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Suboxone is a combination medication of buprenorphine and naloxone. Buprenorphine was approved by the FDA in 2002 as an alternative medication to methadone for the treatment of opiate dependence and is the first opioid ever approved for office-based treatment for opiate dependence. Suboxone is a brand that was developed shortly after.
What Does Suboxone Do?
Like methadone, buprenorphine can help the opiate dependent person block the effects of other opioids and eliminate the cravings and withdrawals while they detox and re-accustom themselves to non-opiate use. These therapeutic options, when combined with psychosocial and psychotherapeutic interventions, have been the most promising approaches to treatment in opiate abuse and dependence. Naloxone has been added to the buprenorphine in Suboxone to deter its abuse.
How Does Suboxone Work?
Buprenorphine is a partial opioid agonist which produces less opiate effects than those of methadone which is a full opioid agonist. An opioid agonist is a drug that can activate opioid receptors in the brain when it attaches to them, producing effects similar to morphine. They work like a key in a lock and only certain keys will fit, so only opioids can activate the opioid receptors. Full opioid agonists such as morphine, heroin, and methadone unlock the receptors completely while buprenorphine can attach to them, but, only activate a few.
Both methadone and buprenorphine are long-lasting opioids which are beneficial in treatment of opiate addictions because they reduce the cycles of intoxication and withdrawals that sometimes have to be repeated several times a day. These medications keep the receptors occupied for 24 hours or more and effectively block the effects of other opioids if they are used.
Suboxone has an added advantage over methadone because the buprenorphine has a ceiling effect when it comes to respiratory depression whereas many methadone overdoses occur as a result of respiratory failures. According to the Centers for Disease Control and Prevention, “The difference between appropriate prescribed doses and dangerous doses of methadone is small.”
The addition of naloxone in Suboxone protects users against overdose.
Physicians have been aware that buprenorphine products are being abused and diverted since buprenorphine became available. Suboxone contains the ingredient, naloxone, which is an opioid antagonist that reverses opiate effects and is often used as an antidote for opiate poisonings or overdoses.
Suboxone abuse is not feasible to the opiate dependent person because the naloxone acts to reverse opiate effects if the person takes too much Suboxone or tries to inject it, causing them to lose the opiate effects of the buprenorphine and go into immediate withdrawals.
Epidemic Rise In Opiate Dependent People
More people are becoming exposed to prescription opiates and finding it difficult to go on with their lives without them after the initial pain management issue has been resolved. Inappropriate prescribing practices, the perceptions that opiates are highly effective and safe when used as prescribed, and the diversion of these drugs to others have resulted in an unprecedented number of individuals who are addicted to opiates, including methadone, without ever using them for recreational purposes.
Of course, recreational and regular use of opioids for the good feelings and euphoria they produce has always been a problem. Depending on a variety of contributing factors, many abusers quickly develop addictions. With the high availability of these drugs for sale on the street along with an increasing tide of access to heroin, millions of Americans need treatment for opiate addictions. However, most never enter a specialized treatment facility for one reason or another.
Treatment Access: Methadone vs. Suboxone
Methadone Treatment Barriers
Historically, treatments for opiate addictions were associated with methadone clinics or opiate addiction rehabs where the person needed to expend time away from home and other obligations in order to participate in the programs or travel to the clinics daily for treatment.
Travel, costs, and time to participate in available methadone programs are often cited as reasons for not receiving treatment for opiate dependence. Barriers to opiate rehab often involve lack of insurance or benefit coverage for substance addictions and concerns regarding duration requirements.
Improved Access to Treatment with Suboxone
In accordance with the Drug Addiction Treatment Act of 2000, physicians who were specially licensed to treat opiate addictions were authorized to dispense buprenorphine medications from their offices, but, there were still limitations for treatment to certain individuals including limitations to the number of individuals they could treat at any given time and limitations in health care coverage.
Today, treatment protocols have changed and in an effort to make treatment for opiate dependence more attainable to the millions of people who need it, more physicians can now prescribe Suboxone for opiate addiction maintenance in the same manner that they would treat those needing help for other medical disorders.
Beginning in 2014, the Affordable Care Act requires most health plans to cover substance use disorders as an essential benefit coverage which requires benefit provisions for opiate addiction treatments at the same levels they are provided for other medical benefits.
The Benefits of Suboxone When Used in Treatment for Opiate Dependence
Suboxone comes in a sublingual film or tablet that can easily be dissolved when placed under the tongue. The effects are long lasting and depending on the levels of opiate dependency, Suboxone can be administered once or twice daily to help the person remain physiologically stable without having to use other opioids. The benefits of using Suboxone for treatment of opiate dependence are:
- Suboxone is a schedule III drug with a higher degree of safety over methadone.
- Suboxone can help the person remain in opiate therapy for an adequate period of time which is crucial to recovery.
- Suboxone has fewer prescription limitations reducing the need for frequent office visits.
- Treatments can be provided in confidentially and without having to attend a methadone clinic where stigmas and long waiting lists are often a concern.
- Suboxone reduces the risk of IV use and needle sharing which can lead to diseases and infections.
- Adequate doses of Suboxone can help the opiate dependent person improve their physical and psychological health when impaired by opiate dependence.
- The steady state of functioning that Suboxone provides allows individuals to perform regular activities at work, school, or at home without the constant disruptions of drug seeking behaviors and the compulsion to use other opioids.
- Suboxone helps to reverse the reinforcement of addictive behaviors that often accompany opiate addictions.
- Suboxone reduces the risk of opiate abuse, overdose, and death.
Comprehensive Suboxone Treatment for Maintenance of Opiate Dependence
Suboxone, alone, is not an effective treatment approach for opiate dependence, although many physicians prescribe it without these additional services. Comprehensive treatment for opiate dependence involves detoxification, counseling, behavioral therapies, and case management where other psychosocial services may be necessary to prevent relapse and treat those issues that would limit recovery progress.
Addiction treatment, according to the National Institute on Drug Abuse “must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society.”
Suboxone Used in Detox Treatment for Opiate Dependence
Suboxone is often used to help manage the cravings and withdrawals during opiate detox. Under careful supervisions, a person can be administered a low level dose of Suboxone with the necessary adjusted dosages to provide comfort and relief during the acute phase of 5 – 7 days. Gradual tapering off of the medication can be easily managed as the person progresses through a formal treatment program.