Category Archives: Medication Assisted Treatment

Methadone or Suboxone

addiction-is-treatable-2A common question among those seeking help is whether methadone or suboxone is the best choice for opioid replacement therapy. It reminds me of the age old debate … which is better, Ford or Chevy? Methadone has been used in opioid addiction treatment for about 45 years. Suboxone has been available to the public for 12 years. Each of these medications has been shown, through conclusive research, to be highly effective in eliminating opioid withdrawal. Both methadone and suboxone achieve a similar outcome, but with subtle differences. [view our comparison chart]

When opiate withdrawal symptoms are no longer a daily preoccupation and source of anxiety, individuals are free to invest their energy & time in productive, meaningful activities. Avoiding withdrawal sickness is the single greatest driver of continued opioid use, and often pushes an individual to desperate measures to maintain a supply of opiates so that they will not get sick.

People unfamiliar with addiction sometimes believe that an addicted person “just wants to get high”. To the contrary, most people with a chronic opioid addiction are just trying to get by, to get through the day without becoming sick all over again. Opioid withdrawal sickness is an exhausting roller coaster ride that rarely slows down long enough to allow an individual to escape. Their relief from opioid withdrawal sickness is typically short-lived, and they then begin feeling sick all over again. Quite a vicious cycle.

This is why suboxone (buprenorphine) and methadone are so valuable as a medical treatment for opioid addiction. These synthesized opioid replacement medications have a slow onset, long duration of action. This means that they don’t quickly spike to maximum levels in a person’s bloodstream like heroin. They reach maximum benefit several hours after they are taken. They then remain active in a person’s system for more than 24 hours and consequently keep painful withdrawal symptoms away. With no fear of being sick, a person can finally live their life and refocus their time where it needs to be: work, school, family, home, etc.

Methadone is a full opioid agonist whereas buprenorphine (the active ingredient in suboxone) is a partial opioid agonist. Because suboxone is a partial agonist, it is somewhat less susceptible to causing overdose and is considered easier to taper off of as individuals lower their daily dosage. As a result of methadone being a full opioid agonist, it is typically more effective with severe, long-term opioid addictions. Suboxone has a peak benefit at 24-32 mg per day whereby higher dosages than this will not produce additional withdrawal relief. However, methadone has no such “ceiling effect” and much higher dosages can be utilized as needed to eliminate a patient’s opioid withdrawal.

Family Support of Methadone Treatment

methadone-treatmentWhen patients enter treatment for opioid addiction, their families are usually relieved yet apprehensive. They may have seen previous recovery efforts not be sustained and their loved one return to active substance use. So, families often learn to be cautiously hopeful.

With methadone treatment, there is a new component in the recovery process with the addition of medication assistance. Whether it’s methadone or suboxone, families become curious as to how their loved one will handle this new medication. As most readers know, there is considerable misinformation and misunderstanding about what methadone can accomplish. This leads a patient’s family supports to sometimes have a wary attitude toward methadone or suboxone.

I would like to share two stories that illustrate how family attitudes can shift. The first patient we’ll call Mary to maintain her anonymity. Mary was a local realtor who had developed an opioid dependence. She had been able to conceal her addiction from her parents, but finally reached a point where it became evident that something was seriously wrong. She told her parents that she was entering “treatment” and would be attending counseling. They supported this decision, but were unaware that Mary’s treatment would include opioid replacement therapy.

Mary had one relapse early in treatment, but made the necessary adjustment and remained drug free for the next 12 months. Methadone worked extremely well for her eliminating her opioid withdrawal and erasing her fear of being sick. Through counseling, her coping improved and her perspective on living a full life returned. She blossomed before everyone’s eyes with improved mood and energy, mental focus, and a renewed spirit. She interviewed with several real estate agencies and was hired by a prominent national realty company. Mary was both excited and grateful.

After this first year, she approached our staff and asked for assistance in telling her parents that she was in “methadone” treatment. She was concerned that they may not understand how important a role it had played in her success and she wanted some back-up from professionals who could answer all her parents’ questions. Mary was also considering a switch from methadone to suboxone with the intention of tapering down off suboxone over several months.

Her parents came to the treatment center and met with Mary, myself, and our nurse. Mary reviewed her progress with her mom and dad and then told them that she had been receiving methadone each day as part of her treatment. She explained how it had assisted her and then asked staff to help elaborate. Her parents listened as we discussed how methadone was an approved medication and had been successful for many years in helping opioid addicted people change their lives. Mary’s mother responded saying “We knew something was working for her. We are so grateful she found you. We have no problem with the methadone and we will support Mary with this.” We went on to discuss her thoughts on transitioning to suboxone and how this might be accomplished. Her parents talked that day about the huge change they had seen in their daughter since coming into treatment and how much it meant to them to see her happy again and getting well.

After the meeting, Mary literally beamed with relief that her parents had been understanding and so supportive. Within the next month, she switched to suboxone and began tapering down over the next four months eventually becoming medication free. Methadone and counseling became the roadmap to safety and sobriety for Mary. It also stabilized her to the point that her skills and abilities as a real estate professional could again be used to build a new future for herself by generating significant income.

