Methadone vs Suboxone for Narcotic Addiction Treatment

Denali Healthcare uses suboxone for narcotic addiction treatment.  We are frequently asked how this is different from Methadone replacement and why do we use Suboxone.

Understanding The Science

The physical affects of narcotics are related to the pharmacology of the drug.  Opiate receptors exist in the body, like light sockets waiting for a bulb.  When we fill a certain percentage of the available sockets with a narcotic, we get an effect- pain relief, euphoria and altered levels of awareness.

If, for the sake of argument, the average person had 100 receptors, and we gave them some Vicodin and filled 80 of them, we get an effect (obviously these numbers are made up, but the concept is what is important to understand).

The problem is that, over time, if we continue to take the Vicodin, we end up with more receptors.  Say after 2 months instead of 100 receptors, we now have 150.  In order to get the same effect as we had when we took enough Vicodin to fill 80 of them to start with, now we have to take enough to fill 120.  Over time, the number of receptors continue to climb.  After 4 months, perhaps we have 300, and now to get the same effect as we originally had we have to take enough Vicodin to fill 240 of the 300 receptors.  Graphing it shows not a straight line, but a rapidly rising curve.

That is the first problem, we develop tolerance to the Vicodin, and must take more and more to overcome that tolerance and get the effect we desire, be it pain relief or euphoria.  The second problem is that the amount of Vicodin we can physically tolerate taking is unchanging, and eventually we can no longer tolerate the amount of narcotic we need to take to keep up with our increasing tolerance.

Not only does this mean we have unanswered pain, but the empty receptors that remain are screaming to be filled.  These are commonly called ‘cravings’.  So we continue to take the high doses of the narcotic not to deaden the pain or feel mellow, but to quiet the receptors and prevent ourselves from going into withdrawal.  We are trapped and can’t get away without going into withdrawal.

FAQ- Is Suboxone a Narcotic?

Strategies To Break Dependency

The basic picture is now clear, this is what happens with narcotic dependency.  We now turn to strategies to break the dependency.

  1. Cold Turkey

    The first is cold turkey.  We simply stop taking narcotics- more and more receptors empty out and the screams of the empty sockets get louder and louder, we get sicker and sicker and in sort order we fail.  Our bodies, with pain, nausea, anxiety and uncontrolled bowels force us to start taking the narcotics again.

  2. Replacement Therapy (Methadone)

    Strategy number two is to simply start taking a narcotic (methadone) again, fill the receptors and accomplish nothing.

  3. Decreasing Dosage (Suboxone)

    The third way is to take a narcotic, and fill 50% of the receptors. We deal with a little sweating and maybe a little nausea until the number of receptors drifts back down over time until that same dose fills perhaps 75% of the ones that are left. Then we cut back to filling 50% of those and repeat the process.

Suboxone Therapy Works

Suboxone occupies the receptors but doesn’t do much for pain or euphoria.  It allows us to concentrate on getting the total number of receptors down to normal over a period of a few months or a year.  We concentrate on withdrawing a little at a time, no more than we can tolerate, and we don’t get a ‘reward’ for taking the drug- other than we are not punished for NOT taking it.

The number of receptors took months to build up to the level we became tolerant and it will take months for them to drift back to normal.  But the key to the program is to always move forward, one step, one reduction in dose at a time.

The Myths of Suboxone:

Many times posts on the internet about suboxone contain comments about it ‘being worse than methadone’ or that it was somehow more addictive.  These comments make good rumors because they have a grain of truth to promote the negative hype.  Here is the truth to the rumors:

  • Suboxone has a 32 hour half life, compared to methadone (6-8 hr) or Vicodin (2-4 hr)
  • Because of the longer half life, suboxone takes longer to clear from the system and withdrawal lasts longer as a result.  Suboxone addiction is more challenging to treat than vicodin or methadone/heroin.

Given that these are true statements, we can all see how problems can arise with suboxone.  If patients are put on high doses (more than 2 strips per day) and NOT weaned every couple of months, they can become dependent.  That is why we at Denali do not use ‘maintenance’ therapy similar to a methadone clinic.  We do not use suboxone for ‘pain’ in an attempt to get past the 100 patient limit as we see and hear of some clinics doing.

The patients that are complaining about suboxone had problems because of poor prescribing and management by ‘suboxone clinics’ that started them on 3-4 strips a day and kept them there for years, a story we hear all the time.  They were set up to fail by their doctors, and fail they did.  Red flag that patients can look for when evaluating doctors for suboxone include:

  • Using suboxone for ‘pain’.  Suboxone in oral form is a poor pain medication.  At $8 a strip, there are FAR cheaper alternatives to suboxone for pain control.  Suboxone is approved for pain management as an injection, but oral suboxone for pain is ‘off label’ and frequently used to attempt to ‘get around’ the limit of 30 or 100 patients under treatment.
  • Using suboxone for ‘maintenance’ long term.  Suboxone can be used in a similar manner as methadone for narcotic addiction, but it is VERY expense and carries with it a much higher chance of addiction than the ‘weaning’ therapy employed by Denali Healthcare.
  • Using ‘subutex’ instead of suboxone on a routine basis.  Subutex does not have the narcotic antagonist combine with the narcotic that suboxone has.  It has a very high potential for abuse.  At Denali Healthcare the ONLY times we use subutex is for pregnant women and in cases of hospital documented anaphylaxis to suboxone.

Cold Turkey Generally Fails

Cold turkey withdrawal has an 80% failure rate.  Suboxone under tight control with constant weaning has about an 80% success rate.  I wouldn’t venture a guess as to the success rate of methadone. How would you even measure it?  It is simply trading one addiction for another.

 

The Denali Way is goal driven.  We have an objective, and a plan to get you there.  The goal is narcotic free, and that means Suboxone free as well.