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Prescription Opioid Addiction Can Be Treated with Suboxone, Study Shows

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The first large-scale study of treatment for addiction to prescription opioids finds the drug Suboxone (buprenorphine plus naloxone) can be an effective therapy. The study found adding intensive counseling for opioid dependence was not helpful, however.

The study, conducted by the National Institute on Drug Abuse (NIDA), included 650 people addicted to prescription painkillers, ABC News reports. They were treated with Suboxone, which mimics some of the effects of opioids, while reducing drug cravings, the article notes.

Half of the participants also received intensive counseling. Over the course of 12 weeks, 49 percent of participants reduced prescription painkiller abuse. Once they stopped taking Suboxone, the success rate dropped to 8.6 percent. The reduction in painkiller abuse was seen regardless of whether participants said they suffered from chronic pain.

“The study suggests that patients addicted to prescription opioid painkillers can be effectively treated in primary care settings using Suboxone,” NIDA Director Nora D. Volkow, MD, said in a news release. “However, once the medication was discontinued, patients had a high rate of relapse—so more research is needed to determine how to sustain recovery among patients addicted to opioid medications.”

The results appear in the Archives of General Psychiatry.

12 Responses to this article

  1. Avatar of Paul Farmer
    Paul Farmer / November 14, 2011 at 11:47 am

    I was one of the counselors in this study and the results are deceptive as well as disappointing. Firstly the “counseling” was primarily education from a very basic CBT perspective. They wanted to have something that anyone at any agency could administer without any specialized training. Every session was required to be based on one of the 12 session topics regardless of the issues the clients brought to the session.

    The results suggest that counseling has no value. I would suggest that ineffective counseling has no value.

    Also it is not a surprise that NIDA Director Nora D. Volkow, MD thinks we need “more research is needed to determine how to sustain recovery among patients addicted to opioid medications”. I would think this might be the place to provide some effective counseling and ongoing support however I assume she is talking about a different pill.

  2. Avatar of stephen ringer
    stephen ringer / November 12, 2011 at 11:01 pm

    The problem with these trials is simple. Stop thinking Suboxone is any different than Methadone. Utilzing Suboxone for a brief two to four week detox, as it was initially intended, is still very effective. We have been doing it for two years now with over 50% sustained abstinence after one year. Suboxone without IOP is absurd. I suspect the poor response is more a reflection of the quality of treatment. Try using recovering addicts who know what it is like to detox and then live clean for the first six months. We now have created a nation of Suboxone dependent addicts…now what do we use to get them off the Suboxone? Sometimes I wonder if these folks doing these trials ever actually used any opiates or understand what the addict needs to change his/her life once the drug is gone. Oh well, another waste of money and time but I am sure the Suboxone folks will be glad to keep selling their poison, I mean replacement drug therapy, to the masses at $5 a pill…and suggesting 16 milligrams a day is a good dose. We stabalize addicts shooting 30 bags of heroin a day on 8 to 12 mgs in three days.
    Suboxone rep comes by often…wonders why we aren’t selling more like all the other local doctors.

  3. Sandra / November 12, 2011 at 12:25 pm

    The question is: why was the suboxone stopped? Presumably none of these people were selected for the study because he or she was one of the chronic pain patients taking only what one MD prescribed? These patients were much better off on suboxone and off, or on much reduced, Rx painkillers, than they were before; so what is wrong with a long-term maintenance program? Puritanism. The idea that people can be left to decide for themselves when to go through withdrawl and the life-work of becoming clean is anathema to some people, just as any kind of treatment of addiction that approaches harm reduction or even a non-punitive approach is.

    It is true that being on long-term therapy with suboxone limits people’s lives, but so do many other treatments for diseases. It’s much better than being without treatment, and it’s less mind-altering than being on many high-dose regimens to treat epilepsy, for example. Having the alternative of abstinence always available is essential, and it is only ethical to offer patients a choice, since treatment options for a life in our society have such a low success rate, compared to suboxone maintenance.

