Treating Opiate Addiction With Suboxone

Opiate addiction is a growing problem in the U.S. as evidenced by the 2015 outbreak of HIV in Indiana which was attributed to the abuse of the drug Oxycontin. In the face of a widening epidemic, a prescription drug called Suboxone (buprenorphine + naloxone) is being increasingly used to treat opioid addiction.

Opiates are a family of narcotic drug derived naturally or synthetically from the seed of the opium poppy plant (Papaver somniferum). They function as sedatives to depress activity in the central nervous system, thereby reducing pain and inducing sleep.

Long-term opiate use can result in an increased tolerance to the drug. When this happens, the user would need to increase the dose to achieve the same effect. This can cause an increasing dependence which we have come to know as an addiction. In some cases, this can lead to accidental overdose and even death.

Some of the most commonly abused opiates include:

• heroin
• fentanyl
• morphine
• Vicodin (hydrocodone)
• oxycontin
• oxycodone
• codeine
• methadone

Suboxone is an oral prescription drug which was granted approval from the U.S. Food and Drug Administration in 2002 to treat opioid addiction. Prescribed as either a sublingual tablet or film, it contains two active drugs:

• buprenorphine, a partial opioid antagonist, which provides relief from craving and withdrawal symptoms by blocking opiate receptors in the brain
• naloxone, an opiate antagonist, which blocks the effects of the opiate drug itself

The combined use overcomes some of the shortcomings of the individual drugs. Buprenorphine, for example, has the potential to be addictive but is less so since the naloxone quashes the opiate effects.

Naloxone, by contrast, works in the background as a deterrent, only taking effect when opiates are injected into the system. When this happens, naloxone can induce withdrawal symptoms including nausea, headache, sweating, restlessness, vomiting, and trembling.

Suboxone has been found to be effective in that it reduces the cravings associated with long-term opiate use while providing deterrence to current use. Compared to methadone, Suboxone is less addictive and faster acting (taking around a week to detoxify compared to weeks or even months with methadone).

Suboxone also seems to work better when used for longer periods of time. One study showed that opiate-dependent youth who used Suboxone for 12 weeks were more likely to remain abstinent compared to counterparts who had only undergone two-week detox treatment.

Suboxone is prescribed as part of a structured drug detoxification program and for maintenance therapy when needed. It is available as a generic (under the brand names Bunavail and Zubsolve) and offered in various formulations to ensure the gradual tapering off of use:

• 12 mg buprenorphine with 3 mg naloxone
• 8 mg buprenorphine with 2 mg naloxone
• 4 mg buprenorphine with 1 mg naloxone
• 2 mg buprenorphine with 0.5 mg naloxone

While approaches can vary depending on treatment centers, there are typically four steps to any Suboxone treatment plan:

• intake which includes a medical and psychosocial evaluation, a urine drug screen, and blood tests to ensure that you can take the drug without harm
• induction to transition you from the opiates you are currently on to Suboxone with the aim of minimizing "cold turkey" withdrawal symptoms
• stabilization where Suboxone is adjusted to the lowest dose to suppress withdrawal symptoms to allow for eventual tapering off and discontinuation of treatment
• maintenance for those with severe addiction who may need on-going, medically supervised treatment and support (including attendance at a Narcotics Anonymous or non-step support group)

Suboxone should not be used in persons with moderate to severe liver dysfunction as the can lead to a worsening of symptoms. Common side effects include headache, nausea, vomiting, excessive sweating, constipation, symptoms of withdrawal, insomnia, pain, and the accumulation of fluids in the legs (peripheral edema).

Suboxone does have the potential for misuse if injected. In such case, the relatively low dose of naloxone does not appear to mitigate the "high" achieved from the buprenorphine component. As such, Suboxone can only be prescribed under a doctor-supervised treatment or maintenance program.

Because opioid addiction is both a physical and psychological illness, treatment requires a multidisciplinary team able to address both of those needs. If you feel you could benefit from Suboxone, contact the hospitals or mental health agencies in your area for referrals to nearby addiction treatment centers.