Detoxing From Heroin With Suboxone and Therapy
Anyone who’s become addicted to heroin knows that it is no easy drug to kick. In fact, anecdotal evidence from numerous studies shows that heroin may be one of the most difficult drugs to successfully quit.
But there are medications and therapies that, in combination, offer hope to those who have long given up on ever being able to get clean of horse. One of the proven medications is Suboxone, or buprenorphine.
Suboxone: What It Is
Suboxone is a brand name for the medication buprenorphine. This is an opioid medication used to treat opioid addiction, either in the privacy of a physician’s office, in drug rehab or dispensed for take-home use by prescription.
Suboxone (buprenorphine) is deemed a safe and effective treatment for individuals addicted to opioids. It is different from other opioids in that it is a partial opioid agonist. Because of this property, it may allow for the patient to experience less euphoria and physical dependence, has a lower potential for misuse, a ceiling on opioid effects and a relatively mild withdrawal profile.
Appropriate dosage of buprenorphine may suppress opioid dependence symptoms, decrease cravings for opioids, reduce illicit use of opioids, block the effects of other opioids and help patients stay in treatment.
The Food and Drug Administration approved Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) and Subutex (buprenorphine hydrochloride) for the treatment of opiate dependence in October 2002. These are the only buprenorphine-based products approved to treat opioid addiction. The FDA approved a generic version of Subutex in 2009.
Examples of opioids are painkillers such as morphine, methadone, hydrocodone and oxycodone. Heroin is also an opioid and is illegal. Opioid drugs are sold under brand names, including OxyContin, Percocet, Percodan, Vicodin, Tylox, and Demerol, among others.
While the idea of taking a medication to overcome heroin addiction sounds like a quick and easy cure, the fact is that any medication–even one that has been proven to reduce cravings for a drug as powerfully addicting as heroin–cannot completely remove the incredibly potent yearning for the drug.
And, just to be clear, there is no present “cure” for addiction of any kind.
Still, there are effective treatments and other therapeutic approaches that can provide the basis for learning how to live a life free of heroin addiction.
Treatment, then, must consist of more than medication. Indeed, the use of Suboxone should be only part of an integrated treatment program that also includes intensive counseling therapy.
Why the need for therapy? Here are some of the main benefits:
- To provide a blueprint for the addict about how to make healthier choices
- To help the addict learn to cope with cravings and urges long after all traces of heroin have left the body
- To teach addicts what to do to prevent relapse
- To increase the motivation to make sounder life choices
- To be able to recognize and cope with triggers
- To know how to best deal with life’s stressors
Because opioid dependence is more than a physical condition, overcoming addiction to opioids requires more than merely dosing the individual with prescription drugs such as Suboxone.
It’s no secret that individuals cannot “go it alone” to overcome their addiction. This applies to all types of addiction, whether it is to painkillers or alcohol or process addictions such as compulsive gambling, workaholism or other types of compulsive behavior.
Yet it is amazing how many individuals come to believe, often with their doctor’s encouragement, that taking a prescription medication will end their troubles.
The truth is that, in the case of opioid dependence, cravings for the substance can occur months or even years after the patient last used the drug. And when such cravings surface, they often appear so unexpectedly and with such an intensity that they propel the individual into a state of panic that can lead to relapse.
Here’s where evidence-based research comes into play. Studies have found that individuals who are being treated with Suboxone and also take part in counseling have a much better outcome than those who continue on Suboxone alone. Why is that? Counseling can assist the individual in learning better ways to cope with events, circumstances and social situations that might otherwise lead them to using again. This is especially true of such events, circumstances and social situations the individual associates with past drug use.
Because strong emotions and certain behavior patterns are part of the opioid dependence picture, it stands to reason that counseling would prove more effective at helping the individual make changes in their behavior and lifestyle so that he or she can focus on long-term recovery goals. Suboxone helps reduce or eliminate the physical cravings associated with opioid dependence. That the counseling occurs in tandem with Suboxone treatment makes the process easier and more effective.
Detoxing and Getting Off Suboxone
Weaning off of opiates with the help of Suboxone or Subutex is the first step in the long-term process of overcoming dependence on opiates. But it shouldn’t be a life-long solution. Once you’re at the point that you have been detoxed and stabilized in initial drug rehab for opiate abuse, the ultimate goal should be to get off Suboxone completely.
Unfortunately, what often happens is that the individual makes the decision to quit taking Suboxone on his or her own, independent of the doctor’s advice. He or she may feel that it’s been long enough, and they don’t like that they still feel a bit intoxicated from the drug. In addition, Suboxone tends to blunt the emotions, and what you want to feel is alive, not deadened.
There’s a problem with quitting Suboxone on your own, however, and that problem is a tendency to relapse during the withdrawal. Now, it may be true that some rare individuals can manage Suboxone withdrawal on their own, but the likelihood of this happening isn’t that great. When anxiety and other issues cause the cravings to rare up with a vengeance, and they will, without clinical support and the appropriate tools, relapse is all but inevitable.
