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Why Is Suboxone Used in Opioid Addiction Treatment?

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suboxone detoxThe National Institute on Drug Abuse estimates that as many as 36 million people in the world abuse opioids, which includes illicit substances like heroin and prescription painkiller medications, such as Vicodin, OxyContin, and Percocet.1 For these people, opioid addiction is a serious concern that can lead to death from overdose and other significant physical and mental health issues. To avoid harm, people struggling with opioid addiction or dependence benefit from seeking professional treatment for these issues in the forms of medically assisted detox and medication-assisted treatment (MAT) to comfortably end use and begin a period of recovery.2,3,4 Frequently, a medication called Suboxone is used in these treatments to aid in detoxification and addiction treatment.2,3,4

Suboxone Detox Programs

Side Note PictureSuboxone detox programs and those that use buprenorphine can help patients stop taking opiate drugs. People who suffer from stronger opioid dependency may be treated with buprenorphine. Read More

What is Suboxone and What Are Its Uses?

Suboxone is a brand name medication used in the treatment of opioid addiction and dependence.2 Suboxone is regularly used as part of a medication-assisted treatment program (MAT) as it can help people addicted to heroin or opioid painkillers quit using, especially when the medication is combined with behavioral therapies.4

Approved for use in 2002, Suboxone can be prescribed by qualified physicians and dispensed in doctor’s offices, providing many with greater access to MAT recovery options.4 In addition to physician’s offices, it can be prescribed in settings, such as:

  • Local health departments.
  • Hospitals.
  • Correctional facilities like jails and prisons.

Suboxone contains two active ingredients:3

  • Buprenorphine: A partial opioid agonist that binds to and activates opioid receptors. As a partial agonist, it elicits less of an opioid receptor response than full agonists like heroin and many prescription painkillers. This means that the opioid effects will be less dramatic than full agonists, but will still prevent the emergence of unpleasant withdrawal symptoms and can alleviate cravings.
  • Naloxone: An opioid antagonist that blocks the effects of opioids. The combination of naloxone with buprenorphine helps deter intravenous abuse of the medication. If people with significant opioid dependence attempt to inject Suboxone, the naloxone will cause withdrawal symptoms to appear soon after use.

Suboxone is prescribed as a thin film that dissolves in the person’s mouth with a 4:1 ratio of buprenorphine to naloxone.2 When the medication is taken as directed, Suboxone can:4

  • Decrease the potential for misuse or abuse.
  • Reduce opioid cravings and withdrawal symptoms.
  • Diminish the dangers associated with opioid overdose.

Other medication options used in opioid treatment include:5

  • Methadone: A full opioid agonist that can only be dispensed through opioid treatment programs (OTPs). Methadone can prevent withdrawal symptoms, block effects of other opioids, and reduce cravings, but the strength of the drug carries risks.
  • Naltrexone: An opioid antagonist that blocks heroin and other drugs from clinging to opioid receptor sites without activating the receptor itself. When someone takes naltrexone, they cannot experience the desired effects of opioids.

Can Suboxone Be Abused?

Yes. Since it contains an opioid, Suboxone can be abused to produce a euphoric high. Since intravenous use causes people to immediately go into opioid withdrawal, those who abuse Suboxone may find other ways to do so, such as:

  • Taking more Suboxone than prescribed.
  • Taking Suboxone without a prescription.
  • Using Suboxone more frequently than directed.
  • Combining Suboxone with other substances, such as alcohol or benzodiazepines, to amplify the effects.

Although Suboxone can be abused, there are several safeguards that help limit the full abuse potential like:3,4

  • The presence of naloxone: The naloxone restricts the methods that Suboxone can be abused. As addiction and physical dependence to opioids grow, injection becomes more appealing for a stronger, faster high. The naloxone diminishes the likelihood of injection attempts, as it makes this route of use unrewarding and can precipitate an immediate, uncomfortable withdrawal syndrome.
  • The ceiling effect: The effects of buprenorphine increase proportionally to the given dose before they begin to level off. This ceiling effect means that people cannot indefinitely take more Suboxone to receive a stronger effect. In addition to minimizing abuse potential, this effect reduces physical dependency, the risk of overdose, and side effects.

What Are the Effects of Abusing the Medication?

suboxone pillsPeople interested in abusing Suboxone may seek the positive effects that the medication shares with other opioids including:2,4

  • Euphoria.
  • Relaxation.
  • Sedation.

As with other opioid drugs, over time the pleasurable effects of the substance give way to the unwanted Suboxone side effects like:2,3,4

  • Headaches.
  • Slowed or shallow breathing.
  • Body aches.
  • Flu-like symptoms, including fever.
  • Dizziness.
  • Constipation.
  • Excessive sweating.
  • Drowsiness.
  • Trouble sleeping.
  • Upset stomach and vomiting.
  • Mood changes.
  • Stress and anxiety.

While rare, there have been reports of hepatitis or severe liver inflammation in association with Suboxone use. Side effects may include:3

  • Dark urine.
  • Yellow skin or eyes.
  • Lightly colored bowel movements.

