Suboxone Maintenance Treatment
Suboxone maintenance treatment (MMT) is a comprehensive treatment program that involves the long-term prescribing of Suboxone for the treatment of opioid use disorder.
Suboxone which is a combination tablet of buprenorphine and naloxone has been used for over a decade in Canada, to bring life back to those suffering from addiction to opioids such as oxycodone (OxyContin® or Percocet®), fentanyl, hydromorphone (Dilaudid®), heroin, morphine, codeine, etc.
Tolerance to buprenorphine develops slowly, so clients can be maintained in SMT indefinitely. If it is prescribed properly, Suboxone is considered medically safe as a treatment for opioid use disorder.
For more information about Suboxone as a pharmaceutical agent, its other uses, side effects, and other properties, visit "About Suboxone".
What is Suboxone Maintenance Treatment?
Suboxone maintenance treatment has been a widely used treatment modality for over a decade, for people who are dependent on opioids.
Buprenorphine which is the main ingredient of Suboxone is a long-acting synthetic opioid partial agonist. People who are dependent on opioids may be dependent on either oral or injectable forms of opioids. Some individuals may also snort or smoke opioids. Buprenorphine is an appropriate form of treatment for opioid dependence, regardless of the route of administration of the drug of dependence.
There is no universal definition of what a Suboxone maintenance treatment "program" is--although the common thread is clearly the use of buprenorphine. Program components and policies vary widely around the world, and within Canada. A comprehensive approach to treatment, however, generally includes a number of key components--which can be delivered in a variety of ways and at varying levels of intensity--including:
- Suboxone dose;
- medical care;
- other substance use treatment;
- counselling and support;
- mental health services;
- health promotion, disease prevention and education;
- linkages with other community-based supports and services; and
- outreach and advocacy.
Within the context of opioids, the definition of detox or detoxification is the management for relief of withdrawal symptoms such as aches, runny nose, chills, sweats, and insomnia, while the patient comes off opioids most often suddenly or "cold turkey". It is usually the first serious attempt at trying to control one's uncontrollable substance abuse. It is also one often urged by family and friends as in "drugs are bad for you; why don't you just stop using?" The problem with detox is that it ignores a key component of opioid abuse. It assumes that a person is entangled in a vicious escalating cycle of substance abuse simply because of a cluster of flu-like symptoms that may last 5-10 days after stopping all opioid use. Through detox, the person will get over the physical withdrawal symptoms, just as someone gets over a bout of flu. However; the problem with the concept of detox emerges when one looks at the statistics that show detox has over a 90% failure rate. Almost all the opioid-addicted individuals that finish detox (not even counting those that leave before the end), relapse to abusing their opioid of drug of choice after leaving detox. The reason is that detox attempts to oversimplify a complex mental health diagnosis, i.e. addiction, into a basic flu-like physical ailment. Very often, the opioid-dependent patient was using opioids for their euphoria, to deal with stress, or self-treat a mental health disorder such as anxiety. The individual's brain cells have thus become dependent on the external opioids just as much the rest of the body, in effect forgetting over time how to make their own natural opioids (i.e. endrophins). Endorphins are essential in the brain's regulation of mood, thinking and emotional response. So once the physical withdrawal symptoms have gone away after detox, the brain cells have not lost their dependence on the opioids for the person's mood, energy and functioning needs. It is the mental withdrawal effects and the ensuing depression, anxiety, insomnia and cravings that soon cause the person to go back to using the opioids. This is why detox is mostly unsuccessful in achieving long-term recovery for addiction.
There is only a minority of patients whom detox may prove successful for. These are typically those patients who have an almost "purely physical" dependence on the opioids, with almost no mental aspects. These patients may have taken opioids for definitive pain that has now subsided, and now wish to stop the treatment. These patients have not been taking self-escalating doses of the opioids, or been seeking a "high", "escape" or stress relief by using them. They usually do not have a history of substance abuse with other classes of drugs such as cocaine, and have never previously engaged in reward-seeking behaviours such as self injection, snorting, chewing, smoking, drug mixing, or overdose.
As discussed, "opioid-addicted" patients (those with any history of seeking mood alteration from the opioids) are usually not good candidates for a detox program. If chosen by the patient to enter the maintenance program, he or she can be stabilized on an appropriate dose of Suboxone. While on a stable dose, the patient then can go back to fixing the tolls that addiction took on their lives. A stable dose in maintenance allows the patient to feel just normal, alert and functional without feeling any of the highs and lows that come with the abuse of the short-acting opioids such as oxycodone (OxyContin or Percocet), fentanyl, hydromorphone (Dilaudid), heroin, morphine, codeine, etc. This stability also allows the patient's brain to slowly adapt to a new chemical balance. Once a patient has been stable in this way, and avoided all abused drugs for a considerable duration, then an attempt could possibly be made in tapering the dose of methadone very slowly while carefully monitoring for signs of relapse. To lower the chance of relapse, the process should take at least one year from the last date of problematic drug use, but could take much longer for many opioid-addicted patients.
