Suboxone – Is A Storm Looming?

When I started Withdrawal Ease in 2009, we received a LOT of repeat orders for Withdrawal-Ease and I honestly couldn’t figure out why. I didn’t really count on many repeat orders because there are more than enough capsules in one order of Withdrawal Ease to cover a normal 10-15 day opiate withdrawal and detox period. And then I figured out what was going on…Suboxone. Over a period of a few weeks I discovered that many of my repeat customers were patients on Suboxone wrestling with Suboxone dependency…or rather, ex-Suboxone patients. Suboxone dependency has become a really serious unintended consequence for those that were looking for a way out of a life dominated by opiates.

For many, Suboxone withdrawal symptoms are similar to opiate withdrawals yet, they tend to last longer. Due to its long half-life, Suboxone withdrawal symptoms can last for weeks; which of course makes it that much more difficult to quit. This is especially true for patients who have been on Suboxone for extended period of time (i.e. years). Long-term Suboxone patients insist that the detox from Suboxone (even from as low as .2 mgs) is monumentally difficult due to the severity of the symptoms and duration of post acute withdrawal symptoms.

I’ve always been a proponent of Suboxone for people who have had treatment resistant heroin addictions with multiple relapses and unsuccessful stints in rehabs. For these “hard-core” addicts, Suboxone can literally be the difference between life and death. It reduces the cravings and can be managed on an out-patient basis.

But I have to say that over the past 7 years I’ve seen SO MANY Suboxone patients visiting the site and also contacting me for advice on how to detox from suboxone. If I had to guess, I would say that 50% of the visitors to this site are here because of Suboxone dependency.

In fact, I conducted Google search queries (i.e. how many people Google a certain term) for “opiate withdrawal” and for “suboxone withdrawal”…the results were pretty eye-opening in my opinion. “Suboxone withdrawal” averages 6,500 searches per month whereas “opiate withdrawal” averages roughly 11,000 searches per month. It bears repeating that Suboxone was developed and marketed as a miracle cure for opiate withdrawal and dependency. Is the cure now quickly becoming worse than the disease?

Unfortunately, not all doctors give their patients the full story. People need to understand that Suboxone is not a simple cure for opiate dependency or withdrawal; it is an alternative for full agonist opiates. It’s powerful too. Even the FDA’s own studies concluded that Suboxone by volume is 20 times more powerful than morphine!

I’m not particularly concerned for those that take Sub (Do you mind if I use the slang term? S-U-B is soooo much easier than S-U-B-O-X-O-N-E) for 2-3 months or so and then taper off. I’m more concerned for those that stay on it for years and then have a very difficult time getting off of it. As I mentioned, some folks can have a Really hard time.

If I were a cynic (and I am), I would say that there are some pharmaceutical manufacturers out there who were not very forthcoming about long-term use of Suboxone. Eh hem… Reckitt Benckiser Pharmaceuticals? I’m not putting this on the doctors that prescribe it because they can only rely on the data that is provided to them from long-term randomized clinical trials conducted and then approved by the FDA. [editors note: since this blog post was first written in 2009, a lot of controversy has swirled around this topic. Doctors who prescribe it now know about the perils of long-term use and are culpable]

For all intents and purposes, Suboxone is still a relatively new drug and the long-term consequences have not yet manifested themselves fully; that will take a while. But based on my experience with the many people that come to this site who are looking for help to get off Suboxone, I’m guessing that there’s something Rotten in Denmark folks. It’s an extremely expensive drug and if you are on it for years and years, you or your insurance company is spending tens of thousands of dollars on Suboxone! That’s a lot of ongoing revenue for big pharma. [Editor’s note: this post was originally written in 2009. Since that time Reckitt Benckiser’s patent rights have expired and they sold off their Suboxone division. There are a couple different companies that market suboxone now]

Here’s essentially what I have noticed with Suboxone patients. Those that have been on it for a year or longer are usually able to taper down to about 1-2mg’s per day without much discomfort but once they try and “jump” to zero, they have a really hard time. This is curious to me because I often hear that reducing the dose from 16 down all the way to 2mg can be relatively easy and without acute withdrawal symptoms. Why is this so easy for people to do? Going from 160mg of hydrocodone to 10mg per day will send anyone into full-blown goose-flesh withdrawals. I just wonder if the ceiling for Suboxone is lower than what most people previously thought. But that’s for another time and another blog.

When people make the jump (opiate detox lingo for “stop taking the drug”) they often experience some acute withdrawal symptoms 2-3 weeks or so and then move on to the next phase of detox which is called PAWS (Post Acute Withdrawal Syndrome). PAWS is basically an extended withdrawal process that some people struggle with for months. The people that I have encountered with PAWS seem to have a lot of psychological symptoms such as ongoing lethargy and depression but there’s no doubt, it’s opiate withdrawal. Of course I have to mention again that Suboxone has a much longer half-life than hydrocodone so it makes sense that it would have an extended withdrawal period.

With that said, I’m really surprised at the acuity and the duration of the symptoms that people go through after an extended course of Suboxone. It’s a bit alarming. And it must be downright scary for those people who thought that they were getting clean and sober by using Suboxone only to find out they they are sort of stuck with a worse “cellmate” than their original drug of choice. I suppose I should be thrilled that I’m getting a lot of repeat customers and that Withdrawal-Ease seems to be very effective for PAWS. But in this case, “customer loyalty” is not a badge of honor.

Again, I know that Suboxone has helped a lot of people but I think some serious research needs to be done on the long-term effects of prolonged Suboxone therapy and its relationship to PAWS. I’m not really a conspiracy theorist but in many ways I smell a rat when I see all of these people suffering from a treatment that was supposed to help them! I think this needs to be studied a bit more extensively. From where I sit, I see a definite relationship between extended use of Sub and Post Acute Withdrawal Syndrome and I bet there are thousands of lawyers just licking their chops to have a big class action law suit against a large pharmaceutical company. Lets all hope it doesn’t come to that because we all know who wins in the end…the lawyers.

I still think Sub may be a good option for some people but a lot of my repeat customers may strongly disagree. We’ll have to wait and see.

-George

Updated 9/15

Are You Struggling With Suboxone Withdrawal or P.A.W.S.? Click Here To Read How To Detox From Suboxone