Statistics from the National Institute on Drug Abuse show that more than 115 people in the United States die every day from opioid overdoses, a national problem that costs the U.S. over $78 billion a year in lost wages, medical treatment, and criminal justice involvement. Treatments vary and often involve a combination of methods, including the use of two drugs called methadone and Suboxone. If you are planning to take prescription painkillers or are currently abusing opioids, you need to know more about these medications.
Opioid Drugs and Addiction
Narcotics, which include prescription painkillers, heroin, and man-made opioids, literally change the way the brain works, altering its reward system and leading to addiction. Signs of addiction include the following:
- Drug cravings
- Dilated pupils
- Stomach aches
- Nausea and vomiting
- Goosebumps and chills
- Body aches
- Extreme anxiety and moodiness
In addition to changing how the reward system works in the brain, opioids affect the entire body. When a person suddenly stops using the drugs, the withdrawal symptoms may last for hours, days, or even longer depending on the amount of the drug taken and length of time it was consumed. Changes in the brain could also lead to a higher risk of future addictions and relapse. Most treatment regimens include drugs like methadone and Suboxone, support groups, and counseling. Meditation, exercise, and good nutrition may also play an important role in recovery.
How Methadone Works
Methadone is a narcotic used as a last resort to treat pain in patients who need 24-hour relief. It is also used to prevent symptoms of withdrawal in people who are being treated for drug addictions. The drug works by altering the reactions of the nervous system and the brain to pain. It also keeps drug users from feeling euphoric highs when they take narcotics like codeine, fentanyl, or hydrocodone. The medication comes in liquid form, wafers, or pills, and a single dose can relieve symptoms from four to eight hours. It is taken once a day but is also effective in higher doses. Researchers have found that heroin addicts, for instance, stay in treatment longer when they take higher-than-usual doses of prescribed methadone.
Doctors initially give methadone as part of a highly supervised treatment plan. If the patient does well and complies with the recommended regimen, the doctor may allow the pills to be taken at home between visits. The prescription must, however, be given through a narcotic treatment program certified by the Substance Abuse and Mental Health Services Administration. The National Institute on Drug Abuse mandates that a methadone treatment program last at least 12 months for a favorable outcome, but the length of treatment for any one person depends on individual progress and needs. Some people may, in fact, benefit from treatment that lasts for years, and no one should drop out of a program before consulting a doctor.
Experts say that long-term success in treating drug addiction is more likely when techniques are used to discourage patients from leaving the program early in their recovery. The acceptance of addiction as a chronic illness means that ongoing care and supervision are needed. Patients are encouraged to look at the possibility of multiple treatments as part of the recovery process.
The Pros and Cons of Methadone
Methadone treatment attempts to manage cravings and withdrawal symptoms of opiates by giving the patient another opiate, a process also known as replacement therapy. Replacement therapy is usually safe when it is medically supervised and used with other kinds of therapy. Methadone, however, is not a substitute for counseling, support groups, and lifestyle changes.
Critics of substitution therapy argue that its use is merely replacing one drug with another, but some experts disagree. Sarah Wakeman, doctor and director of the Massachusetts General Hospital Substance Use Disorder Initiative, says the argument against using drugs like methadone keeps people from getting the help they need. Treating addictions, she adds, is like treating any chronic illness. Those who agree on the therapy’s benefits still disagree on which drugs are best. Methadone, Suboxone, and similar drugs have their pros and cons, and the goal of any treatment is to allow the patient to live a well-balanced and productive life.
How Suboxone Works
Suboxone is a prescription medication used to treat people who have become addicted to narcotics. It contains two active ingredients: buprenorphine and naloxone. Buprenorphine is an opioid, and naloxone is a medication that blocks and reverses the effects of opioids. Suboxone reduces dependence by partially activating the same brain receptors that other opioids activate. Because its effect is long-lasting, one dose per day can effectively prevent withdrawal, relieve cravings, and restore a person’s daily functions. A study done in the United Kingdom found buprenorphine users six times less likely to overdose than methadone users.
While Suboxone can be administered by any specially trained physician or addiction specialist, making it convenient to get treatment, very few doctors have completed the training that is required. Studies, nevertheless, show that both methadone and Suboxone help patients stay in treatment and lower their risk of death by 50 percent as compared to behavioral therapy alone. The drugs also improve the users’ quality of life and help with relapse prevention.
