5 myths about using Suboxone to treat opioid addiction

What is Suboxone and how does it work?

Suboxone, a combination medication containing buprenorphine and naloxone, is one of the main medications used to treat opioid addiction. Buprenorphene is an opioid substitute, and naloxone helps prevent addicted patients from tampering with the pills.

Using medications for opioid use disorder is known as MOUD. Use of MOUD has been shown to lower the risk of fatal overdoses by approximately 50%. It also reduces nonfatal overdoses, which are traumatic, medically dangerous, and which can cause lasting harms. With more than 100,000 overdoses from opioids each year in the United States, over the last several years, MOUD has become an urgently needed intervention that needs to be made more accessible to all patients.

Suboxone works by tightly binding to the same receptors in the brain as do other opiates such as heroin, morphine, and oxycodone. By doing so, it blunts intoxication with these other drugs, it prevents cravings, and it allows many people to transition back from a life of addiction to a life of normalcy and safety.

A key goal of many advocates is to make access to Suboxone much more widely available, so that people who are addicted to opiates can readily procure it. Good places to start are in emergency departments and in primary care doctors' offices. More doctors need to become comfortable with prescribing this medication, which requires at least a modest understanding of how to treat addiction.

The vast majority of physicians, addiction experts, and advocates agree: Suboxone saves lives. The US Government has recently eliminated the requirement that doctors and nurses need to get waivered, which was a time-consuming barrier to prescribing Suboxone. This is part of an urgent attempt to increase the availability of Suboxone prescribers, as the number of opioid overdose deaths remains unacceptably high.

Common myths about using Suboxone to treat addiction

Unfortunately, among the public at large, and even within the addiction community, certain myths about Suboxone persist, and these myths add a further obstacle to treatment for people suffering from opiate addiction.

Myth #1: You aren't really in recovery if you're on Suboxone.

Reality: It depends on how you define recovery. Unfortunately, the recovery community has historically defer="defer"red to the 1930's-era, AA-influenced abstinence-based models — which are not based on any type of science — that state that you are only in recovery if abstain from all intoxicating substance, including medications prescribed by your doctor, for the rest of your life.

This dogmatism doesn't reflect the reality of people struggling with addiction, and has cost many lives by discouraging countless patients who don't fit into this extremely restrictive (and scientifically unsupported) model of recovery.

Fortunately, attitudes on recovery are broadly evolving to more modern conceptions that encompass the use of medications such as Suboxone that help regulate brain chemistry and prevent harms. As addiction is increasingly viewed as a medical condition, medications are seen as front-line treatments.

Suboxone is viewed as a medication for a chronic condition, similar to a person with type 1 diabetes needing to take insulin. To say that you aren't really in recovery if you are on Suboxone is stigmatizing to people who take Suboxone, discourages people from getting the care they need, and does not represent the medical reality of effective addiction treatment.

Myth #2: People frequently misuse Suboxone.

Reality: Suboxone, like any opioid and many other medications, can be misused. However, because it is only a partial agonist of the main opiate receptor (the "mu" receptor), it causes significantly less euphoria than other opiates such as heroin and oxycodone. As such, it is less prone to misuse.

In many cases, people may use Suboxone (or misuse it, if that is defined as using it illegally) to help themselves manage their withdrawal, or even to get themselves off heroin or fentanyl. If Suboxone was more available to those who need it, patients wouldn't have to self-treat. We are, in effect, blaming the victims here.

Myth #3: It's as easy to overdose on Suboxone as it is to overdose with other opioids.

Reality: It is extremely difficult to overdose on Suboxone alone, compared to other opioids, because Suboxone is only a partial opiate receptor agonist, so there is a built-in ceiling effect — meaning there is a limit to how much the opioid receptors can be activated by Suboxone, so there isn't as great a risk of impaired breathing (which is what leads to death with an opioid overdose) compared with potent opiates such as heroin, oxycodone, or fentanyl. When people do overdose on Suboxone, it is almost always because they are mixing it with sedatives such as benzodiazepines, medicines that can additively impair breathing.

Myth #4: Suboxone isn't treatment for addiction if you aren't getting therapy along with it.

Reality: In a perfect world, addiction treatment should include MOUD as well as therapy, recovery coaching, support groups, housing assistance, and employment support. But that doesn't mean that one component, in the absence of all of the others, doesn't constitute valid treatment for addiction. Currently, only about 20% of people with opioid use disorder are getting anything that qualifies as adequate treatment for their disease, due to flaws in our tattered health care system and shortages in qualified providers.

So, while combination treatment is an admirable goal, it is unrealistic to expect that everyone with an addiction will receive all the aspects of treatment that they need. This is especially true if you add in that many people who suffer from addiction often also lack access to regular health care and health insurance. Further, treatment with Suboxone alone, without therapy, has been proven to be effective. But it can be even more effective if combined with additional supports such as therapy, recovery coaching, etc.

Myth #5: Suboxone should only be taken for a short period of time.

Reality: Expert practitioners have different theories on how long Suboxone treatment should last, but there is no evidence to support the claim that Suboxone should be taken for a short period of time as opposed to being maintained on it for the long term, just as a person would manage their diabetes with insulin for the long term.

Ultimately, this comes down to patient preference. Some people wish to stay on Suboxone, as they feel that it contributes to their stable recovery. Others wish to only be on it for a time-limited period so that they aren't beholden to a daily pill that can be difficult to obtain. There is some risk of return or relapse back to addiction when one tapers off of Suboxone.

One of the main obstacles to getting lifesaving treatment for addiction with MOUD is the stigma people face. Fortunately, our society's perception is slowly starting to transform away from an outdated view of addiction as a moral failing, toward a more realistic, humane view of addiction as a complex disease that needs to be addressed with compassion, as well as modern medical care.

We are getting better at meeting patients where they are rather than imposing dogmatic paradigms of recovery onto them. Eliminating myths and misinformation about addiction, and supplanting them with up-to-date, evidence-based treatments, is a critical step in the evolution and improvement of addiction treatment. Eliminating stigma saves lives as more people feel empowered to seek out care.