Back on April 1st, Maryland Addiction Recovery Center posted a blog titled “The Dangers of Long Term Suboxone Use,” that was immediately met with mixed reaction. The blog was seemingly received well by many, with the link being shared over 7000 times on Facebook, numerous retweets on Twitter and much praise within the local recovery community. It was also met with much backlash, with representatives from Reckitt Benckiser (manufacturers of the drug) requesting the blog be taken down and numerous supporters of the drug calling us money hungry treatment center owners and even one doctor calling the blog “perhaps the most narrow minded, misinformed, unsubstantiated, polemical, self interested, non-scientific, and worst of all dangerous articles I have ever seen about Suboxone.” Strong words.
Maryland Addiction Recovery Center’s Views on Suboxone
First, let us clarify. We are not “anti-Suboxone” here at Maryland Addiction Recovery Center. We believe Suboxone is an excellent drug and utilize it here at MARC. However, we believe that Suboxone is used most effectively as a medication used to detox patients off opiates as safely and quickly as possible. We believe this because we believe that drug abuse is simply a symptom of addiction. We believe addiction is more than a physical dependency and that medications like Suboxone treat only the physical aspect of addiction. Therefore, using Suboxone to treat addiction is a band aid for a gunshot wound, or really more like a doctor giving a cough suppressant to treat Bronchitis. The cough is only a symptom of bronchitis and the cough suppressant only treats the cough. Suboxone does not treat the mental or behavioral issues of addiction. It simply deals with the physical chemical dependency and does not treat the actual substance use disorder.
Some of us at MARC are the targeted demographic of Suboxone and we have been on Suboxone and methadone. We do not believe that putting young adults on long term maintenance is good practice. We believe that everyone should have the right to walk the earth free from addiction. We believe not all, but many prescribing providers of Suboxone have no business prescribing the drug as they have little addiction training and do not provide nor urge patients to receive counseling or treatment in conjunction with the medication. We believe many people are not truly offering Medication Assisted Treatment (MAT) but rather offer the medication as treatment. Finally, we believe many providers of Suboxone do not support patients getting off of the drug and therefore rarely see the dangers or the long term effects of Suboxone maintenance.
On that last point, we attempt to provide some context. On November 14th we received an unsolicited email to our web site from a woman living in Ohio we shall call “Lauren” (we would like to note that we have changed the name of the author upon request and have received her authorization to use her emails here. )
Here is the initial correspondence:
“I live in Ohio and came across one of your articles regarding buprenorphine.
I was placed on subutex in 2008 after becoming addicted to opioid pain medication after 6 surgeries for severe endometriosis.
My story is similar to many others. I have been tapering down for well over three years. My doctor essentially discouraged my coming off over and over.
Last year I jumped off roughly .25 mg and made it 8 months. I never felt good or right and ended up back on a small dose .5 -1 mg. at this dose it is wonderful with chronic pain but the side effects (insomnia, severe muscle tension) are issues. I am again having much trouble coming off. This is not a mental issue and I have researched as much information I can. The initial withdrawal (lasting upwards of 30 days) I am not concerned about. It is the amplified pain and ligament issues I have as well as debilitating fatigue 8 months after.
Can you please point me to any research regarding long term consequences of this medicine or provide me with additional information.
We responded to “Lauren” that we would do what we could to find her some objective studies. We also inquired whether we could share her email with several industry professionals and use it to educate people on her own personal experience with long term Suboxone maintenance. This was her response:
You may absolutely share my email with anyone that is interested. I maybe would wish to keep my name confidential unless using my name and my story could be of some benefit towards research and potentially the dissemination of useful information regarding long term buprenorphine use or useful in some other way. I kept my email short as far as details but I have much more information to share if interested and have done a lot of research.
