The misery of withdrawal: It’s what fuels opioid addiction and what scares folks about taking Suboxone, the medication proven to dramatically increase the odds of recovery.
Suboxone does a remarkable job of suppressing opioid cravings, as well as the nausea, vomiting, chills, body aches, and anxiety that make withdrawal so unbearable. But there’s a catch. You have to withstand 12 to 24 hours of those very symptoms before you can safely take Suboxone. If taken too soon, the medication can propel you into immediate and far more severe withdrawal.
“I said, ‘No way — I’m not going to be sick for 24 hours,’” recalls Amber, 37, whose addiction to opioid pills consumed her entire thrift-store paycheck and drove her to steal. “I didn’t believe it was going to work, anyway.”
But Amber’s husband and mom pleaded with her to try. And Amber thought of her brother, who’d died of a heroin overdose.
“I said, OK, what’s 24 hours of misery to maybe get your whole life back? That’s what I had to put in my head: It’s only 24 hours.”
It was by no means an easy 24 hours.
“It feels like you’ve been beaten from head to toe with a bat,” says Amber, a patient at Ideal Option. “The lightest touch is painful. You’re throwing up, and you have diarrhea and cramps in your legs. Lights hurt your eyes. You’re feeling hot and cold and sweating, and you can’t get comfortable.”
She passed the time in bed, her husband by her side. “I was being very, very mean, yelling a lot, crying a lot, throwing stuff. I just laid there and cried. I was like: Get me to the pharmacy NOW.”
“You made it another minute,” her husband would say.
Amber endured the 24 hours, and they drove to the pharmacy. She placed the Suboxone film under her tongue before they’d even exited the drive-through.
“By the time we got home, I was back to feeling like myself,” Amber says. “I didn’t even want to use. I was shocked.”
A year and a half later, Amber has tapered to a maintenance dose of Suboxone. She still works at the thrift store, opening donation bags full of clothes, housewares, and other items that are often littered with drug paraphernalia.
“I find needles and bottles of Vicodin and Percocet,” she says. “In the past, I was tempted to slip them into my pocket, but now it doesn’t even faze me.”
Amber, who’d been addicted to opioids for over a decade and had once lived on the streets, still marvels at how far she has come with the help of Suboxone. “I was a lost cause,” she says. “If I can do it, anybody can.”
“Suboxone Buys You Time to Think”
When you’re addicted to opioids, your brain demands that its opioid receptors — microscopic docking stations on the surfaces of your nerve cells — be continually filled with opioids. It’s a non-negotiable demand. If the receptors are left “wide open and screaming,” you’ll be thrust into agonizing withdrawal, explains Shawna Laursen, M.D., medical director at Ideal Option. So, you use to avoid it.
Suboxone shuts down this cycle. The medication contains buprenorphine, a weakened form of opioid that performs a remarkable trick: filling up those screaming receptors without producing a high.
The medication binds to those receptors so tightly, in fact, that no other opioid — oxycodone, hydrocodone, heroin — can slip in. If you shoot heroin while on the right dose of Suboxone, you’ll feel nothing.
(The exception is fentanyl, which can overpower Suboxone. For this reason, patients addicted to fentanyl may need to recover using methadone, a riskier medication that requires more stringent medical supervision.)
Many patients, like Amber, go directly from opioid addiction to Suboxone, with just the short withdrawal period in between. Other patients start on Suboxone after weeks or months of sobriety and find the medication makes life monumentally easier.
Jenna, a long-time IV heroin and meth user, was able to “white knuckle it” without opioids through nearly six months in jail, battling cravings and temptation every day.
“Meth and heroin were going around the cell block,” recalls Jenna, 34. “It was extremely hard. I made friends with the old ladies playing pinochle.”
Jenna knew that on the outside, she wasn’t likely to hang out with the pinochle crowd. To maintain her recovery, she started on Suboxone as soon as she was released.
“Without it, I might have been tempted to seek out my old friends,” says Jenna. “Suboxone buys you time to think. It’s like an armor. Now, I couldn’t get high even if I wanted to. That demon is battled.”
On Suboxone, Jenna says, she stopped having nightmares about being dropped off in the part of town where she used to use drugs. “I started sleeping really well, which gave me more energy during the day. Now I feel more focused.”
Jenna also feels worthy of recovery and more confident she can rebound from the addiction that caused her to lose custody of her two girls.
“When you’re sitting in jail, you have this mental static, this constant white noise that, if you listen to it, gives you all the reasons you suck and might as well be getting high,” says Jenna, now living with her parents and daughters. “Suboxone takes away that static. Every day I get up and take my Suboxone, and I have clarity of mind.”
Suboxone: A Defense Against Relapse
Without medication, virtually all people with opioid use disorder [OUD] will relapse, no matter how much determination, emotional support, or mental-health counseling they have. OUD rewires the brain to such an extent that cravings never fully vanish. The mere sight of a needle or vibe of the old neighborhood can trigger a relapse.
“The evidence says 95% can’t get off opioids without medication,” says Jeff Allgaier, M.D., Ideal Option’s chief medical officer.
Suboxone lowers the risk of relapse by about half. Still, medication offers no guarantee, which is why medical expertise, supervision, and individualized support are critical for patients on Suboxone.
If you’re on too low a dose of the medication, you may be more susceptible to relapse, especially if you find yourself in a tempting environment.
That’s what happened to Shante, an Ideal Option patient in Washington. After a 10-year addiction to heroin and cocaine, Shante joined an intensive outpatient program that included a Suboxone prescription. She felt solidly in recovery and tapered to an extremely low dose, hoping to get off the medication completely.
But when she went home to Louisiana for a visit, she fell in with her old crowd and relapsed on heroin and cocaine.
“It just happened really quickly,” recalls Shante, who had enrolled in college. “But on the third day, I realized I didn’t want this life. I didn’t want to lose my daughter and everything I had accomplished.”
She called her sponsor for support, forgave herself for the slip-up, and left town right away. Upon returning to Washington, she enrolled in a Suboxone program with Ideal Option, where she was prescribed a higher dose.
“I needed help with the cravings.” She says. “I had to get myself back to a position where I could think clearly.”
The clarity she got from restarting Suboxone helped her face reality: She would never visit her old friends again or even connect with them on Facebook.
“When you’re in addiction and on the streets, those people become your family and friends, but the bonds aren’t healthy,” Shante says. “It was a façade. Now I know I cannot be around those people.”
She’s now studying full-time to become a substance abuse counselor and knows the difference between going to school with and without the help of Suboxone.
“Before I ever started on Suboxone, I would use my homework and school to take my mind off my battles with myself. Mentally my brain was saying, ‘I still want to get high, but I know this is bad for me.’”
Thanks to her medication, she no longer faces those battles. She also knows it may be many, many years before she stops taking Suboxone — if she ever does.
“If you’ve had an addiction to opioids for many years, you are likely to be on Suboxone indefinitely,” says Dr. Allgaier. “But there’s a big difference between dependence and addiction. It’s like taking insulin for diabetes: Patients are dependent on insulin to live but they are not addicted to it in a clinical sense.”
As a substance abuse counselor in training, Shante knows the difference and is at peace with taking Suboxone.
“Every time I think about my life where I am now, one year away from a bachelor’s degree, I feel like I want to cry,” she says. “I didn’t see any of this in addiction.”