Suboxone Detoxification vs. Maintenance for Opiate Addiction Treatment

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Suboxone is a buprenorphine/naloxone medication indicated for the maintenance treatment of opioid dependence. Suboxone can be used, discreetly, to provide effective craving relief and withdrawal reduction in opiate dependence detox and maintenance therapies.

About Suboxone

Suboxone is a schedule III partial opioid agonist/antagonist drug with a lower abuse potential than that of methadone and less likely to produce respiratory depression if abused or diverted. It is the first opiate addiction treatment medication that can be prescribed by qualified physicians outside of a formal Opioid Treatment Program (OTP).

Suboxone films and tablets are available in ranges from 2mg/.5mg to 8mg/2mg of buprenorphine and naloxone, respectively. While the buprenorphine produces limited opiate affects, the naloxone was added to deter abuse and is an antagonist drug that can reverse the opiate affects if the medication is used incorrectly.

Both the films and the tablets are administered orally to be dissolved under the tongue for 24 hours or more of effectiveness. Swallowing the medication produces less bioavailability of the drug and chewing or injecting it can precipitate withdrawals in opiate addicted individuals.

Why Choose Suboxone for Opiate Addiction Treatment

The choice of medications used for opiate addiction treatment is based on patient preferences, safety and efficacy, and treatment goals. Both methadone and buprenorphine can control withdrawal symptoms, improve functionality, and stabilize physiologic processes when the person remains in treatment for an adequate period of time.

Providers of Suboxone for opiate addiction treatment are under less strenuous restrictions and regulations than those that provide methadone for the same reason and services are available within the physician’s office. This allows for convenience, confidentiality, less frequent office visits, and reductions in time and travel which can be especially beneficial for those who would, otherwise, not receive treatment.

Understanding Suboxone

The first step in overcoming addictions is detoxification. With opiates, this process can take a while. Although opiate withdrawals are generally, not life threatening, they can be painful and unpleasant enough that person needs the extra help that Suboxone can provide, both, to get through the acute withdrawal phase and the post withdrawals.

An opiate dependent person can have cravings that last weeks or longer after they detox and Suboxone can be used as long as needed to minimize the possibility of relapse. According to the SAMSHA’s Center for Substance Abuse, “Control of withdrawal symptoms often is insufficient treatment to prevent a relapse to opioid abuse, and detoxification alone may yield only short-term benefits.”

Therefore, it is recommended that the person receive education, access, and easy transfer options to comprehensive long term opioid agonist maintenance as part of any opioid detoxification program.

What Happens when Taking Suboxone?

Withdrawals from opiate dependence are often the main reason an opiate dependent person continues to use the drugs and they may need to do so several times a day in order to feel “well”. The idea behind Suboxone in opiate detox is to help the person get past the physical and psychological impact of withdrawals and cravings by keeping a sufficient balance of opiates in the system to keep them engaged in the detox process.

The difference with Suboxone is that it is long lasting and sticks to the opioid receptors in the brain without fully activating them. Once the person receives a dosage that they can feel comfortable with to remain in the detox program, the physiological functions of the brain can begin to improve and stabilize.

With enough time away from the shorter acting opiates, tolerance is reduced and the cravings can be better managed. As the clinician and the opiate dependent person determine a readiness to discontinue Suboxone detox treatment, the dosages can be gradually tapered off with minimum adverse effects.

Maintenance Treatment

Comprehensive, long-term opioid agonist maintenance remains the most promising treatment for controlling opioid use and preventing relapse. It allows the person to continue working and performing other obligations while reducing the use of other opiates and the disrupting behaviors that are commonly associated with opiate addictions. Suboxone maintenance for addiction treatment can help to prevent disease, needle sharing, crime, mortality, and other familial or social dysfunctions while improving overall health.

According to the 2013 SAMHSA’s N-SSATS report for 2011, the number of clients receiving buprenorphine increased from 727 in 2004 to 7,020 clients in 2011 for those in OTPs and from 1,670 clients in 2004 to 25.656 in 2011 for those receiving treatment at non-OTP facilities.

What Happens when Suboxone is Taken as part of a Maintenance Treatment?

Suboxone can be prescribed up to 30 days for maintenance therapy and the physicians are not required to observe dosing although they must make continuous assessments regarding the dosage effects and treatment progress. They are also not required to provide the counseling and psychosocial services that one would find in a more structured OTP program and this can leave the person vulnerable to insufficient treatment.

The induction phase is the first step in Suboxone maintenance and the person is started on the lowest dosage necessary to alleviate cravings and withdrawals from opiates. People metabolize Suboxone differently and dosage adjustments in the first week of treatment are based on how the person feels 2-4 hours after taking the Suboxone.

Because Suboxone is stored in body tissues, including the liver, its slow release keeps blood levels steady between doses once sufficient levels are attained. The steady state is reached when the breakdown and elimination of Suboxone is equivalent to the intake and the person is able to function normally without impairment from the medication. A target dose for most individuals is 12 – 16 milligrams of buprenorphine daily.