The opiate addiction epidemic in the US continues to be an issue of major concern for people from all walks of life.
The challenges of treating addiction to prescription painkillers or to illicit drugs like heroin sometimes seem insurmountable. This leads people to try to find pharmacological solutions, such as treating the symptoms of drug abuse with other kinds of drugs.
Suboxone is one of these attempts to treat opiate addiction using a different form of opiate that appears to have a lower addiction potential. The drug’s ability to ease withdrawal with only a very mild high has made it a popular medical treatment for opiate abuse in recent years. However, Suboxone use does come with a risk of abuse and addiction – one that can ultimately make opiate addiction worse, rather than better.
What Is Suboxone?
Suboxone is a mixture of two drugs: buprenorphine and naloxone. Buprenorphine is referred to as a partial opioid agonist, which means that while it does provide an opiate response in the brain, that response only occurs in some of the brain’s opiate receptors. As a result, it produces a milder high than a full opiate agonist, such as heroin or a prescription painkiller.
Naloxone, on the other hand, is an opioid antagonist, meaning that it turns off opiate receptors in the brain. In effect, when it is injected, naloxone counters the action of opioid drugs in the brain, essentially “shutting off” the high. This results in immediate withdrawal from the drug, with a side effect of making the person feel ill. Taking naloxone in pill form prevents this reaction, because the drug cannot be absorbed into the bloodstream through digestion.
Together, these two medicines have been shown to help people who are struggling with addiction to opiates. The expectation was that the effects of the naloxone would deter the temptation to try to inject the buprenorphine to get high. Research described by the National Institutes of Health shows that people who are treated for addiction with Suboxone have a substantially higher chance of staying clean during treatment than those who try to quit “cold turkey.” In addition, Suboxone carries a lower risk of addiction, when compared to methadone.
Unfortunately, these high hopes for the drug’s use have not turned out to result in a miraculous reduction in opioid addiction. In fact, Suboxone has itself become a target for drug abuse, resulting in its own contribution to the epidemic. The National Pain Report refers to this as a potential new drug epidemic, stating that buprenorphine is globally one of the most abused prescription drugs.
The main issue, according to the report, is that people who want to keep up their addictions will use Suboxone to ease the withdrawal symptoms that occur between periods of abuse, making it easier to take breaks between highs without the physical consequences associated with withdrawal. Because this purpose is served just fine by ingestion rather than injection, the naloxone is not a deterrent to using the drug to maintain addiction.
In addition, people who want a high may consume higher than recommended levels of Suboxone, putting them at higher risk of overdose.
Facts and Statistics
According to the Center for Substance Abuse Research (CESAR), retail sales of Suboxone have continued to climb. For example, in 2012, sales were estimated to be more than $1.4 billion, which is over 10 times the amount from 2006. An interesting parallel shows that 27 people in Florida died due to buprenorphine use in 2011 (compared to 62 deaths related to heroin use). This number represents an increase from the six deaths in 2009 that were attributable to buprenorphine use.
In addition, CESAR and others assume that this number of buprenorphine-related deaths is underestimated, because medical examiners don’t routinely test for the drug. Similarly, there is little knowledge about diversion, abuse, and consequences related to Suboxone.
Signs and Symptoms of Suboxone Abuse or Addiction
Recognizing addiction or abuse of Suboxone is often based on behaviors that indicate a legitimate prescription is being misused, or on behaviors that may indicate illegal drug diversion and use are occurring. As described by The Fix, these signs include:
- Too many pills missing from a bottle based on dosing amounts
- Theft of prescriptions
- Secretiveness or lying about medications
- Sleepiness or lack of concentration
- Multiple prescriptions from multiple doctors or pharmacies
As with any kind of addiction, there are other signs that may occur. These signs are used by doctors to diagnose substance use disorders and listed by Psych Central:
- Being unable to control substance use, consuming more than planned, or being unable to stop
- Craving the substance, and spending large amounts of time focused on obtaining and using it
- Having problems in relationships and with daily responsibilities
- Continuing use despite health issues or other consequences
- Giving up activities in favor of substance use
- Using the substance in dangerous situations
When these signs and symptoms are present, Suboxone abuse may be occurring.
- How Abuse Starts
Suboxone is legitimately used as an aid during detox from opiate abuse. However, in some cases, doctors not trained in substance abuse treatment may give longer-term prescriptions intended to provide maintenance treatment. This is not a preferred use of the drug.
