If I’m On A Suboxone Or Methadone Program, Am I Clean?

justice.gov

Q. Is being prescribed methadone or suboxone considered being clean, even though they are addictive, abusable substances?

You’ll get different answers to this question from different people.  Generally the division lies between those who are on maintenance drugs and those who are not.  Both sides of the discussion have their valid points.  However, I believe you answered your own question when you used the expression “addictive, abusable substances.”

The consensus among most professionals and recovering addicts is that “clean”, when used in the context of recovery, means drug-free.  Having all mood-altering substances out of our systems is necessary before the changes that addiction creates in our brains can be repaired.  As long as drugs that modify the reward system (which includes all recreational drugs) are in our bodies, repair and normalization cannot begin.  When we are on Suboxone or methadone maintenance, we are still addicted¹, and our brains are essentially in the same condition as when we were actively using other opioid drugs.  It would seem to be pushing things to call us clean.

That is not to say that there are no benefits to drug maintenance programs.  To the extent that they allow people to cease other drug use and begin to take care of themselves and fulfill their responsibilities, they have some validity.  The problem is that the addiction remains in full force, and relapse — whether to other drugs or simply recreational doses of the maintenance drugs — is only a hair’s breadth away.  Adherence to maintenance programs rests squarely on our willingness to continue to follow them.  That is an extremely dangerous place for an addict to be.

Here at Sunrise, we believe that the proper uses of these drugs are as short-term substitutes for the drugs being abused, with a relatively rapid taper to a completely drug-free condition.  If we wanted, we could easily become licensed to provide maintenance services.  However, we do not believe that is in the best interest of our patients, their families, and the other people in their lives.
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¹If you don’t think we remain addicted on maintenance doses of opioid substitutes, just try quitting.  Both Suboxone (when used for long periods) and methadone have withdrawal syndromes that are worse than the drugs for which they’re being substituted.  Truth.

Comments

  1. Anonymous says:

    Being dependent on a drug and being addicted are different, if your on a prescription drug from a dr and taking it as prescribed and it isn’t negatively impacting your life then as far as I’m concerned that’s being clean .people take mind altering drugs everyday caffeine ,nicotine,sugar are they clean and people are dependent on drugs as well like a diabetic needs insulin and people with high blood pressure need blood pressure meds ,depression I could go on but you get the point .to many people think there shit don’t stink and they can judge others when they don’t know anything about opiate addiction and how to treat it .unfortunately most people think someone got addicted to opiates because of a moral issue ,they are weak or lazy when the fact is a dr gave them there first fix and got them hooked .i say who cares what people think do what’s best for you and don’t Judge and educate yourself before you make comments on what clean is or isn’t because most people in this country is on some form of medication that they will get sick or go into withdrawals from if they stop

  2. Anonymous your wrong..on so many levels its ridiculous.. educate yourself and learn the difference between medications that are needed for daily living and medications that are wanted.. you can live life with drug replacement.. some addicts choose not to.. sickness symptom.. learn the difference

  3. The problem I have with suboxone is that it is still a narcotic and still illegal without a prescription. That’s not the case for the meds for diabetes etc.. It’s still keeping you having a dependancy to a narcotic.

  4. To the anonymous poster, you are heavily still an active addict with that mentality. The fact that you gave excuses to say that you can be clean and there is a difference when you are taking a dr. Prescribed regimented dose of
    Your daily meds to be clean, yet the one who apparently got you addicted was the doctor?? That makes NO SENSE unless you are an addict making excuses to make the “judgement” worse…the judgements were in place before the addictions, first and foremost. Everyone knows the public and social backlash that comes with addiction and opiates in general, but comparing a person with a drug addiction to someone who has diabetes is touchy because you can give yourself diabetes from living an unhealthy lifestyle OR you can be predisposes to it by DNA, same as addiction….the fact is, once that health condition is underway,
    Insulin is needed for the body to function properly from the damages caused by by a potentially self induced lifestyle. Aside from alcohol, as an addict you will never NEED the constant use of a narcotic unless your brain is permanently placed there, which happens under permanent use of maintainence drugs when not tapered off properly until all use is done. Type 1 diabetes doesn’t work the same way type 2 does. Type 2 can possibly be maintained by a difference in lifestyle and regiment and self discipline- JUST LIKE ALOT OF ADDICTIONS. If you understand the predisposition to the inevitable ramification, or even recognized it as a daily possibility and guarantee rather than a worst case scenario, maybe you’d be able to pull your head out of your ass and stop making excuses. Change of environment and entire family dynamic MUST happen if you expect change to happen.

