Is Your Loved One On Suboxone Treatment? Here’s What You Need To Know

November 20, 2020

Buprenorphine/naloxone (brand name: Suboxone) is a medication for addiction treatment (MAT) prescribed by a licensed medical provider that is used to treat addiction to opioids (such as oxycodone, percocets, vicodin, heroin, and fentanyl).

It helps people stay in recovery by decreasing cravings, preventing withdrawal, and blocking misuse of opioids.

The medication can be taken safely for years, and it is very difficult to overdose while taking this medication. Like other opioids, it can cause common side effects such as constipation, nausea/vomiting, sweating, itching, and sexual problems. A patient should work with their doctor to mitigate these side effects.

When taken as prescribed, Suboxone should make a person feel “normal,” not “high” or sedated, allowing them to engage in healthy and responsible behaviors, like going to work, taking care of their kids, paying their bills, exercising and eating nutritious foods.

Suboxone should be taken as part of a comprehensive treatment program, which may include behavioral therapy and other other supportive treatments (such as 12-step meetings like AA/NA, Smart Recovery, getting a sponsor, spirituality, and self-care).

We hope to address common misconceptions family members may have about Suboxone treatment.

Misconception #1: “Addiction is a ‘curable’ disease”

Fact: Addiction is a chronic brain disease in which a person regularly finds and uses drugs despite the negative things that can happen. Besides harming a person’s health, it can change how the brain works, impacting emotions, thoughts, and memory, leading to other harmful actions, and causing difficult relationships with family and friends. Patients should not expect to ever be “cured” of an opioid addiction disease. However, like patients with other chronic conditions, patients can work to minimize its harmful effects by embracing a healthy life in recovery, which often includes both medications and behavioral support.

Terminology
  • Slip: an impulsive action that happens once with regret
  • Lapse: a return to the addiction behavior that is time-limited with less immediate insight
  • Relapse: a return to original level of use or problematic behaviors

We also know that, as a chronic disease, patients in recovery are likely to also battle periods of relapse, in which they lose control of their addiction and return to their previous drug-related behaviors for a period of time. These "relapses" happen in essentially all chronic conditions including high blood pressure and diabetes as this graph [1] illustrates:

It is thus important to acknowledge relapse as part of the recovery journey. Rather than shaming patients who relapse, we must help support them in getting back on track.

Misconception #2: “Suboxone treatment is just trading one addiction for another”

Fact: When helping someone who is struggling with addiction, it is important to recognize what their values and goals are. Most patients harbor a lot of shame and guilt about their addiction and how it has affected their life; they are not proud of the person they have become.  If their goals are to start working again, reconnect with friends and family and regain their trust, pay off their bills, and take on other important responsibilities so they feel like a productive member of society AND Suboxone helps them achieve these goals, it should be embraced as one strategy to take back control of their life and find meaning and fulfillment.

Misconception #3 “Recovering Addicts Shouldn’t be Trusted with Suboxone”

Fact: It is very difficult to misuse Suboxone. Patients know that when they take Suboxone, it blocks their brains’ opioid receptors from illicit substances, so they are less likely to relapse when they have Suboxone in their system. So, most patients who take Suboxone are taking it because they do NOT want to use illicit substances and because they want to be in recovery.

Misconception #4 “The Only Way to ‘Cure’ Addiction is by Going Cold Turkey”

Fact: Abstinence-only therapy (meaning being on NO medications) has higher relapse rates than being on medications that treat opioid addiction (like buprenorphine/naloxone (Suboxone), methadone, or naltrexone). If fact, if a patient detoxes off opioids and then does NOT start one of these medications, 90% of them will relapse within the first 3 months. This puts them at high risk of overdose and death. If they start taking one of these medications, they have a MUCH higher chance of remaining in recovery. Doctors who treat addiction know that patients tend to do better when they are on medications.

Misconception #5 “Suboxone Treatment Doesn’t Work”

Fact: Suboxone therapy has high recovery rates compared to no medications- approximately 50% of patients will remain in recovery 12 months after starting Suboxone. Suboxone therapy also cuts the mortality rates by two-thirds for treated patients, according to this study. [2,3]

Key Point: Patients out of treatment (detoxed off opioids and NOT put on medication like Subxone or methadone) died at about 6 times the rate of people in the general population, while medication treatment with suboxone or methadone brought this to less than 2 times. 

Misconception #6 “Suboxone Users Aren’t Sober”

Fact: Patients who take Suboxone as prescribed should feel “normal,” not “high” and not “sedated.” They should be fully capable of completing their everyday tasks and to the best of their ability--be it working, driving, taking care of their kids, exercising, etc.

