When you think of Suboxone (buprenorphine/naloxone) treatment for opioid addiction, what comes to mind? If you think of it primarily as a detox aid, intended to help decrease the discomforts associated with withdrawal from heroin and other harmful opioids, you’re not alone. This is a common misconception—one that many people spread. But although buprenorphine treatment can be used as a detoxification aid (and often is in inpatient treatment centers), that’s not actually its most functional purpose. In fact, buprenorphine (usually combined with naloxone to prevent misuse of the drug) is best used as a long-term treatment for opioid addiction recovery.
How opioids change the brain
If you or someone you love has been affected by opioid addiction, you’re probably already aware that addiction causes changes in the brain. Opioids, specifically, create a physical dependency as well as a psychological addiction, making them particularly difficult to stop using. Drugs like heroin and prescription pain pills like oxycodone activate our natural opioid receptors, which are integral to many bodily functions such as our pain and pleasure responses, sleep regulation—even breathing. These receptors’ natural function is to respond to neurotransmitters like endorphins, but when we become habituated to external stimulation of opioid drugs, our bodies stop producing these neurochemicals at the normal rate. When we stop taking opioid drugs, the resulting lack of activation—both natural and artificial—can lead to a host of issues that manifest as acute withdrawal and can linger as post-acute withdrawal syndrome (PAWS). Medication-assisted treatment helps to correct some of those changes, helping the brain re-calibrate after addiction.
Methadone has been used to treat opioid use disorder for decades, but buprenorphine has gained popularity among the medical community and among people in recovery. Because buprenorphine is a partial-opioid agonist, rather than a full agonist like methadone, many people find it less likely to cause fatigue and easier to taper from. Because of this, some rehab facilities use decreasing doses of buprenorphine to taper patients from heroin or other short-acting opiates. Hence, the notion that buprenorphine is a short-term “detox drug.”
Patient outcomes support long-term buprenorphine use
Those who use buprenorphine for six months or longer to recover from opioid use disorder tend to have better outcomes than people who use it only as a short-term detox aid. These benefits of Suboxone are only evident when the patient has sufficient time. While abstinence after detoxification is thought to have a relapse rate that can broach 90%, 60 to 90% of patients undergoing buprenorphine maintenance for a year or longer will remain in treatment. The same study even found that those patients who remained in treatment also had better measures of overall health, such as increased social function, and lower viral load in HIV-positive patients. Another study found that extended buprenorphine treatment to a minimum of 15 months led to significant improvement in outcomes versus treatment of only six to nine months.
Buprenorphine for co-existing post-traumatic stress disorder
Applications of buprenorphine for the treatment of PTSD requires more study. Trauma therapists will tell you that if you have PTSD and are not addicted to opioids, you should not look to buprenorphine to manage your symptoms. That’s because buprenorphine causes a dependency. But for someone who needs treatment for opioid addiction, and is therefore already dependent on opiates, buprenorphine may have some added benefits for PTSD. A small study on veterans with co-occurring PTSD and opioid dependency found that buprenorphine helped ease some symptoms of both disorders.
In my personal experience, buprenorphine has helped with both my post-traumatic stress disorder and my opioid addiction. PTSD compounds opioid addiction. It’s recognized among the medical community that patients with co-occurring PTSD and SUD have worse outcomes. For me, detoxing came with an added component of hopelessness, because I knew that even if I beat my heroin addiction, I would still have all that trauma to deal with.
I felt worse during periods of abstinence than I do now on buprenorphine/naloxone. When I was abstaining, I almost felt as though I were still using, but without the benefits of getting high. I was moody, volatile, and suicidal. Eventually, I relapsed. To be clear: buprenorphine has not eliminated my PTSD symptoms. But it has definitely helped manage them, while it fulfilled it’s main purpose of relieving my opioid cravings.
Addressing fears around the potential misuse of Suboxone
Buprenorphine does have some potential for misuse. When not combined with naloxone, buprenorphine offers the possibility of getting some kind of high. (Disclaimer: when I was still in my active addiction, I injected buprenorphine tablets occasionally. My partner and I used to say it was “better than nothing.” The high was pretty dreary.) So yes, it’s possible to misuse buprenorphine.
For this reason, most clinicians who treat opioid use disorder will only prescribe buprenorphine in formulations that include naloxone, like Suboxone and Zubsolv. Naloxone is also the drug found in Narcan, which is used to reverse overdoses. When added to buprenorphine, it prevents misuse by making it impossible to inject the drug and feel its effects. That’s why the naloxone is there. It’s not bioavailable when dissolved in the mouth (as these medications are intended), and only becomes activated if a person misuses their Suboxone by attempting to inject the drug. Essentially, the naloxone cancels out the buprenorphine. People who are committed to their recovery will use their buprenorphine correctly. Relapse may still happen; it’s often a part of recovery. I’ve had my fair share. But because therapeutic doses of buprenorphine block the euphoric effects of other opiates, relapse becomes a lot less appealing when buprenorphine is used long-term.
Ultimately, buprenorphine is a helpful drug for people who are committed to recovery from opioid use disorder (or opioid addiction, as it is commonly called). While buprenorphine does create a dependency—similar to insulin or antidepressants—it helps users move away from addictive behaviors and rebuild their lives. Patients who use buprenorphine long-term tend to have better outcomes than patients who simply use it to detox. That doesn’t mean it has to be lifelong, but it can be. If you eventually decide to taper, a gradual decrease that is supervised by your doctor will give your brain a better chance to heal and leave you with fewer withdrawal symptoms.