  5. I hate to say this but I am afraid if dying while still on Suboxone; I’m 63. I’m in AA and sober but went back out and used herion. I kicked cold turkey myself then it was suggested I go on Sub. Wish I never had. Tapering now: 10mg a day,8am,2pm. But I chose to use and if I die before I get clean I think God will see it that way. I got myself into this position. Sorry if any are offended but what do AA and NA say about self will?

  6. Two sides to every story some addict’s need longer maintenance. The thing with Suboxone above methadone is it have a ceiling effect meaning you can’t get high off of medication once you reach a certain point any other drug you can keep on going. Suboxone is s short term fix but if the addict is succeeding moving forward I don’t see no reason why they couldn’t take it for the rest of their life. I mean if you can do with out Suboxone that’s even better. I believe Suboxone is a better way it’s abuse is limited to anything else.
    One day at a time and don’t live by what others think live to help one another.

  7. Jim Heckel says:

    Subs ain’t clean, sorry. That still maintains the addiction. Ever wonder why subs are called ‘government dope’? That’s why. The only legit use for subs is to have a rapid taper down to zero for someone whose health is too badly compromised for cold turkey quitting – and even then, there’s gonna be some discomfort.

    Meds like Seroquel, Prozac, or other psych meds aren’t mind altering; they are mind restoring. The reason why this is so is that psych meds take an already malfunctioning mind (chemical imbalance or whatever it is) and restore normal functioning. This is the opposite of dope, which takes a normally functioning mind and alters it to produce a chemical high.

    Make no mistake, Big Pharma is not our friend. Their executives and lawyers can be every bit as evil as Big Tobacco when enough money is on the table. It’s one thing to take meds to treat problems that honestly cannot be solved using a nondrug approach. It’s one thing to use subs as a rapid taper for those whose health is too badly compromised for cold turkey withdrawal. It’s quite another thing to use subs to avoid the pain of withdrawal.

    I know this because I have been there. Cold turkey hurts like hell, but it’s really the only way. I took my last fix on November 11, 2016, at 3:30 AM USA Eastern Time and have been abstinent ever since.

  8. anonymous says:

    Wow! Let me start by saying any drug can be illegal if sold and bought improperly. Take alcohol which was illegal at one point. marijuana is still illegal in many states. Let me explain something when you drink caffeine it causes your brain to operate on different level than it is use to, so therefore you have altered your brain and the chemicals in it. That is true with any drug you take. If you take insulin it alters your body and brain to function properly. Like with suboxone it does change the brain to function properly, so it is not different than any other medication, or substance that in fact changes the brains function. So leave people alone if they are on a treatment that is saving their lives and they are not abusing the drug. Telling someone they are not clean when they have worked extremely hard to become clean with help can, devastate them and cause to relapse. One final point, quitting cold turkey from drugs like methadone can kill you no matter your state of your health. I am not addict no choose to be one, I am very educated, and have seen this stuff happen to people around me. The worst thing anyone can do is mean and hateful and not encourage the addict to do what helps them.

  9. It’s truly incredible at the profound ignorance many of you display in your comments, in particular people who have never experienced opioid addiction personally. In my view, your opinions (which is all they are) are null & void.

  10. Addiction is a disease. Not everyone can become addicted. If you research addiction it explains it’s a disorder in the brain. For example, soldiers who were given heroin not all who returned were addicted to it, 1% of them were and needed treatment to get off it or continued to use it. Not everyone is born with the programming to be able to become an addict.