Like methadone, Suboxone is considered safe when its use is properly supervised by trained medical professionals. In 2018, the U.S. Food and Drug Administration approved a generic version that made the drug less expensive, but public health officials cautioned the public about the risks of both the generic and the brand-name drugs. As a result, the drug can now only be administered in a Suboxone clinic under a doctor’s supervision.
The Pros and Cons of Suboxone
Although the Substance Abuse and Mental Health Services Administration reported an increase in the number of emergency room visits involving Suboxone in recent years, over 50 percent of those visits resulted from the nonmedical use of the drug. Like any medication used to treat addictions, use of Suboxone can be habit-forming. Since its debut in 2002, however, it has been used to treat approximately 3 million people with opioid dependencies.
One of the advantages of Suboxone is that it blocks pain in the same way that other narcotics do, but it also keeps the opioid receptors from being stimulated. This means treatment centers can use it to relieve a patient’s withdrawal symptoms without the possibility of abuse. When the opioid receptors are blocked, a person no longer gets a rush of euphoria from other opiates, meaning that patients on Suboxone can take opioids or narcotic painkillers without the usual high.
While experts agree on its effectiveness, they argue about how Suboxone should be given. Some say its use should be short term only while others say long-term use prevents relapse. Advantages of buprenorphine, one of the main ingredients of Suboxone, include the following:
- Lower risk of overdose
- Lower risk of abuse
- Mild withdrawal symptoms
Although patients can experience relief from withdrawal in a few hours after taking the drug, doctors will not give Suboxone until a patient’s symptoms appear. If given prematurely, the drug can trigger withdrawal instead of relief. Suboxone is primarily used for opioid detox and is sometimes accompanied by other medications for anxiety or muscles spasms. Other kinds of medications may be needed to treat people who are addicted to non-opioids such as cocaine.
The Controversy Over Substitution Treatments
Treatment specialists who defend the long-term use of methadone and Suboxone for relapse prevention say the trade-off is worth the risk when compared to the low quality of life most users have. One study showed that patients who took Suboxone reported improvements in their social lives, educational achievements, and treatment progress when compared to those treated with methadone while other studies found no significant difference between the two drugs.
In addition to enjoying a higher quality of life, patients who use Suboxone for longer periods of time do not run the same risk of respiratory failure that they do with other opiates. It may, however, be hard for people to get into a Suboxone treatment program. Because federal regulations prevented certified doctors from treating more than 100 recovering adults at one time, waiting lists have been long. However, doctors may now apply for an extension to increase the patient limit to 275 after one year.
Medical specialists who oppose the use of Suboxone argue that one of the goals of therapy is for the patient to live a life free of drugs. They see Suboxone and methadone as crutches that lead to a drop in feel-good endorphins and an increase in the number of opioid receptors in the brain.
Sharon Stancliff, MD, a Suboxone provider and former director for a methadone clinic in New York City, compares the use of the medications to that of treatments for chronic illnesses like high blood pressure or diabetes. Other physicians like Dr. Logan Graddy, MD, cite examples of recovering adults going back to school, starting careers, and living their lives in ways that would not have been possible without the medications.
Methadone Versus Suboxone
Methadone was introduced in Germany in 1937 and was being used to treat addictions in the U.S. by the 1960s. The Food and Drug Administration approved Suboxone for the treatment of addiction in 2002. Both methadone and Suboxone are substitution treatments that can have side effects, especially when improperly used. On the other hand, the same is true of all medications whether they treat cancer or the common cold.
While methadone has not been proven to be entirely safe for pregnant women, researchers think its benefits outweigh its risks when its use is necessary. They also warn that babies may have mild withdrawal symptoms as a result. In the general population, neither Suboxone or methadone is entirely risk-free, but this is the case with just about all drugs.
Suboxone and methadone each lead to different reactions in the brain and the body, and recovering adults can have individual reactions to these medications. If you are planning to seek treatment for an addiction, you can find out more by talking to treatment specialists and researching your options before deciding which medication is best for you. Whether your goals include going back to school or having better relationships, you can change your life with the right treatment.