Suboxone has been available in Newfoundland only since 2016. Will it replace methadone as the drug of choice for addicts trying to quit powerful opioids?
Methadone has been widely available as treatment for opioid addiction in Newfoundland since 2015. Unfortunately, methadone programs have not been as successful as hoped. Will Suboxone be any different?
At a glance, both treatment programs are very similar. Both methadone and Suboxone are taken daily to treat opioid dependency by eliminating withdrawal symptoms. To be eligible for treatment with either drug, patients must sign a contract with their doctors and agree to regularly provide urine samples.
The main difference between methadone and Suboxone is how the drugs affect the brain. While methadone and Suboxone both activate the opioid receptors in the brain, Suboxone does so to a much lesser degree. Suboxone also acts as a blocker of other opioids while still successfully keeping withdrawals at bay – a feat that methadone can only accomplish in high doses.
The differences in the chemical makeups of the drug mean that Suboxone produces a far less pronounced “high” than methadone. This difference makes Suboxone less appealing to potential abusers and increases its value as a treatment option.
Suboxone is also unique in the sense that it has a “ceiling effect.” After a certain point, a higher dosage will not increase the effects of the drug. As a result, there is less risk of overdose compared with methadone.
As a treatment option, Suboxone has been available in Newfoundland only since 2016 and has had much less time to establish itself as an alternative to methadone. However, interest has been growing steadily.
In Springdale, Dr. Todd Young and his team at the Main Street Medical Clinic provide Suboxone all over the island. Although there are about 20 physicians who can prescribe Suboxone in Newfoundland, Young estimates he is responsible for about 90 per cent of the patients on the program.
Young runs the only “rapid access” program in the province. Patients can self-refer, and it takes only five days from the time of referral to the beginning of treatment. By comparison, methadone takes three to four months.
“When someone is reaching out for help, they need it now,” said Young. “They don’t need it three months down the road . . . Methadone and Suboxone are harm-reduction strategies, and harm reduction should be available in a timely manner.”
Young treats patients all over the island via telemedicine; however, once a community has enough demand for Suboxone, he opens monthly clinics in those areas. His most recent monthly clinic opened recently in Placentia. There is another in Stephenville.
He says Suboxone treatment will continue to gain popularity due to its effectiveness and unique characteristics.
“It’s a cleaner, safer drug. Bottom line,” Young said.
Sasha Clarke of Marystown began using opiates as a teenager and struggled with addiction for several years. Clarke started the Suboxone program in December and has been very pleased with the results.
Clarke first heard about the program through word of mouth while waiting for acceptance to a methadone maintenance program.
“I heard it was a lot easier to get on,” said Clarke. “When I started talking to the doctor, it only took about a week before I got on it. She said it will be easier to ‘come off’ of than methadone when I was ready.”
The doctor in question, Dr. Stephanie Slaney, is currently the only provider of Suboxone treatment on the Burin Peninsula. Slaney accepts patient referrals from only two local doctors at present – but she plans to open a Suboxone clinic in July.
Clarke says Suboxone allows her to function normally without impairing her in the way opiates would.
“You don’t get high off it. It makes me more productive, but I wouldn’t say I get high off it.”
Clarke originally had to have each daily dose of Suboxone administered by a pharmacist, but after several successful months on the program she earned some privileges. Now, she requires only one “witnessed dose” per week and receives six additional doses to take home with her.
It was the flexibility of the program that appealed most to Adam Lewis. Lewis, a recently married father of one, had been receiving methadone for three years prior to starting Suboxone. He found methadone to be just as effective at managing his addiction but was unable to get the necessary carry-out doses to work turnarounds in Alberta.
“Three years of my life, I was on methadone. I couldn’t go to Alberta. I couldn’t go nowhere. Liquid handcuffs, right?” he said.
Before going to Alberta for his two-month work stints, Lewis obtains 60 eight-milligram doses of Suboxone, to be taken daily.
Lewis, once a heavy drug user, says he has abstained from all illegal opiates since starting the program and puts a great deal of faith in its ability to manage addiction.
“If eight mg’s can do me, it can do it for anybody”
Although both Suboxone and methadone treatment have been very beneficial to some addicts, there are some notable issues they share in common. There is a risk of overdose associated with both drugs, although it is greater with methadone. The risk is greatly increased by the consumption of alcohol or any other medication that slows down breathing.
Another troublesome trend with both treatment options is a tendency for people to remain on the program for either extended periods or indefinitely. As the end result is, ideally, to live free from opiates, this continued use is considered a failure.
When treatment does work, though, there is no denying the positive impact it has in the patient’s life. Former addicts such as Lewis would gladly tell you so.
“We were just getting by the last few years. Now I got a full-time maintenance job. A wicked gig,” Lewis said.