  11. Mike Smith says:

    Mind over matter period Think as recovery sickness as war! Your in the trenches alone , you have enemy’s around what you gonna do? JMO Cold Turkey Period Then the Wars On Game Time Roll with it It,all start bad then get a lot worse and just before yea think it’s over,it’s not hang on , ahhh finally I think im getting them Yes im beating it.No blame No weakness. Just do it kick that shit.

  12. L Lockerby says:

    I was hit by a car on October the 24th, 2018 and we’re prescribed pain medications. After my doctor took me of of the pain medicine, I started methadone maintenance for pain management and it has been very effective and helpful in my recovery. Thank you.

  13. This is a common issue that most people who get into medicated assistance programs will face. I myself have been in methadone treatment since July 2011 and have not used since. Medically assisted treatment programs means essentially being in a medication based therapy for illicit drug addiction. Many people who don’t understand the purpose or difference between medically assisted treatment and illicit drug addiction will say you are just trading one drug for another. But the facts I list below should show anyone that not only is there a difference between the two, but moreover, medically assisted treatment is helpful and addiction to illicit street drugs is harmful.

    1. Methadone (or any other medication used to treat drug addiction) is a highly regulated substance that is made in a lab by licensed technicians who have been educated and trained specifically for that purpose. Unlike heroin, you know what you are putting in your body when you take a 10mg pill or 100ml orally in liquid form.

    2. When used therapeutically, the same amount of daily medication is taken at roughly the same time every day, rather than fixing up whenever you get the ache. A purposefully structured dosing routine helps to eliminate the “I need to fix” reward structure that addicts have rewired their brains to want and crave.

    3. When someone starts medically assisted treatment, they start at a fairly low dose and increase over a slow amount of time, all while being observed by a doctor so that the patient can reach a therapeutic dose (where the dose is most effective with the least amount of side effects or no side effects at all) and not go any higher. Once they have reached that point, after a couple weeks of being on methadone, any euphoria the get from methadone mostly disappears and the medication is primarily taken to keep from the patient from experiencing withdrawal. This is when the psychological aspect of treatment begins to take precedence.

    4. Medically assisted treatment is much more than just being on medication. There are rules, groups, AA/NA, counseling sessions/group sessions, individual counseling, UA/drug screens, that the patient must participate in. Failure to do so can lead to loss of “take-out” medications, a reduction in daily dosage, or even being removed from treatment altogether. Medication is just a part of the treatment as a whole.

    5. By being in this treatment, the patient no longer needs to buy heroin or any other illicit substances off the street, and stops contributing to the continuity of drugs in their respective communities.

    6. Methadone is a highly regulated substance, and all recipients are watched closely for proper dosage, side effects, and proper administration. Most places have a yearly, or twice yearly, requirement that patients get a complete check up and physical examination from their main physicians. This includes, but is not limited to, complete blood work analysis, metabolic panel, cholesterol and diabetes screening, and any other tests the doctor would like to perform on top of that.

    7. There are perks and rewards for patients that do better over time, like getting “take-outs” so they don’t have to come in every single day to get their dose. The most successful of them will get 2 to 4 weeks worth of medication at a time, just like any other prescribed medication. After a long period of time with no dirty UA’s, the amount of groups they are required to attend may go down as well.

    8. The goal of medicated assisted treatment is to get most people away from physical dependence eventually. Where in addiction you always have to take more and more to keep getting high, on methadone, you go down a milligram every week or two until you can stand on your own. Not everyone can do this though. There is a very small percentage of people who were so addicted for so long (30 – 40+ years), they will have to be in medicated treatment for the rest of their lives. These are people who have used heavily their whole lives and didn’t get into treatment until their 40’s, 50’s, or even 60’s. In these specific instances the damage done can be too great to overcome, and the best thing to do would be just to maintain treatment from then on out. But these make up a tiny portion of the entire demographic of people in medically assisted treatment. Most people who participate will “graduate” the program at some point.

