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WHY WE USE SUBOXONE TO DETOX OVER 7 DAYS - AND NOT FOR LONG TERM MAINTENANCE (MAT)

A pilot study of buprenorphine—naloxone combination tablet (Suboxone®) in treatment of opioid dependence

"No subject appeared destabilized by unsupervised dosing."

Two-year Experience with Buprenorphine-naloxone (Suboxone) for Maintenance Treatment of Opioid Dependence Within a Private Practice Setting

"Seventy-five percent had successful outcomes by remaining in Suboxone treatment (43%), tapering successfully (21%), transferring to methadone maintenance (7%), or inpatient treatment (4%)."

Long Term Suboxone™ Emotional Reactivity As Measured by Automatic Detection in Speech

"We found in long-term SUBX patients a significantly flat affect (p<0.01), and they had less self-awareness of being happy, sad, and anxious compared to both the GP and AA groups."
"There has been a shift in mental health services from an emphasis on treatment focused on reducing symptoms based on health and disease, to a more holistic approach which takes into consideration quality of life [4]. Historically, the primary outcome goals for substance abuse treatment are harm reduction and cost effectiveness; with secondary outcomes including quality of life, and reduction of psychological symptoms [5]. Quality of life is characterized by feelings of wellbeing, control and autonomy, a positive self-perception, a sense of belonging, participation in enjoyable and meaningful activity, and a positive view of the future [4]. There is evidence that happy individuals are less likely to engage in harmful and unhealthy behaviors, including abuse of drugs and alcohol [5]. In addition, treatment approaches addressing depressive symptoms are likely to enhance substance-abuse treatment outcomes [6]."

Buprenorphine Outpatient Outcomes Project: can Suboxone be a viable outpatient option for heroin addiction?

"A total of 220 participants were included in the study. The age range of participants was 18–67 years with most being African American males. Eighty-three (38%) remained in the study for at least 1 month, with 37 of the 83 (45%) remaining in treatment for >3 months. Ten of the 37 (27%) never relapsed after their longest period of abstinence from heroin. During the first year after initiating treatment with Suboxone, hospitalization and emergency room visit rates for all 220 participants decreased by 45 and 23%, respectively, as compared to the year prior to starting treatment. The number of legal charges for drug possession decreased from 70 to 62. Anecdotally, the quality of life seemed to improve in those who were treated with Suboxone for longer periods of time and received regular counseling."

Suboxone Misuse Along the Opiate Maintenance Treatment Pathway

Patients have potential to misuse suboxone when in long term treatment

Comparing methadone and Suboxone in applied treatment settings: the experiences of maintenance patients in Lanarkshire

Greater effects of withdrawal with Suboxone
Increased dependence with Suboxone
Compliance Factors:
"Patients founds to be noncompliant were more likely to suffer from comorbid psychiatric illness. Patients who tested positive for benzodiazepines or cannabis were more likely to be noncompliant with treatment. Although the rate of noncompliance (inaccurate pill count) was high, patients were still found to be taking their prescribed buprenorphine as evidenced by positive UDS for buprenorphine/norbuprenorphine. In addition, our sample had a high rate of negative UDS screens for opioids and cocaine."