Is Suboxone sober? Why does long-term Suboxone treatment have such a bad reputation in 12-step meetings?
Suboxone reduces cravings and withdrawal effects from opioids like pain pills or heroin. But is Suboxone sober? Opioid withdrawal feels like a bad flu, combined with a panic attack. This painful detox can keep people running back to pain pills or heroin even when they’re ready to quit. Those first brutal days of detox can feel impossible. I’m speaking from experience here.
But there is help, in the form of prescription medication. Suboxone helps you survive opiate detox and stabilizes you for living sober. Suboxone, Zubsolv, and Bunavail are all different brands of buprenorphine/naloxone. These medications are FDA-approved to treat opioid use disorder. Suboxone is medication-assisted treatment for opiate addiction. It’s a medications that acts as a treatment to help you stay sober. Thus, medication-assisted treatment.
SAMHSA, NIDA, and the World Health Organization agree that Suboxone is an important treatment for opioid addiction. It reduces cravings and decreases overdose death rates. This isn’t up for debate. Studies show Suboxone saves lives and keeps people sober.
It should be a no-brainer, right? If this medication works to help people stay sober, you might think it would be welcomed with open arms. We are in the midst of an overdose crisis exacerbated by COVID-19. But Suboxone isn’t accepted by large portions of the treatment and recovery community. Less than ½ of treatment centers offer any type of medication, and less than ⅓ of patients struggling with opiate misuse ever receive it. (source)
A sponsor told me a long time ago, “Just because you’re an addict, doesn’t mean you have to be in pain.” I’ve carried that belief with me, and I believe it to be true for all people using opiates who are struggling to quit today. Let’s bust four myths about Suboxone and other types of medication-assisted treatment. These myths keep people from considering medication as an option.
1. Myth: A drug is a drug is a drug.
This is a response to Suboxone heard in Narcotics Anonymous meetings. A drug is a drug is a drug, and if you’re on one, you aren’t sober. But this isn’t true. You know it, and I know it. All drugs aren’t created equal. Drugs vary in their level of addictiveness, their legality (which affects purity), and their benefits. Street drugs cut with fentanyl can kill you. Suboxone, or other forms of buprenorphine/naloxone, can reduce the likelihood that you’ll relapse and die. When taken as prescribed, they can improve your quality of life and chances of long-term recovery. That’s sober to me. (source)
The dangers of cross-addiction are real, and this common refrain originated from a place of goodwill. It’s a simple reminder that many mood-altering substances can be misused and you need to listen to your body and mind and understand your own limits. Recovery isn’t all abstinence-based — some people who have had a problem with opioids find they can drink normally. Others who consider are in recovery from alcohol and other drugs choose to smoke marijuana in moderation. And even if you’ve chosen to abstain from all drugs and alcohol in abstinence-based recovery, that doesn’t mean you’ll need to swear off all medication for life. It’s possible to take medication under a doctor’s supervision even in abstinence-based recovery and stay sober.
2. Myth: Suboxone makes you high.
Suboxone is a partial opioid agonist, with weaker side effects than heroin or methadone. It has a “ceiling effect.” This means if you do feel any sort of buzz (which most users don’t report, a switch from heroin or pain pills to Suboxone is not pleasant – trust me, I’ve done it), it will level off even if you increase your dose. Meaning that by definition, you won’t be able to get high. You’ll be stabilized. (source)
As with any medication, it’s important to take as prescribed and check-in with your clinician about how you’re feeling. If you are feeling out of it or mood-altered, they can adjust your dose. Most people who are on the right dose of Suboxone note that they feel normal, not inebriated.
3. Myth: Suboxone is trading one addiction for another.
There’s a big difference between addiction and dependence. Physical dependence is an aspect of taking certain drugs. Antidepressants like SSRIs, blood pressure medications, and epilepsy medications all cause physical dependence. This means that if you stop taking these medications, you with experience some type of withdrawal from them. Does this mean we’re all addicted to our antidepressants? Nope. It means our bodies have adapted to them.
But addiction is a brain disease. It’s characterized by compulsive drug use despite harmful consequences. Addiction looks different than taking medication. Many of us are dependent on antidepressants. We can’t stop taking them cold turkey. But that doesn’t mean we’re craving them. It doesn’t mean we’re staying up all night taking more of them. Dependence doesn’t equate to addiction. And in the case of Suboxone, it reduces the symptoms of addiction. Cravings decrease, and you can focus on daily living free of drugs or alcohol. This is the essence of sobriety, achieved with support through buprenorphine/naloxone. Chelsea Chang, LMSW and counseling lead at Workit Health says, “Harm reduction and Suboxone saves lives, focus on what works for you and how it is saving your life.” (source)
4. Myth: Suboxone is mood-altering, so you can’t take it and be sober.
Outside of any 12-step meeting, you might find some folks vaping and chugging Monster Energy drinks. All that nicotine, caffeine, and sugar is mood-altering. But it’s socially acceptable, so we encourage it. Living Sober, the Alcoholics Anonymous guide on how to get through early recovery, recommends reaching for something sugary to beat cravings. What is that sugar doing? It’s altering your mood. If Suboxone isn’t sober, whose to say sugar, caffeine or nicotine are? We need to think past the mood-altering rule and into a more personal and private decision of self-care. What works for you? What doesn’t work for you?
The reality is, opiate addiction is mood-altering, even after you quit using. When you misuse opiates long-term, you throw your brain chemicals off balance. That imbalance can lead to post-acute withdrawal syndrome. Post-acute withdrawal can cause depression, cravings, and sleep disturbances for months. You feel funky, and your mood is altered. This can stack the decks against you. Because your brain is trained to turn to a single solution when you feel bad: USING OPIATES. Suboxone solves this problem by giving your brain back the chemicals your opiate addiction depleted. It does this while preventing the euphoria caused by other opioids.
Is it easier, in the world of drug addiction, to categorize all drugs as bad? It might be, on the surface. But that sort of black and white thinking doesn’t serve us in recovery. It’s tempting, as we all point fingers at big pharma, to tell everyone to screw all meds. To say, “Suck it up. Stop using, without any help.” But it sounds easy until you’ve been there. We’d all kick opiates without any help if we could. But there’s a solution that makes the process of opiate addiction a little less painful. So let’s start treating it like one. Suboxone isn’t the enemy here. Heroin and pain pill addiction is.
As Workit Health’s Head of Marketing, Kali Lux leans in to the culture gap between addiction, recovery, and medicine. She’s interested in finding solutions that work for substance users better than drinking or drugging does, and believes Workit is one of them. She’s written extensively on her own experience through addiction into long-term recovery. You can connect with her on Twitter @kalireadsbooks.