Jennifer Serrentino, M.D. Recently Discusses the Suboxone Controversy.
Buprenorphine with naloxone, better known by its brand name Suboxone, is a medication used for opiate dependence. The purpose of the medication is to assist individuals addicted to opiates (prescription pain medication or heroin) who want to stop abusing these substances.
Individuals with opiate addictions struggle to get abstinent due to extreme withdrawal symptoms, like pain, vomiting, diarrhea, and relentless cravings. Suboxone is sometimes used to “detox”, or get opiate addicted people off of their pain pills or heroin without such a drastic withdrawal.
However, once the withdrawal period is over, there is more than likely a period of time where addicted individuals experience extreme cravings. This period can last months and puts the addicted person at continued high risk for relapse.
Suboxone works as a combination stimulator and blocker of opiate receptors in the brain. These receptors in the brain are where opiates exert their euphoric effects. The buprenorphine molecule sits on the opiate receptor, weakly stimulating it and blocking it at the same time. Because it weakly stimulates the receptor, it decreases cravings and withdrawal symptoms, and when used appropriately, does not cause a euphoria or “high”. Additionally, because its parked on the receptor, it blocks opiates from getting onto these receptors, thereby blocking the euphoria they would normally cause.
Where is the controversy then?
[Suboxone is at times “diverted”. That means that it is prescribed to someone, but that person inappropriately gives it to friends or sells it. Suboxone does have “street value”, and is sometimes used illicitly when someone cannot get opiates and does not want to experience withdrawal or as a substitute to experience some euphoria or “high”. This has caused some to view Suboxone as just another drug that can be abused and has limited therapeutic value.
Suboxone is still considered to have opiate properties and there has been controversy as to whether a person on Suboxone can consider themselves abstinent from drugs. Twelve step recovery programs will sometimes consider someone on Suboxone unable to accrue “clean time” (time free from drugs) until they are off of this medication. However, most of Dr. Serrentino’s patients on Suboxone who attend these programs or meetings have described more acceptance of this medication maintenance.
Suboxone maintenance is intended as a temporary treatment for opiate addicted persons to work on their recovery without repeated relapses. Recovery from addiction is a complicated process that includes working on psychological issues that may have been present prior to the addiction, figuring out better coping strategies for emotions rather than using substances, repairing fractured relationships with families and friends, and building a better and more appropriate social network of people, places and things that support recovery and abstinence. These changes help support the opiate addict when trying to taper off of Suboxone after a period of abstinence. Suboxone maintenance can be a very helpful tool in recovery from dependence but it is only one piece of the treatment. If someone just receives a monthly Suboxone prescription and maintains abstinence without working on any of those other aspects, Dr. Serrentino believes they are at higher risk for relapse once it is tapered.
http://www.jenniferserrentinomd.com/ [Dr. Serrentino __title__ Suffolk County Psychiatrist] is a psychiatrist certified to prescribe Suboxone in the office setting. Dr. Serrentino is open to doing evaluations for appropriateness of Suboxone maintenance. Dr. Serrentino does have the expectation that Suboxone prescribing will only happen in the context of other aspects of addiction and recovery being addressed in treatment. That may include weekly psychotherapy with a therapist who specializes in addictions, group therapy for addictions, family involvement in treatment, regular attendance at regular twelve step meetings such as Alcoholics Anonymous or Narcotics Anonymous, or any combination of the above.