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The Science of Suboxone: Does it Work?

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Suboxone, a tablet or sublingual film that contains a combination of buprenorphine and naloxone, is a medication that was approved by the Food and Drug Administration (FDA) in 2002 for the office-based treatment of opioid dependence, addiction, and withdrawal.1-3

Dependence, Addiction, & Withdrawal

Abusing or misusing prescription medications.Before learning about the pharmacologic mechanism of action of Suboxone and how it can help people who are addicted to opioids, it’s important to note the difference between opioid dependence and addiction. Dependence occurs due to chronic opioid abuse; it means that your body has adapted to the presence of the drug and needs it to function optimally. If you abruptly quit or reduce opioid use, unpleasant withdrawal symptoms are likely to emerge. Addiction is a chronic, relapsing condition that occurs when you continue abusing a substance despite knowledge of the negative consequences. To develop some degree of physiological dependence doesn’t necessarily mean you are addicted, but most people who are addicted also have significant substance dependence as a component of their addiction.

Opioid withdrawal symptoms can be extremely painful and distressing and may cause people to relapse in order to ease these unwanted symptoms, thus perpetuating the cycle of opioid abuse.

Some common opioid withdrawal symptoms include:4

  • Dysphoric mood (general feelings of dissatisfaction or unease).
  • Nausea or vomiting.
  • Diarrhea.
  • Muscle aches.
  • Fever.
  • Sweating.
  • Excessive tearing or runny nose.
  • Dilated pupils.
  • Goose bumps.
  • Yawning.
  • Insomnia.

Suboxone is available by prescription from certified doctors who treat patients in their private offices, as well as at qualified drug detox centers.2 Although exact numbers aren’t available on the number of people who currently use Suboxone, the most recent reports from the Drug Enforcement Administration (DEA) indicate that 9.3 million buprenorphine prescriptions were dispensed in the U.S. in 2012. From January to March 2013 alone, 2.5 million buprenorphine prescriptions were dispensed.5 These numbers are promising and suggest that millions of people have taken the necessary steps towards a healthier and happier life free from opioid addiction.

What is Suboxone & How Does it Work?

Suboxone, which the FDA states is the “preferred medication” for maintenance treatment for opioid addiction, contains both buprenorphine and naloxone, each of which has a different function.2

What opioid overdose looks like.Buprenorphine (previously marketed as Subutex) is a partial opioid agonist drug. This means that, like other opioids, it attaches to the opioid receptors in your brain and can produce opioid effects, such as pain-relief, euphoria, and respiratory depression. However, because it is a partial agonist, it produces these effects to a lesser degree than full opioid agonist drugs, such as methadone (another medication used to treat opioid addiction) and common opioids of abuse, such as heroin and many prescription painkillers.6-9

Because it interacts with opioid receptors, buprenorphine can reduce withdrawal symptoms and cravings and, in doing so, helps to stabilize people during detox and maintain them throughout longer-term treatment. That said, even as a partial opioid agonist, buprenorphine may elicit the some of the “positive” effects characteristic of other opioid drugs, such as pain relief and mild euphoria. These reinforcing effects can increase, in a dose-dependent manner, up until moderate doses, at which point a ceiling is reached, and effects stabilize. Suboxone — a combination of buprenorphine and naloxone — was formulated to minimize the potential for misuse.6,10

Naloxone is FDA-approved to manage opioid overdose and, in combination with buprenorphine, to treat opioid dependence. It is a high affinity opioid antagonist, which means it tightly binds to and blocks the activation of mu-opioid receptors in your brain, therefore helping to deter opioid abuse. As a competitive opioid antagonist drug, it is capable of removing many other drugs that are bound to these receptors, which makes it a useful drug both for reversing opioid overdose and eliminating the desired effects of abused opioids.11 Naloxone helps prevent relapse because it makes opioid abuse a futile effort — because your opioid receptors are blocked, you won’t experience the high or pleasure associated with opioid use.

Further, if a person dependent on other opioids injects Suboxone, they will experience a rapid onset of distressing withdrawal symptoms, which is why this is a beneficial drug for people who are at a high risk of abusing buprenorphine alone.7

Is it Effective in Detox?

Scientific studies have demonstrated Suboxone’s effectiveness in helping people detox from opioids, as well as maintain abstinence in the long run.

One clinical review reported that Suboxone is superior in effectiveness over traditionally-used detox medications like methadone, naltrexone, and clonidine. Furthermore, the review also found that office-based treatment with Suboxone for a minimum of 4 weeks showed the largest percentages of negative urine screens, sustained opioid detoxification, and treatment retention rates.10

Getting assessed before choosing a detox program.Another review reported that buprenorphine-based medications have a “superior safety and efficacy profile.” This review demonstrated that Suboxone is safer than other medications (like methadone) and is highly effective during all three phases of detox (induction, stabilization, and maintenance).13

Not only is Suboxone beneficial for detox, it is also more cost-effective in the long-term for both patients and health plans. One study examined opioid-dependent participants who were divided into two groups — one that was treated using Suboxone or Subutex, and the control group that was either treated using another modality or not treated at all. The results of this study found that, though office visits and pharmacy costs were higher for people who were treated with Suboxone/Subutex, the costs were offset by the fact that the treatment group utilized fewer expensive health care services than those in the control group — a positive cost-benefit outcome that supports the use of buprenorphine as a cost-effective treatment option.14

