Aware of my advocacy efforts with methadone and medically assisted recovery for opioid addiction, JamezD of the Island Recovery Centers asked about my stance on Buprenorphine.
There's certainly some history around this (there always is)
that we're simply not aware of, but our addiction docs
seem to think that "Bup" is a superior approach to dealing
with opioid dependence… ~ Misleading on Methadone
Both drugs are used in treatment of heroin and pain killer addictions. Methadone and Buprenorphine work in a similar fashion but are usually administered and dosed differently to block opioid receptors in the brain to prevent withdrawal symptoms. Neither of the drugs produces the meteoric euphoric high that accompanies heroin and pain killer opioids and in fact cancel out the high of other opioid drugs taken during treatment. I feel Suboxone® is a superior form of Buprenorphine because of the additive naloxone which prevents misuse and abuse by injection and intranasal ingestion (snorting).
Click "Read more" to continue...
Click the graphic on the right for additional panels produced by The National Alliance of Advocates for Buprenorphine Treatment to see how the addicted brain is “tricked” into complacency avoiding opiate withdrawal symptoms.
Now we have the basics out of the way lets get back to the question at hand, my stance on bupe. As a partial agonist with a much longer lasting effect Suboxone® wins hands down, at least on paper, as seemingly the better treatment drug in medically assisted recovery for opioid addiction. It takes lower dosages to work, can be administered by physicians outside the traditional methadone clinics, and its formulation is designed to prohibit abuse. However, textbook qualifications don’t always mesh with real world application and my experience has shown that methadone is still a more effective treatment.
The reason for this in my humble opinion is that the medical profession expects too much out of Buprenorphine and Suboxone® much like the addicts who are also looking for a quick fix. Methadone is administered in liquid form daily at the clinic. There is constant interaction between patient, nurse, and counselor in a well defined routine (like nature abhors a vacuum, addiction abhors structure). Yes it is stronger and harder to taper from but the effectiveness of methadone is incontrovertible when it comes to eliminating withdrawals and stabilizing patient’s psychosocial life crisis. Combine this with daily exposure to a recovery environment at the clinic and the patient’s chances for successful treatment are increased manifold. Methadone is not perceived as a quick fix, is strictly regulated, and the chances of the addict gaming the system are reduced. Unfortunately not all clinics provide this type of positive environment, but regardless I think the worst thing a medical professional can do is hand an addict a bottle of pills and say “here is the answer you’ve been looking for.”
Now this doesn’t mean that I am against the use of Suboxone®, but I do believe that this drug will be a much greater tool for recovery if it is administered in the same manner as methadone. Yes, that takes away many of it advantages including privacy, reduced stigma, and ease of use… but hey, who said recovery was supposed to be easy?
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Not getting involved in the bupe vs. sub issue ( a more subtle clinical discussion), but you might have a point about the way the different meds are delivered. It makes a lot of sense to require involvement in a counseling program of some kind. I'm not sure if showing up for 10 minutes at a methadone clinic meets that objective.
However, in your bupe/sub vs. MMT discussion, isn't it possible to combine methadone with other drugs which still get you high? don't people still die from methadone overdose?
Isn't your discussion focused more on the delivery than on the drug(s) themselves?
If they were delivered the same way or with required counseling, what your preference be?
keep up the good work..
I am more concerned with the delivery. I posted the technical info for readers who were unfamiliar with the subject, personally rudimentary graphs are about the extent of my knowledge of the pharmaceuticals.
On the application side, I have had several patients enter my recovery class at the methadone clinic after failing suboxone treatment "while own their own". They do much better in the methadone program and the post above is what I can offer based on this experience.
but labrat made a very good point... you can abuse any drug. As far as methadone overdoses, most agree the methadone is diverted from pain management, not treatment.
Most of the overdose deaths I see here in the South the Methadone is diverted from pain management, and also involves alcohol or benzos.
""However, in your bupe/sub vs. MMT discussion, isn't it possible to combine methadone with other drugs which still get you high? don't people still die from methadone overdose?"""JAMEZD
The same drugs that can be mis-used with methadone to get patients high--will cause an increased in euphoria with Buprenorphine as well-if patients aren't getting enough medication or are "hell bent" on getting high they will find a way with methadone OR buprenorphine...and the same class of drugs that are usually seen in methadone overdoses (benzo's and barbitutes and alcohol) will also cause overdose when mixed with Bupe. Case in point a professional WWF athlete that was found to have died due to buprenorphine and barbituate overdose.