    9. There are always mandatory UA’s, random UA’s, and call backs/check-ins, which means if you have “take outs” you must bring them all in within 24 hours to be inspected for tampering or misuse. Any sign of misuse and they will have their take outs confiscated and have to start their treatment from the beginning all over again, or in extreme circumstances, possibly even kicked out of the program. It is possible that a patient can be kicked out. If someone cannot stop using while in treatment, eventually the treatment is deemed useless for that person and they are let go to free up the spot to give someone else a chance to get clean. I have see it happen before. You need to be SERIOUS and READY when you go into treatment.

    10. I feel that the above facts demonstrate that there is a clear difference between medication assisted treatment and using an illicit substance. Most people don’t understand the damage that addiction does to our bodies and our minds. In a way it’s similar to what radiation exposure does. Once it happens, the damage is done. There are no treatments or procedures that will cure it or reverse it. The damage is permanent. However, one can still learn to live a normal and healthy life afterword. Medically assisted treatment can help us to relearn normal thought patterns, retrain our brains and maybe even rewire the cognitive processes we damaged during addiction. One cannot turn back the clock, but we can get to a place where normal and fulfilling life can be experienced again! I am walking, living proof of that 🙂

  14. Felecia says:

    As someone who spent 11 years as an IV heroin addict and stopped using herion November 1, 2018 and had been on methadone ever since but am on a slow taper I call bologna on people saying methaodone isn’t helpful and is just as bad as the orginal addiction. Methadone never made lie or break my morals, herion did though. I agree methadone shouldn’t be forever (maybe for some it is though!) Every time I quit cold turkey I went 100% cross eyed and remained that way until I relapsed. Using methadone has so far prevented that along with other “unlikely” side effects of quitting cold Turkey. Suboxone never worked for me because my body took 4 months before it could push the herion out or produce a clean urine screen, not everyone is the same and I am living proof that herion withdrawl isn’t harmless. I am also far enough into recovery to know as addicts we do make excuses for our behavior. I personally think if you haven’t experienced opiate addiction yourself you have no idea what you are talking about. It was judgy people like the know-it-alls here that made me feel worse while using and in turn I used more- OF COURSE THAT WAS MY CHOICE and the excuse I used then but that’s the reality of an addicts mind set- are you here to help or hurt? Cause if you’re trying to help you should try being more empathetic. The moment I didn’t hear the outside worlds judgements and started hearing supportive words of encouragement my whole world changed. My fiancee used methadone to get clean and he has been clean of all things including methadone because he used it correctly, tapered down and quit. It’s not impossible. For me, methadone saved my life and I very much so look forward to tapering off it as well

  15. Anonymous says:

    I take replacement medication because it allows me to live my life without the power of addiction controlling me. It’s been part of my life for 26 plus years you notice that I have used the word life twice that’s because I have had one for 26 plus years. I mean that is what it’s about isn’t it? ? The LORD changed my heart, the medicine is for the body

  16. Drake H says:

    I get called a dirty junkie everyday and Im on subs. Take 10mg a day. I hate being on it. My alcoholic gf calls me a junkie everyday of my life. I’m am an embarrassment to her she says. I don’t want to use at all. I have a great mindset and want to be completely clean for me and my son. I got clean before for 10 years and relapsed in august 2019. Had a horrible summer of 2019 and hasn’t gotten any better. To hear ppl make fun of me for being on subs really hurts especially when it’s your own family. I’m still trying to stay strong and ignore the rude comments. Please don’t make fun of ppl for getting help and trying to stay clean from the other drugs. Please I cry everyday being called names

  17. Your footnote contains a subjective opinion, not an objective fact – claiming that the withdrawal from suboxone or methadone is worse than the withdrawal for the drugs they replace is not a claim that even can be made – they’re used to substitute for a wide range of drugs from hydrocodone to heroin. While it is true that the withdrawal from maintenance drugs will almost always be LONGER than the other drugs, it is milder than many of them. It seems to be all about the half lifes. Dilaudid (hydromorpone ) has a fairly short withdrawal syndrome, but it is brutally intense, where methadone (provided a taper occurred first, and in a recovery setting, one would hope it did) it should be considerably milder – still no fun, to be sure – but milder, and it will take longer – just like it takes withdrawal longer to even set in after the last dose, with an average half life of 36 hours.

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