When should I stop taking Suboxone?
Suboxone can provide you with relief from withdrawal symptoms and drug cravings. That might tempt you to stop your Suboxone use, but stopping too early can be a serious mistake, as you might slide back into drug abuse. However, taking the drug for too long might keep you from working with your team on a more permanent solution. It’s best to discuss your individual recovery process with your doctor. Together, you can come up with a tapering schedule that’s right for you.
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When people who have struggled with addiction to heroine or another opiate go through a professional rehab program, they may be prescribed Suboxone as a way to support recovery from opiate addiction.
According to an article in the American Journal on Addictions, prescriptions of Suboxone and other formulations of its main component, buprenorphine, increased substantially between 2003 and 2013.
Some individuals, or their families and friends, who have dealt with Suboxone maintenance as a form of opiate addiction recovery may be frustrated by this because they feel like they’re simply exchanging one drug for another. This can lead to a strong desire to stop taking Suboxone.
There is a difference between addiction and dependence – and in the case of Suboxone, this creates a big question for doctors and researchers about how maintenance medications might affect the individuals who take them. Regardless of the answer to this question, however, it’s important to know when it’s okay to stop taking Suboxone and when it’s better to stay on the drug in order to avoid relapse into opiate addiction.
The Difference between Addiction and Dependence
Opiates create a feeling of euphoria in the brain and can reduce pain as a result; this is why they are often used in treating acute or chronic pain. As described in an article in Addiction Science & Clinical Practice, a person who uses a prescribed opiate painkiller over a long-term period experiences changes in brain chemistry that result in the body becoming dependent on the drug – meaning that the drug takes over the body’s natural actions, so that when the person tries to stop taking the substance, withdrawal symptoms occur.
With dependence on opiate medicines, the person does not crave more of the drug or lose the ability to control the dosing of the drug. The person simply must keep taking it to avoid withdrawal.
Addiction to an opiate is caused when abuse of the substance causes further changes in the brain that result in cravings for the euphoria; these individuals are unable to control their use of the substance, resulting in an overwhelming need to increase dosage or frequency of use.
Proponents of Suboxone state that because of the way it works in the body, the medicine can often result in dependence without leading to addiction. For this reason, it can be used as a medicine-based treatment for opiate addiction by reducing the likelihood of cravings and loss of control. Others assert that the difference between addiction and dependence in the case of opiate use is a very fine line and that Suboxone does nothing to treat the underlying mechanisms of addiction.
How Suboxone Works
The main component of Suboxone is buprenorphine, which is a partial-opioid agonist – this is a substance that, while also a type of opiate, causes a lesser effect in the body than a full opiate like heroin or morphine. Buprenorphine therefore can block the full opiate from accessing the relevant parts of the brain.
The other component is naloxone, which inhibits opiate action and, if absorbed too quickly into the body, can cause severe withdrawal symptoms. It is included in the medicine to prevent individuals who are being treated from wanting to crush and snort the Suboxone or otherwise behave in ways that cause them to become addicted to it instead.
Using Suboxone in Opiate Addiction Treatment
As described in a literature review from the Canadian Agency for Drugs and Technology in Health, together, the two components of Suboxone create a maintenance medication that can help those who are addicted to opiates by reducing cravings while at the same time minimizing the symptoms of opiate withdrawal.
By maintaining a constant Suboxone dosage, individuals can significantly lower their chances of relapsing into opiate addiction.
This is supported through a study from the Journal of the American Medical Association, which showed that about 80 percent of young people addicted to morphine started using morphine again if they took buprenorphine for only a short time and then tapered off it, whereas 70 percent of those who took it for a longer term continued abstinence from the drug during long-term treatment.
How this works can be confusing; because the use of Suboxone for opiate addiction treatment is most often continued indefinitely, some people who take the medication feel as if they’ve traded one addiction for another. They may feel pressure, personally or from family or friends, to discontinue Suboxone as well, feeling that this is the only way to be completely free of their addiction. This misunderstanding risks relapse back into true addiction.
The main issue seems to have to do with the general mechanism of addiction. If individuals are not truly interested in breaking the cycle of addiction, they may take advantage of the treatment system to get this drug. In these cases, Suboxone’s ability to help the person struggling with an opiate addiction may be negated.
Stopping Suboxone cold-turkey, on the other hand, could send a person into withdrawal and allow cravings for opiate substances to return and perhaps even increase, making the individual want to resume opiate use and spiral back into a cycle of addiction that may be worse than before taking Suboxone.
When to Stop Suboxone
Nevertheless, there are still times when stopping the use of Suboxone is desirable, or even necessary. In some situations, the medicine’s side effects may be too uncomfortable. The individual may encounter physical situations that require stopping the medication temporarily, such as pregnancy, nursing, or a need for surgery. It is also possible to have allergic or other dangerous reactions to the drug, which can result in trouble breathing, itching, hives, or similar problems. In these cases the individual should see a doctor immediately.
To summarize, based on the official drug information on Suboxone, individuals may need or desire to stop taking Suboxone if they are:
- Showing signs of an allergic reaction to the medicine
- Having trouble breathing
- Exhibiting signs of overdose
- Having surgery
- Pregnant or nursing
- Experiencing side effects that are too difficult to manage
- Showing signs of continued addiction or substance abuse
In addition, if individuals show lifestyle and behavior changes that indicate they may be able to maintain long-term recovery without Suboxone, the drug may be tapered and discontinued, with other therapy and measures put in place to support continued abstinence. These types of behavioral changes are often achieved through residential, medically supported addiction treatment and therapy programs.
No matter what the reason for stopping use of Suboxone, it is important to use a doctor’s guidance in order to avoid relapse or withdrawal issues.
A medically based detox and treatment program can help a person ease away from Suboxone and work toward recovery.
Alternatives and Other TreatmentsIf Suboxone must be discontinued, there are other options for opiate addiction treatment. According to an article from Harvard Medical School, naltrexone on its own is one of these options. Because it is an opiate blocker, it triggers withdrawal. However, a person who continues taking it faithfully will not relapse; nevertheless, many addicts do stop taking it, possibly again because of the need to keep taking it regularly, or because of the withdrawal symptoms. It is important to note that, while they are uncomfortable, opiate withdrawal symptoms are not deadly.
Another alternative is methadone. However, this is similar to Suboxone in that it is a maintenance medication that maintains the person’s dependence on opiate substances, and it may not be a preferable option for the same reasons.
Other alternatives to Suboxone include:
- Behavioral treatment
- Individual and/or group therapy
- Group support and 12-Step groups
- Family counseling
- Residential treatment
Of these, residential treatment is often considered to be the treatment most able to provide people who are working toward recovery from their addictions with both the medical treatment and post-treatment support mechanisms that lead to long-term recovery.