The next case example is about a woman we’ll call Sarah. Sarah came to our agency seeking methadone treatment after several years of heroin addiction that had recently worsened. Amazingly, she was still working full-time although she was exhausted and emotionally depressed. She began treatment and within three months barely resembled the person that had been admitted to our program. She gained weight. The light returned to her eyes and her smile. Her mental clarity improved dramatically, and both staff and patients remarked how her personality had surfaced. Sarah had been fatigued and depressed for so long that it was as if she was buried inside herself covered by layers of pain, and tired from the battle of fighting her addiction.

We watched her come back to the person she truly was. We discovered that Sarah was actually a human dynamo and a very capable person who had been struggling under the massive weight of a chronic heroin addiction. As she progressed through treatment, she met many milestones of success. In due time, she informed her parents that she had been receiving methadone and explained to them how helpful the medication had been. I had a phone conversation with Sarah’s mom who lived in another part of the state. She explained that she did not know much about methadone, but was very appreciative for what we had done for her daughter. As a great job opportunity had surfaced in the hometown of Sarah’s parents, she relocated to their town and transferred her treatment to a clinic there.

Two months after Sarah moved, we received a huge fruit basket in our office from her parents thanking us for being a support to her and informing us that Sarah was doing beautifully.

These are true stories and examples of methadone’s beneficial role in recovery as well as illustrating that family fear can be replaced by understanding & family support. These examples show a stark contrast between what a person looks and feels like when they first arrive vs. how far one can go once they become stable on methadone and moving forward on the path of recovery.

> Search Methadone Clinics By State

Suboxone Facilitates Safety and Recovery

suboxone-doctorSuboxone is a leading medication in the treatment of opioid dependence and has been available since 2002 when the FDA approved Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride).

Suboxone tablets have since been replaced by the thin sublingual suboxone film that is also dissolved under the tongue. While methadone has been highly successful for several decades, suboxone has expanded the range of options for those suffering with opioid withdrawal.

Fighting off opioid withdrawal is at the core of opioid addiction and is chiefly responsible for the stress that addicted individuals feel as they try to function normally each day. Suboxone not only helps patients eliminate opioid withdrawal sickness and associated cravings, but it also brings the opportunity to function again as an employee, a parent, or a spouse.

Many patients report not only feeling relief from the welcomed absence of withdrawal sickness, but recapturing the focus necessary to make strides in other important areas of their lives. This illustrates the profound advantage that some patients derive from opioid replacement therapy.

There are an increasing number of physicians now providing opioid addiction treatment services and utilizing suboxone due to its effectiveness and patient convenience. Additionally, some traditional methadone clinics are adopting buprenorphine (suboxone) as a second option for their patients.

Suboxone therapy ultimately increases safety for opioid addicted patients since they are less prone to secure opiates illicitly. It may also save them from having to rely on heroin or other potentially high-risk medications (like benzodiazepines) in order to “get by”. Patients are better able to cut ties with those that have provided them opiates illicitly and this is extremely helpful to the recovery process.

If choosing suboxone, it is important that individuals go the proper route and enroll in therapy with a buprenorphine-approved physician. This cannot be overstated. A doctor specializing in the administration of buprenorphine (suboxone) can provide the necessary assistance to make suboxone therapy effective and to help patients taper down successfully should they decide to discontinue suboxone therapy.

For more on this topic, visit our Suboxone Doctors information page.

You can also perform a comprehensive search of Suboxone Doctors by clicking view the complete list on our Search Clinics By State page.

Methadone Maintenance For Opioid Treatment

methadone-and-opioid-treatmentOpioid Treatment is a category that includes several different interventions or approaches relating to opioid use disorders. People sometimes mistake opioid treatment for “opioid detox” when they are technically two different processes.

Opioid detox refers to the process of helping an opioid addicted individual discontinue their use of opioids and be medically monitored as the body withdraws from them. In a supervised setting, a person is typically assisted through a short-term opioid detox (3-10 days) by the administration of various medications used to manage withdrawal symptoms like clonidine (to guard against high blood pressure), vistaril (to reduce nausea and anxiety), and even buprenorphine (to minimize the severity of the opioid withdrawal process).

There are also variations on an opioid detox referred to as a taper. A taper often occurs on an outpatient basis and involves a more gradual reduction in dosage of either methadone or buprenorphine (suboxone) over time. This taper may take as long as 90 days and allows the individual to adjust more comfortably due to the slower, milder reduction in dosage that occurs over a coarse of weeks or months.

Maintenance is the term which refers to maintaining an individual for a significant period of time on either methadone or buprenorphine (suboxone) to allow for stabilization on the opioid replacement medication. Since opioid addiction introduces dramatic brain chemistry changes in conjunction with strong physical dependency and cravings for opiates, many people find that they need a substantial period of stabilization on methadone in order to have a realistic chance at building a personal recovery. Numerous individuals have decided that they will utilize methadone for only a few weeks with the intention of tapering off of it very quickly. This strategy is prone to failure and tends to end in dramatic relapses back to heroin and other illicit opioids.

