According to the FDA, "Suboxone is a prescription medicine used to treat adults who are addicted to (dependent on) opioid drugs (either prescription or illegal) as part of a complete treatment program that also includes counseling and behavioral therapy." It can be prescribed by a certified doctor or dispensed to patients of a treatment center for opioid dependence and addiction.
A relatively new medication that was approved only about twelve years ago (October 2002), Suboxone treats opioid dependence and addiction and has been found to be very successful with both and easily tolerated by patients. With the help of Suboxone, many opioid addicts have been able to change their lives and become free of opioid dependence.
Suboxone actually contains two different drugs: buprenorphine (a partial opioid analgesic) and naloxone (an opioid antagonist). The two medications work together to help treat opioid dependence and abuse.
According to the DOJ, "Buprenorphine was first marketed in the United States in 1985 as a schedule V narcotic analgesic." However, it was discovered that the drug, a partial opioid analgesic, could be a beneficial treatment for opioid dependence and narcotic addiction. As it is an opioid, buprenorphine can produce the same effects that other opioids can including:
- Respiratory Depression
- Pain Reduction
But the effects buprenorphine produces, compared to those produced by full opioid agonists, are much less.
Drugs like methadone and heroin produce extreme opioid effects while buprenophine, especially when taken in low doses, only causes the barest effects that are opioid-like. This is why it is such an effective medication for "enabl[ing] opioid-addicted individuals to discontinue the misuse of opioids without experiencing withdrawal symptoms" (SAMHSA).
Naloxone is "in a class of medications called opiate antagonists," according to the NLM. It can actually block the effects of opioids on the brain and is most often used to treat opioid overdose by injection. Naloxone was added to buprenorphine to make the drug Suboxone in order to lower its abuse factor.
Suboxone is most commonly prescribed in a doctor's office by a physician with the necessary credentials, including the DEA identification number stating their ability to prescribe the medication. The availability of Suboxone in doctor's offices makes it easily obtainable to patients than medications that have been used to treat opioid dependence in the past, such as methadone.
Patients who are treated for opioid addiction and dependence with methadone have to attend treatment in specific outpatient centers where they can receive their medication. Suboxone use does not require this which can be beneficial in a number of ways, including:
- Giving patients the opportunity to be treated by doctors they know
- Freeing up spots on the long waiting lists for methadone maintenance or methadone clinics
- Allowing patients to receive treatment without the stigma that often follows methadone use
- Giving patients an easy way to receive treatment for opioid dependence and addiction and allowing them to continue living their lives while receiving their treatment
Suboxone most commonly comes as a tablet that can be placed under the tongue (sublingual). The tablet then dissolves there. According to the FDA, it comes in "2 mg and 8 mg strengths" and is prescribed at whichever strength depending on the need of the individual.
The instructions for taking suboxone safely and as prescribed Are:
- To fold along the dotted line of the foil pouch
- To tear down at the slit
- To drink water before taking the medication in order to moisten your mouth and help the Suboxone film dissolve more easily
- To hold the film by the outside edges between your fingers
- To place the Subxoone film under your tongue near the base and either left or right of the center of your mouth
Your doctor may tell you to take two films at once. If so, you should place the second film "under your tongue to the opposite side" and keep the two films from touching if possible (FDA 1). You must not chew or swallow the film before it dissolves because tis will prevent it from working as well as possible. Do not talk or move your mouth very much while the film is dissolving.
When Taking Suboxone, One Should Avoid:
- Operating heavy machinery or driving, as the drug can cause drowsiness and make a person slow to react in the way prescription opioids often can.
- Drinking alcohol or taking CNS depressant drugs as the combination can lead to severe respiratory depression, loss of consciousness, coma, and even death
- Taking and abusing other opioid drugs
Suboxone, like all medications, has side effects which may create complications for the user. The common side effects caused by Suboxone are:
- Painful tongue
- Causing the mouth to become redder than normal
- Causing the mouth to become numb
- Mild intoxication
- Blurry vision
- Decrease in sleep
- Back pain
- Withdrawal symptoms from opioids
Suboxone can perpetuate withdrawal symptoms from opioids if misused. Some of the serious side effects caused by Suboxone are:
- Coordination problems
- Respiratory problems/depression
- Liver problems, signs of which are: jaundice of skin or whites of eyes, dark urine, light stool, decrease in appetite, abdominal pain and nausea.
- Allergic reactions, signs of which are: rash, hives, swelling of the face, loss of consciousness and wheezing.
- Decrease in blood pressure, signs of which are: feeling dizzy "if you get up too fast from sitting or lying down".
Any of these conditions could be dangerous and should be monitored by a doctor. If you are exhibiting symptoms that point to these conditions, get in touch with your doctor right away or go to a hospital as the conditions they represent can be dangerous or even life-threatening.
