A note from a reader with a question about Suboxone:
Suboxone has really worked for me in getting off vicodin. But I have been unable to stop taking Suboxone. It occurred to me recently that this may turn into a lifelong dependency. If so, what are the long-term side effects of Suboxone?
Thanks so much,
Suboxone really is best thought of as a long-term, potentially life-long medication. Your attachment to pain pills will in all likelihood be life-long as well. Many people who stop brief treatment with Suboxone are surprised at the cravings for opiates that they have. It isn’t that Suboxone increases the cravings, but rather, buprenorphine is so effective at eliminating them that people forget how attached to opiates they were. I generally recommend that people stay on Suboxone long-term– perhaps forever, or until something better comes around. They are much safer on Suboxone, as it helps avoid impulsive relapses that can result in felony arrests or overdose.
There are very few long term effects from Suboxone. Long term opiate use in general can lower testosterone levels in men, which can reduce sex drive and in severe cases impact fertility. Buprenorphine can lower testosterone as well, with an effect less powerful than that of opioid agonists.
Other short-term side effects (that over time become long-term side effects) include dry mouth (which long-term, in theory, could cause an increase in tooth decay), constipation (which could lead to hemorrhoids, diverticulitis, anal fissures or peri-rectal abscess), sweating (which could lead to… social problems?). The opiate antagonist naltrexone can cause liver damage in high doses, and it is related in some ways to naloxone, which is a component of Suboxone. But he naloxone does not get absorbed to a significant degree, and so the chance of liver damage is minimal.It may be a good idea to check a set of labs once per year, though, to check the liver, kidneys, thyroid, and blood cell system, just for safety’s sake.
Some docs insist upon keeping everyone on Suboxone in endless psychotherapy. I do not think that therapy should be universally required, and I do not think that ‘forced therapy’ is very helpful. People tend to view psychotherapy as a benign activity that might help, and can’t hurt. But anything with the power to change a person for the good, also has the power to make things worse. Psychotherapy is an active intervention that is not appropriate for everyone.
In some parts of the country, It is hard to find doctors willing to treat people wih addiction similar to patients with other chronic conditions– i.e. prescribing effective medication without placing a number of other requirements on patients. People with addictions should receive the same considerations about privacy and autonomy as other patients.
I hope that answers your questions–