Thus, doctors refer to patients on Suboxone as being “in remission.” 

Misconception #7: “Suboxone treatment represents a lack of willpower to overcome addiction”

Fact: Addiction is a chronic medical disease, just like high blood pressure and diabetes. It is NOT a moral failing nor a failure of will power.  Even when patients do NOT want to use illicit opioids, they often use them to avoid the awful feeling of cravings and withdrawals. Patients struggling with addiction often feel intense shame and guilt over their continued use.Suboxone treatment allows stabilization of the brains’ opioid receptors so that patients are able to feel normal and make changes in lifestyle, behaviors, and psychiatric conditions that are more consistent with their values. Suboxone helps them enter a life of recovery rather than cycles of relapses. 

Misconception #8: “My loved one should only be on Suboxone for a short period of time and come off as soon as possible.”

Fact: Suboxone can be taken safely for years. We know that, after starting to take Suboxone, it takes a minimum of 6 months for the brain to start to rewire back to normal and at least 18 months for the brain to return to more normal functioning (meaning patients can think more clearly and make more rational decisions, are in touch with their emotions, and their memory has returned to normal). 

Patients should thus remain on Suboxone as long as they need. There is never any rush to come off. If patients are thinking about coming off, they should first demonstrate an ability to function well in their day-to-day lives (working, taking care of their responsibilities, having a good support system, and able to manage stress in healthy ways). Any attempts to come off Suboxone should be done very gradually and in conjunction with their doctor’s guidance.

How can you help support a loved one who is in Recovery from an Opioid Addiction

Educate Yourself on Suboxone Treatment

Join groups of others who have loved ones struggling with addiction. These groups also help you to better understand addiction. Here are some national support groups to join

Avoid language that is stigmatizing & promote more respectable terminology

Avoid words like “addict” “junky” “clean” and “dirty.” Rather, describe people as “struggling with opioid addiction” or “in recovery.”

Set Realistic Expectations

Recognize that “relapse is part of the recovery journey.” If your loved one relapses, rather than scolding and shaming, help them get back on track.

Celebrate the Small Victories

For patients struggling with addiction, we say “one day at a time” or even “one hour at a time”; one hour can turn into two and into three. Any time not using drugs should be considered a victory!

Provide Emotional Support

Create a judgment-free, loving environment. Patients struggling with addiction are often full of shame and guilt. What they need most is someone who does NOT judge them and wants to help.

Trust the Professionals

The internet and search engines are fraught with misinformation; rather than learning about addiction through questionable sources that might promote misconceptions, use professional and reputable addiction resources that are based on medical science.

Here are two great websites packed with reliable information:


If you are concerned about a loved one’s behavior, express your concern and let them know you are here to help. For more info (videos and audio files) on HOW to have this conversation, here are two helpful websites:

Remember to take care of YOURSELF. Being a caregiver for a person struggling with addiction can be very stressful and emotionally draining. You can reach out for further help for YOU or your loved one by calling: 1-800-662-HELP (4357) for free and confidential information and treatment referral

Since relapse may occur, all friends and family members should have naloxone (a medication used to reverse and opioid overdose) AND know how to use it. For info on how to use naloxone (aka “narcan”), visit the National Institute on Drug Abuse (NIDA’s) website. There is a great 5 minute video that will instruct you: https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-reversal-naloxone-narcan-evzio 

Bicycle Health uses Suboxone to help patients in their journey of recovery. To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment in comparison to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.

About the Author

Randi Sokol, MD, MPH, MMedEd

Randi Sokol, MD, MPH, MMedEd, is an Assistant Professor at the Tufts Family Medicine Residency Program and Instructor at Harvard Medical School. She is Board Certified in both Family Medicine and Addiction Medicine. She earned her B.A. at the University of Pennsylvania, her Medical Degree and Masters in Public Health from Tulane University, completed Family Medicine Residency at UC-Davis, and earned a Masters in Medical Education through the University of Dundee.

Citations

  1. McLellan AT , Lewis DC , O'Brien CP , and Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284:1689-95.)
  2. Treatment in French Office-Based General Practice: A 7-Year Cohort Study. Ann Fam Med 15(4): 355–358.
    Evans E, Li L, Min J, et al. 2015. Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006–2010. Addiction 110(6): 996–1005
  3. Sordo L, Barrio G, Bravo MJ, et al. 2017. Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. British Medical Journal 357:j1550.

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