Addiction Treatment: Is Suboxone the gold standard?

By Lucas Bennett, Evan Massey MD, Charles Wilbert APRN-CNP, Henry Fuqua CADC

Dr. Evan Massey discusses the impact of narcotics on brain function, highlighting mechanisms on a whiteboard.

Deeper Healing Through Abstinence-Based Models

Abstinence-based models of addiction treatment encourage a deeper, long-term healing process, making them the better option for many people. These models prioritize psychological and behavioral changes through therapy, support groups, and lifestyle modifications, fostering personal growth and sustainable recovery. They advocate for complete freedom from all substances, aligning with the philosophy that true recovery involves transforming the entire lifestyle, not just stopping drug use. This approach not only addresses the immediate issues of addiction but also encourages the development of new coping mechanisms, which are vital for long-term sobriety and overall well-being. Choosing abstinence-based treatment over Suboxone treatment for addiction offers a safer and more comprehensive treatment approach, focusing on completely avoiding the use of narcotics, by addressing the root causes of addiction.

The Historical Legacy of Alcoholics Anonymous

Alcoholics Anonymous, founded in 1935 (Alcoholics Anonymous), gave birth to a method of treatment for alcoholism which was later adapted into different formats to treat other substance use disorders or “SUD.” This was the gold standard treatment prior to the introduction of methadone in the 1960s (Dole and Nyswander 647) and buprenorphine, the generic for Suboxone, in the 2000s (A Brief History of Suboxone). Suboxone is a medication widely used in the treatment of opioid addiction, consisting of buprenorphine and naloxone. Buprenorphine, an opioid itself, is used to reduce cravings and withdrawal symptoms without delivering the full euphoric effect typical of opioids. Naloxone, an opioid antagonist, blocks the effects of opioids and is claimed to prevent misuse of the medication (Volkow). Suboxone was approved by the FDA in 2002. Today, Suboxone is touted as the gold standard for addiction treatment, while abstinence-based models that have helped many recover have fallen under attack and are even being labeled as discrimination by some.

The Effectiveness of Abstinence Models

Historical evidence suggests the abstinence models, like the one found in Alcoholics Anonymous, have been very effective. For a long time, Alcoholics Anonymous (AA) has impacted millions seeking sobriety. With a presence in approximately 180 nations and a membership exceeding two million, AA has established over 118,000 groups worldwide. This wide-reaching influence underscores the effectiveness and adaptability of AA's approach to recovery, emphasizing peer support, mutual aid, and the Twelve Steps program (Stanford Medicine). This doesn’t include Narcotics Anonymous or patients of treatment centers where the model is adapted. This leads to one major question: if there has been such widespread success, why is another treatment being sought? My opinion is that the metric of measurement is flawed.

Metrics and Limitations of Suboxone Studies

Suboxone studies look at things like improved patient survival, increased retention in treatment, decreased illicit opiate use, decreased criminal activity, patients’ ability to gain and maintain employment, and improved birth outcomes among women who have substance use disorders and are pregnant (Bennett). They ignore crucial components in the quality of life.

In a study conducted by the authors of Long Term Suboxone Emotional Reactivity, they established two things: individuals undergoing long-term treatment with Suboxone show significantly reduced emotional awareness and expressiveness, particularly in recognizing emotions such as happiness, sadness, and anxiety, when compared to those in the general population and participants in Alcoholics Anonymous programs. Additionally, individuals showed a tendency to continue substance misuse, potentially causing fatal drug interactions or overdose (Hill, Edward, et al).

Some psychiatrists suggest that giving Suboxone to treat long-term addiction can block 80% of the patient’s feelings. Dr. Scanlan, board-certified in addiction medicine, says this to his patients when they don’t want to get off the medication because they feel good: "You are not dealing with your feelings because you are still not feeling—you are still numb” (Steven R. Sanlan, MD).

Perspectives from Professionals

In the ongoing debate about the most effective addiction treatment, differing perspectives emerge from interviews with professionals in the field.

• Henry Fuqua's Observations Henry Fuqua, a seasoned CADC with seven years’ experience in Medication-Assisted Treatment (MAT) and two years with abstinence-based models, voices concerns over the prolonged use of MAT programs. According to Fuqua, these treatments often become a substitution rather than a solution, with many patients remaining on the medication long-term without efforts to taper doses, ultimately not addressing the root causes of addiction (Fuqua).

