Addiction is defined as a chronic, but treatable, medical condition.[1] People with addictions or substance use disorders (SUDs) have permanent changes in brain chemistry, and they may always struggle with relapse urges.
If you’re in treatment for opioid use disorder (OUD), your treatment can prevent you from relapsing.
Suboxone (a prescription medication that combines buprenorphine and naloxone) is a safe and effective long-term OUD therapy. Many people take it for the rest of their lives to resist relapse urges.
However, some people decide - for any number of valid reasons - to discontinue Suboxone. Maybe you truly have no urge to use opioids at all and feel very stable in your recovery and therefore don’t feel you need Suboxone. Maybe it is a burden to see your provider on a monthly basis. Maybe you prefer to not be on any controlled substances. There are many good reasons that individuals chose to discontinue Suboxone, particularly once they are very stable in their recovery.
However, if you and your doctor decide it’s time to consider Suboxone cessation, you should probably taper your drug use. If you quit abruptly, you may develop uncomfortable withdrawal symptoms. Therefore you should always talk to your doctor about the best way to decrease your dose. Together, you can come up with a plan for how to best discontinue the medication, avoid any uncomfortable withdrawal symptoms or side effects, and monitor carefully for any concerns for relapse.
Suboxone attaches to the same opioid receptors as opioid drugs like heroin and OxyContin. It can ease withdrawal symptoms and help people focus on therapy to stay abstinent. Suboxone can be used either short or long term.
Some individuals may choose to use Suboxone only very short term (days to weeks) while they acutely “detox” from opioids. While this is an option, we know from extensive research that people who use Suboxone only very short term are much more likely to relapse and return to drug use as compared to patients who stay on suboxone long term - on the order of months to even years. [2]
Because the rates of relapse are much higher with short term use of Suboxone only, almost all addiction clinicians recommend long term use, on the order of months to years. Some people choose to stay on the medication indefinitely because they know it prevents them from relapsing. Long term or even indefinite use is thought to be generally very safe and in fact recommended for anyone with a history of OUD. [3]
Any medication always comes with risks and benefits. Research confirms Suboxone is very safe long term. In general, in the addiction medicine community, it is thought that the risks of illicit drug use (infections, overdose, cardiopulmonary complications, etc.) far outweigh the risks of Suboxone therapy, and therefore it is much safer to use Suboxone long term if the alternative is illicit opioid use.
Suboxone is processed by the liver, and some people worry that they'll damage this critical organ through their medication use. Researchers say the risk of liver damage is extremely low, even in people who take Suboxone for a long time.[4] Moreover, liver damage due to other drug use - the alternative- is probably much more likely.
In a secondary study of people taking Suboxone for multiple years, out of the 4% of patients who died, none of those deaths were opioid related. [5] Stats like this suggest that Suboxone reduces the risk of opioid related overdoses.
While Suboxone dependency is usually much less than full opioid dependency, you can develop dependency on Suboxone, because it is still an opioid medication, albeit only a “partial” opioid. This means you can develop some withdrawal symptoms if you discontinue it quickly, particularly if you have been on it for a long time. Tapering helps you to avoid these issues.
Your doctor can help you develop a taper schedule based on your current Suboxone dose and underlying health issues. Follow this plan, and you'll take a smaller amount every few days to weeks until you take nothing at all. The speed at which you taper should be a shared decision between you and your doctor.
Tapers do unfortunately come with risks of relapse. [6] Patients should not taper or discontinue Suboxone use if they have any desire to return to opioid use. Moreover, they should be encouraged to speak openly and honestly with their physicians about any cravings they have to return to opioid use while they are tapering. You can always change your mind and decide to continue your Suboxone if your cravings to use opioids return without this medication.
Remember that you're not required to quit taking Suboxone. If you think there's even a slight chance that you'll relapse when you quit, it might be smart to stay on your medication. However, many people do appropriately and successfully discontinue Suboxone. If you are interested in slowly discontinuing your Suboxone, talk to your prescriber or reach out to us here at Bicycle health.
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