Polydrug Use in Patients Using Buprenorphine

“Medicated-Assisted Treatment (MAT) is the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a "whole-patient" approach to the treatment of substance use disorders,” reads the description of MAT on the website of the Substance Abuse and Mental Health Services Agency (SAMHSA). The idea behind MAT is straightforward: suppress dangerous cravings patients may experience when withdrawal from addictive opioids kicks in—buy some time and prevent a fatal overdose until the “counseling and behavioral therapies” lead to a full recovery from opioid use disorder (OUD).  

Methadone, buprenorphine, and naltrexone are the three FDA-approved medications used to treat addiction to opioids such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone. (Suboxone is the trade name of a medication that combines buprenorphine and the opioid antagonist naloxone.)

As SAMHSA explains, “people may safely take medications used in MAT for months, years, several years, or even a lifetime.” And there’s the problem—for many addiction professionals that doesn’t sound like recovery at all. Methadone has been around for a long time and some patients have been on methadone for decades without ever going into complete sobriety.

Somehow, the “temporary” medication is never tapered while the behavioral therapies are eventually abandoned. And that’s not the only problem. Many patients continue to use other addictive substances on the side although that is strictly counter-indicated.

The recent Millennium Health Signals Report revealed a significant presence of other drugs, most notably marijuana, in patients who have been prescribed buprenorphine.

The findings were based on “Millennium's retrospective analysis of more than 150,000 urine drug test results for buprenorphine patients from July 1, 2017 to July 1, 2018, testing for 40 illicit drugs, medications and drug metabolites. Marijuana was the drug with the highest percentage of positives in the sample of individuals who were prescribed Suboxone, at 23.28 percent. The drugs with the next highest percentage of positives in this group were gabapentin (21.34 percent), alcohol (10.75 percent) and cocaine (7.07 percent),” reported Gary Enos in Addiction Professional.

The prevalence of marijuana is a powerful illustration of the widespread notion that cannabis use is either harmless or yields medical benefits. Marijuana use has even been suggested as a treatment component for OUD.

Suboxone has certainly been shown to cause dangerous reactions when used concurrently with alcohol, sedatives, and other tranquilizers. In their study on cannabis use among opioid-dependent individuals on opioid substitution therapy (OST), Yatan Pal Singh Balhara and Raka Jain stated that continued cannabis use, while on OST, “can have potentially adverse effects on treatment outcome. These individuals continue to be exposed to the risks associated with cannabis use. Also they can experience interaction of cannabis metabolites and OST agents. Additionally, focus on opioids as primary drug of abuse can lead to limited focus on ongoing cannabis use among these individuals.”

Recovery from addiction is much more than the suppression of cravings with the help of an opioid replacement therapy. While it may stabilize the patient in the short term, what is really required is a complete biopsychosocial and spiritual re-calibration of the patient involving serious life-style changes. Even changing people, places, and things often falls short if the inner change of the individual is not forthcoming.  

Addiction treatment at The Farley Center is abstinence based with the aim to achieve long-term sobriety and full recovery for our patients. Our treatment model allows us to help them with detoxification and short-term stabilization in a residential setting. During their stay, our patients receive psychotherapy—individually and in a group setting—experiential therapeutic interventions, integration into a 12-Step recovery program, education, and sober-life skill-building.

If you or someone you know is struggling with substance use and could benefit from addiction treatment services, please contact The Farley Center  at 800.582.6066 or fill out our admissions request form.