What Sets Suboxone Apart From Other Medication-Assisted Treatments?

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What Sets Suboxone Apart From Other Medication-Assisted Treatments?

By Tiffany Swedeen 09/03/18

When taken as prescribed by an opiate addict, Suboxone doesn't allow me to avoid or escape reality. This is one way it differs form other MATs.

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Tiffany Swedeen

I’ve used the same pharmacy for over a decade. The tech filling my prescription this morning was the same one that had filled my Vicodin prescription for four years, on the first of the month every 30 days, like clockwork. 

Today, I smiled at her as she stuffed a different prescription into a small white bag: 28 individually wrapped, “lime” flavored, orange-tinted filmstrips.

“You’re still on Suboxone?” she questioned.

“Yep.” I answered. “I don’t see weaning off anytime soon. My recovery is strong and life is good.”

She raised a skeptical eyebrow.

“Aren’t you just trading one for another? Wouldn’t it be better to never get on it? Nobody gets off of this stuff… It just seems like a waste…no different than any other drug addict.”

My body deflated with a sigh, but I tried to give her the benefit of the doubt. I wasn’t expecting these questions from a woman whose career relies on understanding complicated medical pharmacokinetics, but I get it. She doesn’t grasp the complexities of addiction.

I simply explained to her the differences in lifestyle, motivation and integrity between using illegal substances to get high, and using a medication as prescribed as one of many tools in a recovery program. 

She’s not alone in her misunderstanding. Suboxone and other forms of medication-assisted treatment (MAT) are confusing and controversial, for addicts and “normies” alike. MAT isn’t the only thing that’s hotly debated. We argue whether addiction is a disease or a choice, what labels we should use, and how anonymous we should be. We quarrel about jargon, literature, sponsors and steps. 

One thing most addicts and alcoholics can agree on is this: We don’t like to be uncomfortable. The inability to tolerate emotional or physical pain is often what sets us hurling down the spiral of addiction.

An injury, illness, stress, loss, or combination of all of them (in my case migraines, divorce, job burnout) led us to drink or use to dull the pain. Whether its numbing out, sleeping it off, or chemically re-energizing, we’re professionals at self-medicating.

Going to extreme measures to either chase pleasure or run from pain, we drink, use, pop, dose, snort, shoot and eat our way to an alternate reality.

Could the pharmacy tech be right? Am I just trading one negative habit for another in an attempt to evade my problems? Like other opiates, Suboxone causes physical dependence and withdrawal if you stop taking it. How is taking it daily any better than taking Vicodin, Percocet, or heroin? I’ve often heard: “You might as well get in a managed cannabis program and smoke weed every day – isn’t that better than taking an opiate? “

My answer?

“No.”  

But that answer hasn’t always come easily. Even as a grateful patient of this medication, I’ve grappled with the decision. Sobriety means getting honest with myself, taking into consideration anything that might be used as a “crutch” or negate recovery.

I have to ask myself: Why am I OK with taking Suboxone? Why don’t I feel like a shady addict, living in the shadows and sneaking drugs, even though I am officially still taking an opiate? 

The answer came to me during a particularly stressful day when all I wanted to do was get high, get wasted and go to sleep. That’s impossible to do in sobriety. I’ve had to learn to cope with emotions, to accept reality, and to tolerate discomfort. 

A light bulb came on: Suboxone is different because it doesn’t change me or my circumstances. It doesn’t get me high.

Suboxone doesn’t do what other opiates did for me; I can’t numb physical or emotional pain. On Vicodin and alcohol, I was irritable, suffered memory loss, was incapable of personal growth and spirituality. I spent my time and energy chasing drugs, chasing a high, running from withdrawal. I cannot avoid or escape reality by taking Suboxone. At all.

When taken as prescribed by an opiate addict, it differs from other harm reduction and medication-assisted treatment such as methadone or marijuana by that fact.

The form of Suboxone I currently use can’t do anything to enhance my mood even if I take it other than prescribed. I can’t dissolve it in liquid and shoot it, because the Narcan in it (the ingredient that prevents overdose) will put me into immediate withdrawal.

I can attempt to get high by taking more than prescribed, but once my brain’s receptors are filled, Suboxone ceases to give any more effect. That undeniably sets it apart from other drugs — over-the-counter and otherwise.

Methadone, on the other hand, can easily be abused. I’ve done it myself. Taking three times the amount of methadone I should have, I went to a meeting to “work on recovery.” I couldn’t tell you what happened at that meeting, or how I got home.