There is a safe and effective way to get off Suboxone. This is best accomplished in a detoxification maintenance program at a facility that specializes in this service.
What happens during detoxification from Suboxone? After an initial assessment, the dose of Suboxone will be gradually lowered. The tapering-off schedule will be different for each client, based on dosage at time of admission. Assessment of the individual for physical or psychological effects of tapering takes place every few hours to ensure that withdrawal is as comfortable as possible. Some non-addictive medications may be used to ease the symptoms.
Where to Get Help
What should you do if you suspect a friend or loved one is using heroin? In no uncertain terms, you should encourage the individual to get help. And help is readily available from a number of sources.
Talk with the family doctor about getting a referral to treatment for heroin abuse. Or get in touch with federal, state or local agencies that can provide direction. There’s an online treatment facility locator (http://dasis3.samhsa.gov/) maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) or you can call the toll-free treatment referral helpline at 1-800-662-HELP.
Check out this list of state substance abuse agencies (http://findtreatment.samhsa.gov/ufds/abusedirectors) and find resources and assistance in your state or locale.
County behavioral health organizations may also be able to provide help.
Check out Narcotics Anonymous (NA) (http://na.org/).
Remember that it’s almost impossible to kick addiction to heroin alone. And detoxing (coming off the drug) without 24-hour medical supervision is not only difficult, it’s dangerous. Just coming clean doesn’t solve the problem of dependence. Psychological counseling and learning healthier coping strategies are required in order for the individual to be able to achieve and sustain a drug-free lifestyle. Family support is also crucial, since understanding and encouragement of the loved one who is recovering from heroin abuse or dependence means developing and maintaining a strong support network.
Begin the Dialog
What you can do, right now, is to begin to have the dialog that’s necessary to get the ball rolling for treatment. Expect some resistance. The longer he or she has been using heroin, the tougher the job will be of convincing your loved one that the time is right for coming clean.
It may be necessary to stage an intervention. If that’s the case, go for a professional interventionist–and make sure you’re willing to do what it takes to ensure that the home your loved one returns to following treatment is fully supportive of a clean and sober lifestyle. That may mean that family members need to get some form of counseling or therapy at the same time as the person in treatment. At the very least, go to 12-step family groups for the loved ones of addicts. You’ll not only learn a lot, but also begin to understand how you can better help your loved one who’s striving to get on the road to recovery.
Getting Started with Counseling
There are many ways to begin counseling and each individual needs to choose the best path to getting started. For some, counseling will be a natural offshoot of a drug rehab or residential treatment program for opioid dependence or addiction. Others will have a discussion with their doctor, likely the same doctor prescribing Suboxone, and obtain a referral to a therapist.
Here is some of the counseling available:
- Private one-on-one therapy with a trained professional
- Group counseling, either by itself or in conjunction with individual counseling
- Online group counseling with a trained professional and a group of peers
Beyond counseling, there are also support groups that the individual can participate in to help solidify his or her recovery foundation. These 12-step support groups, including Narcotics Anonymous, are a terrific addition to therapy. Many individuals find them invaluable in their recovery because they are with peers who share the same overarching goal: long-term sobriety.
To find an appropriate therapist, ask your doctor for a referral. Also check out the National Alliance of Advocates for Buprenorphine Treatment (NAABT) (http://www.naabt.org/) for a list of nearby counselors.
The NAABT is a non-profit organization whose mission is to educate the public about the disease of opioid addiction and the buprenorphine treatment option, to help reduce the discrimination and stigma associated with patients with addiction disorders, and to help connect people to treatment providers.
Once a therapist has been selected, make an appointment for an initial consultation. Then, if satisfied that the therapist is a good fit, the next step is to get started with counseling.
Another avenue for finding therapy is to use the Treatment Facility Locator (http://dasis3.samhsa.gov/) maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA). This is an online searchable directory of drug and alcohol programs showing the location of facilities around the country that treat alcoholism, alcohol abuse and drug abuse problems.
Included are listings for residential treatment centers, outpatient treatment programs and hospital inpatient programs for drug addiction and alcoholism. Select “Detailed Search” and click the box for “Buprenorphine Services” to search for treatment facilities offering such services in addition to detoxification and treatment (including counseling).
There is also the Buprenorphine Physician and Treatment Program Locator (http://buprenorphine.samhsa.gov/bwns_locator/) maintained by SAMHSA.
Beginning of the Journey to Healing
Making the decision, or encouraging a friend, loved one or family member to go into treatment for heroin addiction, is probably the biggest hurdle. Once this all-important decision is made, the real healing work can begin.
Whether you are the individual looking to overcome heroin addiction or want to be supportive of someone who is about to embark on the healing journey, know that the combination of medication-assisted treatment using Suboxone plus extensive therapy, conducted in a specialized treatment center, offers the best hope for beginning the recovery journey.
The most important point to keep in mind is that lifestyle changes will be essential once detox from heroin and the initial rehab is complete. Plan to participate in 12-step and/or self-help groups for the foreseeable future. This is a lifelong journey, but one that begins with the decision to get help.