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What Is Suboxone?

Suboxone (buprenorphine and naloxone) is a prescription medication that was approved for clinical use by the Food and Drug Administration in October 2002. It is used primarily to help patients dependent on opioid painkillers, or opiate drugs such as heroin, quit the use of these substances through medication-assisted treatment (MAT). Suboxone, as well as other pharmaceuticals that use buprenorphine, present a safe and effective treatment option that aids greatly in the ability to treat opioid dependency in patients. Like all prescriptions approved for use in MAT, Suboxone is prescribed in conjunction with a well-rounded approach to treatment comprised of medication, behavioral therapy, counseling, and social support programs.

Medications containing buprenorphine are greatly beneficial in that they are among the first prescriptions that treat opioid dependency that are available to be prescribed and distributed by physicians' offices under the Drug Addiction Treatment Act of 2000 (DATA 2000). This legislation allows for qualified physicians in the United States to offer drugs containing buprenorphine in many different settings for the purpose of treating opioid misuse and dependency. As a result, prescriptions such as Suboxone are much more easily accessible to patients in need of treatment than attempting to travel to the nearest possible methadone clinic, as patients can now seek treatment at qualified locations such as offices, correctional facilities, their local health departments, or community hospitals.

Other FDA-approved buprenorphine products besides Suboxone include:

  • Zubsolv (buprenorphine and naloxone) sublingual tablets
  • Bunavail (buprenorphine and naloxone) buccal film
  • Buprenorphine-containing transmucosal products for opioid dependency

How Does Suboxone Work?

Suboxone is unique in its ability to diminish the risk of misuse. It also lessens prominent physical symptoms of opioid dependency, including cravings and withdrawal symptoms. This, in turn, lessens the likelihood of overdose and is much safer to prescribe to patients.

As a partial opioid agonist, Suboxone can cause similar effects to opioids, such as respiratory depression and euphoria, but these symptoms are more mild and less likely to cause dependency than those found in drugs like heroin or methadone.

With each dose taken, the opioid effects of Suboxone will increase, but these symptoms will plateau at moderate dosages. Because the euphoria and other symptoms are both more mild in nature and level off at lower doses, the likelihood of misuse and dependency are largely mitigated. Better still, Suboxone is long-acting to the point that many patients can benefit from taking it every other day as opposed to daily.

What Are The Side Effects Of Suboxone?

Suboxone's side effects are similar in nature to those presented by opioids, and can include the following:

  • Muscle cramps and aches, fever
  • Nausea, constipation, and vomiting
  • Cravings and inability to fall or stay asleep
  • Distressed or irritable moods

What About Suboxone Misuse?

Due to Suboxone's opioid-like effects, there is a chance that it can be misused by patients, especially those who do not already have an opioid or opiate dependency. Naloxone, which is added to the buprenorphine, is an agent that is added to decrease the chances of illicit Intravenous use. When taken under the tongue, (sublingually) as prescribed the opioid- like effects of buprenorphine will take hold and the naloxone remains inactive if no other opioids are in the patients system. However, if the tablets are crushed and administered via injection, Naloxone will be the predominant agent and cause an immediate opioid withdrawal syndrome as a result.

What Precautions Should Be Taken With Suboxone?

Patients are advised to take the following precautions before taking Suboxone:

  • Consult your doctor before taking any other medications in conjunction with Suboxone
  • Ensure that your physician is informed about any health complications you may be having, especially with your liver.
  • Avoid the use of illegal drugs of any kind, as well as alcohol and tranquilizers, sedatives, or other pharmaceuticals that can slow breathing. Combining large quantities of medication with Suboxone use can lead to overdose or death.

What About Pregnant or Breastfeeding Women On Suboxone?

The amount of information currently in existence about the use of buprenorphine medications to treat pregnant women with opioid dependency is limited, but thus far, the few reports that have been made available on the subject suggest no significant adverse effects or problems using Suboxone or similar prescription medications.

In the meantime, buprenorphine has been classified as a Pregnancy Category C medication by the FDA, which indicates that, while largely considered safe, the risk of adverse side effects has not been entirely ruled out yet. The current standard treatment for opioid-dependent pregnant women undergoing MAT is still methadone.

Who Benefits The Most From Suboxone?

The patients that will benefit most from treatment for opioid dependency with buprenorphine medications like Suboxone should meet the following guidelines:

  • Diagnosed with opioid dependency by an objective and qualified professional
  • Have been checked and consequently cleared for buprenorphine usage without health conflicts
  • Informed about the various treatment methods made available for opioid dependency before agreeing to being treated with buprenorphine
  • Willing to adhere to the safety precautions outlined for their MAT

Confidentiality is vital--and legally required--before beginning treatment with buprenorphine. Under Confidentiality Regulation, 42 Code of Federal Regulations (CFR) 2, it is imperative that information about patients' substance and alcohol usage must be addressed with more sensitivity and confidentiality than other types of medical information given. Before treatment, it is critical to that steps are taken to guarantee the privacy and confidentiality of patients' health information, especially that which is personally identifiable.

Treatment with Suboxone and other buprenorphine medications is split into three different phases:

The Induction Phase

This first phase of treatment is generally performed in a physician's office or similar location certified for use of approved buprenorphine products such as Suboxone. Medication is given to the patient after he or she has abstained from opioid use for 12 to 24 hours and is starting to experience the early symptoms of withdrawal. It is critical to keep in mind that buprenorphine medications can exacerbate or bring on acute opioid withdrawal symptoms in patients who are not experiencing early stage withdrawal and/or have other opioid medications in their bloodstream.

The Stabilization Phase

This phase begins once the patient has either stopped using or greatly reduced the use of opioids, no longer experiences cravings, and experiences side effects rarely, if at all. Dosage of the chosen buprenorphine medication may be adjusted accordingly during this time. Once patients have stabilized, due to the long-acting nature of buprenorphine, some may be able to take drugs like Suboxone every other day as opposed to daily doses.

The Maintenance Phase

The third and final phase begins with a patient doing well on their current dosage of buprenorphine. The amount of time required for this phase differs from patient to patient, and can be indefinite if necessary. However, if the patient has stabilized, medically supervised withdrawal is often recommended in order to guide the patient into a state of no longer being physically dependent on medications or drugs with effects similar to opioids. This process also allows for the focus of treatment to shift to other forms of rehabilitation, but MAT may still be used in order to prevent a potential relapse. Medication-assisted treatment with Suboxone or other buprenorphine medications achieves the most success in conjunction with various forms of behavioral therapy, counseling, and/or self-help programs.

Switching To Suboxone From Methadone?

It is possible for patients to make the switch from methadone to buprenorphine treatments such as Suboxone. However, these medications are very different from one another, and patients that are on high doses of methadone for treatment of acute physical dependency are not as likely to benefit from buprenorphine. Studies have shown buprenorphine to be an ideal alternative for those patients who are on moderate doses of methadone to treat physical dependency on opioids or opiates. Conversely, those currently taking buprenorphine medications can switch to methadone as well.

Ultimately, there are numerous factors that determine whether Suboxone and other buprenorphine medications are an ideal choice for someone currently treating opioid dependency with methadone.