If I take three times my Suboxone dose, I’ll likely not notice much enhanced effect, and I’ll screw myself over, since I’ll be short three doses and will somehow have to explain to my doctor why I ran out early. I’ll potentially be kicked out of the program as well, without ever even getting high! For an addict like myself, it’s not worth it. 

Marijuana as harm reduction has become popular, and is considered safe because there’s no lethal dose. However, for daily users and first-time experimenters alike, marijuana impairs judgment, driving, and learning. Smoking weed and then showing up to meditate or work on the 12 steps is counterproductive.

Treatment centers that prescribe cannabis generally give participants their dose at night, to make sure that they’re not high during meetings and counseling sessions in the daytime. This isn’t necessary with Suboxone – there’s no roller coaster effect of “high” vs “sober.” I feel no different after taking my daily dose than I do when I wake up in the morning prior to taking it.

I experience every range of emotion, the same as I would without medication. If life is hard and painful and sad, I can’t go to my Suboxone box and take a big dose to make it all go away. But methadone, marijuana, Vicodin, heroin?…..Escaping life and avoiding pain is exactly what they’re good for.

Suboxone isn’t a perfect fix by any stretch. Prescriptions can be diverted and sold on the street. Active heroin addicts will sometimes buy it to avoid withdrawal, if they can’t get their drug of choice. That’s an unfortunate fact. But is it the worst- case scenario? Every time a person injects heroin, they’re risking death by overdose or a systemic infection. There’s no guarantee that the substance is what the dealer says it is.

When an addict buys street Suboxone, they’re taking a safer opiate. They’re protected against agonizing, incapacitating withdrawal, which leaves them helpless for their family or employer. They could even have a few days feeling like their “normal” self; maybe even well enough to join a meeting and consider recovery. I don’t condone or encourage the sale of Suboxone on the street.

There are increasing safeguards set up by prescribing clinics and pharmacies that make it really difficult for someone to get their hands on another person’s medications. I’m just suggesting that Suboxone on the street isn’t the most dangerous or dreadful thing that can happen. 

Suboxone does have side effects, and it’s important to mention that not all Suboxone is created equally. Addicts are the ultimate manipulators. Certain pill forms can be crushed and used inappropriately (the safest from is widely considered the film strip which is part buprenorphine/part narcan).

If an opiate-naïve person (one who has not been abusing either heroin or prescription meds) takes Suboxone, s/he will very likely experience an initial sense of euphoria or sleepiness.  But the same can be said for Benadryl, Nyquil, or prescription nerve pain meds such as Gabapentin. The list of drugs that have potential for abuse is extensive. Recreational use is a separate situation altogether; misusing any medication is completely out of line with recovery.

Abuse is dependent on motives and intention, not the side effects themselves. Nicotine and caffeine are two highly addictive substances that can be mood altering and cause withdrawal if stopped cold turkey. They’re not only acceptable in recovery, they’re plentiful; Coffee is supplied at meetings in unlimited doses. The use of these doesn’t negate one’s sobriety. 

Self-improvement, spirituality, and community connection are now my daily foundation. Suboxone doesn’t impede this. It doesn’t change my perception of reality or my ability to be mindfully present. I no longer look for any means to avoid discomfort (ok sometimes I eat brownies or surf social media– we’re all a work in progress!!)

Using tools I’ve gained from mindfulness and my recovery community, and maintained on a low dose of Suboxone to help keep cravings at bay, I work though challenges with balance and compassion. If I were still getting high, this wouldn’t be possible. 

Suboxone’s not a magical cure. But it is a safe alternative to other opiates. It’s a solid tool that helps many of us maintain sobriety and the presence of mind to progress in recovery and personal growth. 

Tiffany Swedeen, RN, BSN, CPC/CPRC is a certified life and recovery coach, She Recovers Designated Coach, and a registered nurse in recovery herself from opioids and alcohol. Tiffany lives “sober out loud,” proudly sharing her story through advocacy and blogging and is passionate about helping others do the same. Her goal is to eradicate shame and empower all to live a life of radical self-love. You can contact Tiffany through her website Recover and Rise, read her blog www.scrubbedcleanrn.com and follow her @scrubbedcleanrn. 

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Tiffany Swedeen, RN, BSN, CPC/CPRC is a certified life and recovery coach and a registered nurse in recovery herself from opioids and alcohol. Tiffany lives “sober out loud,” proudly sharing her story through advocacy and blogging. She is passionate about helping others do the same. Her goal is to eradicate shame and empower all to live a life of radical self-love. You can contact Tiffany through her website Recover and Rise, read her blog www.scrubbedcleanrn.com and follow her on Twitter

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