Some of the most serious effects of Suboxone abuse are addiction, tolerance, and physical dependence. Addiction is marked by a strong, intrusive desire to get and use Suboxone in spite of negative consequences in various areas of life functioning. Opioid addiction or an opioid use disorder may be demonstrated by indicators like:8

  • Having many failed attempts to control or quit use of Suboxone.
  • Taking more Suboxone or using more often than intended.
  • Failing to maintain commitments at home, work, or school.
  • Spending more time under the influence of Suboxone or recovering from its effects.
  • Experiencing changes in social networks or increased conflict with loved ones.
  • Continuing to use Suboxone despite increased physical or mental health risks.

Withdrawal Symptoms

In an individual that is physically dependent on Suboxone, quitting or greatly reducing use will result in the emergence of withdrawal symptoms.

Like with heroin and prescription opioids, Suboxone withdrawal symptoms can range from mild discomfort to significant distress. Withdrawal symptoms may include:8,10,11

  • Depression.
  • Anxiety.
  • Restlessness and irritability.
  • Increased sensitivity to pain.
  • Nausea and vomiting.
  • Diarrhea.
  • Muscle aches.
  • Watery eyes/ runny nose.
  • Excessive yawning.
  • Increased sweating.
  • Goose bumps.
  • Dilated pupils.
  • Fever.
  • Hot and cold flashes.
  • Difficulty sleeping.

The severity of these symptoms will be influenced by the dose, frequency, and total duration of use. Individual differences including previous withdrawal experiences, concurrent substance use, and mental health status can play a role as well.

Detox Timeline

Detoxification (detox) refers to the body’s ability to process and remove unwanted toxins from the system. In general, Suboxone produces withdrawal symptoms that are somewhat less intense but with a detox timeline that is longer-lasting than an opioid like heroin.8 Suboxone is a long-acting opioid, which means that the drug requires more time to be detoxed than short-acting opioids.8

Suboxone withdrawal symptoms will begin between 12 and 96 hours after last use, if ended abruptly.8,11 These acute withdrawal symptoms can last for between 10 and 21 days in total.11,12

Another aspect of the Suboxone detox timeline is the presentation of protracted withdrawal or post-acute withdrawal syndrome (PAWS).12 PAWS consists of symptoms that persist even though Suboxone has been eliminated from the body. Suboxone protracted withdrawal symptoms can last for months after last use and include:12

  • Fatigue.
  • Depression.
  • Anxiety.
  • Irritability.
  • Sleep disturbances.

Detox Treatment Options

advantages of detoxDepending on the individual’s needs, supports, and current symptoms, Suboxone detox can take place in many locations.10 For example, someone that has been using Suboxone as recommended by their physician can likely detox slowly at home by reducing the amount of medication used each day, as per their doctor’s predetermined tapering schedule.3 By tapering the medication in this way, withdrawal symptoms are minimized or eliminated.

Other people will need more intense, structured services to manage their detox. For example, if someone has been abusing Suboxone at high levels for a long duration, mixing the medication with alcohol and other drugs, and has had opioid withdrawal symptoms in the past, they may require a higher level of care called inpatient/residential.5 Treatment in an inpatient or residential setting focuses on structure and consistency, with the person living in the treatment center during their detox process. Inpatient/residential detoxes range in services and duration of treatment with options like:10

  • Medically managed intensive inpatient detoxification: Offers 24-hour care in an acute, hospital setting.
  • Medically monitored inpatient detoxification: Provides 24-hour care in a detox center.
  • Clinically managed residential detoxification: Around-the-clock care with somewhat less medical staff support than the more intensive detox varieties.

A person that requires some professional detox treatment but does not meet the criteria for inpatient/residential may be appropriate for outpatient treatment. Outpatient treatment allows the individual to receive detox and behavioral therapy for a set amount of time during the week while living at home and tending to their other responsibilities.10

No matter the level of treatment, detox will focus on managing Suboxone withdrawal safely and comfortably. With a medical team on staff, medications may be administered to aid the process. Since buprenorphine is a common treatment during detox from other opioids, the staff may focus on symptomatic treatment by prescribing medications aimed at reducing nausea, pain, irritability, and sleeping problems.11

The course of Suboxone detox will be as unique as the person in treatment. It is important to remember that safety during detox is always essential. Although Suboxone withdrawal isn’t typically life-threatening, 24-hour care may be the most beneficial option to lower the risk of immediate relapse and in the event that mental or physical complications may arise.

Sources

  1. National Institute on Drug Abuse. (2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
  2. Drug Enforcement Administration. (2013). Buprenorphine.
  3. Substance Abuse and Mental Health Services Administration. (2014). The Facts About Buprenorphine.
  4. Substance Abuse and Mental Health Services Administration. (2016). Buprenorphine.
  5. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  6. Medscape. (2015). Buprenorphine/Naloxone Toxicity.
  7. National Institute on Drug Abuse for Teens. (2017). Prescription Drugs.
  8. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  9. Medscape. (2016). Withdrawal Syndromes.
  10. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment.
  11. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Setting.
  12. Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.

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