  4. Joseph D. Anticoli / November 12, 2011 at 3:12 am

    My personal and professional experience has shown me that the only ethical, workable, and effective way to treat substance use disorders is determined by what’s best suited to each individual case and the likelihood of its incorporation. The more diverse the options are, the better the outcomes will be. We must meet the client where THEY are at and move from there; not from some pretentious ideal. It’s absurd and childish to expect a hijacked brain to act contrary to the trajectory determined by metabolic inertia. The only responsibility the individual has is to them self and those who they interact with. The implied accountability each relationship presents is defined only to the degree it does not obstruct or harm anyone else’s freedom of choice; including what foods or substances one chooses to consume. The common denominator our citizenship is determined by is the implied social contract we have with each other. The social contract is defined only by its primary purpose, e.g. I expect a certain level of performance when you drive your car and you expect the same from me. Trying to control secondary, conditional elements like what others eat, drink, inhale or supposite RECTALLY is a distortion of the primary purpose. Any truth which is not self-evident is corrupted by the ego with its opinions and desire to control others. If I choose to, or choose not to utilize medication-assisted treatment, whether it be buprenorphine or methadone, is MY choice and nobody else’s.

  5. Avatar of Mike
    Mike / November 11, 2011 at 10:18 am

    Subuxone is an effective drug substitution but not a wise or ethical long-term approach to recovery. The same was said of methadone when it was first used. The problem, of course, is that encouraging people to remain addicted to anything is unethical. The drug certainly has it’s place in the tool box, but it is not “the answer” to opiate addiction. The suboxone approach really bothers me and many of my colleagues because 1. Addicts will naturally make the choice to take another opiate pill rather than go participate in more traditional therapies, self-help and treatement. 2. The entire suboxone movement has in inherent financial motive for physicians and pharmaceutical companies. 3. There is an undertone running through the national suboxone initiative that suggests that opiate addicts are unable to achieve recovery without using another opiod drug. This is simply not true, as evidenced by the tens of thousands of recovering opiate addicts in the U.S. today.
    Much more research,practice design, and prescriber accountability needs to take place in the suboxone arena in order for the practice to be fully embraced by many working with addictive disorders.

  6. Avatar of john
    john / November 10, 2011 at 1:55 pm

    Yes, it confirms what I already knew as well.
    For those who think suboxone is NOT a long term strategy, I sure would like to know what is. I have been in this business as a provider for 18yrs. It has been a godsend for these folks as I remember the suffering these clients would go through prior to suboxone. Our next challenge is to see if vivitrol pans out for opiate dependence. Many people may prefer it as it is not an opiate. We’ll just have to see, but at 1,200.00 a shot, yikes!

  7. Avatar of Kevin Fields
    Kevin Fields / November 9, 2011 at 2:15 pm

    My observational experience with this drug is that the Dr.s prescribing it don’t know enough first hand information about it yet & are mishandling their patients who are on it. Very bad withdrawal, maybe worse than the original problem…

  8. Fred C / November 9, 2011 at 1:58 pm

    My apologies for not reading the article first. they did taper them off and still got those terrible results. At the Tx center I worked at, some patients were sent home with ongoing Rx for 2 mg suoxone maintenance doses and the ones I talked to said they had milder cravings and were able to maintain recovery as long as they took the small dose daily. Maybe that will be the next study.

  9. Fred C / November 9, 2011 at 1:47 pm

    I guess it’s good to have a study done but this has been known for years. A maintenance dose with 2 mg buprenorphine helps long-time heroin users resist cravings. the drop to 8.6% after dropping medication is disappointing. long-term success rates for heroin recovery are usually quoted at 15%(the lowest of any drug.) Are painkillers even less quitable than heroin? Did they just stop the suboxone or were they tapered off?

  10. Avatar of jerry pastore
    jerry pastore / November 9, 2011 at 1:46 pm

    As a long time drug/alcohol counselor, my experience with clients using Suboxone is similar. Yes, it is a very useful agonist, however the withdrawal from Suboxone is every bit as uncomfortable as from opiods. As a harm reduction strategy maybe, “treating” opiod addiction, not really

  11. Avatar of Quinton K
    Quinton K / November 9, 2011 at 1:40 pm

    Certain amino acids work wonders in helping methamphetamine addict to enter into meaningful recovery…..I guess because they are sold without a physicians perscription and big Pharma doesn’t push them only a few counselors know this.

