I’ve got to be clear right from the beginning, there’s no magic bullet if you’re addicted to opiates. At some time or another opiate addicts will with out a doubt, experience some withdrawal. In my experience, the fear of withdrawal was the main motivating factor that drove me to seek out more drugs. This is part of the addiction cycle. Getting the drug, doing the drug, getting the high, coming down, seeking ways to get more drugs, and finnally getting the drugs. So while the goal of any rehab or therapy program is to get 100 % clean and off of substances, it is not realistic to expect most opiate addicts to just quit “cold turkey”. In this circumstance the best approach to freedom is through a maintenance program.
We’re going to take a look at two different types of maintenance therapies: Methadone and Suboxone. We call them maintenance therapies because both drugs offer the patient’s body to be free from physical withdrawal so they can focus on dealing with life and recovery instead of constantly planning how to get their next fix.
The use of methadone and Suboxone are a great way to manage your life around the mental therapy that an addict most certainly needs if they are to be successful. There are people that use them for years, and that’s OK, as long as you are attending your treatment sessions. Personally, I was on Suboxone for 2 years before I tapered off. Some patients end their maintenance program within weeks or months of starting treatment. This approach has worked great as well. Every patient’s circumstances are different. Which ever scenario you choose, these medications have their pros and cons, and that’s what we’re here to find out about.
Agonists, Partial Agonists, and the Ceiling Effect
These are the three main terms that you need to be familiar with while learning about maintenance methods.
Opiate agonists The brain has these things called receptors that play a part in regulating our mood and the way that we feel pain. The reason opiates affect people the way that they do is because of the brain’s opiate receptors. In very simple terms, when you ingest heroin the drug crosses the blood/brain barrier very quickly and then attaches itself to the opiate receptors. While these receptors are filled with the opiate a user will feel euphoria and become less sensitive to pain. When the receptors become empty (after the drug wears off) the body will start to go into withdrawal. (Not Pleasant).. This is what an opiate agonist like Vicodin, Heroin, Methadone, or Morphine does. In other words, an opiate agonist will make you high.
Opiate antagonists are drugs that when ingested, attach themselves to the opiate receptors in place of actual drugs like Heroin. The receptors for those drugs would already be filled with the antagonist, therefore no effect would be felt. Popular opiate antagonists include Naltrexone and Naloxone.
Partial opiate agonists have what is called a ceiling effect. One way to describe this effect is: Imagine that there was a drug on the market that had most of the effects of an opiate agonist except after ingesting a certain amount the intoxicating effects of that said drug could not get any more intense. Put very simply, that is what a partial opiate agonist is. The two most popular partial opiate agonists are Suboxone and Subutex. (Both Buprenorphine). When taking Suboxone or Subutex, once you have filled all of the holes in the receptors there can be no more effect from the drug. You have reached the ceiling effect of it. That does not mean that you can’t overdose! There is a bit of controversy among doctors about how many tablets a day are necessary for the patient to be medicated properly. What they’re finding out is that patients don’t need more then 2 8 mg tablets per day. It used to be common to give highly tolerant users 3 8 mg tablets per day, but anything over 2 is just a waste of money, as the opiate receptors are already maxed out.
Putting It All Together Buprenorphine, being a partial opiate agonist, is widely considered a safe maintenance drug. While there are cases of overdosing from Buprenorphine, they are mostly associated with abusing alcohol or barbiturates at the same time. If taken as directed Suboxone and Subutex will reach the ceiling effect before any major harmful side effects can take place. Because of this, Suboxone patients do not really need to be monitored full time. It is possible to over dose if any barbituate and/or alcohol is taken with Suboxone. Your doctor will go over that with you in detail. There are cases when Suboxone’s ceiling effect can make the drug less effective, especially for patients who have very severe, and long-term opiate habits. In these cases, a partial opiate antagonist might not do the job well enough, therefore the patient will still feel quite uncomfortable and have moderate to severe withdrawal symptoms.
Enter the topic of Methadone. Methadone is a full opiate agonist. It does not have a ceiling effect. So, if a patient is still experiencing withdrawal symptoms, the doctor can adjust the dosage until the issue is compensated. I feel that as a responsible source of information, I should inject the necessary cautions and warnings about using methadone. Most doctors today are against methadone therapy (unless they own the local methadone clinic). I will tell you that I was abusing methadone for about a year and it did not turn out well when my source disappeared. Methadone withdrawal is much more painful then other opiate withdrawal. However, In all fairness I never did taper down so I don’t want to paint an inaccurate picture here. I just am a little cautious about using it because of how i know that personally it would not work out for me. I would still be abusing heroin. Everyone is different!
Take A Look At More Information To Help You Decide:
Suboxone takes more time to go through your system than methadone does. Methadone has a much shorter half life. What this means is, methadone will cause withdrawal to kick in really sudden and on the dime when about 24 hours goes by between doses. Suboxone is way more lenient and usually will last in your system for a good 36 hrs. Don’t pay any attention to that though. It is very important to take these medications on a strict time schedule. This is because it is proven that they are more effective that way.
Can’t someone Abuse These Drugs Too? Methadone is often abused by people who have no intention of trying to eventually stop. Because it takes about 45 minuets for Methadone to kick in, a new user might try and take more then prescribed to feel the high that they are used to. Then once it all really kicks in, it’s too late and overdose could occur. Both Suboxone and Methadone are sold on the black market and many patients will sell their scripts for money to buy actual Heroin! It is a growing problem, but in my opinion these treatment drugs help so many people that are not trying to game the system and to be honest one can never conquer corruption 100% of the time. It is possible to feel a euphoric effect when first starting Suboxone treatment, but that will go away in awhile. Soon you won’t even know that you’re on it!
What About Overdose? Overdose is always a concern for any medication. I recently read that over 3,000 people die of Methadone overdose per year. Mostly none of those deaths were methadone maintenance patients. Remember Suboxone overdose can happen too! Mixing it (or any other opiate agonist/partial agonist) with drugs like xanax and alcohol are sure ways to overdose. If Suboxone is crushed and injected, the abuser is in for a painful surprise. The Naloxone will most likely induce severe withdrawal symptoms.
Withdrawal? The answer is YES! Both of these drugs will cause withdrawals if stopped suddenly. You must follow you doctor’s maintenance program and don’t stray off course. It is possible to ween off of Suboxone without too much discomfort. I did it myself and the trick for me was a very slow taper. Don’t let any doctor push you around! Go down to 1/2 a milligram if you have too. That’s what I did.
What about Price? Methadone is about $50 a week. Suboxone is quite expensive. The usual price is 6-7 dollars per pill. I think that it’s worth the cost to get well again. Both of these drugs have helped many many people. Be sure to take them exactly as directed for best results. Good Luck, and stay strong! It is achievable to turn this nightmare around!