One additional study further supports the overall benefits of Suboxone — this study recruited 220 active heroin users, treated them with Suboxone, and followed their progress after discharge to examine quality of life, legal problems, emergency department visits, and abstinence from heroin. The results of this study found a substantial decrease in the number of hospitalizations and emergency room visits, a reduced rate of legal charges, and anecdotal reports of an improved quality of life for those who were treated with Suboxone and regular counseling.15

Medication is an important part of detox and recovery, but keep in mind that Suboxone is most effective when combined with behavioral therapy, which can help rectify maladaptive behaviors and instill coping skills. This combination treatment is referred to as medication-assisted treatment (MAT).6

Part of a Comprehensive Plan

Counseling is required by federal law for people who receive MAT. Medication addresses many of the issues that arise during withdrawal and detox. It helps to normalize neurotransmitter levels, block the effects of opioids, reduce cravings, and help stabilize bodily functions, but it doesn’t rectify the underlying causes of addiction. The combination of medications and counseling techniques used in MAT has shown to be very effective because it treats not only the physiological effects of addiction, but aims to address the whole person, which includes psychological/social/occupational factors as well.

MAT is a comprehensive approach that includes medication, behavioral counseling, vocational counseling, education, and a number of additional treatment and assessment services. Because addiction is a multi-faceted disease that can impact many areas of a person’s life, this approach helps to address all of the needs a person in recovery may have.

Full recovery is the goal of MAT. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT provides many benefits, such as: 6

  • Improved patient survival.
  • Increased retention in treatment.
  • Decreased illegal opioid use and other types of criminal behaviors.
  • Increased ability to obtain and maintain employment.
  • Improved birth outcomes in women who have substance abuse disorders while pregnant.
  • Reduced risk of relapse.

Can You Become Addicted?

People who use detox and addiction medications may be concerned about replacing one drug for another and the potential for developing a new addiction. This is a common misconception that unfortunately causes many people receiving MAT to be stigmatized by those ignorant to MAT and how it works.

Remember, addiction is a complex condition characterized by compulsive drug use regardless of negative effects.

Using Suboxone under a doctor’s guidance is a much safer and more beneficial alternative to continuing illicit opioid abuse. If you take Suboxone as directed by your physician, you should not be at risk of developing a secondary opioid addiction.

Types of detox medications.

It’s possible that long-term Suboxone use can lead to dependence, meaning your body has adapted to the presence of the drug, but this is a normal side effect of prolonged use of many medications/substances. Because Suboxone contains a partial opioid agonist, some physical dependence can be expected to develop over time.

When the time is right and someone in a MAT program wants to quit using Suboxone, they will work with their doctor to establish a gradual tapering/reduction program, so that their dose can be lowered in increments over time. This helps a person slowly and safely wean off of the drug. This will help prevent withdrawal symptoms and cravings that can occur when you abruptly cease using any drug; significant withdrawal symptoms associated with a gradual taper of Suboxone are unusual.16

How to Find a Suboxone Doctor

Don’t allow addiction to dominate your life any longer. It is never too late to turn your life around. You don’t need to suffer during detox — Suboxone may be the right choice to help you get through withdrawal and start you on the path to becoming clean and sober.

Please use this link to find a doctor who is certified to dispense Suboxone. Professional treatment can help you take that important first step towards sobriety.

Sources

  1. National Institute on Substance Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Addiction Medications.
  2. Food and Drug Administration. (2011). Highlights of Prescribing Information.
  3. Center for Drug Evaluation and Research. (2002). Approval Letters.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  5. Drug Enforcement Administration. (2013). Buprenorphine.
  6. Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment: Buprenorphine.
  7. U.S. National Library of Medicine. (2018). MedlinePlus, Buprenorphine Sublingual and Buccal (opioid dependence).
  8. U.S. National Library of Medicine. (2018). DailyMed, LABEL: SUBOXONE – buprenorphine hydrochloride, naloxone hydrochloride film, soluble.
  9. Kosten, T. R., & George, T. P. (2002). The Neurobiology of Opioid Dependence: Implications for TreatmentScience & Practice Perspectives1(1), 13–20.
  10. Shah, A., Young, J. & Vieira, K. (2014). Long-term Suboxone Treatment and its Benefit on Long-Term Remission for Opiate Dependence. Journal of Psychiatry, 17(6).
  11. DrugBank. (2018). Naloxone.
  12. Shoblock, J. & Maidment, N. (2006). Constitutively active micro opioid receptors mediate the enhanced conditioned aversive effect of naloxone in morphine-dependent mice. Neuropsychopharmacology, 31(1), 171-7.
  13. Khanna, I. K., & Pillarisetti, S. (2015). Buprenorphine – an attractive opioid with underutilized potential in treatment of chronic painJournal of Pain Research8, 859–870.
  14. Ruetsch, C. & Tkacz, J. (2009). Cost-Effectiveness of Buprenorphine-Medication Assisted Treatment Among Opioid Dependent Patients: Results from a Retrospective Analysis of Health Plan Membership Claims Data. Conference: Academy of Managed Care Pharmacy.
  15. Sittambalam, C. D., Vij, R., & Ferguson, R. P. (2014). Buprenorphine Outpatient Outcomes Project: can Suboxone be a viable outpatient option for heroin addiction? Journal of Community Hospital Internal Medicine Perspectives4(2), 10.3402/jchimp.v4.22902.
  16. The National Alliance of Advocates for Buprenorphine Treatment. Dosing Guide For Optimal Management of Opioid Dependence: Suboxone.

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