Doctors think they can treat opiate dependence with medication alone. They may be wrong as much as 90% of the time.

At Reliance Center, the key medication we use to alleviate opiate dependence is Suboxone—the trade name for a combination of two drugs, buprenorphine and naloxone. The buprenorphine alleviates the opiate craving and creates a sense of stability, and the naloxone acts as an opiate antagonist. If you try to use the drug in a way your not supposed to- like shooting or snorting it- you’re going to go into immediate withdrawal-an experience you don’t want to have. But if you use the the medication as prescribed, by lettting it disolve under your tongue, very little naloxone gets absorbed into your system. A pretty good deal, all in all.

Suboxone has been distributed by doctors since 2002, but its success has been less then had been hoped.

Here’s how it was supposed to work:

You would go to your doctor, he would give you Suboxone pills, you would go home, take them at the suggested frequency and dosage, and you would no longer be dependent on opiate pain pills. You could lead your normal life, and after a period of time, when you were stable, you could slowly taper off the Suboxone and go about your life free of any medication dependence.

Now, here’s what really happened:

Of the people who went to these doctors and got the prescription for Suboxone alone, as many as 50% did not fill their 2nd month’s prescription, and as many as  90% may not have filled their 3rd month’s prescription.

If these numbers are accurate—and they may be closer to accurate then we wish they were—this is really unfortunate and quite sad. Considering the number of people who really want to be cured of their dependencies, so they can go back to productive lives as students, employees, and parents, something really had to be done.

What the doctors distributing  Suboxone may not have  realized, was just how insidious the addiction to opiates and other synthetic prescription pain pills really are. They can be so easy to get, and their effects so easy to conceal, that they become a part of the fabric of people’s daily lives—in fact, without them, those lives feel dull, flat, and boring, like someone just sucked out all the color and energy.

The answer to substantive dependence is  substantive treatment—not residential, necessarily, but something that’s more a part of a patient’s daily life than just taking a pill, including regular counseling that fills the “hole” left by the drug.

And, since the government has determined providing three months of counseling offers the best chance for successfukl outcomes, a treatment regimine  should be at least that long—and the patient needs to commit to that time when signing up for the medicine. This way, they patient realizes right from the start, that getting his or her life back is about more then just taking a pill.

Suboxone is a wonderful development, but there’s a secret ingredient required: therapy. Once that’s added, it’s amazing what can happen.