  12. Avatar of JasmineKay
    JasmineKay / April 12, 2013 at 8:12 pm

    I am a 22 year old mother of a 3 year old son and a 1 and a half year old step daughter. I was addicted to opiates for 7 years. That’s right, I started taking opiates when I was just 13 and was using daily and heavily for about 5-6 months by the time I turned 14.
    There was a brief period where I had weaned myself off of the morphine (my drug of choice at the time.) This is when I was 17 years old. I had switched from heroin back to morphine to make the taper process easier. I had the motivation to do this because I was pregnant and I was told that I would lose my baby if he had been born addicted. (The law in my state says that if a minor parent gives birth to an addicted child the state will assume custody of said child.) I was sober for about 3 months until the day my son was born.
    At the hospital the doctors gave me an injection of nubain (Nalbuphine hydrochloride) and also some intravenously. Nubain is a powerful semi-synthetic opiod analgesic. This is what caused my relapse. I left the hospital with a prescription for vicodin and that began yet another downward spiral for me.
    I continued using until I was 20 years old. Which is when I hit rock bottom.
    I was wearing and also cheeking/chewing three 100mcg/hr Fentanyl patches a day.
    Fentanyl is a synthetic opiate that is 100 times more potent that morphine with 100mcg (that is micrograms!!) is approximately equivalent to 10mg of morphine. This habit was very expensive for me, well for anyone it would be expensive. Being that on the streets (in my area) one 100mcg/hr patch costs $40 and I needed three of them each day.
    One patch when used correctly should last up to 72 hours when applied to a part of the body where it is supposed to go and you are careful about doing things you’re not supposed to do with it on. Well most patients who use fentanyl patches are cncer patients and are bed ridden so I guess when they made the patche they figured there wouldn’t be much movement. I am saying this because my patches would start coming off after only about 24 hours.
    I knew that the patches still had quite a bit of medicine in them after they are taken off (even when they are worn for a full 72 hours).) I would place the patch on my cheek after I would take it off and then chew it after a short while. This would give me the results that my addicted brain wanted.
    I would only do this after first applying a new patch 30-45 minutes before removing the old one and I did this every morning. Also in a 24 hour period I would have another 2 patches used. Because I would cut them into pieces and chew up those pieces every couple hours so my continuous high wouldn’t go away.
    I always had a patch on because fentanyl is short acting (especially when chewed), my tolerance is so high, and in between chewing pieces of a new patch I would feel withdrawals.
    My point in telling you this is so you can understand how heavily I was using. I began suboxone treatment when I was 20 years old. I started at 24mg/day three times/day and I tapered VERY SLOWLY over the course of a year. I got down to as low a dose as .25mg/day and I “jumped” off. (Jumpped off is a term commonly used among suboxone patients.) When I quit taking suboxone I began taking naltrexone orally so that I would not be able to get high off of opiates if I had the urge to use.
    I was prescribed a combination of drugs to take the first couple weeks after stopping suboxone. My doctor called this a “comfort cocktail”. It was a mixture of benzos, chlonidine and other meds to help with withdrawal symptoms. I took it for the first week to two weeks and felt fine when I stopped taking it.
    I have since been sober for 13 months and I would NEVER even think of going back to using! I am happy. Suboxone really did save my life. And I would NOT have been able to quit without it.
    I also wanted to add that I did go to therapy every week. I did one on one therapy with a psychiatrist who specialized in addiction medicine. And that also helped me to succeed in staying sober. I still see this psychiatrist.
    I believe that therapy plays a big part in suboxone recovery, or any recovery at all. With or without suboxone. And even recovery from other addictions.

    Well, that is my story. I hope that I inspire somebody with it.
    And also I hope to prove that suboxone as a maintenance medication can be effective if done correctly.

    :heart: – Jazz

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