On the front page of yesterday’s The New York Times, Deborah Sontag published an article on the controversial use of buprenorphine (known mostly as Suboxone) as a methadone alternative in opioid addiction treatment. While the drug originally had many supporters within the community, critics complaining of everything from using opioid substitutes in addiction treatment to its efficacy in long-term recovery and potential for abuse. The most troubling problem, Sontag points out, is that the drug is feeding a thriving underground market for recreational users. The article goes on to document the troubled history that some of the federally regulated physician prescribers have had, leading to license suspensions and arrests, as well as the support the drug has throughout the addiction and recovery field.
Coming at a time when the prescription painkiller epidemic was exploding in North America, buprenorphine was seen as the “holy grail” in opioid dependency treatment. Even the critics can’t deny that the drug has performed well with co-occurring disorder patients (chronic pain sufferers with opioid dependency). But like an increasing number of medications, abuse—whether for commercial gain or just another high—has shadowed any success buprenorphine can claim. Overall, it is a very balanced article on a volatile subject.
Central Recovery Press prides itself in working with some of the best minds and independent thinkers working in addiction treatment. We asked Dr. Skip Sviokla, author of From Harvard to Hell and Back: A Doctor’s Journey through Addiction to Recovery to give us his thoughts on the debate:
Medication Assisted Treatment
The use of Suboxone in a recovery setting has been nothing short of remarkable in helping my opioid-dependent patients regain full recovery and experience the joy such recovery can bring.
Although methadone holds a large place in medication assisted treatment, it is no Suboxone. The very nature of the harm reduction model as it is employed in large volume methadone clinics is not supportive enough to consistently keep their patients mind-altering drug-free. No methadone patient has ever come to me with the spontaneous statement that I frequently hear my Suboxone patients say: “I feel just like I did before I started using!”
Careful monitoring, counseling, twelve-step facilitation, and a carefully controlled withdrawal from the drug all have roles to play in the march toward full recovery.
It is the strong Mu receptor affinity coupled with its partial agonist activity that give Suboxone its special place in opioid dependence treatment.