For many individuals, suboxone (buprenorphine plus naloxone) is an effective first-option for opioid addiction treatment, but it does not work for all patients. This treatment modality is very similar to methadone treatment in that it involves the administration of a legal opioid (buprenorphine) to stabilize the biochemistry of the opioid-dependent person. The active ingredient, buprenorphine, is similar to methadone in that it is an opioid pharmaceutical with properties that make it effective for treating opioid addiction.
Suboxone treatment is most typically provided via physician office practices and in OTPs, such as the clinics BHG operates. We offer suboxone in some of our facilities for patients who may want to start with that option. In areas where we do not provide suboxone as an adjunct therapy, we work with non-OTP suboxone providers (who are limited to working only with suboxone in an office-based setting) on a referral basis, as we believe suboxone can be an appropriate first step for less severe forms of opioid addiction.
Importantly, our OTPs are much more highly regulated than the typical non-OTP suboxone practice. This is important, since suboxone – like any opioid – carries with it a potential for diversion, misuse, and overdose. Contrary to some claims, many communities have experienced problems with illicit or “street” forms of suboxone. Our OTPs are also much more comprehensive in terms of the services that are required for patients. Our patients are required to participate in behavioral therapy (counseling) as part of their treatment plan. This is not the case with most suboxone-only providers, who typically offer no such option.
Thus, suboxone can be effective for less serious addictions, but it tends to be less effective as a treatment for persons with more serious and long-term opioid addictions, and it does not work for many patients regardless of their addiction severity. As various authorities and government agencies have noted, “buprenorphine is unlikely to be as effective or more effective than optimal-dose methadone, and therefore may not be the treatment of choice for patients with higher levels of physical dependence on opioids.” (U.S. Food and Drug Administration. FDA Talk Paper: Subutex and Suboxone approved to treat opiate dependence.) These studies further conclude that without the close monitoring, psychosocial therapy, and other rehabilitative services provided by OTP clinics, the long-term benefits of buprenorphine/suboxone for many patients must be cautiously considered. We have consistently found that a treatment program must treat both the chemical dependency and the behavioral issues to give persons struggling with addiction the optimal chance for success.
In the end, both methadone and suboxone are highly regarded as effective tools for opioid addiction, and to suggest anything less is to create a false choice between the two that only undermines the needs of patients.