My child has been addicted to Suboxone (prescribed by a Physician) for 2 years. What started out as a treatment plan to assist with helping by child “get off” of addiction to Opiates has turned into it’s own beast. I believe it has kept my child in addiction mode. Does anyone have any thoughts on this drug?

ANSWER 1 OF 2: EXPERT PATTY INGRAM

The goal of Suboxone treatment is to reduce illegal opiate use and to help ease individuals off their opioid of choice. Suboxone is a partial opioid agonist, and produces a milder effect, reducing cravings without generating extreme highs and lows. Suboxone detox is difficult because the drug is still an opioid, though weak, and can cause long term mental and physical addiction.  Traditional drug rehab treatments many times are unsuccessful for Suboxone. The Waismann method (detoxing while under anesthesia) has had some success. The larger question here is this: What does “addiction mode” in your child look like? In general, if a patient’s life is getting larger (increased activity, better nutrition, more socialization, improved ability to work/perform at school), rather than smaller (isolating, depressive symptoms, lack of interest in daily life) then continued therapy could be a good route. If the patient is returning to behaviors much like their original addiction, then a medically monitored detox may be the best choice. Physicians are divided on this and I believe it truly has to be patient specific. - Patty Ingram, Drug and Alcohol Counselor (RAS) Intern and Educator

ANSWER 2 OF 2: EXPERT MEL POHL, M.D. 

Because relapse rates with opioid addiction are so high, many clients and treatment professionals have turned to medication assisted treatment (formerly called maintenance) programs that provide long-lasting opioids such as methadone (Dolophine) or buprenorphine (Suboxone and Subutex).  I am not a fan of buprenorphine for maintenance for the reasons stated below, but there are many addiction specialists who believe that it is the best available treatment for opioid dependence. I am not among them.

Buprenorphine’s unique pharmacology causes less of the same negative side effects commonly seen with morphine and methadone (e.g., respiratory depression, cognitive impairment, and euphoria more likely to be associated with craving and abuse) and has opened the way for treatment of opioid dependence in new settings. This allows treatment options to reach those who may not have previously had access or don’t feel comfortable with other treatment settings such as a methadone clinic. Buprenorphine has been touted as a safe, low risk option for treatment of opioid dependence because of its mild effects and a ceiling effect at high doses. Yet, despite the apparent advantages of buprenorphine over other opioid maintenance medications, an abuse potential remains.

Here are several key questions to consider regarding the use of buprenorphine for the treatment of opioid addiction:

• Is the brain of the opioid addict more normal with buprenorphine than without, as many medication assistance proponents assert? At least with methadone dependent addicts, it has been shown that
  brain dopamine transport system is impaired compared to abstinent opioid addicts.
• Is there a reasonable hope of achieving a buprenorphine-free state once it has been started? If so, when is the logical time to attempt withdrawal? After six weeks, six months, two years? If withdrawal fails, is that because of dependence on buprenorphine, which is extremely difficult to discontinue, or is relapse inevitable in the absence of some opioids? We all know that discontinuing maintenance doses of opioids is extremely difficult; but is that because of withdrawal (protracted with buprenorphine) or is it because the brain requires a medication like buprenorphine to function and feel normal.
•  There are clinics that have sprung up in some cities that include buprenorphine treatment among a vast “service line” menu, including Botox, Restalyne, liposuction, and teeth whitening. Do we truly expect an addict to find recovery in such a setting?
• How are you to manage these clients as an addiction professional? It is your task to help clients find quality in their lives.  Can you steer them to buprenorphine-friendly meetings? Should the      maintained addict go to mainstream meetings and hide the fact that they are on buprenorphine. It is not uncommon for addicts who disclose their status to be ostracized or encouraged to discontinue medications by nonprofessional peers. Can you help clients navigate these difficult waters and develop a supportive community to help them as they live life on life’s terms?
• Some feel that opioid-free is simply not an achievable state; the data appears to suggest low percentages of successful abstinence. Where are all the addicts who are successful? There are     thousands of opioid addicts in recovery who have abstained through the help of the twelve-step fellowships for decades. We know it can be done, but how can we tell who is likely to be successful?
• Do we commit everyone to maintenance for life? Is this “harm reduction” or are we actually doing harm by using mediations for all without attempting to help clients achieve a drug-free state? Do we try abstinence a time or two or ten? Do we eventually accept buprenorphine-maintained recovery as a reasonable alternative? Do we try again for abstinence after a time?  If so, when? -Mel Pohl, M.D., Medical Director, Las Vegas Recovery Center