The Use of Suboxone for Opiate Addiction

The Use of Suboxone for Opiate Addiction Addiction Drug Use Opioids Print Treating Opiate Addiction With Suboxone Combination Drug Offers Advantages Over Methadone Therapy By Mark Cichocki, RN twitter linkedin Mark Cichocki, RN, is an HIV/AIDS nurse educator at the University of Michigan Health System for more than 20 years. Learn about our editorial policy Mark Cichocki, RN Medically reviewed by Medically reviewed by Steven Gans, MD on December 09, 2014 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on November 20, 2019 Pamela Moore / Getty Images More in Addiction Drug Use Opioids Cocaine Heroin Marijuana Meth Ecstasy/MDMA Hallucinogens Prescription Medications Alcohol Use Addictive Behaviors Nicotine Use Coping and Recovery Opiate addiction is a growing problem in the U.S. as evidenced by the 2015 outbreak of HIV in Indiana which was attributed to the abuse of the drug Oxycontin. In the face of a widening epidemic, a prescription drug called Suboxone (buprenorphine naloxone) is being increasingly used to treat opioid addiction. Understanding Opiates Opiates are a family of narcotic drug derived naturally or synthetically from the seed of the opium poppy plant (Papaver somniferum). They function as sedatives to depress activity in the central nervous system, thereby reducing pain and inducing sleep. Long-term opiate use can result in increased tolerance to the drug. When this happens, the user would need to increase the dose to achieve the same effect. This can cause an increasing dependence which we have come to know as an addiction. In some cases, this can lead to accidental overdose and even death. Some of the most commonly abused opiates include: HeroinFentanylMorphineVicodin (hydrocodone)OxycontinOxycodoneCodeineMethadone Treating Opioid Addiction With Suboxone Suboxone is an oral prescription drug that was granted approval from the U.S. Food and Drug Administration in 2002 to treat opioid addiction. Prescribed as either a sublingual tablet or film, it contains two active drugs: Buprenorphine, a partial opioid antagonist, which provides relief from craving and withdrawal symptoms by blocking opiate receptors in the brainNaloxone, an opiate antagonist, which blocks the effects of the opiate drug itself The combined use overcomes some of the shortcomings of the individual drugs. Buprenorphine, for example, has the potential to be addictive but is less so since the naloxone quashes the opiate effects. Naloxone, by contrast, works in the background as a deterrent, only taking effect when opiates are injected into the system. When this happens, naloxone can induce withdrawal symptoms including nausea, headache, sweating, restlessness, vomiting, and trembling. Effectiveness Suboxone has been found to be effective in that it reduces the cravings associated with long-term opiate use while providing deterrence to current use. Compared to methadone, Suboxone is less addictive and faster acting (taking around a week to detoxify compared to weeks or even months with methadone). Suboxone also seems to work better when used for longer periods of time. One study showed that opiate-dependent youth who used Suboxone for 12 weeks were more likely to remain abstinent compared to counterparts who had only undergone two-week detox treatment. How Its Prescribed Suboxone is prescribed as part of a structured drug detoxification program and for maintenance therapy when needed. It is available as a generic (under the brand names Bunavail and Zubsolve) and offered in various formulations to ensure the gradual tapering off of use: 12 mg buprenorphine with 3 mg naloxone8 mg buprenorphine with 2 mg naloxone4 mg buprenorphine with 1 mg naloxone2 mg buprenorphine with 0.5 mg naloxone Treatment Plans While approaches can vary depending on treatment centers, there are typically four steps to any Suboxone treatment plan: Intake which includes a medical and psychosocial evaluation, a urine drug screen, and blood tests to ensure that you can take the drug without harmInduction to transition you from the opiates you are currently on to Suboxone with the aim of minimizing cold turkey withdrawal symptomsStabilization where Suboxone is adjusted to the lowest dose to suppress withdrawal symptoms to allow for eventual tapering off and discontinuation of treatmentMaintenance for those with severe addiction who may need on-going, medically supervised treatment and support (including attendance at a Narcotics Anonymous or non-step support group) Considerations Suboxone should not be used in persons with moderate to severe liver dysfunction as the can lead to a worsening of symptoms. Common side effects include headache, nausea, vomiting, excessive sweating, constipation, symptoms of withdrawal, insomnia, pain, and the accumulation of fluids in the legs (peripheral edema). Suboxone does have the potential for misuse if injected. In such case, the relatively low dose of naloxone does not appear to mitigate the high achieved from the buprenorphine component. As such, Suboxone can only be prescribed under a doctor-supervised treatment or maintenance program. Because opioid addiction is both a physical and psychological illness, treatment requires a multidisciplinary team able to address both of those needs. If you feel you could benefit from Suboxone, contact the hospitals or mental health agencies in your area for referrals to nearby addiction treatment centers.