Sometimes Suboxone itself is used in a Suboxone-assisted detox program by starting it and then reducing the dose over a short term, e.g. 2-4 weeks. The same mentioned issues that make non-assisted detox unsuccessful play at medication-assisted detox, in making it a productive option for only a small minority of patients.
If you’ve been using opioid drugs such as heroin, OxyContin, codeine, Dilaudid, Percocet and others, and you’ve come to a point where you know you can’t go on using, but you can’t seem to stop either, Suboxone maintenance treatment (SMT) may be right for you. A physician consultation and examination is required who is a candidate for SMT. SMT is generally useful for those over 18 who meet a diagnosis of opioid use disorder based on the DSM V (Diagnostic and Statistical Manual of Mental Disorders). The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) defines opioid use disorder as a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of
The DSM V criteria are based on a pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12‐month period (emphasis ours):
- Tolerance, as defined by either of the following: A need for markedly increased amounts of the substance to achieve intoxication or desired effect; or Markedly diminished effect with continued use of the same amount of the substance.
- Withdrawal, as manifested by either of the following: The characteristic withdrawal syndrome for the substance; or the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
- The substance is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control substance use.
- A great deal of time is spent on activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain‐smoking), or recover from its effects.
- Important social, occupational, or recreational activities are given up or reduced because of substance use.
- The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine‐induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).
This is a very common question. There is still no one answer to this question. The best possible answer is that most people who are successful coming off Suboxone show three important characteristics:
1- Their lives have been stabilized after they've been on methadone maintenance treatment for more than a year.
2- The decision to stop taking Suboxone is made with their doctor, who gradually decreases the dose while providing support.
3-They've made changes in their lives that show they're stable. For example, they may have a stable family life, support from the non-drug-using community, steady satisfying employment and fewer financial or legal difficulties.
It is important to understand that Suboxone, when taken as prescribed, is a safe and effective medication that individuals can take for years. Sometimes people stay on Suboxone as long as they need to and many patients have stayed on methadone for life. Whether short-term or long-term, research has shown that Suboxone maintenance is the most effective treatment for opioid dependence.
First you have to see our physician, who will do an assessment. If found to be suitable for the treatment, you could be started in the program the same or next day. You can make call for an appointment here.
Suboxone maintenance is a long-term treatment for addiction to opioids. Once a patient is stabilized on a stable dose of Suboxone, the negative thoughts, associated with addiction, often diminish and go away. The patient’s life tends to normalize and functioning increases, which can include caring for their families, working, achieving educational goals, addressing both mental and physical health co-occurring disorders and enjoying an active, healthy lifestyle. Achieving a healthier, normal life through Suboxone maintenance is a valid form of recovery from opioid addiction. Improvement in all areas of health and social integration increase with the length of time in treatment. The greatest positive change comes in the first year of treatment.
Similar to the medicines prescribed for diabetes, asthma, high blood pressure, depression, or other chronic medical problems, Suboxone is not a magic treatment. No single medication or behavioral intervention can be a magic bullet for all patients seeking help for opioid addiction and the medical, psychiatric or social problems which may co-exist with it Suboxone maintenance treatment has proven to be the most effective way to treat opioid addiction. Research shows that life expectancy, health and vocational and educational achievement are much improved while substance abuse and criminal activity are greatly reduced for patients in SMT. Proper use of medication eliminates withdrawal symptoms and the craving for heroin, oxycodone, hydromorphone or other opioids and the structure and counseling required and offered provides an opportunity for patients to address problems and issues related to their addiction.
A Your doctor will provide the pharmacy with a prescription for your Suboxone. This prescription must be renewed periodically by your doctor. He or she will determine how often you come for appointments, depending on your needs and progress. Suboxone is a medication that is taken sublingually (under the tongue). When you first start on Suboxone, you will be asked to go to your pharmacy each day to take the medication. As you progress in your treatment, you may be eligible to take home some doses. These are called "carries." Your carries must be stored safely to make sure the medication is not taken by anyone else, especially a child.
It depends on how one defines cure. Suboxone in SMT is a medication that will control your addiction, so you can get back to normal functioning in life. If one defines cure as absolute abstinence from all opioids, there is no medication or technique that has been shown to achieve that. However if one defines cure as getting back to normal functioning, work and family life, then Suboxone maintenance can be viewed as an effective cure since it has been shown more than any other medication or method to achieve these goals.
Unless ordered by a court, SMT is voluntary, so you can stop it at any time. However, studies have shown to successfully stop methadone without a very high chance of relapse to abusing other opioids, one has to be in the program at least 1 year (preferably 2) from the last use of illicit hard drugs. A successful taper of methaone can be tried very gradually over a 3-6 month period, while carefully monitoring for signs of relapse to illicit drug use.
Take-home doses of Suboxone or "carries" are an essential part of an SMT. The criteria for getting carries are standardized and stipulate that, barring very exceptional circumstances, a patient has to be in the program at least 4-8 weeks before obtaining a carry for one day per week. The guidelines also stipulate that the patients, when without problematic drug use, can achieve an additional carry every 2-3 weeks, for up to 6 carries per week.