Methadone maintenance for most opioid-addicted persons involves receiving methadone for a year or more. This length of time dramatically raises the probability of successful physical stabilization and necessary thinking, behavior, and lifestyle changes which lead to long-term drug abstinence and sustained, productive living. Put very simply, when people attempt to rush through the process of stabilization & recovery, they sabotage their chance of experiencing real success. For that reason, maintenance is a therapeutic process which should be regarded as a one year commitment or longer, and tapering off of methadone or buprenorphine should not be rushed. Bear in mind that not all individual situations are exactly the same and there are unique exceptions.

There are many different factors that play into how long a person needs to remain on methadone or suboxone maintenance. This is highly individualized depending on the length and severity of one’s opioid abuse history, one’s present medical status and general state of health, the availability of social & emotional supports, and the presence of any co-occurring psychiatric disorders like depression.

There is considerable misinformation about methadone tapering and a bit of fear-mongering that often occurs around the topic. People that generally taper successfully off of methadone or suboxone are individuals that have invested time in counseling and personal recovery growth, and who have developed a good working relationship with their doctor or treatment staff. These individuals approach tapering as a gradual goal and are allowed to halt or slow down their taper as needed. This allows their body time to adapt to the somewhat lower dosage. It also allows them to proceed slowly and carefully such that any anxiety or fears can be successfully identified and managed.

Choosing The Right Direction: Detox – Methadone – Suboxone

CRC Health Group to Receive $495,000

feature4bAn article in Maine’s Bangor Daily News outlines a case recently decided in which the Town of Warren, Maine was found to have adopted an ordinance that was ruled discriminatory and in violation of the Americans With Disabilities Act.

CRC Health Group had been fighting to open a methadone clinic in Warren to provide treatment services to those struggling with the disease of opioid addiction. However, the town of Warren had opposed this initiative for several years. U.S. District Court Magistrate Judge John Nivison approved an agreement in which the town of Warren will pay $495,000 to CRC Health Group to drop its lawsuit.

CRC offers a variety of behavioral health treatment programs around the country and has a special focus in opioid addiction services utilizing medication-assisted treatment like methadone and buprenorphine.

Maine has a substantial opiate addiction problem and is in need of more resources for those individuals stuck in the vicious cycle of opiate addiction and withdrawal.

Historically, there have been other similar cases in which town planning boards attempted to oppose the construction of a local methadone clinic. This is commonly referred to as NIMBY (Not In My Back Yard). However, denying people ready access to a needed medical service appears to come with serious financial repercussions.

For More: A Message To The Community

Advocating For Addiction Treatment

recovery-journeyTreatment for addiction is one path which may be taken to help rebuild a person’s life when alcohol or drugs have become a problem. There is a compelling documentary recovery film recently out entitled The Anonymous People. The film is an interesting retrospective on the recovery movement in the United States and how it evolved, beginning with AA in the 1930′s, until present day.

A special focus in the film is highlighting the message that people do recover from addiction, that there is a solution to this disease – and that solution is the decision to choose recovery. Recovery is a process that changes lives and takes individuals to a new destination in their life. Recovery is the journey that saves & enhances lives. To that end, recovery from addiction is of incomparable value.

In life, bad choices are made every day. As human beings, we learn to make better choices – often through the mistakes we endure as we travel through life one day at a time.

In reviewing the variety of recovery “paths”, there exist several routes by which an addicted person can find hope and direction in learning to live a drug free life. Some find their answers in church-based recovery programs. Churches recognize the reality of substance addictions and many have developed their own spiritual programs for dealing with drug addiction and offering hope for a better future.

12 Step Programs have been in widespread use for a long time and many lost in addiction have found the support, fellowship, and help needed in the rooms of AA, NA and other 12 step based programs. Some people in recovery from opioid addiction may find that their decision to take methadone or buprenorphine (suboxone) is not well-received in 12 step programs. This can make it difficult to feel accepted or supported there. However, not all NA or AA meetings are the same. NA and AA have themselves evolved over time, and some NA and AA members welcome all people suffering from addiction regardless of their drug of choice.

Addiction treatment is yet another path that leads toward recovery and the possibility of positive change. Treatment, like 12 step meetings, can vary considerably from one program to the next. Opioid treatment in particular often uses medication assistance as an additional tool to help people in their recovery journey. While medication assistance is scientifically proven to be beneficial to opioid addicted persons, it has endured some controversy through the years as those on the outside looking in chose judgment & criticism over compassion and understanding. Methadone and suboxone are proven, effective tools for alleviating the suffering that comes from opioid withdrawal.

In The Anonymous People documentary, there is a strong message that addicted people deserve love & support. Addicted people are from all walks of life. If treatment works, then advocating and supporting treatment is just and worthwhile. The film makes a persuasive argument that better advocacy is needed for the funding of addiction treatment services across the country. Addiction treatment advocacy has not been as effective as advocacy for other critical health conditions like HIV/AIDS or cancer.

As more families struggle with addiction and more voices are ultimately heard in their plea for treatment funding & support, we will hopefully see a shift in society whereby recovery is embraced as the answer to addiction.