ALSO, buprenorphine (by anedoctal evidence) seems to be easier to DISCONTINUE using for a day or two to get "high" on dope or other "good" opiates and it appears to be easier to over-ride it's blockade effects when used in smaller doses than methadone.
When a patient is sent home from DAY THREE with a months worth of pills and little contact in between Doc visits -it's very easy to hide off label use and abuse. Addicts first coming into treatment are very vulnerable and still too sick to be making rational choices with a bottle of ANY medication that can cause euphoria--especially if it takes the addition of other dangerous drugs to get that HIGH.
ALSO, methadone seems to calm cravings (again anecdotally) better than buprenorphine in addicts with longer use time and higher tolerances. While suboxone is very good at reducing cravings and ending withdrawal in many patients--it also doesn't seem to be as good at easing the depression associated with addiction.
This is why Suboxone should always be seen as an ALTERNATIVE to methadone, rather than a replacement for it. Only time will tell if it will prove itself to be as successful a treatment as methadone is, but chances seem to be good that it will continue to be a good FIRST LINE treatment for opiate addicts. While methadone should always be considered if the "easier to access" Suboxone doesn't work for the patient.
We don't limit the amount of antidepressants, diabetes, cholosterol or epilepsy meds available to patients-why on earth do treatment professionals feel the need to limit addicts to ONE choice?
Thanks for the support Discovery Alcoholic....I am sure the patients at the clinic are very thankful as well!
thanks for the kudos, it means a lot to me.
Okay, I'm a 25 year old recovering addict.I have been addicted to oxycontin and xannax for 10+ years. I have tried the methadone and suboxone... I'm currently on the suboxone. To be honest, I just called my local methadone clinic and talked to a counselor I know there, I told him I was on suboxone and that I felt more irriated, stressed, and the side effects where horrible. I did so much better on methadone. I was on it for two years and after my first drug screen I failed I never failed another one in two years. Now on suboxone, I have used oxy's and xannax. I agree that the clinic interaction with the nurses, doctors, and counselor's is a much more effective way of treatment. I believe that addicts need structure due to the fact that we've not had structure in our lives other than drugs. This is just my opinion....
do they have a recovery program outside of the counselors at your methadone clinic?
you are probably on two low of a dose of suboxone and are having breakthrough symptoms/cravings. why don't you go to a na meeting everyday at the same time and the same place and take your suboxone on the way there. I have been in the methadones clinics when patients come in to get it and they usually spend the waiting time outside smoking and 1 minute w/ the nurse. not quite the counseling that you would expect. what about drug screens? w/ methadone you have to explain to your employer why you are on methadone...
Thanks for the feedback on my question..
It's very helpful..
jim
well, I don't know about Suboxane and Methadone but Buprenorphine is excellent for treating addiction.
Where I live, they have many centers which use Buprenorphine the same way as you said methadone is for heroin and other opioid addictions, that is the patients are required to come everyday and they have to take the Buprenorphine pills in front of the nurses/counselors/doctors present. Buprenorphine does completely block out all of the withdrawal effects and further it does not give even the slightest high. There are many many patients always there and after medication time, the patients also have NA style meetings. So, there is the same kind of routine interaction for addicts just as you said and Buprenorphine does not even give the slightest of highs while it is easier to taper of from so I think it is better provided that addicts are not given a bottle of pills of Buprenorphine and told that they have to use it in such and such manner, they'll obviously never do that. Frankly, its never the withdrawals but other things that hamper recovery like a complete lack of purpose in life for example, you have to take care of them and then you will go through the discomfort of withdrawals anyhow.
Presently, I also go to a center like this everyday for treatment. Though they declined to give me buprenorphine for my codeine addiction, they gave me something else for the first 4 days which eased the mild codeine w/d's. (I don't even know what they gave me and don't care to know) For me, it's the 'psychosocial life crisis' you mention that has made it difficult for me to give up my choice drugs for months now. Something else you posted is also so true, addiction abhors structure and getting in to a nice routine has helped me a lot. I simply go to this center everyday, spend the day there, sitting in meetings, talking to some friends I have made there, helping the new heroin addicts that come in each day, get them admitted if needed and helping out with other small chores throughout the day and then going to the meetings in the evening. Without dedicating myself to a routine like this, I could never stay of off drugs for longer than a few days but this time, living this way, I am about to complete a month clean in a few days now finally ...
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