Your article was eye opening in that I learned another reason why my doctor, who is very respected in this state in addiction treatment, kept stating that there were no benefits to my coming off subutex and that it was “safe” to stay on it for the rest of my life. I learned that he was perhaps using the harm reduction model with me. I had never heard of this model before and frankly I don’t feel my circumstance warranted this model. He always seemed puzzled that I would want to come off and downplayed the taper or what to expect. Interestingly I have recently visited two more physicians who prescribe this med to gather any info on their experiences with long term problems. Neither had seen anyone successfully come off.
I was also validating to see that others experience symptoms in waves. One part of the day I felt fine and the next, I’d get a wave that lasted two hours for months after. I had never read that in all my research. Sometimes it’s hard to research this medication because the internet is laden with addicts who talk about how bad their withdrawal is after 4 days or are just seeking or whining.
I appreciate you getting back to me. I also appreciate the work your organization is doing and thank you for any information you may be able to send my way.
Please let me know if I can help in any way. Before going on subutex I got my graduate degree and was teaching college, 6 years later I am not the same person.
Respectfully, [Name redacted]”
This was the last correspondence with “Lauren”. We would like to point out one point of fact: The original blog from MARC mentioned Suboxone while “Lauren” mentions long term use of Subutex. There is a difference in the medications: Suboxone contains naloxone, a substance that is added to keep people from abusing the medication as using opioids while on naloxone puts the user in an immediate state of withdrawal. Subutex does not contain naloxone. Subutex has one active ingredient, buprenorphine, while Suboxone has two active ingrediants, buprenorphine and naloxone. That being said, both medications are often abuse, sold on the streets and certainly have a street value. Recent surveys actually have Suboxone as the most abuse drug in American’s prisons at the current time.
“Lauren’s” personal insight and battles with a drug so wildly accepted as a “miracle” drug by many in the medical and treatment community is concerning. Ever since people suffered from addictions there have been miraculous “miracle” drugs claiming to be able to fix, treat or cure the addiction. At one time, doctors thought LSD was a treatment for alcoholism. Methadone was hailed as a miracle drug for the Vietnam vets returning with heroin addictions. Now Suboxone is being hailed as miracle drug for opiate addicts and those that do not believe that are called closed-minded or antiquated in their approach.
We at Maryland Addiction Recovery Center have been opened for one year and have had numerous patients come to us in need of help for long term Suboxone maintenance use. These people are abusing alcohol, benzodiazepines and cocaine, they claim to suffer from bouts of depression and anxiety, they have multiple DUIs or have been acting out behaviorally or claim personal problems in their relationships or their employment. They clearly are not “doing well” and their quality of life is suffering. Yet many in the “Medication As Treatment” would view them as a success because they have not abuse opiates in 5 or 10 years.
Our philosophy here is different. We believe in quality of life, in comprehensive addiction treatment, in freedom from addiction. We believe in recovery. We believe there is absolutely a place for medication in the treatment of addiction but we believe many people mistake “a place in treatment” for “treatment”. We believe a primary care physician or an OBGYN or a podiatrist that have taken several hours of addiction training and a DEA license to prescribe Suboxone to 100 patients at a time has no business claiming they offer a treatment for addiction. That may offend some people. As people who have been on the receiving end of that “treatment”, we are okay with that stance. We believe a 21 year old heroin addict deserves better than to be placed in a harm reduction model in order to decrease overdose statistics. We believe that as addiction treatment providers we have a responsibility to try everything possible to treat a patient’s addiction before telling them that their “best chance” is to be on Suboxone or methadone or any other medication for the rest of their life. We believe that anyone suffering from substance abuse and their families deserve every ounce of our effort to be given a chance to live a life of recovery, free from the misery and pain and shackles of addiction.
We hope “Lauren’s” story resonates with some of you. As addicts in recovery we absolutely understand how taking a pill seems like a much easier way to deal with an addiction than comprehensive treatment. We are not judging those on Suboxone or methadone. We truly understand. However, our hope with sharing “Lauren’s” story is hopefully to educate addicts, parents, families and providers about the dangers associated with these medications from one person’s painful journey in the hope that it will prevent some people from choosing that route and instead have them seek out an alternative.