioid addiction. Use of powerful, addicting, abusable and divertible drugs is euphemistically called "maintenance," and patients are encouraged to stay on these drugs for years and years.

As you describe, abstinence from opioids is painful in the early stages, so good treatment can follow a step approach that may involve the use of another addicting substance early in the treatment phase of detox. It is standard practice to use benzos for alcohol detox but we never maintain a patient on these meds. Methadone and now buprenorphine (the active ingredient in Suboxone) have been used as detox meds to control the withdrawal symptoms and as a tapered dose to wean the patient off the opioid and promote abstinence.

Abstinence is the ideal goal, but it is difficult to maintain in early recovery: There is a very high risk of relapse if patients are not protected from accidental or impulsive use of opioids. Can something be done to protect the patient? Staying on opioids like methadone and Suboxone is one strategy, and there is another radically clear option: naltrexone. Naltrexone was developed as a non-opioid to protect patients from relapsing. It allows patients to achieve their goals of abstinence from opioids and prevents relapse. You can be on naltrexone for a period of time, and then when the behavioral changes that you’ve achieved as a result of the counseling program have taken root, you can stop the naltrexone without any withdrawal symptoms.

So that is my recommendation to you—discuss this option with your program. Being on a non-opioid medication like naltrexone will give you the abstinence from opioids that you are looking for, but it will be much easier than trying t​o stay drug-free without any medication. Being on Naltrexone in no way defeats the goal of being opioid-free.​

Percy

Percy Menzies has provided training on the use of anticraving medications to reduce recidivism within the criminal justice population. Full Bio.

To continue the discussion on Suboxone, please see some other recent Ask an Expert columns.

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