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 injection of prescription oral painkillers. In the face of a widening epidemic, a prescription drug called Suboxone (buprenorphine + naloxone) is being increasingly used to treat opioid addiction.

Understanding Opiates

Opiates are a family of narcotic drug derived from or related to the opium poppy plant (Papaver somniferum). They function as sedatives to depress activity in the central nervous system and reduce pain.

Long-term opiate use can result in increased tolerance to the drug. When this happens, the user would need to increase the dose to achieve the same effect. This can cause dependence, meaning that there are withdrawal symptoms when the drug is stopped. It can also lead to a behavioral pattern where the drug continues to be used in spite of adverse consequences. This has come to be known 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

Treating Opioid Addiction With Suboxone

Suboxone is an oral prescription drug that 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 decreases withdrawal symptoms and opiate cravings without having full opiate effects.

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

Effectiveness

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.

Suboxone 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.

How It's Prescribed

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

• 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

Treatment Plans

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)

Considerations

Suboxone should be used with caution 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. 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.