The Conversation We Need to Have About Suboxone
By: Zac Clark
I was grateful to see Congress recently remove the need for an X-Waiver to prescribe buprenorphine to treat opioid use disorder – a major win for access – but I was deeply disappointed by the abrasive Ophelia suboxone ad campaign launched touting it as the sole path to recovery.
It’s time to have a more nuanced conversation about Suboxone: the brand name drug that combines buprenorphine and naloxone to manage opioid withdrawal symptoms and reduce cravings. And I believe my experience with the drug – both as an addict and now as CEO of a substance use disorder and mental health organization – can help shed light on the implications of increased access.
I was first introduced to Suboxone in 2010. I was fully dependent on opiates at the time, and my dealer had run out of his supply. As the withdrawals started to settle in, I panicked and asked my dealer if he had any ideas. He sold me two orange pills. Desperate, I threw the medication under my tongue and was amazed at the immediate relief I felt.
For the next 18 months, I would use Suboxone (both from the street and prescribed by an addiction psychiatrist) until I could get my hands on the drugs I was really seeking. I’d go on it for a week or two to stockpile money, so I could buy opiates in larger quantities.
Then I hit rock-bottom – caught stealing money from my Dad to buy drugs – and I entered inpatient treatment. I was diagnosed with an opioid use disorder, and during my first meeting with the staff psychiatrist, he explained to me that he was going to use my old friend Suboxone (well, Subutex to be specific, which removes the naloxone) to help with my withdrawal symptoms. It would keep me safe and comfortable during the toughest days, which would allow me to settle into and focus on my treatment work.
I took it as prescribed and eventually tapered off it. I trusted the doctors and followed their directions, a key element to any treatment plan. I ended up staying in treatment for four months, enough time for my mind to clear and buy into the new life recovery would afford me. By moving into sober living, continuing with therapy, exercising regularly, practicing meditation, and attending 12-step-based recovery meetings, I have proudly been able to maintain my recovery for the last more than 11 years.
I made the decision after treatment to leave my job in corporate America and start a career in behavioral healthcare to help others struggling with substance use. Both in my professional and personal recovery circles, I was surprised by how much of the conversation was dominated by Suboxone. The opinions were strong and varied greatly.
Friends and colleagues claimed those who use Suboxone long-term are “not sober.” Doctors assured me Suboxone was going to change the world forever, the answer to a massive problem. “You cannot treat someone who is dead,” they would say. A 2018 study published in the Annals of Internal Medicine, in fact, found Suboxone decreased opioid overdose death rates by nearly 40%.
The intensity of these conflicting opinions confused me, especially given my lived experience: Suboxone helped me. But there’s an important caveat. Without treatment, Suboxone served primarily as a bridge to tide me over until I could get more opiates. Paired with therapy, community, and treatment, it was an invaluable tool to my recovery.
At Release Recovery – the organization I founded in 2017 – some patients come to us with the expectation that they will taper off of their prescribed Suboxone/Subutex over a long period of time. Others arrive with more severe opioid use disorders and are prescribed it indefinitely. And some, like myself, are prescribed Subutex to detox off of opioids and seek other methods to maintain their recovery. In nearly all cases of diagnosed opioid use disorder, Suboxone is an important part of the treatment plan. I’ve seen the positive outcomes firsthand: Suboxone saves lives, which is why removing barriers to accessing it is worth celebrating.
Still, Ophelia’s “F*ck Rehab” marketing campaign is dangerous. It pushes a narrative that further stigmatizes treatment, disrespects the millions of people who’ve been helped by it, and potentially scares off millions more who could be helped by treatment. Sadly, we know that only 10% of individuals impacted by a substance use disorder receive treatment.
The opioid epidemic is one of the biggest issues facing America today, taking 70,000 lives a year. It’s a challenge that won’t be solved by tearing each other down or clinging to outdated views of treatment. There are many pathways to recovery, including medication assisted treatment. We must lift up and leverage the advances in our field, while also recognizing their limitations. Most of all, we need to support those bravely seeking recovery – however they seek it.
Zac Clark is the founder and CEO of Release Recovery, a full-service substance use disorder and mental health organization based in New York that offers transitional living, case management, interventions, clinical services, and other essential recovery and family support services.