Is Suboxone Addictive?
A common criticism of Suboxone treatment is that patients are simply replacing one addictive drug for another. This simplistic reduction misunderstands the goals of treatment.
Is is true that Suboxone and its active ingredient buprenorphine cause dependence with long term use. This means that with prolonged use, the body becomes acclimated to the drug and sudden discontinuation of the drug will result in withdrawal symptoms. Sometimes people distinguish this phenomenon as “physical dependence” to contrast “psychological dependence” which refers to the urge to use a drug to soothe negative emotions, even if the person does not need the physical effects of the drug.
It is true that a person taking Suboxone will become physically dependent on the substance. They will develop a tolerance to its effects and if they stop taking the substance, they will experience withdrawal. If that is the case, are these patients “addicted” to Suboxone?
In truth, the only metric which matters is quality of life. That is why doctors created the diagnosis of “Substance Use Disorder” in order to identify patients who need help for their problematic use of substances, regardless of whether they are physically dependent on the drug or not.
Addiction is the older term to describe problematic substance use. Substance Use Disorder (SUD) is the modern diagnosis used by doctors today. Addiction is still used by both lay persons and professionals, but in this article we will use the scientific term SUD to avoid ambiguity. The criteria for the diagnosis of SUD consists of eleven diagnostic criteria distributed into four major categories:
Substance Use Disorder (SUD) Diagnostic Major Categories
A) Impaired Control Over Substance Use
1) using larger amounts of a substance or using for longer periods of time than intended
2) desire to reduce or cut down use
3) spending large amounts of time obtaining, using, or recovering from effects of substances
4) cravings to use substance
B) Social Impairment Due to Substance Use
5) substance use impairs ability to fulfill major tasks at work, school, or home
6) continued substance use despite social or interpersonal impairment
7) reduction of social, recreational, or occupational activities due to substance use
C) Risky Use of Substances
8) recurrent substance use in dangerous environments
9) persistent use despite knowing that it may worsened physical or psychological health
D) Pharmacologic Factors
10) tolerance (requiring higher levels of substance to have desired effect)
11) withdrawal (sudden discontinuation of substance causes adverse symptoms which are relieved with further drug use)
A person using substances (such as opioid drugs) only has SUD if they have at least two of the eleven criteria from any of the four categories. If they have 2-3 criteria, their SUD is mild. If they have 4-5 criteria, they have moderate SUD. Anyone that meets 6 or more criteria has severe SUD. The severity of a patient’s SUD helps doctors decide how to best treat them and also allows for comparison over time which helps track treatment progress.
Some people may argue that they do not have a SUD because they are not physically dependent on a drug and can stop at any time. However, based on the DSM-V definition of SUD, these people can have a SUD if they display at least two other criteria such as impaired performance at work and cravings. Tolerance and withdrawal symptoms are only two criteria out of eleven and it is possible for a person to suffer from SUD if they exhibit other problematic behavior related to their use of a substance.
Conversely, the DSM-V definition of SUD specifically excludes substances taken as prescribed for treatment of a medical condition. If this was not the case, then by the strict definition, a type II diabetic taking insulin might meet the criteria for “insulin use disorder” because they have tolerance to the substance and experience withdrawal symptoms when it is withheld and improve with insulin administration.
A person who is physically dependent on a substance does not necessarily have a SUD if that substance is prescribed for a legitimate medical purpose and they do not meet any other criteria aside from tolerance and withdrawal. This describes most patients taking Suboxone prescribed by a physician for treatment of opioid use disorder.
While it is possible that a person could abuse Suboxone and meet the criteria for a SUD diagnosis, this does not apply to most patients taking Suboxone under the care of a physician. Therefore it is incorrect to characterize a patient using Suboxone as directed for treatment of SUD as being “addicted” to Suboxone.
Suboxone is FDA approved for the treatment of opioid use disorder and is proven to improve quality of life and reduce the risk of death from opioid use disorder. If you are ready to get treatment for your opioid use disorder, seek care today. Contact NTE Health to schedule an appointment to start your recovery on your terms.
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If you or someone you love is suffering from problematic drug or alcohol addiction use and is seeking treatment, contact the clinic by calling or clicking the “Get Started” button in order to schedule a discovery call and initial evaluation, both of which are free.
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North Tampa Executive Health Clinic is directed by Dr. Jack McGeachy. He provides confidential and comfortable addiction treatments and therapy for opioid and alcohol use disorder. Rather than a rehab or detox, meaning that each patient is cared for one-on-one by a medical doctor, in contrast to other treatment programs. Heed Help? Book your in office appointment in the Tampa office or via video conferencing today.
Helping patients with addictions in Tampa Florida, Temple Terrace, Brandon, Bloomingdale, Carrollwood, Thonotosassa, Town N Country, Lutz, Wesley Chapel, Land O Lakes, St. Pete, Clearwater, Oldsmar, Westchase, Palm Harbor, Tarpon Springs and surrounding areas.
