Is Suboxone sober? Why does long-term buprenorphine treatment have such a bad reputation in 12-step meetings?

Suboxone (the popular name brand of medication buprenorphine/naloxone) reduces cravings and the withdrawal effects from heroin and pain pills. Any heroin or pain pill user knows that a fear of the horrible physical and emotional opiate detox can keep us using long after we want to quit. Even if we’ve tried to quit (and I’m speaking from experience), we might end up using again because we can’t make it through those first brutal days of detox.

Suboxone helps you survive opiate detox, and stabilizes you for life sober. Brand names Suboxone, Zubsolv, and Buavail (different forms of the same medications, buprenorphine/naloxone) are expert-backed options categorized as medication-assisted treatment for opiate addiction. They’re medications that, with counseling, act as treatment to help you stay sober. Thus, medication-assisted treatment.

Large expert organizations like SAMHSA, NIDA, and the World Health Organization agree that medication-assisted treatment decreases opioid use, opioid related-deaths, and increases success in treatment. This isn’t up for debate, studies show medication-assisted treatment saves lives, and keeps people sober.

It should be a no brainer, right? If medication-assisted treatment like Suboxone works, and we’re in the midst of an opioid epidemic, you think it would be welcomed with open arms. You’d be thinking wrong. Less than ½ of privately funded treatment centers offer medication-assisted treatment, 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 opiate users who are struggling to quit today. Let’s bust four myths about Suboxone and other types of medication-assisted treatment, that keep many addicts in pain today.

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 simply isn’t true. You know it, and I know it. All drugs aren’t created equal. Street drugs cut with fentanyl can kill you, and can make you so high you fall asleep eating ice cream in your bed, or worse. Suboxone, or other forms of buprenorphine/naloxone, can reduce the likelihood that you’ll relapse and die. When taken as prescribed, then can improve your quality of life and chances of long-term recovery. That’s seriously sober to me. (source)

“Suboxone, or other forms of buprenorphine/naloxone, can reduce the likelihood that you’ll relapse and die. ”

2. Myth: Suboxone makes you high.

This myth stems from Suboxone’s medication-assisted treatment precursor, methadone. Methadone can create a slight euphoric effect, and it can make you tired. But Suboxone is a partial opioid agonist, with a weaker side effects than heroin or methadone. It has a “ceiling effect” meaning 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)

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 SSRI’s, certain 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.

“There’s a big difference between addiction and dependence. ”

But addiction is a brain disease, characterized by compulsive drug use despite harmful consequences. This means if you can’t stop taking antidepressants despite the fact that you’ve spent all your money on them, your friends and family have told you they can’t stand to be around you when you’re on them, and you’ve missed a ton of work because of them, but still, you crave them like crazy and stay up at night taking just another Effexor, Cymbalta… that would be addiction. This is not what happens with medication-assisted treatment, or antidepressants, or plenty of other doctor-prescribed medication when we take it as prescribed. With Suboxone, just the opposite happens. Cravings decrease, and you can focus on daily living free of addiction. (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 a certain kind of 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. 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?

“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.”

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, with depression, cravings, and sleep disturbances continuing long after short term withdrawal has ended. 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, while also keeping you from getting high.

“Is it easier, in the world of drug addiction, to categorize all drugs as bad?”

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, “Just suck it up. Stop using, without any help.” But it sounds easy until you’ve been there. We’d all gladly 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.