Most often, Suboxone abuse begins after a legitimate prescription for detox from abuse of other opiates, such as prescription painkillers or heroin. After this point, abuse may develop for certain reasons that include:
- Using higher or more frequent doses than prescribed to increase effects
- Using the drug to ease withdrawal with the intent of continuing the addiction
- Using the drug at very high levels in attempts to get high
In some other cases, Suboxone may not be prescribed at all, but may be obtained from supplies diverted illicitly either to help maintain addictions to other drugs or in attempts to get high.
- Co-occurring Issues with Suboxone Abuse
Because of its properties, Suboxone abuse can often indicate that abuse of other opiate drugs or of other nervous system depressants like benzodiazepines or alcohol may be co-occurring. This is an important factor to be aware of if Suboxone abuse is suspected.
People who use Suboxone who also use benzodiazepines or alcohol are at higher risk of severe complications than those who are abusing Suboxone alone. The reason for this is that all three substances act on the body in the same way, including by slowing heartbeat and respiration. If these drugs are used in combination, as described by an article from Drug and Alcohol Dependence, breathing can slow to the point of stopping.
People who use any of these types of drugs may have other co-occurring psychological issues, including anxiety or depression, that the person is self-medicating through the substance abuse. For this reason, when managing Suboxone abuse, it is important to understand how these mental health disorders may co-occur with and have an effect on the substance use disorder.
Long-term Effects of Suboxone Addiction
Because Suboxone is an opioid, it can cause some of the same issues as other opiates with long-term use. According to the National Institute on Drug Abuse, these include:
- Insomnia and restlessness
- Decreased ability to concentrate
- Damage to the heart and circulatory system
- Damage to the respiratory system
- Brain damage caused by lack of oxygen resulting from slowed breathing (hypoxia)
Long-term use and abuse of any opiate drug increase tolerance to the drug, causing the person to continually increase the amount taken as the body adjusts to lower doses. This, in turn, can increase chances for overdose after a period of abstaining from the drug. The person tries to return to the high dose used before stopping; however, the body has lost its tolerance, and overdose is likely.
Again, because of the reasons that Suboxone is generally abused, long-term use can result in long-term addiction to other substances.
The best way to prevent this problem is to get treatment for Suboxone abuse or addiction.
Getting Help for Suspected Suboxone Abuse
When a person is abusing Suboxone, chances are there are other drugs involved. This can indicate that the person is not interested in treatment or recovery from addiction, but instead wants to continue using drugs. This can be a difficult position to be in, because one of the key indicators that treatment will be successful is the individual’s motivation to get and stay clean.
However, as indicated by an article from Psych Central, even people who aren’t seeking help can be encouraged to get treatment and successfully achieve recovery. One of the best known ways to do this is through a staged intervention, in which an individual’s loved ones confront the person about the substance abuse and encourage entry into a treatment program.
Interventions of any kind are more likely to be successful if a treatment program is selected and ready to enroll the individual as soon as there is agreement to get help. It’s important to research the treatment facility in order to make sure that the treatments are appropriate and research-based therapies shown to increase the chances for long-term recovery are used.
In addition, because Suboxone is often an element of co-occurring abuse of other substances, it is important to seek a program that treats co-occurring disorders, in order to give the greatest opportunity for a positive outcome and long-term recovery from all associated disorders and addictions.
Treating Addiction to Suboxone
It is possible to recover from Suboxone abuse and the potential co-occurring addiction or other mental health disorders. Treating these addictions includes several steps, including:
- Detox: This involves weaning the body off the substance with a minimum of withdrawal symptoms to encourage continued participation in treatment.
- Therapy: Behavioral and emotional counseling can help the person learn to manage triggers and cravings, and that increases motivation to achieve recovery.
- Peer support groups: Social support from others dealing with the same issues can provide accountability, more motivation, and guidance based on experience.
- Aftercare: This includes programs to ease the person back into daily life while encouraging continued abstinence and motivation to stay drug-free on a long term basis.
The main intention of these programs is to promote relapse prevention, helping the person build an arsenal of tools to avoid returning to drug use. As a chronic disorder, substance abuse has a high potential of relapse and no cure. However, with dedication and motivation, substance addiction and abuse can be managed, similar to how other chronic illnesses are managed.
Because Suboxone is intended to treat addiction, its status as a target of abuse and addiction can be challenging to manage. With attention and focus, a person who is struggling with Suboxone abuse – as well as other problems with addiction and abuse – can learn to manage symptoms and emerge from treatment with the ability to avoid returning to opiate use, leading to a more positive future.