Evidence-Based Treatment
At Sunshine Coast Health Centre, we are constantly striving to be industry leaders in Canadian drug rehab and alcohol treatment. A large part of that is being an evidence-based facility. This means we don’t subscribe to a certain methodology, but rather operate according to the peer-reviewed evidence coming in from professionals in the field. Advancements in neuroscience, psychiatry, and addiction medicine inform our treatment approach.
Many drug and alcohol rehabs in this country are abstinence-based. This means that no drugs or alcohol are allowed on-site, and they teach strict sobriety. While this may sound like it makes sense, it ignores the real-life fact that many people are on medications that have nothing to do with their reasons for receiving treatment. SCHC has a dedicated medical staff who look at all your prescriptions and health concerns and will re-issue your necessary prescriptions from the in-house pharmacy. This includes prescribing Suboxone as a policy for those withdrawing from opioids. Critics say this is swapping one drug for another, however, the evidence shows it is best practice when dealing with opioids.
What are Methadone and Suboxone?
A 2013 Canadian review outlines what Methadone and Suboxone are and how they differ. Methadone is an opioid receptor agonist. Suboxone is a combination of an opioid receptor agonist (Buprenorphine) and an opioid receptor antagonist (Naloxone). Methadone attaches to the opioid receptors and blocks the high from opiates like codeine and heroin. It was originally developed in 1937 to help those suffering from extreme pain. Methadone today allows people to manage the often painful opioid withdrawal symptoms while also preventing them from experiencing a high if they do return to using substances. Without pharmaceutical intervention like this, over 80% of people who detox from opiates go back to using substances very shortly after.
Buprenorphine (part of Suboxone) helps aid in the relief of withdrawal symptoms as well but is not as strong as methadone. Combined with Naloxone it creates Suboxone. The addition of Naloxone is to prevent misuse of the medication. If someone were to inject Suboxone instead of taking it as prescribed (ie. tablet form) the Naloxone gives sudden severe withdrawal symptoms. The addition of Suboxone to the doctor’s repertoire is clearly needed. In 2013 in the USA, Suboxone sales outpaced both Adderall and Viagra combined. Suboxone only became legal in Canada and the USA in the last ten to fifteen years so studies on its effectiveness are young. However, researchers so far believe it to be much safer than Methadone due to it being harder to abuse.
Why Suboxone?
New guidelines published in the Canadian Medical Association Journal on behalf of the Canadian Research Initiative in Substance Misuse recommend that our policy of subscribing to Suboxone become industry standard across all drug and alcohol rehabs in Canada. Withdrawing from opioids, even with medical supervision, puts the substance user at a high risk of overdose should they relapse, which the vast majority of patients do.
Suboxone blocks the opiate receptor sites in the brain so the client cannot get high from other opioids like fentanyl or heroin. It also helps mask some of the severe physical withdrawal effects so clients can get through the detox process easier. It is safer than Methadone and has fewer side effects. Prescribing Suboxone sets our clients up for success in their recovery.
Suboxone Recommendations for GPs and Drug and Alcohol Rehabs
The new guidelines were released to help Canadian family physicians provide the best standard of care to their patients dealing with opioid dependence or addiction. The opioid crisis that has gripped Canada has affected many people who were prescribed opioid pain medication without realizing how easily a dependence could occur.
The recommendations state that family physicians should be prescribing Suboxone as the first line of treatment for those suffering from opioid dependence (with Methadone as a secondary option); that they should treat patients with opioid addiction as chronic condition patients like those with diabetes and heart conditions; and that detox should not be recommended unless the patient can go immediately into long-term evidence-based treatment.
That last recommendation is a nod to the fact that many residential treatment facilities are abstinence-based, and so do not allow people stabilized on Methadone or Suboxone to enter treatment. The recommendation is that inpatient rehabilitation facilities start to use Suboxone to stabilize their clients while they go through treatment.
While most drug treatment and alcohol treatment programs in Canada are still abstinence-based, there are a few evidence-based rehabilitation centres in Canada, like Sunshine Coast Health Centre in Powell River, BC, that use Suboxone for their opioid clients. If you use opioids and are looking for evidence-supported treatment in Canada to help you recover, connect with our admissions coordinator here.
References:
- Suboxone versus Methadone for the Treatment of Opioid Dependence: A Review of the Clinical and Cost-effectiveness
- Methadone and Suboxone: What’s the Difference Anyway?
- Management of Opioid Use Disorders: A National Clinical Practice Guideline
- Opioid Addiction Should Be Treated With Prescribed Medication When Possible, New Canadian Guideline Says
- Specialized Detox for Opiates
- Suboxone Treatment as Part of our Drug Rehabilitation
