Do Suboxone Doctors Give Second Chances After Relapsing?

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Yes, absolutely. Doctors who prescribe Suboxone understand relapses are common and will keep working with you, even if you make a mistake by returning to misuse.

Addiction, or substance use disorder (SUD), is a chronic disease characterized by relapse.[1] Most people with SUD will slip back into prior habits at least once. Each time, you have the opportunity to learn, grow, and understand yourself and your substance use disorder even better.

Don’t let stigma and misinformation keep you from asking your doctor for help. Chances are, your doctor both understands when relapse happens and will actually be appreciative of your trust and openness in disclosing how you are doing with your treatment, good or bad. 

Why Would a Doctor Discontinue My Suboxone Prescription?

Depending on your Suboxone prescriber, you may be asked to leave regular urine samples to monitor whether or not you have ingested other drugs or opioids while you are taking Suboxone. Historically, some doctors would not prescribe Suboxone to a patient if they were found to be using other substances or other opioids while on Suboxone.

However, as we learn more about addiction, we have learned that this is generally the wrong approach. Doctors would never take away someone’s Diabetes medication just because they ate too many sweets. In the same way, most addiction specialists now recognize that relapse is a normal part of the recovery process. The solution is definitely not to stop therapy. If anything, it is to continue therapy and offer even more psychosocial support.

How Do Doctors Monitor For Relapse?

Nowadays, the practice of monitoring for relapse by using urines is controversial. 

Some doctors offices check urine in order to verify that a patient is taking their Suboxone. They may also check a urine drug screen to see if the patient is taking other drugs in addition to Suboxone.

There are no laws about urine drug screening while taking Suboxone. Whether or not a doctor choses to insist on collecting a routine urine drug screen is up to his/her discretion, or sometimes the policy of the clinic where he/she works.

Historically, most doctors did check regular urines for all patients on either Suboxone or Methadone.

Nowadays, some doctors that prescribe Suboxone choose to not routinely check urines, as they prefer to trust their patients and rely on them to disclose if they are using. We don’t insist that patients “prove” to us that they are taking other medications, and some doctors feel that the same should be true of Suboxone.

Other doctors may still choose to order a urine drug screen for safety reasons. The argument is that they want to know if you are using other drugs so that they can counsel you to avoid use of drugs that may be risky to use in conjunction with Suboxone. However, they may still continue your prescription so long as they are sure that you understand the risks of using other medications, particularly illicit substances, along with your Suboxone.

For example, some doctors feel that, if you are using Cocaine as well as Suboxone, there are real risks, but because there is no current medication treatment for cocaine use disorder, it is still better to offer patients Suboxone therapy to treat their Opioid use disorder, whether or not they continue to use Cocaine while on Suboxone. So long as the patient understands the increased risks of combining substances, ultimately they are in charge of the decisions they make with their own bodies. 

Is There a Time Limit on How Long You Can Receive Suboxone?

No. OUD is a chronic condition, and some people need to stay on medications for the rest of their lives. In fact, studies show that a lack of Suboxone access increases the risk that people will buy the drug from dealers.[4] As long as you need the medication to stay well, your doctor should provide it. Most doctors that prescribe Suboxone actually encourage their patients to stay on it as long as necessary to prevent relapse, even if that is life long. 

The Bottom Line

Of course, Suboxone doctors give second chances. Most providers understand that opioid use disorder is a chronic disease, and it is therefore understood that relapses can occur.

If your urine drug screening shows substances that are not part of your recovery plan, it’s an opportunity for you and your provider to explore what is going on in your life and develop a plan to continue to help you. This can involve additional office visits to help check in, referral for more intensive therapy or behavioral support, or even increases in your Suboxone dose to help you avoid cravings and continued misuse.

As providers, we are here to help, not judge or penalize. We always prefer honesty to ensure we are treating you as safely and effectively as possible. Our goal, like yours, is to keep you on the road to recovery.

Sources

  1. The Process Addictions and the New ASAM Definition of Addiction. Journal of Psychoactive Drugs. https://pubmed.ncbi.nlm.nih.gov/22641960/. January 2012. Accessed July 2022.
  2. Buprenorphine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459126/. May 2022. Accessed July 2022.
  3. Shifting Blame: Buprenorphine Providers, Addiction Treatment, and Prescription Monitoring in Middle-Class America. Transcultural Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540139/. August 2016. Accessed July 2022.
  4. Inability to Access Buprenorphine Treatment as a Risk Factor for Using Diverted Buprenorphine. Drug and Alcohol Dependence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3449053/. December 2012. Accessed July 2022.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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