Earlier this month we worked with a family from South Carolina at our Richmond Coleman Institute office. Accompanied by his parents and younger sister, Tim (not his real name), a 27-year-old college educated young man who works in the finance world, came to us for a Medically Assisted Withdrawal off Suboxone. Four years earlier, after struggling to stop using prescription pain pills (Roxicodone®, Percocet, and Opana), he easily found a doctor who was quick to prescribe Suboxone. Indeed, with the buprenorphine and naloxone provided by the Suboxone, his cravings for short-acting pain pills was gone. The doctor saw him each month and regularly prescribed him 30-60 8/2mg sublingual strips. He told him to use one or two a day, as needed. Several months after beginning Suboxone treatment, Tim was on day one of a week-long business trip when his Suboxone was stolen. He wasn’t too worried because he had an appointment scheduled with his doctor the following week. And anyway, he’d been contemplating stopping the ‘subs’ on his own. He felt confident about never going back to playing around with opiates ever again. He didn’t experience any particularly intolerable side effects in the first 48 hours, but soon after that, he started having flu-like symptoms. “I was having the chills, my back and bones ached and I couldn’t sleep. The restless legs were the worst.” He was embarrassed to admit to me that he actually didn’t tie these symptoms to Suboxone withdrawal right away; he didn’t really get that Suboxone was “addictive”. His prescribing doctor had failed to mention this, simply telling him that it was okay for him to stay on Suboxone indefinitely.  


  This is actually a very common scenario for us. Many patients who are seeking Medication Assisted Treatment (MAT) from opioids will be offered Suboxone. Some people will use it for a short period and hopefully remain abstinent; others like Tim, will have an indefinite plan for continued prescriptions. Countless patients and families tell me they were unaware that getting off Suboxone could be worse than getting off heroin or prescription opioids. Post Acute Withdrawal Symptoms (PAWS) from Suboxone and other buprenorphine containing products like Bunavail® and Zubsolv® can go on for weeks. It seems to be worse for some people than others, and perhaps this depends on the length of time and the strength of the medication. But all of our patients who have weaned themselves from 24mg to 16mg to 8 mg to 4mg—struggle greatly to get off the last 1-2mg. At the Coleman Institute we offer a Non-Addictive Medically Assisted Withdrawal Process for patients seeking to stop both long acting and short acting opioids. Our method accelerates the removal of opiates from the opiate receptors and replaces them with naltrexone. This means for instance, that instead of having a 30 to 50 day detox off of Suboxone, we complete it in 8 days. Naltrexone is a pure opiate antagonist, or an “opiate blocker.” When naltrexone is populating the opiate receptors, no physical cravings for opiates are felt. We strongly encourage patients to commit to taking naltrexone for at least a year, but no matter when they discontinue this medication, there are no withdrawal symptoms from it since it is not an addictive substance. Tim’s family is representative of many who, believing they are helping their child get the most effective treatment for opioid addiction, may not have the full understanding of just how difficult it can be to discontinue Suboxone. A Non-Addictive Medically Assisted Treatment may be a better choice. Joan Shepherd, FNP