Is Suboxone 'Slowly Killing You? (psst– no, it isn't)

Today someone found my site while searching for the ‘suboxone slowing killing you’ keywords.  Curious, I clicked on the keywords and was taken to a site called ‘steady health’ where some people were bashing Suboxone.  In most parts of the country Suboxone providers vastly outnumber Suboxone patients and opiate addicts looking for Suboxone so I suppose it is a good thing to reduce the number of patients seeking Suboxone– besides, it is always BEST when the patient is truly desperate, providing of course that the patient survives long enough to make it to treatment.

“

Suboxone is a long-term medication for the most part. It does not cure addiction; it puts addiction into remission. Speaking as an opiate addict, that is a wonderful thing; the old model of treatment was that an addict had to lose everything, and then if he survived, go into treatment– which most people don’t finish. After treatment of 90 days (studies show 90 to be the ‘magic number’; shorter treatments are not worth much) patients go to meetings for life. Stop meetings and relapse follows… in a year, two years, ten years (mine was eight years)– but it always comes back. I wish that was not the case, but it is– and anyone who investigates the situation will find that out for him/herself. Why the late relapse? Because the brain remembers opiates just like it remembers other things. If you return to you childhood home after forty years, you will still know which room is the bathroom, even if the door is closed. Same thing.
Suboxone will stop cravings and make a person feel normal; the constant obsession for opiates is relieved, allowing the mind to return to thinking about other things. The shame and guilt fade over time, allowing the addict to put down the mask and fake self and instead share intimacy with others. Is it perfect? No. But is it better than what we had, and better than using? ABSOLUTLELY!
My gripe is with people who write about things that they do not know about… one writer called ‘hammerhead’ posted info on the site information that is fantasy. Some of it is just plain incorrect on anatomical and physiological grounds; some of it is silly conjecture, and some of it is opinion about things where opinion is not necessary because facts are known. A person standing outside doesn’t have to guess about the current weather. Hammerhead is in the basement with the radio playing, telling the people outside whether the sun is shining (darn that’s a good analogy!). Here is a sample– regarding withdrawal– with my comments interspersed:
This is not the case with suboxone. Buprenorphine enters your body and quickly binds very strongly to the mu opioid receptors in the brain. It stays in your body for a long time having a half-life of 17 hours because it’s not floating around freely in the bloodstream – it stays superglued to your receptors – so strongly that not even naloxone can knock it off – and very slowly releases from the receptors and is eliminated. It has a very mild action on the receptor while it’s there.
The actual half-life is 36 hours, but that is a good thing, not a bad thing!  That allows a person to take a single dose of Suboxone per day in the morning, allowing the obsession with opiates to fade away.  This would not be possible with a drug that had to be taken several times per day.  The other inaccuracy is the concept of drugs ‘binding’ to receptors.  The field of receptor kinetics is a vast area on its own, but the drugs that bind (the term is ‘ligands’) don’t really ‘stick’ to the receptor– they are in a constant back-and-forth of binding and unbinding, with ‘association kinetics’ for binding and ‘dissociation kinetics’ for letting go.  ALL opiates, AND naloxone, will compete at the receptor with buprenorphine;  when given in combination they all do some binding, but the one with the greatest ‘affinity’ (which is essentially the ratio between association and dissociation kinetics) will have the predominant clinical effect.
What this means is that Suboxone leaves the receptors quite fully charged with electrical energy and as it slowly leaves these receptors send out very strong distress signals. Over 3 to 5 days the Suboxone will slowly get out of your body and as every little bit of it leaves it leaves behind a receptor sending out a powerful distress signal.
Poppycock!  ‘Receptors’ do not get ‘charged with electrical energy’.  Activation of opiate receptors turns on a series of enzymes inside the neuron;  these enzymes produce chemicals called ‘second messengers’– chemicals like cAMP (cyclic-AMP) or cGMP.  Receptor do not send out ‘distress signals’.  I presume he is talking about ‘withdrawal’… what happens is that the neurons fire more often in response to the increase in cAMP inside of them;  remove the agonist and the receptors leading to cAMP production and the neurons fire less;  that means that those neurons are no longer doing ‘what they do’– no longer triggering brain regions into euphoria, no longer turning off pain input at the spinal cord, etc.
Ordinary agonists such as morphine, oxycodone, hydromorphone, hydrocodone will agonize the receptor – producing a buzz – and when it leaves the receptor there’s not a lot of energy there – so the receptor sends out a mild distress signal. But – these agonists have half-lives of anywhere from 35 minutes for Fentanyl to 2 1/2 hours for oxycodone up to about 4 hours or so for morphine. That means they leave the receptors quickly.
This is so mixed up I don’t know how to correct it.  Half-life is not a function of the receptor– it is a function of binding to proteins in the bloodstream so that the drug doesn’t diffuse into liver cells where it would be destroyed;  it is a function of the chemical structure of the drug and whether the body can break it down easily;  it is a function of solubility in fat– particularly with fentanyl– which in high doses soaks into fat stores in the body where it is inaccessible to breakdown by the liver.  Fentanyl was my ‘drug of choice’, as I was an anesthesiologist (this pathetic junkie was/is me)– fentanyl in low doses leaves the brain by redistributing into fatty parts of the body, but in high doses those areas become filled and the only way for fentanyl to leave is by metabolism by the liver, which is much slower.  So the ‘half life’ for short IV doses of fentanyl is 20 minutes, but for large doses the half life is 2-3 days!.
So what we’re used to is having a lot of receptors being left by our drug of choice quickly and those receptors sending out weak distress signals. It doesn’t take more than a day for full withdrawals to hit.
But with Suboxone we get a small number of receptors being left and those receptors sending out strong distress signals and it takes 3 to 5 days for all of it to go away.
No.  The delay in withdrawal with Suboxone (buprenorphine) is because of the ceiling effect.  The max stimulation occurs at a certain level of buprenorphine in the body– let’s say ’10’.  But a person is on a dose that is higher, and causes a level of ’50’.  After stopping Suboxone the level in the body drops constantly from 50, reaching ’10’ in three days.  While it is above 10, the receptor is still maximally stimulated and so there is no withdrawal– until the level gets below 10.  That is why a person tapering Suboxone will notice no withdrawal until they get below a daily dose of 4 mg or so.
I’ve found Suboxone withdrawals to be much worse than opiates. It takes 2 or 3 days for the full withdrawals to hit and they last over a week – almost 2. It’s like withdrawals in slow motion. I hate it.
Many detox and treatment centers now use Suboxone as a ‘step-down’ agent to make withdrawal more tolerable.  Withdrawal symptoms are affected by patient expectation and by prior experiences with withdrawal… I had a patient once stop Suboxone between appointments.  I asked her with surprise, ‘didn’t you get sick?!’  She replied ‘No…. was I supposed to?’  She said that in retrospect she had been tired lately.  On the other hand a person who reads some misleading information on the web who then stops Suboxone will sit in misery, picturing all of these ‘distress signals’ flying through their body, expecting the worst…   THAT person will likely feel pretty miserable!
We also have animal studies which are more helpful (since rats don’t read the internet).  They clearly show that buprenorphine has a milder and shorter withdrawal than opiate agonists, when measured objectively by appetite, sleeping, aggressive behavior, etc.
Like I said, Suboxone isn’t perfect.  But I have known several people who are now dead from opiate dependence, and if they had found Suboxone they would likely be alive.  There are enough reasons for an addict to remain in denial and stay sick– there is no need to add reasons that just aren’t true!!
SuboxDoc
Suboxone Talk Zone
Suboxone Information
Suboxone Forum