• Dr. Evan Massey's Insights Similarly, Evan Massey, MD, who has experienced MAT from both the patient and provider sides, suggests that those seeking MAT are often looking for an easier, softer solution to an issue that is much more complex than drug replacement (Massey).

These insights challenge the notion of Suboxone as a gold standard in addiction treatment, suggesting that while it may serve a purpose in the short term, it is not a comprehensive long-term solution, especially when compared to abstinence-based models that aim for complete recovery and independence from substances.

The Role of Suboxone in Harm Reduction

One major point in favor of Suboxone is its proven ability to reduce the harm associated with opioid addiction. Studies show that Suboxone significantly lowers the risk of fatal overdoses (Volkow).

In addition, some critics of abstinence-only programs argue that such models often fail to address the biological aspects of addiction. The problem with this logic, however, is the data available paints a different picture. Referring to National Center for Drug Abuse Statistics graphs on opioid-related deaths starting in 2002, the FDA approval of Suboxone did little to disrupt or change the annual growth of related deaths. Instead, they continued to grow at a consistent rate, indicating that Suboxone the medication had little effect on the problem as a whole (Opioid Crisis Statistics).

Conclusion: A Tailored Approach to Recovery

In conclusion, Suboxone treatment being the gold standard depends on what you’re seeking through treatment, but it certainly isn’t the gold standard for all recovery. Suboxone marks a modern approach aimed at reducing the immediate harms of addiction, while abstinence-based methods like those pioneered by Alcoholics Anonymous tap into a deeper, more comprehensive healing process without side effects associated with narcotics.

Works Cited

"A Brief History of Suboxone: How We Got Here." Recovery Care, 31 Aug. 2020, www.recoverycare.org/blog/a-brief-history-of-suboxone-how-we-got-here.

Alcoholics Anonymous. “The Start and Growth of A.A. | Alcoholics Anonymous.” Www.aa.org, 2022, www.aa.org/the-start-and-growth-of-aa.

Bennett, Johnathan Lucas, “Suboxone vs. Abstinence Recovery.” A Vision for You Recovery, 17 Mar. 2022, avisionforyourecovery.org/2022/03/16/addiction-treatment-suboxone-vs-abstinence/. Accessed 9 Apr. 2024.

Bennett, Johnathan Lucas, and Evan Neal Massey. “Interview with Dr. Evan Massey MD on Methods of Addiction Treatment.” 5 Apr. 2024.

Bennett, Johnathan Lucas, and Henry Fuqua. “Interview with Henry Fuqua CADC M.A.T Vs Abstinence Model.” 14 Apr. 2024.

Dole, Vincent P., and Marie E. Nyswander. "A Medical Treatment for Diacetylmorphine (Heroin) Addiction: A Clinical Trial with Methadone Hydrochloride." Journal of the American Medical Association, vol. 193, no. 8, 1965, pp. 646-650.

Hill, Edward, et al. "Long Term Suboxone[TM] Emotional Reactivity As Measured by Automatic Detection in Speech." PLoS ONE, vol. 8, no. 7, 9 July 2013, p. e69043. Gale In Context: Opposing Viewpoints, link.gale.com/apps/doc/A478358068/OVIC?u=kctcsjcc&sid=bookmark OVIC&xid=664c06c8. Accessed 30 Mar. 2024.

“Opioid Crisis Statistics [2023]: Prescription Opioid Abuse.” NCDAS, 1 Jan. 2023, drugabusestatistics.org/opioid-epidemic/.

Scanlan, Steven R. "Suboxone: concerns behind the miracle." Addiction Professional, vol. 8, no. 6, Nov.-Dec. 2010, pp. 28+. Gale Academic OneFile, link.gale.com/apps/doc/A248189478/AONE?u=kctcsjcc&sid=bookmark-AONE&xid=0e2631bb. Accessed 8 Apr. 2024.

Volkow, Nora D., and Carlos Blanco. "Medications for opioid use disorders: clinical and pharmacological considerations." Journal of Clinical Investigation, vol. 130, no. 1, Jan. 2020, pp. 10+. Gale In Context: Opposing Viewpoints, link.gale.com/apps/doc/A612694392/OVIC?u=kctcsjcc&sid=bookmark-OVIC&xid=864f0a7d. Accessed 31 Mar. 2024