For the most part, patients who take Suboxone are familiar with the side effects as they are similar to those caused by opioids. If you are concerned about any side effects you experience from Suboxone, speak with your doctor and discuss your options.
According to the FDA, "IMS Health National Prescription Audit Plus indicates that 9.3 million buprenorphine prescriptions were dispensed in the U.S. in 2012" (FDA 2). In the early months of 2013 (January to March), 2.5 million prescriptions for buprenorphine were dispensed.
Between Suboxone and Subutex which are the two brand name medications prescribed to buprenorphine users, Suboxone is actually "the formulation used in the majority of patients" (FDA 3).
Suboxone is, for all intents and purposes, a popular medication which works well and is well-tolerated by patients. Some of the pros of Suboxone as a treatment for opioid dependence and addiction are:
- Suboxone is "less tightly controlled than methadone."
- Suboxone has a lower abuse potential than Subutex because of the inclusion of naloxone.
- Suboxone is well-tolerated by patients, not like Naltrexone which, according to Harvard Medical School, has much more trouble in this respect. "Most addicts simply stop using [Naltrexone], or refuse to take it in the first place;" a problem Suboxone does not have because its effects are not as strong as Naltrexone's.
- Suboxone is easy to obtain from specific doctors and specific pharmacies
- SAMHSA states that "studies have shown that buprenorphine is more effective than placebo and is equally as effective as moderate doses of methadone in opioid maintenance therapy."
- Suboxone a good addition to short-term opioid dependence and addiction treatment.
However, Suboxone cannot fully take the place of medications like methadone. SAMHSA also states that "buprenorphine is unlikely to be as effective as more optimal-dose methadone, and therefore may not be the treatment of choice for patients with higher levels of physical dependence." It should be used for patients who are looking to more quickly work through their addictions to opioids and not usually those who need long-term maintenance.
Suboxone is effective for the treatment of certain individuals and should not be used to treat every person addicted to opioids, especially if they have had multiple relapses or have abused opioids for many years. For someone who has abused opioids for less time and wants a quicker, less controlled method of treatment, Suboxone could be very effective.
Treatment for opioid dependence and addiction should not solely consist of Suboxone treatment or any one medication. The best type of treatment for opioid dependence and addiction is the combination of both medication and behavioral treatment. This is how Suboxone is a part of the full treatment process.
According to the NYDH, "Because buprenorphine helps with withdrawal and cravings, it can help to protect people from risky behaviors and can lower the chance of someone having an overdose." It also keeps people more focused on their treatment, less likely to relapse, and more likely to continue the behavioral side of their addiction treatment.
As stated by the NIDA, "Behavioral treatments help patients engage in the treatment process, modify their attitude and behaviors related to drug abuse, and increase healthy life skills." The use of medications like Suboxone make it easier for a patient to focus on their behavioral treatment and, in turn, behavioral therapies "can also enhance the effectiveness of medications."
Suboxone treatment can be very beneficial to many patients, and many have found that taking the drug helps them work through their addictions and dependencies on opioids. If you are wondering whether or not Suboxone treatment may be right for you, ask yourself these questions:
- Am I dependent on opioids?
- Do I not feel normal unless I've taken opioids?
- Do I need opioids to get out of bed in the morning or fall asleep at night?
- When I stop taking opioids, do I exhibit physical and psychological withdrawal symptoms, including: anxiety, bone and muscle pain, diarrhea, vomiting and flu-like symptoms.
- Do I abuse opioids?
- Do I take opioids with alcohol commonly?
- Do I take opioids more often or in higher doses than I was prescribed?
- Did I begin taking opioids in order to feel the euphoric high they can cause in high doses or do I take them for that reason now?
- Am I addicted to opioids?
- Can I not stop taking opioids on my own?
- Have I tried to stop and was unsuccessful?
- Has my use of opioids caused many problems in my life in the last year including: financial problems, work problems, legal problems, school problems, relationship problems and family problems.
- Despite these issues, am I still unable to stop abusing opioids?
- Has my addiction to or dependence on opioids been short-lived or not a condition I have struggled with for many years previously?
- Do I feel motivated to stop abusing opioids and to follow a treatment regimen if I could receive medical assistance?
If you answered yes to many of these questions, then Suboxone treatment as a part of formal addiction and dependence treatment may be right for you. According to SAMHSA, "Ideal candidates for opioid addiction treatment with buprenorphine are individuals who have been objectively diagnosed with opioid addiction and are willing to follow safety precautions for treatment, can be expected to comply with treatment... and who agree to buprenorphine treatment after a review of treatment options." If this describes you, then Suboxone treatment could be beneficial to you at this time.